Elimination 

Overview of Elimination in GI and GU Systems

  • Focus on gastrointestinal (GI) and genitourinary (GU) systems

  • Practical lab skills involving catheters, ostomy supplies, and nasogastric (NG) tube insertion.

Patient Case Study

  • Patient: TCVA with hypertension, diabetes, urinary incontinence, and recent aspiration incident.

  • Functional Ability: Partial assistance to use commode; can bear weight on right side with walker.

  • Living Situation: Resides with daughter.

Understanding Aspiration

  • Definition: Aspiration occurs when food or fluid enters the trachea instead of the esophagus, potentially leading to pneumonia.

  • Vital Signs:

    • Heart Rate: 89 bpm

    • Blood Pressure: 136/85 mmHg

    • Respiratory Rate: 22 breaths/min

    • Oxygen Saturation: 93%

    • Temperature: 98.3°F

General Assessment Techniques

  • Importance of asking about bowel movements, dietary habits, and medications.

  • Consider privacy and dignity during assessments.

Physical Assessment Components

  • Health History: Collect information about past bowel habits and issues.

  • Physical Assessment:

    • Inspection: Examine abdomen for abnormalities.

    • Auscultation: Listen for bowel sounds indicating peristalsis, looking for hyperactivity or absence of sounds.

    • Palpation: Assess for tenderness or abnormalities.

Key Concepts in Elimination

  • Peristalsis: Movement of the GI tract that can be assessed through bowel sounds.

  • Defecation: The act of bowel movement; associated with Valsalva maneuver, which can be harmful when constipated.

Factors Affecting Elimination

  • Nutrition: Importance of fiber and hydration for healthy gut function.

  • Medications:

    • Opioids can cause constipation.

    • Other medications may lead to diarrhea or bleeding.

Stool Condition and Assessment

  • Types of stool include soft, hard, and diarrhea.

  • Specimen Collection:

    • Hemoccult tests for hidden blood in stool; also tests for C. Diff and parasites.

  • Diagnostic Procedures: X-ray for obstructions; endoscopy for direct examination of GI tract.

Management of Constipation and Diarrhea

  • Constipation Management:

    • Recommend high fiber intake, increased fluids, and physical activity.

    • Address personal habits and chronic issues (i.e., pain from hemorrhoids or pregnancy complications).

  • Diarrhea Management:

    • Understand underlying causes, including infections or dietary issues.

    • Emphasize hydration as key to preventing dehydration and electrolyte imbalance.

Bowel Diversion

  • Definition: Surgical alteration for bowel management (e.g., colostomy, ileostomy).

  • Stoma care: Monitor stoma appearance for health indicators; skin protection is crucial during management.

  • Stoma Education: Teaching patients about their care and management post-surgery.

Urinary Elimination Overview

  • Anatomy of GU system: Includes kidneys, ureters, urethra, and prostate.

  • Common issue: Enlarged prostate can obstruct urine flow; interventions may include medications or catheterization.

Assessment of Urinary Function

  • Ask about urinary patterns, medication use, and history of urinary tract infections (UTIs).

  • Assess urine appearance: Normal should be clear and light yellow.

  • Identify symptoms of urinary issues:

    • Polyuria: Excessive urination, common in diabetes.

    • Oliguria: Decreased urine output, a potential sign of kidney issues.

Types of Urinary Incontinence

  • Stress Incontinence: Leakage upon physical exertion due to weakened pelvic floor muscles.

  • Urge Incontinence: Strong urge to urinate followed by involuntary leakage.

  • Overflow Incontinence: Chronic retention leading to leakage of small amounts of urine.

  • Functional Incontinence: Inability to reach the bathroom due to physical limitations.

GI and GU Health Maintenance

  • Emphasize hydration and nutrition for maintaining healthy elimination.

  • Patient education: Teach about signs of complications and when to seek help.

  • Importance of good hygiene practices to avoid complications like UTIs and skin irritations from incontinence.