Unit 10- Elimination

1. Unit 10- Elimination Metro Community College Nursing Program Nancy Pares, RN, MSN

2. Urinary Elimination • Terms used for expelling urine • Urination • Micturition • Voiding • Know anatomy and physiology • Kidney, nephron, glomerulus

3. Factors influencing • Stage of growth and development • Psychological factors • Sociocultural factors • Personal habits • Muscle tone • Fluid intake • Disease conditions • Surgical procedures • Medications • Diagnostic procedures

4. Common urinary problems • Urinary retention • Lower UTI • incontinence

5. Types of incontinence • Total • Functional • Stress • Urge • reflex

6. Symptoms • Urgency • Dysuria • Frequency • Hesitancy • polyuria • Oliguria • Nocturia • Hematuria • Retention • residual

7. assessment • Intake and output • Color • Clarity • odor

8. Routine analysis • Ph • Protein • Glucose • Ketones • Blood • Specific gravity

9. Types of urine specimans • Clean voided Midstream • Sterile • 24 hour • Culture and sensitivity

10. Methods to promote voiding • Positioning • Run water • Immersion • Privacy and time • Adequate fluids

11. Catherization: how and why • Intermittent • Indwelling • Bladder distention • Prevent skin breakdown • Obtain sterile speciman • Assess residual • Relieve obstructed flow • Surgical procedure • Accurate intake and output • Bladder irrigation

12. Care of catheters: indwelling • Keep system closed • Keep bag below bladder • Don’t let bag touch floor • Coil excess tube on bed • Check for kinks • Encourage fluid intake • Cath care x2 daily • Empty collection bag every shift

13. Bowel elimination: • Defecation • Reflex occurs when the fecal mass enters rectum • Voluntary and involuntary • Sphincter relaxation • Valsalva maneuver

14. Factors influencing • Age • Diet • Position • Pregnancy • Diagnostic tests • Fluid intake • activity • Psychological factors • Habits • Pain • Medications • surgery

15. Causes of constipation • Irregular habits • Inadequate fluids • Lack of exercise • Low fiber diet • Habitual laxative use

16. Impaction: S &S • No stool • Continual oozing • Loss of appetite • Abdominal distention • Cramping • Rectal pain

17. Diarrhea: causes • Emotional stress • Intestinal infection • Allergies or intolerances • Medications • Colon disease • Surgical procedures

18. Incontinence: causes • Spinal cord trauma • Multiple sclerosis • Cerebral vascular accident (CVA) • Muscle tone decreased • pathological

19. Flatulence • Accumulation of gases • Increased with decreased mobility or obstruction

20. Hemorrhoids: causes • Increased venous pressure • Excessive straining • Pregnancy • Congestive heart failure • Liver disease

21. Normal characteristics of feces • Infant---yellow • Adults---brown • soft formed • Additional notations • Frequency • Shape • constituents

22. Lab tests for feces • Guaic/hemacult • Melena • Ova and parasites

23. Promoting regularity • Diet • positioning • Exercise • Digital stimulation • Timing of defecation • Cathartics/laxatives/enemas • privacy

24. Types of Enemas • Tap water • Stimulates by distention • 750-1000 cc • Saline • Stimulates by distention • 1 tsp salt

25. Types cont • Hypertonic • Draws fluid into the colon (distention) • 4 ounces of fluid • Ex: fleets • Soapsuds • Irritates mucosa • Castile soap • 7500-1000 cc

26. Types cont • Oil retention • Low volume • Softens feces • Must retain for extended time • Up and down flush • Aids expulsion of gas • Small amt of fluid introduced, lower bag--repeat

27. Enema administration • Explain procedure • Sim’s position • Lubrication tube 3-4 in. • Insert tube gently toward umbilicus • Do not raise container more than 18 in above anus • Ask client to retain as long as tolerable • Record type and amount of soln and content return • Observe for intolerance: