Concept Elimination /Elimination pattern

Define elimination pattern
Describe factors that can alter urinary function
Discuss common problem of urinary elimination
Discuss nursing process for a patient with altered urinary elimination pattern
Describe factors that can alter elimination function
Discuss common problems of elimination.
Discuss nursing process for a patient with altered fecal elimination pattern

2. By:
Muhammad Baqar
RN,P.B.CHN,BScN,MSPH
ConceptofElimination
CollegeofNursingSukkur
2024

3. Elimination
Theactofdischargingorexcretingwasteproductsfromthe
body.
Eliminationisabasichumanfunctionofexcreting
wastethroughthebowelandurinarysystem.

4. EliminationPattern
Eliminationpatternsdescribetheregulationcontrol,and
removalofby-productsandwastesinthebody.
Thetermusually referstothemovementoffecesorurine
fromthebody.

5. UrinaryElimination
UrinaryEliminationistheremovalofwasteproductsfromthe
bodythroughtheurinarysystem

6. FactorsAffectingUrinary Elimination
Ageanddevelopmentalstage
Dietandfluidintake
Psychosocialfactors
Healthalterations/PathologicConditions
Medication
SurgicalandDiagnosticProcedures

8. CommonProblemsofUrinaryElimination
UrinaryTractInfections(UTI):cystitis,urethritis,and,in
males,prostatitis,Pyelonephritis.
Urinaryretention:Urinaryretention,orinabilityto
emptythebladder
Urinaryincontinence:Urinaryincontinenceistheinability
tocontrol,bladderemptying.
Urinarydiversions:Urinarydiversioninvolvesthereroutingofthe
ureterstotheabdominalwallforexcretionofurinefromthebody.

9. CommonProblemsofUrinaryElimination
Urinary Calculi (Kidney Stones)
Benign Prostatic Hyperplasia (BPH):Enlargement of
the prostate gland in men.
Neurogenic Bladder: Dysfunction of bladder control
Urinary Fistula: An abnormal connection or passageway
between the urinary tract and in line structures, such as the
vagina, rectum, or skin
Functional Impairment: Mobility limitations, cognitive
impairment, or communication barriers.

11. SelectedFactorsAssociatedwithAlteredUrinaryElimination
Pattern SelectedAssociatedFactors
Polyuria IngestionoffluidscontainingcaffeineoralcoholPrescribeddiureticPresenceofthirst,dehydration,
andweightlossHistoryofdiabetesmellitus,diabetesinsipidus,orkidneydisease
Oliguria,
anuria
Decreaseinfluidintake.Signsofdehydration.Presenceofhypotension,shock,orheartfailure.History
ofkidneydisease.Signsofrenalfailuresuchaselevatedbloodureanitrogen(BUN)andserum
creatinine,edema,hypertension
Frequencyor
nocturia
Pregnancy,Increaseinfluidintake,UTI
Urgency Presenceofpsychologicalstress,UTI
Dysuria Urinarytractinflammation,infection,orinjury.Hesitancy,hematuria,pyuria(pusintheurine),and
frequency
Enuresis FamilyhistoryofenuresisDifficultaccesstotoiletfacilitiesHomestresses
IncontinenceBladderinflammation,cerebrovascularaccident(CVA;stroke),spinalcordinjury,orotherdisease.
Difficultiesinindependenttoileting(mobilityimpairment).Leakagewhencoughing,laughing,
sneezing.Cognitiveimpairment.Retention.Distendedbladderonpalpationandpercussion.
Associatedsigns,suchaspubicdiscomfort,restlessness,frequency,andsmallurinevolume.Recent
anesthesia.Recentperinealsurgery.Presenceofperinealswelling
Medicationsprescribed.Lackofprivacyorotherfactorsinhibitingmicturition

13. TheNursingProcessandUrinaryElimination
Assessment
Acompleteassessmentofaclient’surinaryfunctionincludes
thefollowing:
•Nursinghistory
•Physicalassessmentofthegenitourinarysystem
•Hydrationstatus
•Examinationoftheurine:(diagnostictestsandprocedures)

17. TheNursingProcessandUrinaryElimination
Diagnosis
NANDAInternational(2009)includestwogeneral
diagnosticlabelsforurinaryelimination:
•ImpairedUrinaryElimination:dysfunctioninurine
elimination
•ReadinessforEnhancedUrinaryElimination:Apattern
sufficientformeetingofurinaryfunctionsthatis
eliminationneedsandcanbe
strengthened’

18. TheNursingProcessandUrinaryElimination
Diagnosis
Othersalsoincludes:
•FunctionalUrinaryIncontinence
•OverflowUrinaryIncontinence
•ReflexUrinaryIncontinence
•StressUrinaryIncontinence
•UrgeUrinaryIncontinence
•RiskforUrgeUrinaryIncontinence
•UrinaryRetention

20. TheNursingProcessandUrinaryElimination
Planning
Thegoalsestablishedwillvaryaccordingtothediagnosisand
definingcharacteristicsfocusonurinaryeliminationproblems.
Appropriatepreventiveandcorrectivenursing
Interventionsthatrelatetothesemustbeidentified.
Specificnursingactivitiesassociatedwitheachofthese
interventionscanbeselectedtomeettheclient’sindividual
needs.

21. TheNursingProcessandUrinaryElimination
Nursinginterventions
Maintainingnormalurinaryelimination
•PromotingFluidIntake
•MaintainingNormalVoidingHabits
•AssistingwithToileting

22. TheNursingProcessandUrinaryElimination
Nursinginterventions
Preventingurinarytractinfections
•UTIisgreaterinwomenthanmen
•Drinkatleast8to10eight-ounceglassesofwaterperday
•Alwayswipefromfronttobackafterurinationor
defecation
•Wearcottonunderwear
•Urinateafterhavingintercourse
•OntimereportanysymptomsofUTI

23. TheNursingProcessandUrinaryElimination
Nursinginterventions
Managingurinaryincontinence(Bladder)Training
•UIisnotanormalpartofagingandoftenistreatable.
•Bladderretraining
•Habittraining

24. TheNursingProcessandUrinaryElimination
Nursinginterventions
PelvicMuscleExercises(Kegel,exercises)
MaintainingSkinIntegrity
ApplyingExternalUrinaryDrainingDevices(condomor
externalcatheter)
Clientteaching

26. BowelElimination(Defecation)
Boweleliminationistheexcretionofwastesfromthe
gastrointestinal(GI)system
BowelElimination(Defecation)isanaturalprocessbywhich
thesoiledwasteproductsofdigestion(fecesorstool)are
eliminatedfromthebowel.

27. FactorsAffectingBowelElimination
Ageand
developmentalstage
Dietandfluidintake
Activityandexercise
Psychosocialfactors
DefecationHabits
PositionDuring
Defecation
(Squatting)
Pregnancy
Pain
Medicalandsurgical
interventions
Privacy

28. CommonProblemsofBowelElimination
BOWELELIMINATION
flatulence(orgasaccumulation):
Constipation:
Impaction
Diarrhea
Fecalincontinence
Boweldiversions

29. CommonProblemsofBowelElimination
Boweldiversions
ileostomy
Colostomy
TransverseColostomy
Loopcolostomy
Endcolostomy
Irritable Bowel Syndrome (IBS)
Anal Fissures

30. TheNursingProcessandBowelElimination
Assessment
NursingHistory
•Whencollectingthenursinghistory,askthepatientabout:
Usualboweleliminationpattern(howoften,color,
regularity,odor)
Recentchangesinfrequencyandregularity
Lifestyleinformation(diet,fluidintake,exercise,
stressors)

31. TheNursingProcessandBowelElimination
Assessment
Useofassistiveaids(laxatives,enemas)
Currentmedications
boweldisease,cancer,Medicalhistory(inflammatory
neuromusculardisorders)
DiagnosticTestandProcedures:
PhysicalExamination

35. TheNursingProcessandBowelElimination
Nursingdiagnoses
Bowelincontinence
Constipation
Riskforconstipation,
Perceived
constipation
DiarrheaRiskfor
impaired skinintegrity
Riskfordeficientfluid
volume
Deficientknowledge
Disturbed bodyimage
Impairedsocial
interaction

36. TheNursingProcessandBowelElimination
Planning
Identifyinggoalsandexpected outcomes
Itisimportanttodevelopgoalsandoutcomesthatarerealisticfor
theclientandhisorheruniquesituation.Themajorgoalsfocuson
following
•Maintainorrestorenormalboweleliminationpattern.

37. TheNursingProcessandBowelElimination
Planning
•Maintainorregainnormalstoolregularity.
•Preventassociatedriskssuchasfluidandelectrolyteimbalance,
skinbreakdown,abdominaldistention,andpain
•Settingpriorities,andplanninginterventions

38. TheNursingProcessandBowelElimination
Nursinginterventions
Assessboweleliminationpatternsandcontributingfactors
Increasephysicalactivity
Increaseintake ofdietary fiberandfluids
Schedule orencouragetoiletingattimeswhenthe
person’sdefecationurgeisstrongest.
Positionthepersontofacilitateeaseofelimination.

39. TheNursingProcessandBowelElimination
Nursinginterventions
Provide privacy for elimination.
Administer stool softeners or bulk-forming laxatives or
antidiarrheal agents may be given for diarrhea as
prescribed by the physician.
I.Enema:Used for temporary relief of constipation
II.Digitalremovalofstools:Usedwhenapatienthasan
impaction
III.Rectaltube:Usedtorelievegas.
IV.Nasogastricintubation:Usedtorelievepressurecaused
bytheaccumulationoffluidsandair.

40. Conclusion
Eliminationpatternsdescribetheregulationcontrol,andremovalofby-productsandwastesinthebody
Theurinarysystemplaysanimportantrole inmaintainingfluid, electrolyte,andacid–basebalance.
Manyvariablesinfluenceurinaryelimination,includingdiet,fluidintake,activitylevel,ageand
developmentalstage,psychosocialfactors,healthdeviations,andmedicalandsurgicalinterventions.
Urinaryretention,urinaryincontinence,andUTIsarethethreemostcommonurinaryelimination
alterations.
Boweleliminationpatternsvarywidelyfromindividualtoindividual.
Age,diet,fluidintake,levelofactivity,healthstatus,andemotionalstateallinfluenceanindividual’sbowel
eliminationpattern.
Alterationsinboweleliminationincludeconstipation,diarrhea,flatulence,fecalincontinence,andbowel
diversions
Nursesprovidecareforpatientswithcommonlyoccurringeliminationalterations,including
•Urinarytract infections,Urinaryincontinence,Urinaryretention,
Constipation,Diarrhea&Bowelincontinence.