Care of Patient with Elimination needs.pptx

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1. Care of Patient with Elimination needs Abhishek A Joshi Nursing Tutor GCON , Bhavnagar

2. Thought Of The Day A Goal without a Plan Is Just a WISH

3. Introduction & Definition of Elimination Importance of Elimination Characteristics of Urine Factors affecting normal urinary elimination Alterations in Urinary Elimination Physical Assessment of urine by Nursing Process Content

4. As dietary intake digestion and elimination is important for the quality of life, similarly elimination of metabolic waste products is very important. Elimination is equally important to the ingestion of food, fluids etc. IF the organs of elimination like Kidney, Intestines are functioning normally, the waste will be eliminated as fast as form, if not then excessive accumulation waste in body and irritates the vital organs. Introduction

5. Elimination is defined as “The removal of waste material from the body like urine, feces, sweat, discharge etc. t hrough the kidneys, intestine, lungs and skin” Definition

6. Nurse should teach the healthful habits of elimination & to prevent the disease by encouraging the periodical Health Examination. It is responsibility of the nurse to provide the patient proper facilities and also the privacy during elimination of bowel & Bladder. Noting the number, quantity and character of elimination. As the nurses plays an important role in the observing and recording the quantity and quality of body waste, hence she must be aware of the normal physiology of elimination process. Importance of Elimination

7. Volume: 2000 to 2500 ml of urine excreted in 24 Hours. It depends on water intake. Output increases in cold weather and decreases in hot weather. Color: Normally urine is pale yellowish/amber in color. When quantity increase it become pale yellow, when quantity decrease it become deep yellow. Characteristics of Urine

8. Appearance: normally clear with no deposits. Odour : Aromatic odour , Strong Ammoniac. Reaction: Acidic in nature Specific Gravity: 1.016 to 1.025 Constituents: Water (96%), Urea (2%), remaining 2% consists of uric acid, creatinine, chlorides, phosphates and oxalates. Cont …

9. Fluid intake Loss of body fluid Nutrition Body position Psychological factor Factors affecting normal urine elimination

10. (1) Dysuria: it means painful voiding. Pain may be associated with UTI ( Urinary Tract Infection) and as felt burning sensation during urination. May be due to inflammation of bladder/urethra, after sexual activity and often due to STD (Sexual Transmitted Disease). Alterations in Urinary Elimination

11. (2) Polyuria: it is formation and excretion of excessive amount of urine in the absence of concurrent increase in fluid intake. When Urine output increase to 2500 to 3000 ml/day, it’s called polyuria. It may be due to Diabetes, diuretics , caffeine/alcohol . Cont …

12. (3) Oliguria: the formation and excretion of decreased amount of urine. Urine output is less than 500 ml/day. Due to vomiting, diarrhea, burns etc. (4) Anuria: As the kidney approaches the complete failure as a functioning organs, the person become auric. Urine output is less than 100 ml/day. Cont..

13. (6) Nocturia : Voiding during normal sleeping hours is called nocturia . When lying and supine, edema decreases as fluid enters the circulation. This increases blood flow to the kidneys thus increase Glomerular filtration and urine output. (7) Hematuria: indicates blood in urine. Due to UTI , trauma, renal stone, cancer etc. Cont …

14. (8) Pyuria: it means urine contains pus. Which is the accumulation of an end products of an inflammatory response. These may be microorganisms and WBcs occurs in presence of UTI . Presents in UTI . (9) Urinary Retension : it is the inability to empty the bladder of urine. The person is either unable to relax the bladder or unable to external urethral sphincter to allow passage for urine. Inability to void within 8 to 10 hours of last voiding. Cont …

15. (10) Urinary Incontinence: it is involuntary loss of urine from the bladder. (11) Urgency (Overactive Bladder): occurs when the pressure in the bladder builds suddenly, and it becomes difficult to hold in the urine . You have the urge to pee even though your bladder is not full. “ Gotta go Now” feeling. Cont …

16. (12) Frequency of urine: Voiding in frequent intervals is known as frequency. Each void usually contains less than 250 ml of urine. Sometimes urgency and frequency often occurs together. Cont..

17. Assess Temperature, Pulse, Respiration, Blood pressure and Weight. General Inspection: skin integrity, color, peripheral edema. Examination of the abdomen, pelvis, genitelia and rectum. Diagnostic Test Physical Assessment

18. Body image disturbances Incontinence stress Self care deficit Impaired skin integrity Altered urine elimination Urinary retention Nursing Diagnosis

19. Health promotion Client education Promoting normal micturition Stimulating micturition reflex Maintaining elimination habit Provide bladder training Maintain adequate fluid intake Preventing infection Promotion of comfort Teach Kegel (Pelvic floor exercise) Implementation

20. “A rubber tube through the urethra and to the bladder.” It’s provides a continuous flow of urine in clients, when clients are unable to control micturition. There is two types: ( i ) Intermittent technique is a straight single use catheter introduced to drain the bladder. When the bladder is empty, the nurse immediately withdraws the catheter. It can be repeated if necessary. (a) Catheterization

21. (ii) Indwelling/Foley Catheter remains in place for an extended period until a client is able to completely and voluntarily. It should be change periodically. Cont..

22. Male catheterization

23. Female catheterization

24. Relieve discomfort of bladder distention Obtain sterile urine specimen Assess presence of residual urine Long term management of clients with spinal cord injury. Obstruction of urine flow Sever urinary retention Indication of Catheterization

25. Incontinent males may wear a condom catheter to collect urinary drainage. This device consists of a condom connected to the tubing which drains into a collection bag. (2) Condom Catheter

26. Frequency 1-2 per day Color Brown Consistency Soft, formed Shape Cylindrical Amount 100-300 gm/day Odor Pungent Characteristics of normal feces

27. Water Solids Bacteria Undigested food fiber Fat Inorganic martial Protein Composition of normal stool

28. Nutrition: nature & type of food Age & Development Drugs Lifestyle & Habit Fluid Intake Medical Problems Stress & Emotions Body Position Privacy Factors affecting Bowel Elimination

29. ( i ) Constipation (ii) Diarrhea (iii) Flatulence Common Bowel Eliminations Problems

30. Constipation is a symptom not a disease. It is a decrease in frequency of bowel movements. It results by prolonged or difficult passage of hard, dry stool. ( i ) Constipation

31. Irregular bowel habits & ignoring the urge to defecate can cause constipation. Client who have a low fiber diet, low fluid intake slows peristalsis. Lengthy bed rest or lack of regular exercise. With increased age the abdominal muscle elasticity loses and reduces intestinal mucus secretion. Bowel Obstruction Causes

32. An enema is an injection of solution into lower bowel for washing and evacuating its content. Introduction of solution into large intestine through anus for removing feces and cleansing the bowel. (a) Enema

33. It is a procedure of introduction of medication into the rectum in the form of suppository. Purposes: To stimulate peristalsis To promote defecation To act as analgesic/antipyretic (b) Rectal Suppositories

34. Administering Suppository

35. It may be defined as washing the colon with large quantities of solution in order to clear the colon of feces. (c) Bowel Wash (Colon Lavage)

36. Colostomy is an operation in which an artificial opening is made into the colon on the anterior abdominal wall. It will permit the escape of f eces and flatus. It permits the healing of the bowel distal to the colostomy opening since it diverts the fecal contents from affected area. It provides when a rectum or anus are non functional. Ex. Traumatic condition, birth defect. (d) Colostomy

37. It is an increase in the number of stools and the passage of liquid, unformed feces. It’s a symptom of disorder affecting digestion, absorption and the secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly, irritation the colon can result in an increased mucus secretion. As a result, feces become water and client may be unable to control to urge defecate. (ii) Diarrhea

38. Harded stool that’s stuck in the rectum or lower colon due to chronic constipation. Fecal impaction often occurs in people who’ve been constipated for a long time. Fiber added to the diet, exercise, laxatives may prevent inspection. If not then Per Rectal examination (PR) or enema should be given. (iii) Impaction

39. Providing Urinal/Bed pan

40. Male Urinal

41. Female Urinal

42. Fracture Bed Pan

43. Bed pan Chair

44. Latest upgraded Bedpan

45. 1. PEE VEE ; ‘‘ FUNDAMENTALS OF NURSING ’’ SECOND EDITION;PUBLISHED BY JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LIMITED;NEW DELHI; P NO.-196-210. 2. LOTUS PUBLISHERS; ‘‘A TEXT BOOK OF NURSING FOUNDATIONS ’’ 2 ND EDITION;EDITED BY CELESTINA FRANCIS & KRITIKA ; P.NO . 377to 380. 3 . WEBPAGE; WWW.WIKIPEDIA.COM : THE TOPIC OF “NURSING CARE FOR PATIENT WITH PAIN” BY DR ARJAN SHAH. Bibliography