Concept of Elimination-1.pptx elimination pattern including urinary pattern in it

concept of elimination

1. Bowl Elimination

2. Learning outcomes After completing this chapter, students will be able to: 1. Describe the physiology of defecation. 2 . Identify factors that influence fecal elimination and patterns of defecation. 3 . Identify common causes and effects of selected fecal elimination problems and describe methods used to assess fecal elimination. 4 . Identify examples of nursing diagnoses, outcomes, and Interventions for clients with elimination problems. 5 . Identify measures that maintain normal fecal elimination patterns .

3. Introduction Elimination of waste products o f digestion from the body is essential t o health. The excreted waste products are referred to as feces or stool.

4. Points to remember Large intestine (colon) include the cecum; ascending, transverse, and ascending colon; sigmoid colon; rectum and anus. Product of digestion flatus ( largely air, by product of digestion of CHO) and feces Rectum contains folds that extend vertically containing a vain and an artery folds helps retain feces within the rectum

5. Elimination pattern Elimination patterns  describe the regulation, control, and removal of by-products and wastes in the body. The term usually refers to the movement of feces or urine from the body.

6. Main focus of elimination Bowel elimination. Urinary elimination.

7. Digestive system

8. Peristalsis I s wavelike movement produced by the circular and longitudinal muscle fibers of the intestinal walls; it propels the intestinal contents forward.

9. Peristaltic movements

10. Defecation Defecation is the expulsion of feces from the anus and rectum. It is also called a bowel movement . Feces Made up of 75% water and 25% solid normally brown in color Escherichia coli or staphylococci

11. Physiology of defecation Peristaltic waves move the feces into the sigmoid colon and the rectum Sensory nerves in rectum are stimulated Individual becomes aware of need to defecate Feces move into the anal canal when the internal and external sphincter relax

12. Cont…. External anal sphincter is relaxed voluntarily if timing is appropriate Expulsion of the feces assisted by contraction of the abdominal muscles and the diaphragm Moves the feces through the anal canal and expelled through anus Facilitated by thigh flexion and a sitting position

13. Cont. 2. Diet: Sufficient bulk (cellulose, fiber) Insoluble fiber promotes the movement of material through the digestive system and increases stool bulk Soluble helps lower blood cholesterol and glucose levels. 3. Fluid Intake and Output: D aily fluid intake of 2,000 to 3,000 ml. 4. Activity: Activity stimulates peristalsis .

14. Cont. 5. Psychological Factors: Emotional instability increases peristaltic activity and subsequent nausea or diarrhea. 6. Defecation Habits: Ignores urge to defecate Weakened conditioned reflexes Habitually ignored

15. Cont. 7. Diagnostic Procedures The client is restricted in taking meals Prior thus normal defecation is placed i n halt until eating resumes . 8. Medications: Side effects of drugs can interfere with n ormal elimination. 9. Pathologic Conditions: Spinal cord injuries and head injuries can decrease the sensory stimulation for defecation.

16. Cont. 10. Pain : Clients who experience discomfort when defecating (e.g., following hemorrhoid surgery)

17. Problems of elimination Constipation Diarrhea Bowel incontinence Flatulence

18. Constipation It may be defined as fewer than 3 bowel movements per week. This infers the passage of dry, hard stool or the passage of no stool .

19. Characteristics of constipation Decreased frequency of defecation. Hard , dry stool. Painful defecation. Abdominal pain, cramps, or distension. Anorexia , nausea Headache Reports of rectal fullness, or pressure, or incomplete bowel evacuation.

20. Causes and factors Insufficient fiber intake Insufficient fluid intake Insufficient activity Irregular defecation habits Chronic use of laxative or enemas Pelvic floor dysfunction or muscle damage Poor motility

21. Causes…. Neurological conditions e.g. stroke , paralysis Emotional disturbance Medications e.g. opioids, iron supplements, etc

22. Fecal impaction Mass or collection of hardened feces in folds of rectum that cannot be expelled or Fecal impaction  is a severe  bowel  condition in which a hard, dry mass of  stool  becomes stuck in the colon or rectum. This immobile mass will block the passage and cause a buildup of waste, which a person will be unable to pass. Causes usually: Poor defecation habits Results from unrelieved constipation Treatment Removed manually Must have physician order

23. Fecal impaction

24. DIARRHEA Passage of liquid feces and increased frequency of defecation Characteristics: Spasmodic cramps, increased bowel sounds Fatigue, weakness, Malaise and emaciation A symptom of disorders affecting digestion, absorption, and secretion of the GI tract

25. Causes Stress, Medications,( laxatives, cathartics) Antibiotics Allergies, Intolerance of food or fluids, Disease of colon e.g. malabsorption syndrome

26. FECAL INCONTINENCE Loss of voluntary ability to control fecal and gaseous discharges Generally associated with: Impaired functioning of anal sphincter or nerve supply Neuromuscular diseases Spinal trauma Tumor of external anal sphincter muscle. Nursing Considerations Incontinence can harm a clients body image Incontinence predisposes the skin to breakdown

27. FLATUENCE It is the presence of excessive flatus in the intestines leads to stretching and inflation of intestines. Flatulence can occur from variety of causes Foods Abdominal surgery Narcotics

28. NANDA Nursing diagnosis for fecal elimination problems Bowel Incontinence Constipation Risk for Constipation Perceived Constipation Diarrhea

29. Related nursing diagnosis Risk for Deficient Fluid Volume Risk for Impaired Skin Integrity Low Self-esteem Disturbed Body Image Deficient Knowledge Bowel Training Ostomy Management Anxiety

30. Outcomes Maintain or restore normal bowel elimination pattern Maintain or regain normal stool consistency Prevent associated risks such as fluid and electrolyte imbalance, skin breakdown, abdominal distention and pain

31. Nursing considerations Promoting regular defecations by the provision of privacy Timing Nutrition and fluid Exercise Positioning Teaching about medications Decreasing flatulence Administering enemas Applying a fecal incontinence pouch Ostomy management

32. Ostomy An ostomy is an opening for the gastrointestinal, urinary, or respiratory tract onto the skin. Gastrostomy: (is an opening through the abdominal wall into the stomach) Jejunostomy: ( opens through the abdominal wall into the jejunum) Ileostomy: (opens into the ileum (small bowel ) Colostomy: opens into the colon (large bowel).

33. Ostomy cont. Gastrostomies and jejunostomies are generally performed to provide an alternate feeding route. The purpose of bowel ostomies is to divert and drain fecal material Stoma: T he opening created in the abdominal wall by the ostomy.

34. Ostomies Ostomies can be temporary or permanent. Temporary colostomies performed for traumatic injury or inflammatory conditions of the bowel. They allow the diseased portions of the bowel to rest and heal. Permanent colostomies are performed to provide means of elimination when the rectum or anus is nonfunctional as a result of a birth defect or a disease such as cancer of bowel

35. O stomies

36. References Kozier & Erb‘s . Fundamentals of Nursing: concepts, process and practice, 11th Edition. Potter & Perry's, Fundamentals of Nursing,2nd Edition