MS Chapter 17

Concept 17
Elimination

Lesson 17.1
Elimination

•           Define and describe the concept of elimination.

•           Notice factors that place individuals at risk for elimination problems.

•           Recognize when an individual has problems with elimination.

•           Provide appropriate nursing and collaborative interventions to optimize elimination.

Define and Describe the Concept of Elimination

Definition

Elimination is excretion of waste from the body

Bowel elimination is passage and dispelling of stool through the intestinal tract by means of intestinal smooth muscle contraction

Scope of Concept

Includes the normal or expected physiological process of waste formation and excretion as well as problems associated with the process

Includes impairment of bowel elimination

Review of Anatomy and Physiology

Bowel Elimination

Colon

Rectum

Anus

Peristalsis

Sphincter

Gastrocolic reflex

Variations and Context

Control

Fecal incontinence

Retention

Retention of stool

Discomfort

Infections and Inflammation

Neoplasms

Organ failure

Consequences: Loss of Control

Cause: Involuntary release of urine or feces

Leads to

Skin breakdown

Changes in daily activities

Changes in social relationships

Consequences: Bowel Retention

Causes: Ignoring the “urge to go” or decreased peristalsis

Leads to retention of stool in the rectum

Stool dries and hardens

Constipation

Impaction

NOTICE FACTORS THAT PLACE INDIVIDUALS AT RISK FOR ELIMINATION PROBLEMS

Populations at Risk

Individual Risk Factors

Collaborative Learning #3

In your learning group, discuss how the following risk factors are linked to elimination problems.

Age

Pregnancy

Neurological impairment

Altered mobility

Cognitive impairment

Congenital defects

Medical conditions

RECOGNIZE WHEN AN
INDIVIDUAL HAS PROBLEMS
WITH ELIMINATION

Assessment

History

Examination findings

Inspection

Auscultation

Palpation

Diagnostic Tests

Laboratory tests

Culture, occult blood

Pathology

Radiographic tests and scans

Direct observation tests

Colonoscopy, sigmoidoscopy

Provide appropriate nursing and collaborative interventions to optimize elimination

Clinical Management:
Primary Prevention

Clinical Management:
Secondary Prevention (Screening)

Colonoscopy screening

Occult blood screening

General discussion questions:

Who should undergo these screening procedures?

How often should each be done?

What factors inhibit persons from having these screening procedures done?

Collaborative Interventions

Treatment strategies depend on the underlying condition

Pharmacologic agents

Incontinence management

Invasive procedures and surgical interventions involving bowel elimination

Pharmacologic Agents

Antibiotics

Diuretics

Antispasmodics

Agents to manage constipation

Analgesics

Surgical Interventions:
Bowel Elimination

Colectomy

Colostomy or ileostomy

Rectal prolapse repair

Hemorrhoidectomy

Interrelated Concepts

Nutrition

Fluid and Electrolytes

Acid-Base balance

Mobility

Cognition

Link to Exemplars

Collaborative Learning #5

In your learning group, brainstorm for 3 minutes to list medical conditions you can think of that cause problems in elimination. For each condition, indicate the type of problem (whether a bowel problem or a bladder problem, or both) and the population group(s) affected.

Featured Exemplars