1. Chapter 51:
Elimination

2. 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

3. 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

4. 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

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

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

7. 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

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

9. 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

10. 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

11. 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

12. 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

13. 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

14. Helping the Client to Use a Commode

15. 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

16. Types of Catheters

17. 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

18. 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

19. 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

20. 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

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

22. 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

23. 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

24. 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

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