Chapter 51: Elimination

Elimination To maintain homeostasis Elimination of liquid and solid waste products is necessary Changes in bowel or bladder habits May be signs of illness, or they may cause illness Standard Precautions Use gloves and other protective devices when coming in contact with any body secretion or drainage from the client

Elimination (cont.) *Urine Body’s liquid waste product Urination, micturition, or voiding 1 ml per kg of urine per body weight per hour *30ml/hr *urge to void triggered when 250 ml of urine has collected in the bladder Feces Body’s solid waste product Bowel movement (BM) or stool Defecation Excretion of feces

Urinary Elimination Output depends on Fluid intake and kidney efficiency Processes, such as respiration, perspiration Salt intake and fluid contained in feces Edema (overhydration) Excess of body fluid that collects in the tissues Dehydration Deficiency in body fluids

Characteristics of Urine *Color *Clarity Odor Volume *Specific gravity Acidity Abnormal components

***Patterns of Urinary Elimination Urinary frequency Urgency Dysuria Nocturia Enuresis Polyuria Incontinence Urinary suppression Oliguria Anuria Urinary retention Distention Retention overflow Temporary urine retention

Urinary Tract Problems Urinary tract infection Urethritis: Inflammation of the urethra Cystitis: Inflammation of the bladder Nephritis and pyelonephritis: Inflammation of the kidneys *c/o urgency, frequency, dysuria, chills, abdominal discomfort, flank pain, urine may be cloudy *Upper UTI Chills, nausea, flank pain, urinate frequently to decrease urinary stasis

Urinary Tract Problems Urinary Calculi Calculi or stones formed from substances excreted by the body May occur in the kidney or bladder *renal colic

Bowel Elimination The bowel responds to even the slightest changes in a person’s usual eating or exercise habits Daily assessment Characteristics of the client’s stools Changes or difficulties that the client reports

Characteristics of Feces *Color Dark, black, or tarry stools, melena Bright red blood Consistency Hard, dry stools *chronic constipation *diarrhea Shape Odor Density *steatorrhea Abnormal components Fecal impaction

Patterns of Bowel Elimination Patterns of elimination are unique to each individual Nursing data collection Frequency Regularity Client reported changes If the person is symptom-free, bowel movements occurring less often are not a cause for concern

Flatus Flatus: Intestinal gas Flatulence: Condition of having intestinal gas Most flatus is reabsorbed through the vasculature of the intestinal wall; some of it is expelled with defecation Abdominal signs and symptoms Diminished or absent sounds indicate that the bowel is functioning improperly *auscultate for BS in each quadrant Then palpate Document *nursing care guidelines 51-2 Table 51-2

Assisting With Toileting Helping the client to the bathroom *show the client how to use the signal light in the bathroom or give the client a signal pager to call for help Giving and removing a bedpan or urinal Bedpan Fracture bedpan (fracture pan) Urinal Helping the client to use a commode

Helping the Client to Use a Commode

Assisting With Urinary Elimination Urinary catheters Latex or vinyl tube that is inserted to remove urine Straight catheter Foley catheter (Retention catheter or indwelling catheter) Suprapubic catheter Indicated in gynecologic or urologic surgery **Crede’s maneuver

Types of Catheters

Caring for the Catheter Maintain bag level lower than the client’s bladder level. Check the equipment and its function frequently. Observe for the flow of urine through the tubing. Measure the amount of urine in the bag. Empty the bag regularly. Irrigate catheter to ensure patency if ordered. *remove the catheter from the bag connection daily and swab the connections with antiseptic

Urinary Incontinence Male client External catheter, external incontinence guard Female client Perineal pad or disposable incontinent brief Bladder retraining Plenty of fluids and exercise (Kegel exercises) Catheter connected to closed drainage system *incontinence-determine regular pattern Self-catheterization

Urinary Retention Temporary retention After receiving anesthesia When using the bedpan Report if urinary retention continues, the bladder becomes distended, and the client is uncomfortable Catheterization

Assisting With Bowel Elimination Fecal retention Short-term (constipation) Long-term (fecal impaction or bowel obstruction) Suppositories Bullet-shaped, soft wax-like mass Melts after administration, releasing medication

Assisting With Bowel Elimination (cont.) Enemas Cleansing enema Commercially prepared disposable enema Fleet* *Carminative enema Anthelmintic enema Emollient enema *Oil retention enema-25-30 min Medicated enema The return-flow enema (Harris flush) TWE* Observe for fluid overload (HTN, bounding pulse)

Assisting With Bowel Elimination (cont.) Manual disimpaction or digital evacuation If fecal impaction does not respond to an enema or if the client has paralysis *stop the procedure immediately if the client complains of pain, faintness, nausea or experience bleeding *digital removal is contraindicated in cardiac conditions, after reproductive surgery, abdominoperineal repair, rectal surgery, colostomy and GU surgery

Assisting With Bowel Elimination (cont.) Bowel retraining For the client who is unable to have a bowel movement naturally or is incontinent of stool *Use of rectal tube for expelling gas *colostomy-patient should empty Fecal incontinence pouch Very frequent liquid stools

Nausea and Vomiting Nausea Unpleasant abdominal sensation Vomiting or emesis Involuntary action that expels stomach contents *Projectile vomiting *may contain bright red blood, coffee ground material, bile Report if the client vomits intact medication tablets. Save the tablets for identification *have client lie on right side

Nursing care procedures 51-1 51-3 51-4 51-7