Unit 6 Elimination-student view

Bowel and Urinary Elimination Overview

Unit 9 Introduction

• Focus on bowel and urinary systems and their elimination functions.

Bowel Elimination

Digestive System Overview

• The digestive system functions to digest food and drinks to utilize nutrients effectively.

Anatomy of the Digestive System

• Components include:

  • Salivary Glands

  • Mouth

  • Esophagus

  • Stomach

  • Small Intestine

    • Duodenum

    • Jejunum

    • Ileum

  • Large Intestine

    • Cecum

    • Appendix

    • Colon:

      • Ascending, Transverse, Descending, and Sigmoid

  • Rectum

  • Anus

  • Liver and Pancreas as accessory organs.

Feces Production

• Bristol Stool Chart Types:

  • Type 1: Separate, hard lumps.

  • Type 2: Solid, lumpy.

  • Type 3: Solid, smooth with cracks.

  • Type 4: Soft, snake-like.

  • Type 5: Soft blobs with clear edges.

  • Type 6: Mushy, fluffy pieces.

  • Type 7: Watery, no solid pieces.

Factors Affecting Bowel Elimination

• Physiological Factors:

  • Age

  • Diet

  • Fluid intake

  • Physical activity

• Psychosocial Factors:

  • Personal habits

  • Positioning

• Other Influences:

  • Pain

  • Pregnancy

  • Surgery & Anesthesia

Conditions Altering Bowel Elimination Patterns

• Diverticulitis- an inflammatory condition of the diverticula in the colon, which can lead to symptoms such as abdominal pain, fever, and changes in bowel habits.

• Irritable Bowel Syndrome- a functional gastrointestinal disorder characterized by symptoms including abdominal pain, bloating, and altered bowel habits, which can fluctuate between diarrhea and constipation.

• Bowel Obstruction- a blockage in the intestine that prevents the normal passage of digestive products, leading to symptoms such as severe abdominal pain, vomiting, and constipation.

• Ileus- a temporary cessation of bowel activity, often resulting in abdominal distension, discomfort, and the inability to pass stool or gas.

  • A bowel obstruction is a physical blockage in the intestines caused by a tangible obstruction like a tumor, scar tissue, or hernia, while an ileus is a functional disruption of intestinal motility where the bowel isn't moving properly due to a lack of muscle contractions, without a physical blockage present;

• Ulcerative Colitis- a chronic inflammatory bowel disease that causes inflammation and ulcers in the digestive tract, primarily affecting the colon and rectum, leading to symptoms such as diarrhea, abdominal pain, and rectal bleeding.

• Crohn's Disease- a type of inflammatory bowel disease that can affect any part of the gastrointestinal tract, leading to symptoms such as abdominal pain, severe diarrhea, fatigue, and malnutrition.

Altered Bowel Elimination Issues

• Common Problems:

  • Constipation

  • Diarrhea

  • Incontinence

  • Flatulence

  • Hemorrhoids

  • Ostomies

Bowel Diversions

• Types of Ostomies:

  • Colostomy (large intestine)

  • Ileostomy (small intestine)

• Ostomy Subtypes:

  • End stoma- result of colorectal cancer or type of bowel disease

  • Loop stoma- resolve medical emergency and are temporary.

    • loop of bowel supported on abdomen with approximal stoma draining stool and a distal stoma to drain mucus

  • Double-barrel stoma- created by dividing the bowel into two separate stomas, often used in cases of trauma or disease.

    • Proximal stoma drains stool, and the distal stoma leads to inactive intestine

Complications and Care for Ostomy

• Care:

  • Consultation with a WOC nurse for education.

  • Regular dressing changes and skin integrity monitoring.

• Complications to Manage:

  • Skin irritation

  • Hernias

  • Prolapse

  • Narrowing

  • Blockages

  • Bleeding

  • Infections

Constipation

• Generally not serious in healthy individuals.

• Common Causes:

  • Laxative overuse

  • Inadequate fluid/fiber intake

  • Sedentary lifestyle

  • Pregnancy and surgery where impaction can occur.

• Treatment Strategies:

  • Use of bulk-forming products

  • Increase fiber and water consumption

  • Enemas as needed.

Constipation Complications

• Fecal impaction: stool lodged in rectum.

• Presence of diarrhea leaking around impaction.

• Potential hemorrhoids and rectal fissures.

• Risks of bradycardia, hypotension, or syncope due to straining.

Enema Procedure

• Method of introducing fluid into the rectum to relieve constipation or prepare for procedures.

• Can be delegated to trained personnel (PN or AP).

Diarrhea

• Characterized by frequent loose stools with urgency.

• Classification of types: acute (1-2 days), persistent (>2 weeks), and chronic (>4 weeks).

• Causes:

  • Infections (viral/bacterial or inflammatory)

  • Medication side effects

• Importance of monitoring abdominal assessment and fluid status.

GI Diagnostics

• Include various tests for assessing gastrointestinal health:

  • Celiac disease testing- Diagnoses celiac disease

  • Colonoscopy- procedure for colon or rectal cancer; can be used to evaluate GI bleeding, changes in bowel habits, abdominal pain, weight loss

  • Endoscopic retrograde cholangiopancreatography (ERCP)- a procedure used to diagnose and treat conditions related to the bile ducts, pancreas, and gallbladder, including blockages, strictures, or stones.

  • Flexible sigmoidoscopy- evaluates tissue that may be swollen/ irratated: ulcers, polyps, cancer

  • Lower & Upper GI series.- series - a set of X-ray examinations used to visualize the gastrointestinal tract, helping to identify abnormalities such as tumors, inflammation, or obstructions.

Stool Specimen Collection

• Fecal Occult Blood Test:

  • Checks for blood presence.

  • Aseptic techniques employed.

• Stool Culture:

  • Identifies organisms causing severe diarrhea.: parasites, ova, bacterial

Nursing Care for Bowel Health

• Monitor fluid status and elimination patterns.

• Document intake and output (I&O).

• Provide education ensuring regular bowel movements.

Urinary Elimination

Introduction to Urinary System

• Function: Removal of excess waste and fluids via urine.

GI Medications

• Bulk-forming agents - laxative

  • Increase weight & consistency of stool > absorbs water > swelling in intestines

• ◦ Stimulant - laxative

  • Speeds up movement of stool > stimulates muscles of gut

• Emollient - laxative

  • Aids in softening of stools > easier to pass

• Lubricant - laxative

  • Mineral oil laxative > keeps water in stool & intestines

• Hyperosmolar - laxative

  • Draws water into intestines

  • Softens stools > easier to pass

• Kaolin & Pectin - laxative

  • Increase viscosity & volume of stool

• Loperamide – anti-diarrheal

Expected vs. Altered Urinary Characteristics

• Expected: Clear, light yellow, odorless urine; volume/frequency based on fluid intake.

• Altered: Changes in patterns such as incontinence, color, clarity, and skin breakdown.

Factors Affecting Urinary Elimination

• Medications, surgical history, pain, diet, immobility, psychosocial factors, pregnancy, age.

Urinary Terms

• Dysuria: Discomfort or pain during urination.

• Polyuria: Excessive urine production (>3L/day).

• Oliguria: Reduced urine output, often linked to renal issues.

• Anuria: Minimal or no urine production.

• Nocturia: Increased urination at night.

Urinary Alterations

• Incontinence: Inability to control urination.

• Retention: Incomplete bladder emptying. Common signs are hesitancy and urinary frequency.

• Urinary Hesitancy- Difficulty when urinating that causes a weak trickling stream of urine and a need to strain

Conditions Affecting Urinary Patterns

• Dehydration, UTIs, kidney stones, kidney failure, prostate enlargement.

Diuretics

• Thiazide- a type of diuretic that helps to reduce blood pressure and fluid retention by promoting the excretion of sodium and water from the kidneys.

  • Chlorthalidone

  • hydrochlorothiazide

  • Metolazone

  • Indapamide

• Loop- diuretics such as Furosemide and Bumetanide are also commonly used to manage fluid retention and hypertension.

  • Torsemide (Demadex)

  • Furosemide (lasix)

  • Bumetanide

• Potassium- sparing - Spironolactone - a diuretic that helps to retain potassium while eliminating sodium and water.

  • Amiloride

  • Triamterene

  • Spironolactone eplerenone

Urinary Tract Infections (UTIs)

• Commonly caused by bacteria; more prevalent in females.

Kidney Failure and Dialysis

• Understanding the process of removing waste through dialysis, either via blood or abdominal cavity filtering.

Urinary Diversions

• Options when normal urine flow is interrupted, including catheterization and urinary stomas.

Urinary Catheter Types and Care

• Understanding various catheters and their respective uses and care protocols, focusing on infection prevention.

Diagnostics

• Renal Ultrasound- A non-invasive imaging technique used to assess the kidneys' structure and function, helping to identify abnormalities such as stones, cysts, or tumors.

• Bladder Scanner- A device that uses ultrasound technology to measure the volume of urine in the bladder, assisting in the diagnosis of urinary retention and guiding catheterization decisions.

• IV pyelogram- A radiologic procedure that involves injecting a contrast dye into the bloodstream to visualize the urinary tract, including the kidneys, ureters, and bladder, which aids in diagnosing issues like blockages or structural abnormalities.

• Kidney- ureters- bladder xray - A diagnostic imaging technique that uses X-rays to evaluate the kidneys, ureters, and bladder, helping to detect abnormalities such as stones, tumors, or urinary tract obstructions.

Medications Affecting Urinary Output

• Diuretics:

  • Classes include thiazide, loop, and potassium-sparing diuretics.

  • Effect on urine production and body fluids management.