elimination

ELIMINATION: GI/GU SYSTEMS

INSTRUCTOR

Marian L. Obiegbu-Chima, MSN, RN, CDCES
Adobe Stock#566340509
Getty Images Credit: Shubhangi Ganeshrao Kene

MODULE STUDENT LEARNING OUTCOMES

Identify the structures and function of the gastrointestinal (GI) and urinary (GU) systems.
Identify teaching opportunities for health promotion and risk reduction.
Collect subjective data relating to various alterations in the abdomen.
Collect objective data relating to alterations in the gastrointestinal and urinary systems.
Use subjective and objective data from the assessment of the gastrointestinal and urinary systems to identify risk factors, analyze findings, and plan interventions.
Document and communicate assessment findings using proper medical terminology.

CLASS LEARNING OBJECTIVES

Describe the structure and function of the GI and GU systems and their role in elimination.
Explain how elimination is interrelated with other key physiological processes: perfusion, gas exchange, nutrition, mobility, and hydration.
Identify key subjective and objective assessment findings related to GI and GU systems.
Apply the Clinical Judgment Model to elimination-focused patient scenarios.
Recognize health promotion and risk-reduction opportunities across the lifespan.

WHY ELIMINATION MATTERS

When elimination is impaired, other body systems become affected.

ELIMINATION DEFINED

Elimination refers to the excretion of waste products from the body (Giddens, 2025).
- Bowel elimination: The process of expelling feces.
- Urinary elimination: The process of expelling urine.

SCOPE

Waste Formation
  - Efficient elimination of waste products:
    - Waste excretion
    - Impaired elimination

SYSTEMS SUPPORTING ELIMINATION

Gastrointestinal (GI) system
Genitourinary (GU) system

GI SYSTEM STRUCTURE

Mouth (oral cavity)
Esophagus
Stomach
Small intestine
  - Duodenum
  - Jejunum
  - Ileum
Large intestine
  - Cecum
  - Ascending colon
  - Transverse colon
  - Descending colon
  - Sigmoid colon
  - Rectum
  - Anus
Accessory organs
  - Liver
  - Gallbladder
  - Pancreas
  - Salivary glands (parotid, submandibular, sublingual)

GI SYSTEM: FUNCTION

Mouth
- Ingestion, digestion, absorption, waste removal
Esophageal
- Transport of food to the stomach
Stomach
- Mechanical and chemical digestion
Small intestine
- Primary site for digestion and absorption
Large intestine
- Final absorption of water and electrolytes; waste formation

GI SYSTEM: FUNCTION ↔ ASSESSMENT

Methods of Assessment
  - Inspection/observation
    - Skin color, surface characteristics, contour, surface movements
  - Auscultation
    - RLQ → RUQ → LUQ → LLQ using diaphragm for bowel sounds
    - Bell for arterial and venous vascular sounds
  - Percussion
    - Density and size in each abdominal quadrant.
  - Palpation
    - RLQ → RUQ → LUQ → LLQ to assess tenderness, muscle tone, masses, and aortic pulsation

GU SYSTEM: STRUCTURE

Kidneys
- Right kidney
- Left kidney
Ureters
- Right ureter
- Left ureter
Urinary bladder
Urethra
Blood vessels
  - Right/Left renal arteries and veins
  - Inferior vena cava
  - Aorta
  - Common iliac arteries and veins

GU SYSTEM: FUNCTION ↔ ASSESSMENT

Primary Functions
  - Fluid & electrolyte balance
  - Waste removal
  - Blood pressure regulation
Assessment Priorities
- Collect patient history + perform physical examination focusing on urinary patterns (color, incontinence, retention)

INTERRELATED CONCEPTS

Impact of elimination on other bodily functions:
  - Gas Exchange: Impaired gas exchange leads to fatigue and decreased mobility.
  - Mobility: Mobility affects bowel motility and toileting abilities.
  - Nutrition: Nutritional status is affected by elimination.
  - Perfusion: Proper perfusion supports elimination functions.
  - Fluid and Electrolyte Balance
  - Acid-Base Balance

EXEMPLARS

Incontinence (urinary and fecal)
Benign Prostatic Hyperplasia (BPH)
Bowel Obstruction
Constipation
Hemorrhoids
Urolithiasis
Crohn’s Disease
Diarrhea
Gastritis
Urinary Tract Infection (UTI)

CLINICAL JUDGEMENT MODEL

Steps:
  1. Recognize cues
  2. Analyze cues
  3. Prioritize hypotheses
  4. Take action
  5. Evaluate outcomes

UNFOLDING CASE SCENARIO

Patient Snapshot: Mrs. L., a 78-year-old female, admitted for weakness and decreased oral intake.
Symptomatology:
  - Abdominal distention
  - Reduced fluid intake
  - No bowel movement in 4 days
  - Hypoactive bowel sounds
  - Clear yellow urine
Relevant Findings for Nursing Assessment
- Abdominal distention is concerning for constipation or possible bowel obstruction.
Recognize Cues: Identify and prioritize through clinical judgment.

REVIEW QUESTIONS

Q1: Which action should the nurse perform FIRST when assessing a patient’s abdomen?
  - A. Palpate all four quadrants
  - B. Auscultate bowel sounds
  - C. Inspect the abdomen
  - D. Percuss for tympany
Q2: What finding indicates adequate kidney perfusion?
  - A. Dark amber urine
  - B. Cloudy urine
  - C. Pale yellow urine
  - D. Urinary frequency
Q3: Most appropriate teaching to prevent constipation in older adults?
  - A. Use stimulant laxatives daily
  - B. Increase fiber gradually with fluids
  - C. Limit physical activity
  - D. Avoid fluids in the evening
Q4: Which assessment findings increase risk for UTI?
- Inadequate fluid intake, frequent voiding, urinary stasis, immobility, pale yellow urine
Q5: If a patient reports abdominal pain and has rigid abdominal muscles, which action is PRIORITY?
  - A. Encourage ambulation
  - B. Administer prescribed laxative
  - C. Notify the provider
  - D. Apply a heating pad

ELIMINATION IMPAIRMENT

Types of Elimination Issues:
  - Control issues: Incontinence (stress, urge, fecal), retention (BPH, bowel obstruction, constipation)
  - Discomfort: Hemorrhoids, urolithiasis
  - Infections/Inflammation: Crohn’s disease, diarrhea, UTI
  - Neoplasms: Bladder cancer, colorectal cancer, prostate cancer
  - Organ failure: Renal failure (acute, chronic)

Types of Incontinence

Reflex Incontinence: Inability to sense full bladder.
Stress Incontinence: Leakage during activities that increase abdominal pressure (coughing, bending, exercise).
Urge Incontinence: Sudden strong urge to urinate.
Overflow Incontinence: Involuntary loss of urine when bladder is full.
Functional Incontinence: Inability to reach the bathroom in time due to mobility issues.

KEY ASSESSMENT CUES (Present Health Status)

Chronic illnesses: Medications, OTC drugs/supplements, bowel movement patterns, urination patterns.
Past Health History: Abdominal, digestive system issues; urinary tract problems (e.g., leaking urine).
Family History: GI diseases (GERD, PUD, Crohn’s disease, UC, colon CA); urinary tract diseases (kidney stones, cancer).
Personal/Psychosocial History: Stress management, eating habits, substance use (caffeine, alcohol).

CLINICAL MANAGEMENT

Primary Prevention:
  - Environmental factors
  - Maintaining hydration
  - Dietary fiber
  - Physical activity
  - Regular toileting
Secondary Prevention (Screening):
  - Occult blood screening annually
  - Colonoscopy every 10 years
  - PSA screening for prostate cancer
Tertiary Prevention (Treatment):
  - Pharmacotherapy:
    - Antibiotics, diuretics, antispasmodics, agents for constipation
  - Incontinence Management:
    - Products like Pure Wick, biofeedback therapy
  - Surgical interventions:
    - Dialysis, catheterization, nephrectomy, prostate surgery, etc.

SELF-STUDY REVIEW QUESTIONS

Discuss risk factors linked to elimination problems: Age, neurological impairment, altered mobility, cognitive impairment, congenital defects, and medical conditions.

CASE SCENARIO EXAMPLES

An 81-year-old patient with sharp abdominal pain, stable urine output, and a history of CVA needs immediate follow-up for acute abdominal symptoms and underlying conditions. Initial assessment options should prioritize safety and the assessment of any urgency-related complications in bowel elimination.