Elimination

ROYALTY TELEVISION

1. ELIMINATION OF URINE AND FAECES BY JONES H.M –MBA/DMS 1/25/2021 JONES H.M-MBA/DMS 1

2. Elimination is a natural process which is very important for healthy. Healthy individuals have regular elimination habits. 1/25/2021 JONES H.M-MBA/DMS 2

3. Urination: Micturition , voiding and urination all refer to the process of emptying the urinary bladder. urine collects in the bladder until the pressure stimulates special sensory nerve ending in the bladder wall called stretch receptors. 1/25/2021 JONES H.M-MBA/DMS 3

4. Urinary elimination : process of releasing excess fluid and metabolic wastes Normal conditions: average person eliminates approximately 1500 to 3000 mL of urine each day Need to urinate becomes apparent when the bladder distends with approximately 150 to 300 mL of urine 1/25/2021 JONES H.M-MBA/DMS 4

5. Alteration urine production: Polyuria : refer to the production of abnormally large amount of urine by the kidneys. Diuresis : another term of production large amount of urine. Oliquria : is low urine output less than 500ml/ day. Anuria : lack of urine production less than 30 ml / day 1/25/2021 JONES H.M-MBA/DMS 5

6. Altered urinary elimination: Frequency: is the voiding more than normal with frequent intervals. Nocturia : is voiding two or three time at night. Urgency: is the feeling of person must void. Dysuria : means voiding that is either painful or difficulty. Enuresis: is defined as involuntary urination. Urinary incontinence: involuntary urination. Symptom not a disease. Urine retention: accumulation of urine in the bladder and become over distended 1/25/2021 JONES H.M-MBA/DMS 6

7. Oliguria : urine output is less than 400 mL per 24 hours; indicates inadequate elimination of urine Residual urine: more than 50 mL of urine remains in the bladder after voiding Urinary stasis: lack of movement of urine from bladder 1/25/2021 JONES H.M-MBA/DMS 7

8. Dysuria : difficult or uncomfortable voiding and a common symptom of trauma to the urethra or a bladder infection Frequency: need to urinate often Urgency : strong feeling that urine must be eliminated quickly Incontinence: inability to control either urinary or bowel elimination; abnormal after a person is toilet-trained 1/25/2021 JONES H.M-MBA/DMS 8

9. Clients who are weak or cannot walk to the bathroom may need a commode ; clients confined to bed use a urinal or bedpan 1/25/2021 JONES H.M-MBA/DMS 9

10. Anuria : absence of urine or a volume of 100 mL or less in 24 hours; kidneys not producing sufficient urine Urinary retention: the client produces urine but does not release it from the bladder 1/25/2021 JONES H.M-MBA/DMS 10

11. Urinary Elimination (voiding, urination) The kidneys form the urine. The ureters carry urine to the bladder. The bladder acts as a reservoir for the urine. The urethra is the passageway for the urine to exit the body. Continence in the Adult Anatomic integrity of the urinary system Nervous control of the detrusor muscle Competent sphincter mechanism 1/25/2021 JONES H.M-MBA/DMS 11

12. Factor affecting voiding Developmental factor : Infant may urinate 20 times a day. The output decreased at older people according to the decrease of renal function. Fluid and food intake : the healthy body maintains a balance between the amount of fluid ingested and the amount of fluid eliminated. Some foods and fluid change in urine color. Medications : diuretics increase urine formation. Pathologic conditions : such as kidney or heart disorders. Psychosocial factors : such as not suitable time or place. 1/25/2021 JONES H.M-MBA/DMS 12

13. Measures to promote urination 1. fluids 2. listen to sound of running water 3. dangle fingers t warm water 4. crede’s maneuver: applying pressure to suprapubic area Last resort; urinary cathetrization 1/25/2021 JONES H.M-MBA/DMS 13

14. Credes maneuver 1/25/2021 JONES H.M-MBA/DMS 14

15. Providing privacy; assuming a natural position for urination Maintaining an adequate fluid intake Using stimuli such as running water from a tap to initiate voiding. Maintain an adequate fluid intake. Promote normal voiding habits. Assist patient with bedpans or with getting to the bedside commode or toilet, if needed. 1/25/2021 JONES H.M-MBA/DMS 15

16. CATHETERIZATION Catheterization: act of applying or inserting a hollow tube Types of catheters External catheters : urine-collecting device applied to the skin Example: condom catheter 1/25/2021 JONES H.M-MBA/DMS 16

17. Straight catheters: urine drainage tube inserted but not left in place Retention catheters (also called indwelling catheters): left in place for a period of time Example: Foley catheter 1/25/2021 JONES H.M-MBA/DMS 17

18. Reasons for catheterization Keeping incontinent clients dry (last resort, when all other continence measures have been tried) Relieving bladder distention when clients cannot void Assessing fluid balance accurately Obtaining sterile urine specimens Instilling medication within the bladder Measuring the residual urine Keeping the bladder from becoming distended during procedures such as surgery 1/25/2021 JONES H.M-MBA/DMS 18

19. Bowel ( Faecal ) elimination Flatus: is largely air and by product of digestion of carbohydrate. Defecation: is the expulsion of feces from the anus and rectum. the frequency of defecation is highly individual vary from several time per day or three time per weeks. When feces move into sigmoid, the sensory nerves are stimulated. The expulsion of feces is result from relaxation of internal and external sphincter and by contraction of abdominal muscle and diaphragm which increase abdominal pressure. 1/25/2021 JONES H.M-MBA/DMS 19

20. Feces: normal feces are made of about 75% water and 25% solid material. if they feces propelled very quickly along the large intestine there is not time for most water in the chyme to be absorbed and feces will be more fluid. Feces: are normally brown, chiefly due to presence of sterocoblin and urobilin . Which are derived from bilirubin and another factor effect of color is bacteria 1/25/2021 JONES H.M-MBA/DMS 20

21. Continence Consistency of the stool (fecal material) Intestinal motility Compliance and contractility of the rectum Competence of the anal sphincters 1/25/2021 JONES H.M-MBA/DMS 21

22. Abnormal faeces Clay or white color may indicate of absence of bile or bile obstruction. Black, tarry stool may indicate of bleeding from upper gastrointestinal tract or drug. Red: may indicate of bleeding from lower gastrointestinal tract. Pale may indicated to mal absorption. Green may indicate intestinal infection. Dry, hard: dehydration decreased intestinal motility. Pus: bacterial infection. 1/25/2021 JONES H.M-MBA/DMS 22

23. Factors Affecting Bowel Elimination Age Infants: small stomach capacity; less secretion of digestive enzymes; rapid peristalsis; lack neuromuscular development so cannot control bowels Older adults: arteriosclerosis which causes decreased mesenteric blood flow, decreasing absorption in small intestine; decrease in peristalsis; loose muscle tone in perineal floor and anal sphincter thus are at risk for incontinence; slowing nerve impulses in the anal region make older adults less aware of need to defecate leading to irregular BMs and risk of constipation 1/25/2021 JONES H.M-MBA/DMS 23

24. Diet: fiber such as whole grains, fresh fruits and vegies help flush the fats and waste products from the body with more efficiency; decreased fiber → increased risk of polyps; be aware of food intolerances Fluid intake: 6-8 glasses of noncaffeinated fluid daily; liquifies intestinal contents easing passage through colon Physical activity: promotes peristalsis Psychological factors: stress increases peristalsis resulting in diarrhea and gaseous distention; ulcerative colitis; IBS; gastric and duodenal ulcers; crohn’s disease Personal habits: fear of defecating away from home Position during defecation: squatting is the normal position 1/25/2021 JONES H.M-MBA/DMS 24

25. Pain: hemorrhoids, rectal surgery, rectal fistulas and abd . surgery Pregnancy: increased pressure; slowing peristalsis in third trimester Surgery and Anesthesia: lows or stops peristalsis; paralytic ileus = direct manipulation of the bowel and lasts 24-48 hours Medications: laxatives and cathartics; laxative overuse can decrease muscle tone and can cause diarrhea which can result in dehydration and electrolyte imbalance; see Table 46-2 Diagnostic tests: bowel prep; barium 1/25/2021 JONES H.M-MBA/DMS 25

26. Common Bowel Elimination Problems Constipation is infrequent and difficult passage of hardened stool. Causes: improper diet, reduced fluid intake, lack of exercise, and certain meds A significant health hazard Impaction Fecal impaction is a mass or collection of hardened, puttylike feces in the folds of the rectum. Causes: unrelieved constipation Debilitated, confused, and unconscious more at risk Continuous ooze of diarrhea is a suspect sign Diarrhea Causes: antibiotics via any route; enteral nutrition; food allergies or intolerance; surgeries or diagnostic testing of the lower GI tract; C. difficile ; communicable food-borne pathogens 1/25/2021 JONES H.M-MBA/DMS 26

27. Cont ,,,, Incontinence Dysfunction of the anal sphincter Disorders of the delivery of stool to the rectum Causes: physical conditions that impair anal sphincter function or control Flatulence Causes: certain foods; decreased intestinal motility Can become severe enough to cause abd distention and severe sharp pain Hemorrhoids = dilated, engorged veins; internal or external Causes: straining with defecation; pregnancy; heart failure; chronic liver disease 1/25/2021 JONES H.M-MBA/DMS 27

28. HEMORROIDS -Distended veins in rectum, internal and external Caused by straining, pregnancy, obesity, increased rectal pressure 1/25/2021 JONES H.M-MBA/DMS 28

29. Nursing Interventions to Promote Normal Bowel Elimination The nurse can help the patient to achieve a regular defecation by attending to: Privacy Timing- Patients should be encouraged to defecate when the urge to defecate is recognized. Nutrition and fluids Exercise - Ambulation helps to stimulate normal motility, and therefore should be encouraged in post-surgical patients. Positioning 1/25/2021 JONES H.M-MBA/DMS 29

30. Increase fluid intake. Instruct the patient to drink fruit juices. Include fiber in the diet with foods. Administration of laxatives. Administration of Enema 1/25/2021 JONES H.M-MBA/DMS 30

31. Encourage intake of fluids and food. Eating small amounts of bland foods. Encourage the ingestion of food or fluids containing potassium, since diarrhea can lead to great potassium losses. Avoid excessively hot or cold fluids and highly spiced foods and high fiber foods that can aggravate diarrhea. 1/25/2021 JONES H.M-MBA/DMS 31

32. Measures to promote defaecation Promote regular defecation by: Privacy Timing. Nutrition: high fiber diet Increase fluid intake to 2L per day. Exercise Positioning: squatting position best facilities defecation. 1/25/2021 JONES H.M-MBA/DMS 32

33. Teaching about medication. Antidiarrhreal medication or laxative medication. Administrating enema: is a solution introduced in the rectum and the large intestine. Decreasing flatulus by avoid gas – producing food, exercise, moving in bed and ambulation. Bowel training program. ostomy management by stoma color, size and shape, bleeding and amount and type of feces. 1/25/2021 JONES H.M-MBA/DMS 33

34. Health Promotion: establish routine Promotion of normal defecation Sitting position Position on bedpan – see pg. 1196 Privacy Bowel training Proper fluid and food intake Regular exercise Acute Care Meds Cathartics and laxatives Antidiarrheal agents Enemas 1/25/2021 JONES H.M-MBA/DMS 34

35. Types of Enemas Cleansing enemas Tap water Normal saline Hypertonic solutions Soapsuds Oil Retention Carminative – Mag , gylcerin and water; relieves gaseous distention Medicated enemas – Kayexalate 1/25/2021 JONES H.M-MBA/DMS 35

36. Enema administration “Enemas till clear” See pages 1200-1202 Digital removal of stool – last resort Can cause irritation to the mucosa, bleeding and stimulation of vagus nerve Inserting and maintaining a nasogastric tube 1/25/2021 JONES H.M-MBA/DMS 36

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