Fundamental of nursing Chapter 14 ELIMINATION (2).pptx

fundamental of nursing chapter 14

1. Chapter 14 ELIMINATION By: Ahmed A.

2. ELIMINATION The urinary and gastrointestinal systems together provide for the elimination of body wastes. The urinary system filters and excretes urine from the body, there by maintaining fluid, electrolyte, and acid- base balance. Normal bowel function provides for the regular elimination of solid wastes.

3. URINARY CATHETERIZATION Urinary catheterization involves inserting a small tube, called a catheter through the urethra into the bladder to allow urine to drain. Strictly a sterile procedure , i.e. the nurse should always follow aseptic technique. The most frequently used method is urethral catheterization. Urine can also be removed through the suprapubic catheter.

4. URINARY CATHETERIZATION… Indwelling(retention ) catheter- is when catheter remain in place to drain urine over extended period. Straight catheterization- when urethral catheter inserted temporarily to empty urine from the bladder and then is removed. Intermittent catheterization - straight catheterization performed on routine, scheduled basis for a particular client. 10/11/2023

5. INDICATIONS FOR CATHETERIZATION It is performed only when absolutely necessary for fear of infection and trauma 1. To monitor acutely ill patient . - when accurate measurement of urinary out put is necessary such as after trauma, burns or surgery. 2. For patients under going urologic surgery . - to irrigate the bladder or to instill bladder medications

6. INDICATIONS FOR CATHETERIZATION…. As comfort measure for terminally or severely ill patients . For urinary retention not managed by intermittent catheterization - indwelling catheter . For management of urinary incontinence- indwelling catheter is used To collect urine specimens- straight catheterization is used 10/11/2023

7. TYPES OF CATHETERS Straight catheter with only one lumen for intermittent catheterization A double lumen (Foley ) indwelling catheter- when retention catheterization is needed contains 2 lumens : one to remove urine and a second, smaller lumen to inflate a balloon that keeps the catheter falling back from the bladder.

8. TYPES OF CATHETERS…. 3. Triple lumen indwelling catheter Used when urine must be removed from the bladder and the irrigation of bladder with fluid or medication is must also be performed. Usually used after urologic or prostatic surgery . 4. A coude catheter is has a curved that permits easier insertion, especially when the catheter passes an area of narrowed urethra, such that caused by 1 / p 1 1 / r 2 o 2 3 st a ti c h yperplasi a .

9. Urinary catheters are available indifferent sizes. - Sized on French scale of numbers which indicates the diameter of lumen. - The larger the lumen size the larger the French number. Adult sizes range from 12 to 22 Fr sizes 14 to 18 used most frequently for adults

10. Urinary catheters…. Catheter size depends on the size of the urethral canal => # 8-10 Fr – children => # 14-16 Fr – female adults => # 18 Fr – adult male Select appropriate balloon size => The balloons are sized by the volume of fluid or air used to inflate them 5 ml – 30 ml (10 commonly). => indicated with the catheter size 18 Fr – 5 ml. 10/11/2023

11. TYPES OF CATHETERS F ol e y Cath e t er T h r e e - W a y F ol e y Catheter with Balloon Inflated Coudé Catheter

12. TYPES OF CATHETERS…. Indwelling and straight catheters

13. A. MALE CATHETERIZATION Equipment Indwelling catheter with drainage system. Sterile catheterization kit. Adequate lighting source. Disposable gloves (to clean the area) Blanket or drape . Soap and washcloth. Warm water. Towel. Forceps.

14. Male catheterization... PROCEDURE Provide for privacy and explain procedure to client. Set the bed to a comfortable height to work , and raise the side rail on the side opposite you. Assist the client to a supine position with legs slightly spread. Drape the client’s abdomen and thighs , and place the penis over the thighs.

15. Male catheterization... Ensure adequate lighting of the penis . W as h ha n ds , do n dispos a b l e g l o v es, w ash perineal area. Remove gloves and wash hands. Prepare a sterile field, apply sterile gloves , and connect the catheter and drainage system (if necessary). 10/11/2023

16. Male catheterization... Gently retract the foreskin (if present) and, using forceps, cleanse the glans penis with a povidone- iodine solution or other antimicrobial cleanser. Generously coat the distal portion of the catheter with water-soluble, sterile lubricant . Hold the penis perpendicular to the body and pull up gently. 10/11/2023

17. Male catheterization... Steadily insert the catheter about until urine is noted . Continue inserting until the hub of the catheter (bifurcation between drainage port and retention balloon arm) is met. Inflate the retention balloon using manufacturer’s recommendations or according to physician orders.

18. Male catheterization... Instruct the client to immediately report discomfort or pressure during balloon inflation; if pain occurs, discontinue the procedure, deflate the balloon, and insert the catheter farther into the bladder. Gently pull the catheter until the retention balloon is snuggled against the bladder neck (resistance will be met).

19. Male catheterization... Secure the catheter to the abdomen or thigh. Place the drainage bag below the level of the bladder. Remove gloves , dispose of equipment, and wash hands. Help client adjust position . Assess and document the amount, color, odor, and quality of urine

20. Male catheterization... Cleanse the glans penis with a cotton ball held with forceps. Correct Catheter Placement: Male Client

21. CONDOM CATHETER Is external catheter used for clients who are unable control voiding. Composed of condom or sheath that is placed on the penis and is attached to tubing that inserts in to a closed collecting bag. Have much lower risk of promoting UTIs . Its drawbacks are dislodgement and leaking . Ischemia and skin break down can also happen with its use.

22. B. FEMALE CATHETERIZATION Equipments – as that of male catheterization PROCEDURE Provide for privacy and explain procedure to client. Set the bed to a comfortable height to work , and raise the side rail on the side opposite you. Assist the client to a supine position with legs spread or to a side-lying position with upper leg flexed.

23. Female catheterization… Drape client’s abdomen and thighs. Ensure adequate lighting of the perineum Wash hands, don disposable gloves, and wash perineal area . Remove gloves and wash hands. Prepare a sterile field, apply sterile gloves , and connect the catheter and drainage system (if necessary). 10/11/2023

24. Female catheterization… Separate the perineum and, using forceps, cleanse the periurethral mucosa with a povidone- iodine or other antimicrobial cleanser. Generously coat the distal portion of the catheter with water-soluble, sterile lubricant. Gently insert the catheter into meatus until urine is noted . Continue inserting for 1 to 3 additional inches. 10/11/2023

25. Female catheterization… Inflate the retention balloon using manufacturer’s recommendations or according to physician orders. Instruct the client to immediately report discomfort or pressure during balloon inflation ; if pain occurs, discontinue the procedure, deflate the balloon, and insert the catheter further into the bladder.

26. Female catheterization… Gently pull the catheter until the retention balloon is snuggled against the bladder neck (resistance will be met) Secure the catheter to the abdomen or thigh. Place the drainage bag below the level of the bladder . 10/11/2023

27. Female catheterization… Remove gloves, dispose of equipment, and wash hands. Help client adjust position . Assess and document the amount, color, odor, and quality of urine

28. R em o v al Withdraw the solution or air from the balloon using a syringe. And remove gently. Dry and make the client comfort.

29. Complications of catheterization Infection of the bladder, ureters and kidney break in sterile technique using catheter for prolonged time(risk is high if>72 hrs) Trauma to the urethral tissue men are at greater risk due to the length and curvature of male urethra.

30. Enema administration Enema administration is a procedure used to introduce fluid into the lower bowel. The purpose of an enema is: To cleanse the lower bowel, To assist in the evacuation of stool or flatus, or To instill medication . Enemas can be large or small depending on their purpose.

31. Enema administration… 1. Large-volume enemas = Are administered to cleanse the bowel of stool by distending colon. = Warm tap water or saline solution is used but for infants and children the saline solution is the only recommended fluid. = Volume - 15 to 60 ml for infants - 240 to 360 for a child - 500 to 1000 ml fluid, 10/11/2023

32. Enema administration…. 2. Small-volume enemas => Are used for the purpose of evacuating stool or instilling medications in the lower bowel. => These are usually found as prepackaged solutions, which contain 150 to 240 ml fluid . => The laxative solution is hypertonic - > draws water from colonic mucosa -> cause water retention to trigger defecation reflex and it will also increase peristalsis.

33. Retention Enema Are enemas meant for various purpose in which the fluid usually medicine is retained in rectum for short or long period – for local or general effects E.g. oil retention enema Antispasmodic enema Principles: Is given slowly by means of a rectal tube The amount of fluid is usually 150-200cc - Cleansing enema is given after the retention time is over

34. Enema administration… Solutions used for enema administration Normal saline - can be 0.9% (isotonic), hypotonic (< 0.9%) , or hypertonic (> 0.9%) & Dilates, simulates, irritates bowel Soap solution- is hypotonic and dilates, stimulates, and irritates bowel Tap water – is hypotonic and stimulates and dilates bowel Emollient (oil)- Lubricates, softens 10/11/2023

35. Enema administration INDICATIONS OF ENEMA Constipation -> to stimulate peristalsis and remove feces or flatus Fecal impaction- to soften feces and lubricate the rectum and colon To clean the rectum and colon in preparation for an examination . E.g. Colonoscopy To remove feces prior to a surgical procedure or a delivery For incontinent patients to keep the colon empty For diagnostic test E.g. before certain x-ray exam – barium enema

36. Contraindication => Enemas are contraindicated in clients with bowel obstruction , inflammation , or infection of the abdomen or if the client has had recent rectal or anal surgery . 10/11/2023

37. Procedure of enema administration Equipments Enema bag with appropriately sized tubing with clamp (adults-22 to 32 Fr, children 14 to 18 Fr, infants 12 Fr) Absorbent pad for the bed Disposable gloves Bedside commode or bedpan if client will not be able to ambulate to bathroom Lubricant Thermometer for enema solution Toilet tissue IV pole Washcloth, towel, and basin

38. Procedure of cleansing enema administration Introduce yourself and explain procedure. Prepare the solution, assure temperature within range of 40.5 to 43oc in adults and 37.7oc for children) by using a thermometer or placing a few drops on your wrist. => Enemas work best when solution is warm. If enemas are too hot, damage can be done to the bowel mucosa. If enemas are too cold, spasms may occur.

39. Procedure of cleansing enema administration Assist patient to left side-lying position , with right knee bent. => Lying flat on left side allows fluid to flow through to colon with contour or curvature of bowel Place absorbent pad on bed under client Hang bag of enema solution above the anus. =>The solution should be 30–45 cm above the rectum for an adult, and 7.5 cm above the rectum for an 1 i / n 1 1 / f 2 a 2 3 n t .

40. Procedure of cleansing enema administration 7 . Lubricate 5 cm of catheter tip . Place bedpan within easy reach . Make the tube air free by releasing the clamp and allowing the fluid to run down little to the bed pan and clamp open to prevent unnecessary distention. Separate buttocks, insert catheter tip into anal opening, slowly advance catheter approximately 10 cm. 10/11/2023

41. Procedure of cleansing enema administration Slowly infuse solution via gravity flow; bag height may be increased but not to exceed 45 cm above anal opening. => Rapid infusion caused by bag height over 45 cm may cause cramping and discomfort. Bowel perforation is also a risk If client complains of increased pain or cramping , or if fluid is not being retained, stop procedure, wait a few minutes, then restart.

42. Procedure of cleansing enema administration Clamp tubing when fluid finishes infusing; remove catheter tip. Instruct the client to retain as long as possible . Assist client to bedpan, commode, or toilet when there an urge to evacuate Discard equipment in proper place. If equipment is reusable , properly clean and store it. Remove gloves and wash hands. Instruct client to call for assistance when finished eliminating, or if untoward feeling occurs, such as lightheadedness or dizziness. Assist client with washing if needed.

43. Procedure of cleansing enema administration

44. Rectal Washout - Is the process of introducing large amount of fluid into large bowel for flushing purpose and allow return or wash out fluid Purpose To prepare the patient for x-ray exam and sigmoidoscopy To prepare the patient for rectum and colo n operation

45. Rectal Washout Procedure Insert the tube like the cleansing enema The client lies on the bed with hips close to the side of the bed (client assumes a right side lying position for rectal wash out) Open the clamp and allow to run about 1,000 cc of fluid in the bowel, then siphon back into the bucket. Carry on the procedure until the fluid return is clear. 10/11/2023

46. Rectal Washout Note that Should be finished 1 hr before exam or x-ray – to give time for the large intestine to absorb the rest of the fluid. Give cleansing enema ½ hr before the rectal wash out. Allow the fluid to pass slowly Amount of solution - 5-6 liters or until the wash out rectum fluid becomes clear

47. Passing a Flatus Tube Purpose To decrease flatulence (sever abdominal distention) Before giving a retention enema Procedure Place the patient in left lateral position Lubricate the tube about 15 cm Separate the rectum and insert 12-15 cm in to the rectum and tape it Connect the free end to extra tubing by the glass connector The end of the tube should reach the (tape H2O) solution in the bowel

48. Procedure The amount of air passed can be seen bubbling through the solution (a funnel may be connected to free end of tube and placed in an antiseptic solution in bowel) Leave the rectal tube in place for a period or no longer than 20 minute – can affect the ability to voluntarily control the sphincter if placement is prolonged Reinsert the rectal tube every 2-3 hrs if the distention has been unrelieved or re accumulates – allows gas to m 1 / o 1 1 v / 2 e 2 3 in t h e di r e c ti o n of t h e r e c t u m.

49. Changing a Colostomy Pouch Equipment Appropriate pouch Skin barrier Pouch clip or rubber band Skin paste Disposable gloves Soap and washcloth Warm water A. B. A. Colostomy Pouch; B. Skin Barrier

50. Changing a Colostomy Pouch Explain the procedure to client and provide for privacy. Include caregivers in instruction if indicated. Assist client to a standing (preferable) or sitting position. Wash hands and don gloves. Remove the soiled pouch by gently pressing on the skin while pulling the pouch. Dispose of the pouch in a plastic bag after removing the clip used to seal the pouch. Cleanse the skin with soap and water.

51. Changing a Colostomy Pouch Inspect the peristomal skin for redness, altered skin integrity, or rashes Remove excessive hair with a safety razor or electric razor. Inspect the pouch opening and ensure that it fits the stoma Apply a skin sealant or skin paste if indicated ; apply skin barrier Gently apply the pouch and press into place Seal the inferior opening with the clip or a rubber band. Remove gloves and discard; wash hands. Note type and size of pouch; condition of stoma (drainage amount and odor; surrounding skin); and client response.

52. Apply the skin barrier to the stoma. Measure the stoma for the colostomy pouch Press the pouch into place.