Elimination

Page 2: Learning Outcomes

  • Understand factors that affect urinary and bowel elimination

  • Familiarize with common urinary and bowel problems

  • Familiarize with how to diagnose problems

  • Familiarize with managing problems

  • Familiarize with stomas and indwelling catheters

Page 4: Factors affecting bowel elimination

  • Age

  • Diet

  • Fluid intake

  • Physical activity

  • Personal habits

  • Position during defecation

  • Pain

  • Pregnancy

  • Surgery and anesthesia

  • Infection

  • Medications

  • Psychological factors

Page 5: Common bowel elimination problems

  • Constipation

  • Impaction

  • Diarrhea

  • Incontinence

  • Flatulence

  • Hemorrhoids

  • Inflammatory bowel disease

  • Bowel cancer

Page 6: Bowel diversions

  • Certain diseases e.g. inflammatory bowel disease

  • Result in the need for temporary or permanent opening (stoma) in the abdomen

  • Stoma: piece of bowel which is exteriorized and pulled through the abdomen wall to re-route feces

  • Two types of stomas; ileostomy and colostomy

Page 7: Complications with a stoma

  • Stoma injury

  • Pouch leakage

  • Peristomal skin irritation

  • Allergic reaction to adhesives or ostomy products

Page 8: Documentation

  • Record the date and time of applying or changing the pouching system

  • Note the character of drainage, including color, amount, type, and consistency

  • Describe the appearance of the stoma and the peristomal skin

  • Document teaching provided to the resident and family (if applicable), their understanding of that teaching, and any need for follow-up teaching

Page 9: Common diagnostic tests

  • Endoscopic procedures

  • Gastroscopy

  • Colonoscopy

  • Radiological examination

Page 10: Health promotion

  • Routines

  • Toilet position

  • Equipment

  • Encourage food and fluid

  • Regular activity and exercise

  • Comfort

  • Reducing psychosocial impact

  • Laxatives

  • Rectal suppositories

  • Anti-diarrheal agents

  • Skin integrity

Page 12: Factors that influence urinary production

  • Growth & development

  • Fluid balance

  • Changes to renal function

  • Changes to bladder function

  • Illness & frailty

  • Psychological and environmental factors

  • Surgical procedures

  • Medications

Page 13: Diagnostics

  • Urinalysis

  • Bladder ultrasound scan

  • Imaging procedures

  • Abdo x-ray

  • Magnetic Resonance Imaging (MRI)

  • Computed Tomography (CT)

  • Endoscopy procedures

Page 14: Common urinary elimination problems

  • Lower urinary tract infections

  • Urinary incontinence

  • Prostatic hypertrophy and prostate cancer

  • Urinary retention

  • Chronic kidney disease

  • Renal calculi (Nephrolithiasis)

Page 15: Indications for catheterization

  • Perioperative use in selected surgeries

  • Acute urinary retention or obstruction

  • Hospice/comfort care/palliative care

  • Accurate measurement of urinary output in critically ill patients

  • Required strict immobilization for trauma or surgery

  • Assistance in healing of severe perineal and sacral wounds in incontinent patients

Page 16: Health promotion

  • Routines

  • Privacy and time to void

  • Stimulating micturition reflex

  • Encourage food and fluid

  • Pelvic floor exercises

  • Skin integrity

  • Routine catheter care

  • Preventing catheter-associated UTI

  • Continence aids and appliances

Page 17: Catheterization

  • Silicon tube inserted into the bladder via the urethra

  • Provides continuous flow

  • Several methods: indwelling catheter, intermittent catheterization, suprapubic catheterization

  • Catheter-associated urinary tract infection (CAUTI) accounts for 35% of healthcare-associated infections

  • Sterile technique

  • Be alert for post-obstructive diuresis

  • Sterile catheter selection should be based on client need and latex allergy

  • Catheter can be either Silicone, Silicone coated, Hydrogel coated, Silver coated, or Latex

  • Saline 0.9% or antiseptic are appropriate for cleaning

  • Securement device instead of adhesive tape to client's thigh

Page 18: Indications and Contraindications

  • Contraindications: urethral injury, urethral stricture, recent urinary tract surgery, and the presence of an artificial sphincter

  • Not a substitute for urinary or fecal incontinence

  • Indications: acute urine retention or bladder outlet obstruction, need for accurate urine output measurements in critically ill patients, perioperative use, prolonged surgery, surgery requiring large-volume infusions or diuretic use, continuous bladder irrigation, administration of drugs directly into the bladder, intraoperative urinary output monitoring, assistance in the healing of open sacral or perineal wounds or skin grafts, prolonged immobilization, improved comfort for end-of-life care if necessary

Page 20: Nursing care

  • Use sterile technique when inserting, manipulating, and maintaining

  • Maintain a sterile, continuously closed drainage system; don't disconnect or break the system unless absolutely necessary

  • Avoid irrigation unless necessary

  • Indwelling urinary catheter inserted for surgery, ensure its discontinuation within 24 hours after surgery unless another indication exists

  • Review the need for the indwelling urinary catheter daily

  • Remove it as soon as it's no longer necessary

Page 21: References

  • Watt, E. (2021). 'Maintaining continence; urinary'. In Potter and Perry's Fundamentals of Nursing 6th ed. Elsevier, pp. 1043-1088.

  • Watt, E. (2021). 'Maintaining continence; bowel'. In Potter and Perry's Fundamentals of Nursing 6th ed. Elsevier, pp. 1090-