FON- Ch 15 Elimination and Gastric Intubation

Urinary Elimination

Urinary Elimination

removes excess fluid and metabolic waste (urine) to maintain electrolyte balance
- Micturition/ Voiding/ Urination

Urinary Tract Infection (UTI)

infection of one or more organs of the urinary tract
(kidneys, ureter, bladder, urethra)

Characteristics of Urine

- Volume: 30mL/hr
- Color: pale straw to amber
- Clarity: transparent (clear)
- Odor: faintly aromatic
- Residual Urine: less than 50mL

Commode

chair with an opening in the seat under which a receptacle is places

Bedpan

vessel for receiving the urinary and fecal discharges of a patient unable to leave his or her bed

Fracture Bedpan

A curved, smooth upper end and a tapered lower end used for patients unable to lift their hips.

Urinals

Used to collect urine; male and female urinals differ in shape

Urinary Catheters

soft plastic or rubber tubing
- maintain urine flow
- divert urine flow
- facilitate healing postoperatively
- introduce new medications by irrigation
- dilate/prevent narrowing of the urinary tract

Catheritization

inserting a catheter tubing into the urinary bladder/ureter/kidneys

Urinary Catheter

Urinary meatus and the urethra into the urinary bladder

French (Fr) System

catheter size 14-Fr (thicker diameter) to 24-Fr (thinner diameter)

Indwelling Catheter

- stay inside the body for a while, urine drains into a bag
- Coudé catheter
- Foley catheter
- Malecot, De Pezzer, and Mushroom catheters
- Ureteral catheter

Coudé Catheter

- tapered tip aids in insertion for those with enlarged prostate glands (swollen)

Foley Catheter

balloon near the tip (inflated after insertion) holds the catheter in place for continuous drainage

Malecot/ de Pezzer/ Mushroom Catheters

- used to drain urine from the renal pelvis of the kidney
- inserted by physician

Robinson Catheter

multiple openings to facilitate intermittent drainage

Whistle-tip Catheter

slanted, larger orifice tip
- for pt with blood in the urine

Ureteral Catheter

Long and slender to pass into the ureter

Suprapubic Catheter (cystotomy/ vesicostomy)

catheter inserted into the bladder through the abdominal wall above symphysis pubis
- divert urine flow from the urethra to treat injury to the bony pelvis, urinary tract, surrounding organs/strictures/ obstructions

Simple Urethral Catheter

a straight catheter designed for in and out procedures (no balloon)

Condom (Texas) Catheter

external male catheter
- used for incontinent men to minimize skin irritation from urine
- limits infection of indwelling
- remove daily for cleansing and inspecting

Intermittent Self Catheterization
(short term/ straight catheters)

- used for the pt who experiences spinal cord injures or other neurological disorders that interfere with urinary elimination
- drain urine in the bladder and removed after drainage is complete

Documentation After Catheter Insertion

- type of procedure
- time and date
- characteristics of urine
- patient response
- patient teaching done
- assessment data of the urinary meatus

Self-Catheterization

for pt with spinal cord injury or neurological disorders
- promotes independence

Routine Catheter Care - Indwelling Catheter

- aseptic technique
- perineal hygiene every 8hrs
- cleans with mild soap and water first 2 inches of the catheter
- clean urinary meatus down the catheter
- Don't use powders or lotions

Routine Catheter Care - Condom Catheter

- secure catheter to the penile shaft (snug/secure)
- do NOT tape: limits blood supply to the penis (necrosis)

Assessing During Routine Catheter Care

assess urethral meatus and surrounding tissue for:
- inflammation
- swelling
- discharge
- Note: amount, color, odor, consistency of discharge

Removal of Indwelling Catheter

- after surgery: 8-24hrs
- maintain fluid intake: 1.5-2 L/day
- check for signs of UTI: 2-3 days later
- mild burning with first void
- assess for urinary retention
- most void adequately within 8 hrs after removal

Incontinence

inability to control urine or bowel elimination
- pressure in bladder great or sphincters too weak
- pt exercises to strengthen muscles around sphincters

Stress Incontinence

small leakage of urine when one laughs, coughs or lifts heavy objects

Urge Incontinence

constant leakage when bladder contains urine

Bladder Training

achievement of voluntary control over voiding
- muscles of the perineum
-clamp- unclamp routine to improve bladder tone

Kegal Exercises

- exercises pelvic floor: stop urine flow during voiding
- hold tension doe 10 secs and relax for 10 secs
-

Crede's Method

gentle manual pressure over lower abdomen to express urine from the bladder at regular intervals

Habit Training

voiding schedule
- regular intervals (1.5-2 hrs)

Defecation

elimination of bowel wastes
- expelling feces ( indigested food, dead bacteria, fat, bile pigment, living cells, intestinal mucosa, water)

Characteristics of normal Stool (Feces)

- Amount: moderate
- Color: brown (affected by dietary changes)
- Odor: affected by foods
- Consistency: normal soft/formed
- Frequency: 1-3 days

Normal Elimination Depends on:

- balanced diet (high fiber)
- fluid intake 2000- 3000 mL
- activity promoting muscle tone and peristalsis
- routine time for defecation

Hemorrhoids

swollen, inflamed veins in the anus and lower rectum
- straining during bowel movements
- increased pressure during pregnancy/ heaving lifting
- internal (rectum) or external (anus)
- discomfort and pain as hard stool pass through the irritated rectum

Goal for Patients with Hemorrhoids

- decrease pain
- prevent elimination problems
- prevent damage to swollen tissue

Flatulence

presence of air or gas (flatus) in the intestinal tract
- consuming gas producing liquids and foods
- swallows excessive amounts of air or constipation
-decreased peristalsis, abdominal surgery, narcotic medication, decreased physical activity
- ambulate to relieve discomfort

Enema

- a solution into the colon via the anus
- promotes defecation
- volume and type: lubricate, break ip decal mass, stretch the rectal wall, initiate defecation reflex

Reasons for Enemas

1. Cleanse the colon before a diagnostic procedure or abdominal surgery
2. Management of constipation or fecal impaction
3. Administration of medication

Cleansing Enema

- stimulates peristalsis (large volumes of fluid tp distend the bowel)
- empty colon completely
- Used before surgery or GI diagnostic procedure
- Place in Left Sims
- encourage pt to retain fluid for at least 5 minutes
- 750-1000 mL
- mild cramping

Tap Water Enema

- primary purpose is to cleanse the bowel of stool

Water and Soap Solution Enema (cleansing enema)

- step to purge air from tubing
- open the clamp and fill the tubing with solution, then reclamp

Oil Retention Enema

- used when fecal impaction is suspected (lubricates rectum and colon, softens feces)
- enema should be retained for 30 min

Documentation After Enema

- Type and volume of enema
- Characteristics of the result (stool):
color, presence of mucus, presence of blood, amount
- how patient tolerated the procedure

Fecal Impaction

collection of feces in the rectum

Rectal Suppository

oval/cone-shaped mass that melts at body temperature and is inserted into the rectum

Colostomy

creation of an artificial opening into the colon
- pt with cancer of the colon, intestinal obstructions, intestinal trauma, inflammatory disease of the colon
- permanent or temporary

Ileostomy

opening in the ileum (small intestine)
- entire colon removed or bypassed
- pt inflammatory bowel conditions and cancer of large intestine

Urostomy

diversion of urine away from a diseased or defective bladder
- pt cognitive anomaly, bladder removed because of disease, trauma, or obstruction

Intake & Output

- maintain homeostasis
- normal daily lost must be met by the normal daily intake
- 2500mL

Medicated Enema

to bring down an extremely high potassium level

Return-Flow Enema

expel flatus