Elimination

Elimination

Objectives

  • Discuss principles surrounding abdominal assessment of a client.

  • Obtain a nursing history from a client with alterations in urinary elimination.

  • Describe and perform a physical assessment focused on urinary elimination.

  • Discuss anatomical and physiological factors influencing urinary and bowel elimination.

  • Describe expected and unexpected findings related to urinary and bowel elimination.

  • Assess a client’s elimination patterns.

  • Discuss conditions altering a client’s elimination patterns.

  • Examine the use of urinary and bowel diversions for managing elimination.

  • Discuss nursing care measures for clients with a bowel diversion.

  • Describe nursing interventions to promote normal bowel elimination.

  • Identify diagnostic tests related to elimination and the nurse’s role in obtaining specimens.

  • Describe nursing interventions for clients with incontinence.

  • Explain principles for obtaining stool and urinary samples.

  • Insert and maintain urinary catheters.

  • Perform closed catheter irrigation.

  • Measure post-void residual with a bladder scanner.

Case Study: E.A.

  • E.A. is a 67-year-old female with a history of left-sided weakness from a CVA, hypertension, diabetes, and frequent urinary incontinence.

  • She is partially assisted to the commode and uses a walker to bear weight on her right side.

  • She lives at home with her daughter and husband.

  • Currently being examined for possible right upper-lobe pneumonia from aspiration.

  • Vital signs: HR 89, BP 136/85, RR 22, O2 93%, Temp 100.3°F.

  • Reports no pain (0/10).

Bowel Elimination

  • Understanding normal structure and function aids in recognizing alterations.

Anatomy of the GI Tract

  • Mouth, esophagus, stomach, small and large intestines, anus, and the defecation process are integral to bowel elimination.

Normal Structure and Function of the Gastrointestinal Tract

  • Key concepts:

    • Feces: The waste matter expelled from the intestines.

    • Peristalsis: The involuntary constriction and relaxation of muscles in the intestine, leading to movement of the contents within.

    • Defecation: The discharge of feces from the body.

    • Valsalva Maneuver: A technique that reduces the risk of defecation issues.

GI Assessment

  • Strategies for effective gastrointestinal assessment

    • Consider privacy, nutrition, pain, medications, and GI problems.

    • Assess last bowel movement (BM) characteristics.

    • Procedures: stool characteristics, tests like hemoccult, endoscopy, and X-rays.

Factors Influencing Bowel Elimination

  • Factors include age, diet, fluid intake, physical activity, psychosocial factors, personal habits, positioning during defecation, pain, pregnancy, surgical history, and medications.

Abdominal Assessment Protocol

  • Sequence: inspection, auscultation, and palpation.

  • Key anatomical landmarks include liver, stomach, colon regions, and relevant quadrants.

Inspection

  • Objectives during abdominal inspection include checking the position, skin color, and symmetrical appearance of the abdomen.

  • Observations should include any bulging, distention, or development of masses.

Auscultation

  • Essential for detecting bowel sounds and determining their frequency which can indicate gastrointestinal health.

  • Expected findings: 5-35 sounds per minute.

Palpation

  • Conducted to assess tenderness or abnormal muscle tone; expected findings include no tenderness and relaxed muscles.

Reporting Bowel Elimination Information

  • Key signs to document: bloody stool, abdominal pain, changes in bowel habits, and excessive diarrhea.

Common Bowel Elimination Problems

  • Constipation: Difficulty in passing stools; lack of fluid intake or physical inactivity can contribute.

  • Impaction: Severe constipation leading to a blockage.

  • Diarrhea: Increased frequency of liquid stools; underlying causes include infections or dietary factors.

  • Incontinence: Loss of control over bowel movements.

  • Flatulence: Gas accumulation causing discomfort.

  • Hemorrhoids: Swollen, inflamed veins in the rectum.

Nutrition Education for Constipation

  • Recommendations include increasing fiber and fluid intake, encouraging physical activity, and sometimes utilizing medications or enemas.

Pharmacological Interventions for Constipation

  • Laxatives: Various types include bulk-forming (e.g., Metamucil), emollient (Colace), and stimulant laxatives (e.g., Dulcolax).

  • Side Effects: Potential risks associated with overuse, especially in opioid-related constipation.

Enemas for Emptying the Colon

  • Enemas instill a solution into the rectum, promoting stool expulsion; options include saline, tap water, soapsuds, and oil retention enemas.

Diarrhea Management

  • Focus on identifying and treating underlying causes, and maintaining hydration.

Urinary Elimination

  • Key functions include waste elimination, electrolyte regulation, hormone production, and overall fluid balance.

Structure of the Urinary Tract

  • Comprises the kidneys, ureters, bladder, and urethra, with the kidneys filtering blood to produce urine.

Act of Urination (Micturition)

  • Involves complex coordination of urinary and bladder muscle contractions.

Factors Affecting Urination

  • Influences from developmental stages, dietary habits, psychological stressors, medical conditions, and prescribed medications.

Nursing Assessment for Urinary System

  • Integrated assessment of voiding patterns, physical examination, urine characteristics, and hydration status.

Normal Urine Characteristics

  • Ideally clear, light yellow, and odorless; assessments include color, clarity, and presence of sediment.

Reporting Abnormal Urinary Issues

  • Document symptoms such as cloudy urine, burning on urination, difficulty voiding, and strong odor.

Symptoms of Urinary Alterations

  • Urgency: Strong desire to void.

  • Dysuria: Pain during urination.

  • Frequency: Increased incidence of voiding.

  • Polyuria: High volume of urine output.

  • Hematuria: Blood in urine, indicating serious conditions.

Urinary Incontinence Types

  • Includes stress, urge, overflow, reflex, functional, and transient types.

Urinary Retention

  • The condition of the bladder not fully emptying; can lead to complications such as infections or bladder damage.

Nursing Care for Urinary Issues

  • Include assessing post-void residual, addressing underlying causes, and appropriate diagnostic studies.

Teaching Strategies for UTI Management

  • Emphasize hygiene, hydration, and specific patient education on preventive practices.

Diagnosing Kidney Stones

  • Recognizing risk factors and symptoms, along with treatment options such as increased fluids and potential surgical interventions.

Urinary Diversions

  • Types include continent and incontinent diversions, crucial for patients requiring management of urinary flow.

Patient Education on Urinary Diversions

  • Focus on self-care behaviors, follow-up care, and community resource availability.

Urinary Catheterization

  • Understanding indications, types (intermittent vs. indwelling), and proper care strategies to avoid complications.

Catheter Insertion & Removal Guidelines

  • Ensure a sterile technique, patient comfort, and post-care education about potential complications.

Case Study Part Two: E.A.

  • Develop an assessment that includes updated vitals, indications for urinary catheter insertion, and essential supplies required for comprehensive care.

Quick Quiz

  • Test knowledge on urinary retention symptoms and related assessment findings.

Urine Specimens Handling

  • Importance of labeling, timely submission, and understanding collection methods for various tests.

Measuring Output and Input

  • Guidelines to ensure accurate recording of all bodily fluid intake and output, emphasizing critical evaluation of changes.

Interpreting Intake and Output Charts

  • Understanding dehydration and fluid overload signs based on comparative intake and output data.