1 / 81

Elimination

Elimination. Basic Principles . Wash Hands & Wear Gloves Infection control, your protection & your client’s protection Privacy Embarrassing Positions for urination Independence. Functions of Urinary System. Remove wastes from blood to form urine

bernad
Download Presentation

Elimination

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Elimination

  2. Basic Principles • Wash Hands & Wear Gloves • Infection control, your protection & your client’s protection • Privacy • Embarrassing • Positions for urination • Independence

  3. Functions of Urinary System • Remove wastes from blood to form urine • Remove nitrogenous waste products of cellular metabolism • Regulates fluid and electrolyte balance The nephron = functional unit of the kidney and forms the urine

  4. Goal of Urinary System • To maintain chemical homeostasis of the blood. • Filtration by the Nephrons • H2O, glucose, amino acids, urea, creatinine, major electrolytes • Not normally large proteins or blood cells • Proteinuria is a sign of glomerular injury • Normal adult 24hr output = 1500-1600ml.

  5. Overview of Urinary System • Kidneys • Bean shaped organs • Either side of vertebral columns T12 – L3 • Right kidney lower due to liver • Urine produced with filtration of blood through nephrons • Major role in fluid & electrolyte balance

  6. Ureters • Connect kidneys to bladder • 10 -12 in length, ½ in diameter in adult • Peristaltic waves • Renal colic • Micturition

  7. Bladder • Distensible, muscular sac • Reservoir for urine ( approx. capacity = 600mls ) • Organ of excretion ( norm. voiding= 300mls) • Lies in pelvic cavity behind symphysis pubis

  8. Urethra • Short, muscular tube • Urine from bladder to meatus and from the body • Female 4-6.5cm (1 ½ - 2 ½ in.) length • Male 20cms ( 8 in.) • Urinary and reproductive systems

  9. Meatus • External opening of the urethra, male & female • The need to void is a conscious awareness

  10. Life Cycle Changes • Infants & children • Unable to concentrate urine b/c kidneys are immature • Urine is light yellow • Void frequently • Voluntary control @ 24mos. when neuromuscular structures develop

  11. Adult • 1500 – 1600 mls urine/24hrs • Concentrates urine – normal is amber colored • Nocturia • Not usually • Decreased renal blood flow during rest • Ability to concentrate urine

  12. Elderly • Micturition impaired • mobility • Diseases, alzheimer’s, CVA • Physiological age related changes • Bladder loses muscle tone and capacity • Kidneys lose ability to concentrate urine • Bladder loses muscle strength

  13. Common Problems • Urinary Retention • Accumulation of urine in the bladder • Inability to empty • Pressure, discomfort and tenderness • Residual Urine = urine retained in the bladder after voiding

  14. Incontinence • Loss of voluntary control to void • Infection, nerve damage to bladder or brain, spinal cord injury, or aging process • Total incontinence = no control • Stress incontinence = sm. amts. Urine excreted involuntarily with coughing or laughing At risk for skin breakdown related to acid urine next to skin. Adult Diapers or Attends

  15. Frequency & Urgency • Nocturia • Enuresis – involuntary discharge of urine • Nocturnal Enuresis • During sleep • Bed-wetting children 5yrs and older • Oliguria • 30mls/hr or 720 mls/24hrs

  16. Renal anuria • cessation of urine production 100mls/24h

  17. Promoting Healthy Urinary Elimination • Urinate as soon as the urge is felt • Avoids stasis and distention • Prevents urgency, infection, and incontinence • Drink about 2liters fluid/day • Limit Na, caffeine, and alcohol

  18. For people with Nocturia • fld. Intake in the p.m. • caffiene and alcohol • Void before bedtime • For Women • Wipe perineum front to back • Void soon after intercourse • Wash hands • Pelvic – floor strengthening exercises (Kegel Exercises)

  19. Client Education • S & S of infection • Fluid intake ( if no restrictions 2-5 L/day ) • Perineal hygiene • Meds. & side effects on urination, color, and volume

  20. Facilitating Micturition • Nursing Measures to promote voiding in people who are having difficulty: • Privacy and natural position • Providing commode or bathroom • Running water • Warm water to dangle fingers • Warm water over perineum ( measure if on In/Out )

  21. Gently stroking inner thighs or pressure to symphysis pubis • Pain relief Warmth to the bladder & perineum relaxes muscles & facilitates voiding. ( Sitz bath or warm tub ) If unsuccessful- urinary catheterization may be indicated

  22. Promoting complete bladder emptying • Prevention of infection • Good perineal hygiene • Adequate fld. Intake • Dilutes urine & flushes urethra • Acidifying urine ( inhibits microorganisms) • Cranberry juice, whole grain breads, meats, eggs, prunes and plums.

  23. Indwelling Catheter Care • Goal- prevent infection & maintain unobstructed flow of urine. Monitor for problems. • Perineal hygiene @ least 2x/day and prn • Do not advance catheter further into urethra during perineal care

  24. Catheter Care • Fld intake (3L/day ) • Handwashing and Gloves • Positioning • Urine bag • Tubing

  25. Bowel Elimination • Function- excrete/eliminate waste products of digestion. • Maintaining normal bowel elimination is essential to health and efficient body functions.

  26. GI System • Small Intestine • Absorption nutrients & electrolytes • 20 ft length, 1 in. diameter • 3 sections • Duodenum • Jejunum • Ileum

  27. GI • Large Intestine • Absorbs H2O and electrolytes • Temporarily stores waste products • Main function is elimination • 5 – 6 ft. length, 6 – 7 cm. diameter • Cecum • Ascending colon ( Right side ) • Transverse colon • Descending colon

  28. Patterns through life cycle • Babies: 3 – 6 BM’s/day • Children: • Neuromuscular structures not developed until 15 – 18 mos. • Voluntary control 2 – 3 yrs. • Pregnant women prone to constipation • Pressure on abd. Organs • Iron supplements

  29. Elderly prone to constipation • Slowing of peristalsis

  30. Determinants affecting elimination • Dietary patterns & fld. Intake • 6 – 8 glasses H2O/day ( 1400- 2000mls ) • fld. Liquifies stool • Dietary fiber stimulates peristalsis • Soft stool

  31. Factors affecting elimination • Fiber ( undigestible residue ) provides bulk • Absorbs fluid • Increases stool mass • Bowel wall stretches • Peristalsis stimulated • Defecation results

  32. Factors affecting elimination • Personal habits • Busy schedule, postpone BM, constipation • Activity & exercise • Immobile activity in colon • Medications • Laxatives • Narcotics with codiene

  33. Factors affecting elimination • Emotions • Anxiety peristalsis & diarrhea • Depression • Pain • Surgery • Anaesthetic causes temporary cessation of peristalsis • Direct manipulation of the bowel stops peristalsis

  34. Common Problems • Constipation – difficult passage of hard, dry stool; infrequent movements • Fecal Impaction – unrelieved constipation, feces wedged in rectum, no BM usually 3days, oozing of diarrheal stool develops • Diarrhea- # liquid stool • Flatulence – abd. Distention & pain

  35. Common Problems • Incontinence – inability to control passage of stool • Hemorrhoids • Dilated engorged veins • Increased pressure when straining • Internal / external • Bleeding

  36. Daily BM Not essential. •  2 / week a concern • Defecation pattern • BM, Stool, Feces, Defecate – all mean waste products expelled via the bowel

  37. Promoting Healthy Bowel Elimination • Privacy • Squatting position • Bedpan position • Cathartics & laxatives • Anti- diarrheal agents • Enemas • disimpaction

  38. Bowel routine • Daily time clock • Hot drinks • Stool softeners • Privavy • Position and abdominal pressure • Bearing down

  39. Assissting with Elimination • Embarrassing & stressful • Usually urge to defecate 1hr. Pc • Bedpans • Metal or plastic • Regular or fracture pan • Cleanliness • Urinals • Commode

  40. Procedure • Privacy- close door, • Side rail as needed • Recumbent with HOB • Tissue • Call bell • Leave alone if possible • Gloves • Clean genitals

  41. Procedure • Remove pan and cover • In & Out • Specimens • Clean pan • Wash hands yours and client’s • Lower bed • Client comfort

  42. Peri - Care • Cleaning of genitals , routine part of complete/ partial bed bath • Incontinence

  43. Procedure for Peri Care • Regular patient • Simple explanation- layman’s terms • Privacy • Gloves • Dorsal recumbent position • Incontinent pad under buttocks • Warm soap and water • Female – separate labia

  44. Procedure for Peri Care • Male – begin penile head move down along shaft, retract foreskin, rinse and dry.

  45. Procedure for Peri Care • Catheter – • Q 8 hrs. • Clean perineum & 2in. Of catheter • No powders / lotions • Avoid advancing catheter • Keep urine drainage bag off floor but below level of bladder • Empty bag Q8 – 12hrs or when bag is full, remember to mark amt. Emptied on In/Out sheet

  46. Avoid use of baby powder/ cornstarch • No medicinal purpose • Can form clumps or will cake in creases • Use vaseline/ zincoxide as skin barrier for incontinent clients

  47. Suppository Administration • Check physician’s order, protocol • Left Lateral position • Gloves • Lubication • Hold with thumb and index finger • Insert with index finger (3 – 4”) never force • Deep breath = relaxes anal sphincter

  48. Caution • Vagus nerve stimulation can cause heart rate to slow – avoid excess manipulation

  49. Enema Administration • Main purpose • Promotion of defecation, stimulate peristalsis • The fluid breaks up fecal mass, stretches the rectal wall & initiates the defecation reflex

  50. Types of Enemas

More Related