3 Elimination BOWEL AND BLADDER Qehioqejq2jp.pptx

AWIOEPO[[AOA\[P3OWP[EOP[OWP[P[[WAPPWA

1. BLADDER AND BOWEL ELIMINATION 1 ELIMINATION

2. Urinary Elimination 2

3. Learning Objectives Describe the process of urination Identify factors that influence urinary elimination Identify common urinary problems Identify nursing interventions related to urinary elimination Identify different types of catheters Explain purpose of catheterization Describe indication of catheterization Demonstrate the procedure for catheterization Identify important precautions of the procedure 3

4. Introduction Urinary elimination depends on effective functioning of: Kidneys Ureters Bladder Urethra 4

5. Kidneys remove wastes from the blood to form urine. Ureters transport urine from the kidneys to the bladder The bladder holds urine until the urge to urinate develops Urine leaves the body through the urethra Introduction… 5

6. Urination Brain structures that influence bladder emptying Cerebral cortex, thalamus, hypothalamus, brain stem Normal voiding involves Contraction of the bladder muscles Relaxation of the urethral sphincter 6

7. Factors influencing urination Amount of urine in bladder Adult normally holds 600 mL Child 150 – 200mL Increasing urine volume stimulates the micturation center in the spinal cord Normally voiding is a voluntary process 7

8. Factors that influence urination Disease Conditions Diabetes – nerve and perfusion changes Multiple Sclerosis – nerve changes Benign Prostatic Hyperplasia - retention Cognitive Disorders Alzheimer’s Disease – may cause detrusor overactivity End-stage Renal Disease – waste buildup 8

9. Sociocultural factors Privacy Psychological factors Anxiety Fluid balance Surgical procedures Medications 9

10. Altered Urine Production Polyuria (or diuresis ) Abnormally large amounts of urine produced by the kidneys Oliguria Low urine output Usually less than 500 mL a day or 30 mL an hour for an adult Anuria Refers to a lack of urine production Usually less than 50 mL a day 10

11. Altered Urinary Elimination Urinary Frequency- voiding at frequent intervals Nocturia - voiding at night Dysuria - pain during voiding Enuresis- involuntary urination (children) Urinary Incontinence- involuntary urination (Adults) Urgency- sudden strong desire to void Urinary Retention- bladder overdistention 11

12. Maintaining Normal Urinary Elimination Promoting fluid intake Maintaining normal voiding habits Assisting with toileting Preventing Urinary Tract infections Managing Urinary Incontinence Bladder training, habit training, apply condom catheter Managing Urinary Retention Medication Catheterization 12

13. Urinary Catheterization 13

14. Purpose of Urinary Catheterization To relieve urinary retention or incontinence To obtain sterile urine specimen To empty the bladder before, during and after surgery In case of bladder obstruction For a patient with neurologic disorders (unconscious patients) For bladder irrigation 14

15. Types of Catheterization Intermittent catheterization Indwelling retention catheterization Intermittent catheterization You introduce a straight single-use catheter to drain the bladder When the bladder is empty, you immediately withdraw the catheter You can repeat intermittent catheterization as necessary Each catheter insertion increases risk of trauma and infection 15

16. Indications Intermittent Catheterization Bladder distention Sterile urine specimen Assessing residual urine after urination Indwelling Catheterization Severe urinary retention Bladder irrigations Measurement of urinary output in critically ill patients 16

17. Contraindications Urethral trauma Pelvic fracture Urethral obstruction Complications Urethral trauma Infections 17

18. Types of catheters Catheters came in different variety of size, materials, and types Catheter types S traight (plain/ robinson ) Retention ( foleys /indwelling) Catheter lumens Single lumen catheter Double lumen catheter- has two lumens Triple lumen catheter – has three lumens 18

19. 19

20. 20

21. 21

22. Catheter size Measured by French scale Catheter size depends on the size of the urethral canal # 8-10 Fr – children # 14-16 Fr – female adults # 18 Fr – adult male 22

23. Catheter length Determined by the clients gender For adult male – 40 cm catheter For adult females – 22 cm catheter Balloon size 5 ml – for adults 3 ml – for children 23

24. Catheterization using a straight catheter Used to drain the bladder for shorter period of time Clients can be taught to insert and remove catheter themselves Use single lumen catheter Purpose To relieve discomfort due to bladder distention To assess the residual urine To obtain a urine specimen To empty the bladder prior to surgery 24

25. Inserting a Retention/Indwelling Catheter Used continuous drainage of urine These catheters are used for Gradual decompression of an over distended bladder Intermittent bladder drainage, & irrigation Continuous bladder drainage Use indwelling catheter ( catheter with more than one lumen 25

26. Applying Condom Catheter External urinary catheters that are worn like a condom Designed for men Non-invasive Indication For client with incontinence For client with overactive bladder 26

27. Bowel Elimination 27

28. Learning Objectives Describe the process of defecation Identify factors that influence defecation Identify common problems of bowel elimination Identify nursing interventions related to bowel elimination Define Enemas Identify different types of Enemas Explain purpose of Enemas Describe indication of Enemas Demonstrate the procedure for Enemas 28

29. Defecation Is the expulsion of feces from the anus and rectum The frequency of defecation is highly individual, Normal feces are made about 75% water and 25% solid material Feces are normally brown 29

30. Activity Psychological factor Defecation habits Medication Diagnostic procedure Anesthesia and surgery Pathologic condition Pain 30 Factors that affect defecation

31. Altered Bowel elimination Constipation May be define as less than three bowel movement per one week Infers the passage of dry hard stool or the passage of no stool Factor contribute to constipation: Insufficient fiber intake Insufficient fluid intake Insufficient activity or immobility Irregular defecation habits Lack of privacy Chronic use of laxative or enemas Medication such as opiates or iron salts 31

32. Fecal impaction Is a mass or collection of hardened feces in the folds of the rectum Diarrhea Passage of liquid feces and an increase frequency of defecation. Bowel incontinence Fecal incontinence Loss of voluntary ability to control fecal and gaseous discharge Flatulence Three source of flatus: Action of bacteria in the large intestine Swallowed air Gas that defuses between the blood stream and the intestine. 32 Altered Bowel elimination…

33. Enemas The introduction of fluid into the rectum and lower colon Given to remove feces and to relieve constipation Also given to clean the bowel of feces before surgery, x-rays Purpose For emptying – soap solution enema For diagnostic purpose (Barium enema) For introducing drug/substance (retention enema) 33

34. Fluid used for Enemas Tap water Increase peristalsis by causing mechanical distension of the colon Normal saline Cause mechanical distension and increase peristalsis Soap solution Increases peristalsis due to irritating effect of soap Epsum salt: (15 gm – 120 gm in 1,000 ml of H 2 O) Cause mechanical distension resulting in increased peristalsis 34

35. Types of enema Cleansing enema Retention Enema Rectal Washout (Siphoning Enema) 35

36. Cleansing enema Administered to remove feces from the colon Purpose To stimulate peristalsis and remove feces or flatus To relieve constipation or fecal impaction To empty colon prior to some surgery To keep the colon empty for incontinent patients To help establish regular bowel function For diagnostic test Before certain x-ray exam Before Colonoscopy 36

37. Types of fluid used for cleansing enema are Tap water Normal saline Soap solution Temperature of the fluid Usually given at 40-43 o c and for children at 37.7 o c Hot – cause injury to the bowel mucous Cold – uncomfortable and may trigger a spasm of the sphincter The amount of fluid to be administered depends on: The age of the person The person’s ability to retain the solution 37

38. Retention Enema Administration of solution to be retained in rectum Is given slowly by means of a rectal tube The amount of fluid is usually 150-200 cc Cleansing enema is given after the retention time is over Temperature of enema fluid is 37.4 c or body 38

39. Bowel Diversion - Ostomies An ostomy is an opening for gastrointestinal urinary or respiratory tract into the skin Gasatrstomy : is an opening in the abdominal wall into the stomach Jejunostomy : into the jejunum Iliostomy : opining into the ileum Colostomy: opining into the colon 39

40. COLOSTOMY CARE Colostomy Is the surgical creation of an artificial opening between the colon and the abdominal wall. Indications of colostomy Obstruction Rectal injuries Colorectal cancer Diverticulitis Birth defect (imperforate anus) Irritable bowel syndrome Ulcerative colitis 40

41. 41

42. Complications of colostomy Blockage of the colostomy Damage to other organs Hernia Infection Internal bleeding Prolapse of the colostomy 42

43. 43

44. Colostomy pouch Is a plastic bag that collects fecal matter from the stoma Fits around the stoma and is attached with adhesive Can be empted through an opening at the bottom Need to be changed every 2 or 3 days 44

45. Colostomy nursing care The pouch is emptied PRN (as needed) The pouch is changed every 2 to 3 days Clean stoma gently by wiping with warm water Assess stoma and peristomal skin Color and moisture ( normaly pink and moist) Rashes Breakdown Measure the stoma diameter 45

46. Thank You! 46