1. CONCEPT OF ELIMINATION

2. Group Members
Abdul Razzaq
Shahbaz Sajjad
Hamza Javeed
Alishba Tanveer

3. Objects By the end of the session students will be able to :
Review the basic anatomy of digestive system .
Define the elimination pattern .
Discuss the common problems bowel elimination.
Identify the nursing care for common problems of fecal elimination.
Discuss common problems of Urinary system.
Identify the nursing interventions for common urinary problems.
Discribe factors that can alter the urinary function
Discuss nursing care for alteration in elimination pattern

4. Anatomy of digestive system
Human GI system is composed of
Mouth
Pharynx
Larynx
Esophagous
Stomach (accessory organ)
Small intestine
Large intestine
Anus

5. Elimination pattern Bowel elimination
Definition : The ability to get rid of waste from the body OR
The expulsion of waste from body is known as elimination
Elimination pattern discribe the regulation , control and removal of by products and wastes in the body . The term usually refers to movement of feces and urine and sweat from the body .
Bowel elimination
It is also known as defecation . Bowel elimination is natural process critical to human functioning in which body excretes wastes products of digestion . OR. Defecation is the act of feces (stool) from the body .

6. Types of colon movement
Continue
Large intestine (colon ) is about 125 – 150 cm long and it has seven parts : cecum , ascending , transverse ,and descending ,sigmoid colon,rectum and anus .
The colon forms the pouches callled haustra . The large intestine is a muscular tube lined with mucous membrane . The muscles are circular and longitudinal to facilitate parietals movement.
Types of colon movement
Haustral Churing : involves back and forth movement of chyme with in the colon.
Colon Peristalsis: is relatively sluggish movement of chyme along the colon .
Mass Peristalsis :is powerful muscular movement along the colon .

7. Characristics of Feces
Defecation Process
Defecation is intinited by two reflexes
When feces enter the rectum , it’s distention gives signals to mesenteric plexus to intiate Peristalsis movement in the descending , sigmoid colon ,and rectum.
The internal sphincter in the anus relaxes and defecation occurs by opening the extenal sphincter.
Characristics of Feces
Feces ( Healthy People) soft , brown , moist and firmed , Distinct ordor
Factors affecting the ordor or appearance
Certain foods , Medications, illness or infection

8. Abnormal Feces
Black : tarry stool may indicate of bleeding from upper gastrointestinal tract or drug .
Red : may indicate of bleeding from lower gastrointestinal tract .
Pale: may indicate to mal absorption .
Greeen : may indicate intestinal infection .
Dry hard: dehydration decreased intestinal motility .
Pus: bacterial infection

9. Factors Promoting Elimination
Stress free environment
Ability to follow personal bowel habits , privacy
High fiber diet
Normal fluid intake ( fruit juice , warm liquids)
Exercise ( walking )
Ability to assume squatting position
Properly administered laxatives

10. Factors Impairing Elimination
Emotional anxiety
Failure to heed defecation reflex ,
Lack of time and privacy
High carbohydrates and high fat diet
Reduced fluid intake
Immobility and inactivity
Overuse of cathartics narcotics analgesic
Inability to squat because of immobility , musculoskeletal deformity ; pain during defecation .

11. Physical Assessment Nursing Diagnosis
Inspection – observe contour of abdomen and note visible Peristalsis
Auscultation – listen for bowel sounds in all quadrants
Percussion – Resonant or tympany over hollow organs dullness over intestinal obstruction
Palpation – Feel for masses , tenderness etc
Nursing Diagnosis
Bowel incontinence related to facal impaction
Risk for constipation insufficient fiber intake

12. Nursing Interventions to promote normal Bowel Elimination
Continue
Diarrhea related to spoiled food
Self esteem disturbances related to bowel
Nursing Interventions to promote normal Bowel Elimination
privacy
Timing – Patients should be encouraged to defecate when the urge to defecate is recongized
Nutrition and fluids – High fiber foods , 2000 cc fluid per day

13. Nursing interventions for constipation patients
Continue
Exercise – Ambulation helps to stimulate normal mobility and therefore should be encouraged in post surgical patients
Positioning – Comfortable position needed . Squatting position common .
Nursing interventions for constipation patients
Increase fluid intake . Instruct the patient to drink fruid juices
Include fibre in the diet with foods
Administration of laxatives
Admission of Enema

14. Nursing intervations For patients With diarrhea
Encourage intake of food and fluids
Eating small amount of bland food
Avoid excessively hot or cold Fluids and and highly spicy food and high fiber food that can aggravate diarrhea
Nursing intervations Of Fecap impaction
Diet (Fibers , lactose and fructose)
Reduce caffeine intake
Anal hygiene / skin care
Dugital removal of stool

15. Plan and Implementation
Promotion of regular bowel habbits
Promotion of normal defecation
Dogital removels of stool
Maintenance of proper food and fluids
Promtion of regular exercise
Intervations
Cathatics / Laxatives : Drugs that include emptying of the interesting. Habitual use of laxatives leads to constipation and irregular frequency.

16. Continue
Enemas : solution introduced into lower lower bowel by way of rectum for the purpose of removing feces.
Suppositories : bullet shaped substance inserted into the rectum beyond the anal sphincter where it melts to aid in elimination .
Digital removels – with prolonged retention of feces ,fecal impaction occurs preventing passege of normal stool . Oil retention enema is given piror to digital removel of sofften stool .

17. Anatomy of Renal system
The renal system is composed of
2 kidneys
2 ureters
1 urinary bladder
1 urethera
Structure of kidneys
Kidneys are pairs of organ
Shape : bean shaped Size : 11cm long ,5 cm wide ,3 cm thick .

18. Continue
Weight: 150 g
Location : The kidneys are lie on the posterior abdominal wall ,
One on each side of the vertebral column .
Position : It is situated at T L 3
Longitudinal section of kidneys shows following parts
capsule
Cortex
Medulla
Hilium ( 3)

19. Urinary system
The urinary system consists of organs that produces and excretes urine from body.
Urine contians waste : mostly excess water , salts and nitrogen compounds .
Primary organs are kidneys .
Normal adult bladder can store UpTo .5 liters
Also responsible for regulating blood volume and blood pressure.
Regulates electrolytes.

20. Urine
The formation óf urine has 3 processess , filtration , reabsorption and tubular secretion .
Urine consits of 95 % water and 5 % solid Substances .
The need of urine to urinate is usually felt at 300 – 350 ml of urine in the bladder .
Thypically ml is voided daily.
Urination
Micturation , voiding ,and urination all refer to the process of emptying the urinary bladder
Stretch receptors special sensory nerve endings in the bladder wall that is stimulated when pressure is felt from the collection of urine Adult 250 – 450 ml children 50 – 200ml

21. Factors affecting voiding
Growth and development Psychological factors
Fluid and food intake Medication
Muscle tone and activity Pathological conditions
Surgical and diagnostic procedures
Common Urinary Elimination Problems
Urinaey retention
Urinary tract infection
Urinary incontinence

22. Altered Urinary Elimination
Frequency : is the voiding more than normal with frequent intervals.
Nocturia : is voiding two or three times at night .
Urgency : is the feeling 9f person must void .
Dysuria : means voiding that is either painful or difficulty .
Enuresis : is defined as involuntary urination.
Urinary incontinence : involuntary urination . Systems not a disease .
Urine retention : accumulation of urine in the bladder and becomes over distended .
Hypospadias : is a birth congenital defect in which the opening of urethra is on the underside of the pinus.

23. Assessing Urinary Function
Determine normal voiding pattern and frequency .
Appearance of urine
Recent changes .
Past or current problems with urination ( burning , urgency etc )
Presence of an ostomy
Factors influencing elimination patterns .

24. Assessment Assessing Urine ursing history
Voiding Pattern , description of urine for any Channing
Urinary Elimination Problems
Presence of Urinary diversion
Physical assessment ; inspection , palpation , percussion and auscultation
Assessing Urine
Color : transparent
Normal kidney produce urine at the rate of 40 – 60 ml / hour or ml/ day
Sterility : no microorganisms
Glucose : not present

25. Continue Nursing Diagnosis Blood : not present
Epithelial cells not present
Measuring urine output
Collecting urine specimen .
Nursing Diagnosis
Altered urinary Elimination related to bladder neck obstruction
Stress incontinence related to relaxation of sphincter .
Risk for infection related to Urinary retention
Self easteem disturbances related to urinary incontinence

26. Planning Maintain normal voiding pattern. Regain normal urine output.
Prevent infection
Maintaining normal urinary elimination.
Promote fluid intake
Assessing with toileting
Practice frequent voiding process .....
Strengthening pelvic floor muscles
Manual bladder compression &kegal exercise.

27. Managing urinary Incontinence
Bladder training – requires that the clien5 postpone voiding, resiat or inhibit the sensation urgency , and void according to a timetable rather than according to urge to void . The goal is to length6 the intervals between urination to correct the Client’ s habit of frequent urination .
Habit training : also referred to as timed voiding or scheduled toileting . There is no attempt to motivate to client to delay voiding is the urger occurs .

28. SUMMARY

29. Any Question

30. Thank you

31. Reference: KOZIER & ERB’S Fundamental Of Nursing By Audrey Berman, Shirlee J. Snyder