unit 13.2: urine & fecal elimination

kidneys

• situated on either side of the spinal column, behind the peritoneal cavity

• right is slightly lower than the left due to the position of the liver

• primary regulators of fluid and acid–base balance in the body

• 1,200 mL of blood, or about 21% of the cardiac output, passes through every minute

ureters

• 25 to 30 cm (10 to 12 in.) long and about 1.25 cm (0.5 in.) in diameter

• upper end of each is funnel shaped

bladder

• a hollow, muscular organ that serves as a reservoir for urine

• detrusor muscle allows the bladder to expand

• capable of considerable distention because of rugae (folds)

urethra

• extends from the bladder to the urinary meatus (opening)

• passageway for the elimination of urine

pelvic floor

• consists of sheets of muscles and ligaments that provide support to the viscera of the pelvis

micturition, voiding, and urination

all refer to the process of emptying the urinary bladder

1. developmental factors

2. psychosocial factors

3. fluid and food intake

4. medications

5. muscle tone

6. pathological conditions

7. surgical and diagnostic procedures

factors affecting voiding

1. fetuses - excrete urine between the 11th and 12th week

2. infants - excrete urine between the 11th and 12th week; voluntary urinary control is absent

3. children - renal growth occurs during the first 5 years of life

4. adults - kidneys begin to diminish in size and function after 50

5. older adults - renal blood flow decreases

(factors affecting voiding)

• developmental factors

psychosocial factors

(factors affecting voiding)

• privacy, normal position, sufficient time, and, occasionally, running water.

fluid and food intake

(factors affecting voiding)

• fluids that contain caffeine (e.g., coffee, tea, and cola drinks) also increase urine production

• food and fluids high in sodium can cause fluid retention

medications

(factors affecting voiding)

• diuretics increase urine formation

• some may alter the color of the urine.

muscle tone

(factors affecting voiding)

• important to maintain the stretch and contractility

pathological conditions

(factors affecting voiding)

• diseases of the kidneys

• urinary stone

surgical and diagnostic procedures

(factors affecting voiding)

• cystoscopy, and surgical procedures on any part of the urinary tract

• spinal anesthetics

1. polyuria

2. oliguria and anuria

2 types of altered urine production

oliguria and anuria

• decreased urinary output

• often indicates impaired blood flow to the kidneys

polyuria

• production of abnormally large amounts of urine

• more than the client’s usual daily output

• can cause excessive fluid loss, leading to intense thirst, dehydration, and weight loss

1. frequency and nocturia

X types of altered urinary elimination

urinary frequency

• is voiding at frequent intervals, that is, more than four to six times per day

• UTI, stress, and pregnancy can cause frequent voiding of small quantities (50 to 100 mL) of urine

nocturia

voiding two or more times at night

urgency

• sudden, strong desire to void

• common in people who have poor external sphincter control and unstable bladder contractions

• not a normal finding

dysuria

• not a normal finding

• it can accompany a structure (decrease in caliber) of the urethra, urinary infections, and injury to the bladder and urethra

• urinary hesitancy (a delay and difficulty in initiating voiding) is associated with this

enuresis

involuntary urination in children beyond the age when voluntary bladder control is normally acquired

nocturnal enuresis

irregular in occurrence and affects boys more often than girls

diurnal (daytime) enuresis

may be persistent and pathologic in origin

urinary incontinence (UI)

• any involuntary leakage

• can lead to depression, feelings of shame and embarrassment, and isolation, and prevent individuals from traveling far from home

• prone to skin breakdown

stress urinary incontinence (SUI)

• most common type of UI

• occurs because of weak pelvic floor muscles and/or urethral hypermobility

• causing urine leakage with such activities as laughing, coughing, sneezing, or any body movement that puts pressure on the bladder

urgency urinary incontinence (UUI)

• also called overactive bladder

• urgent need to void and the inability to stop urine leakage can range from a few drops to soaking of undergarments

mixed urinary incontinence

• diagnosed when symptoms of both stress UI and urgency UI are present

• very common among middle-age and older women

overflow urinary incontinence

• bladder overfills and urine leaks out due to pressure on the urinary sphincter

• men with an enlarged prostate and clients with a neurologic disorder

transient and functional urinary incontinence

• factors outside of the urinary tract (e.g., medications, delirium, infection, constipation)

• subcategory of transient urinary incontinence

• connected with a cognitive or physical impairment

urinary retention

• common causes include benign prostatic hyperplasia (BPH), surgery, and some medications

• overflow incontinence, eliminating 25 to 50 mL of urine at frequent intervals

positioning

(maintaining normal void habits)

• normal position for voiding

• bedside commode for females and a urinal for males

• push over the pubic area with the hands or to lean forward

relaxation

(maintaining normal void habits)

• provide privacy for the client

• allow the client sufficient time to void

• suggest the client read or listen to music

• provide sensory stimuli that may help the client relax

• pour warm water over the perineum of a female

timing

(maintaining normal void habits)

• assist clients who have the urge to void immediately

• offer toileting assistance

for clients who are confined to bed

(maintaining normal void habits)

• warm the bedpan

• elevate the head of the client's bed to Fowler's position

1. Development

2. Diet Sufficient bulk (cellulose, fiber)

3. Fluid Intake and Output

4. Activity

5. Psychologic Factors

6. Defecation Habits

7. Medications

8. Diagnostic Procedures

9. Anesthesia and Surgery

10. Pathologic Conditions

11. Pain

factors that affect defecation

constipation

(fecal elimination problems)

• fewer than three bowel movements per week

• passage of dry, hard stool or the passage of no stool

medications

(fecal elimination problems)

• opioids, iron supplements, antihistamines, antacids, and antidepressants
  

fecal impaction

(fecal elimination problems)

• mass or collection of hardened feces in the folds of the rectum

diarrhea

(fecal elimination problems)

• passage of liquid feces

• increased frequency of defecation

• opposite of constipation and results from rapid movement of fecal contents through the large intestine

1. action of bacteria on the chyme in the large intestine

2. swallowed air,

3. gas that diffuses between the bloodstream and the intestine.

(fecal elimination problems)

• flatulence

  • 3 primary sources of flatus are:

1. hydration

2. fiber rich foods

3. physical activity

4. establish a routine

5. gut friendly foods

6. relax & de stress

ways to promote regular defecation