Fecal Elimination And Urinary Elimination
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•
Feca l E lim inat ion Physiology of Defecation
o o o o o o o o •
•
•
•
Factors that influence fecal elimination
o o o o o o o o o o o o o o o o o o
Color; brown (golden) Consistency Shape Amount Odor Constituents
Selected fecal elimination problem
o o o o
Constipation Diarrhea Bowel incontinence Flatulence
Constipation Decreased frequency of defecation Hard, dry, formed stool Straining at stools Painful defecation Causes include:
• • •
Insufficient fiber and fluid intake Insufficient activity Irregular habits
Fecal impaction
o o o
•
Developmental stage Diet Fluid Activity Psychologic factors Defecation habits Medications Diagnostic procedures Anesthesia Surgery Pathologic conditions Pain
Characteristics of Feces
o o o o o
•
Peristaltic waves move the feces into the sigmoid colon and the rectum Sensory nerves in rectum are stimulated Individual becomes aware of need to defecate Feces move into the anal canal when the internal and external sphincter relax External anal sphincter is relaxed voluntarily if timing is appropriate Expulsion of the feces assisted by contraction of the abdominal muscles and the diaphragm Moves the feces through the anal canal and expelled through anus Facilitated by thigh flexion and a sitting position
Mass or collection of hardened feces in folds of rectum Passage of liquid fecal seepage and no normal stool Causes usually:
• •
Poor defecation habits Constipation
Diarrhea
o o o
Passage of liquid feces and increased frequency of defecation Spasmodic cramps, increased bowel sounds Fatigue, weakness, malaise, emaciation
o •
•
o
•
•
Impaired functioning of anal sphincter or nerve supply Neuromuscular diseases Spinal trauma Tumor
Excessive flatus in intestines Leads to stretching and inflation of intestines Can occur from variety of causes: Foods Abdominal surgery Narcotics
Assessment of fecal elimination
o
•
• • • •
• • • o
•
Loss of voluntary ability to control fecal and gaseous discharges Generally associated with
Flatulence
o o o
•
Stress, medication, allergies, intolerance of floor fluids, disease of colon
Bowel incontinence
o o
•
Major causes:
Nursing History
• • • • • •
Ascertains the client's normal pattern Description of usual feces Recent changes Past problems with elimination Presence of an ostomy Factors influencing elimination pattern
Physical Examination
• • • •
Examination of the abdomen, rectum, and anus Auscultation precedes palpation because palpation alters peristalsis Inspection of feces for color, consistency, shape, amount, odor, abnormal constituents Review any data obtained from relevant diagnostic tests
Review of data from any diagnostic tests
•
Stool exam or fecalysis
NANDA nursing Diagnosis
o o o o o
Bowel incontinence Constipation Risk for constipation Perceived constipation Diarrhea
Related Nursing Diagnosis
o o o o o o
Risk for deficient fluid volume Risk for impaired skin integrity Low self-esteem Disturbed body image Deficient knowledge (bowel training, ostomy management) Anxiety
Desired outcomes
o o o
Maintain or restore normal bowel elimination pattern Maintain or regain normal stool consistency Prevent associated risks such as fluid volume
General nursing interventions
o o o o
Promoting reg. Defecation Teaching about medications Decreasing flatulence Administering enemas
•
Measures to maintain normal fecal elimination pattern
o o o o o •
Privacy Timing Nutrition and fluids Exercise Positioning
Common enema solution and actions
o
Hypertonic (fleet phosphate)
o
Hypotonic (tap water)
• • • •
o
o •
Distends the colon Stimulates peristalsis Soften feces
Soapsuds (pure soap)
• •
Irritates mucosa
•
Lubricates feces and colonic mucosa
Distends the colon
Oil
Cleansing
• • •
Prevent Escape of feces during surgery Prepare Intestines for certain diagnostic tests Removes feces in instances of constipation or impaction
Carminative and return flow
o
Retention
•
Used primarily to expel flatus
Stoma care for clients with an ostomy Normal stoma should appear red and may bleed slightly when touched Assess the peristomal skin for irritation each time the appliance is changed Treat any irritation or skin breakdown immediately Keep skin clean by washing off any excretion and drying thoroughly Protect skin, collect stool, and control odor with ostomy appliance
Ur inar y E li minat ion Process of urination
o
•
Softens feces
o
o o o o o
•
Stimulates peristalsis
Types of enemas
o
•
Distends the colon
Isotonic (physiologic saline)
• • • o
Draws water into colon
Depends on the effective functioning of
• • • •
Upper Urinary Tract (kidneys, ureters) Lower Urinary Tract (bladder, urethra, pelvic floor) Cardiovascular system Nervous system
Urine formation
o
Proximal convoluted tubule
o
Loop of Henle
o
• • •
Most of water and electrolytes are reabsorbed Solutes such as glucose reabsorbed here Other substance secreted
Distal convoluted tubule
• o
• • • •
•
•
•
o o o o o o
Ureters bladders
Urine collects in the bladder Pressure stimulates special stretch receptors in the bladder wall Stretch receptors transmit impulses to the spinal cord voiding reflex center Internal sphincter relaxes stimulating the urge to void If appropriate, the conscious portion of the brain relaxes the external urethral sphincter muscle Urine eliminated through the urethra
Factors influencing urinary elimination
o o o o o o o
Developmental factors Psychosocial factors Fluid and food intake Medication Muscle tone Pathologic conditions Surgical and diagnostic procedures
Selected urinary problems
o o o o o o o o o
Polyuria - urinates a lot of times Oliguria - urinates a bit, anuria - doesn't urinate at all Frequency or nocturia - urinating every night that disturbs sleeping Urgency - cant wait to urinate Dysuria - painful urination Enuresis - bed wetting Incontinence - urinated, can't control Retention - cant urinate, catheterize Neurogenic bladder
Nursing assessment of urinary function
o
o
•
Calyces of the renal pelvis
Process of Micturition
o
•
Additional water and sodium reabsorbed here under control of hormones
Formed urine then moves to:
Nursing History
• • • •
Normal voiding patterns - should urinate 2-4hours interval Appearance of urine Recent changes - in urine or in pattern Past or current problems
Physical assessment
• • • •
Percussion of kidneys and bladder to detect tenderness Inspect urethral meatus for swelling, discharge, inflammation Skin color, texture, turgor, signs of irritation Edema
Assessing urine
• • •
Measuring urine output Measuring residual urine Diagnostic tests
Blood urea nitrogen Creatinine
Characteristics of normal urine
o o o
96% water and 4% solutes Organic solutes include urea, ammonia, creatinine, uric acid Inorganic solutes include sodium, chloride, potassium sulfate, magnesium, and phosphorus
Characteristics of Urine
o
Volume
o o o o o o o o •
NANDA nursing diagnosis
o o o o o o o •
•
•
•
•
Color, clarity Odor Sterility pH Specific gravity Glucose Ketone bodies Blood Impaired urinary elimination Functional urinary incontinence Reflex urinary incontinence - involuntary loss of urine Stress urinary incontinence - too much laughing may cause urge to urinate Total urinary incontinence - continuous and unpredictable passage Urge urinary incontinence Urinary retention
Related nursing diagnosis
o o o o o o o o o
Risk for infection Low self-esteem Risk for impaired skin integrity Self-care deficit Risk for deficient fluid volume or excess fluid volume Disturbed body image Deficient knowledge Risk for caregiver role strain Risk for social isolation
Desired outcome
o o o o o
Maintain or restore a normal voiding pattern Regain normal urine output Prevent associated risks such as infection, skin breakdown, fluid and electrolyte imbalance, and lowered self-esteem Perform toilet activities independently w/ or w/o assistive devices Contain urine w/ the appropriate device, catheter
General nursing intervention
o o o o o o o o o o o
Promote fluid intake Maintaining normal voiding pattern Assisting with toileting Preventing urinary tract infections Managing urinary incontinence Continence (bladder) training Pelvic muscle exercises Maintaining skin integrity Applying external urinary drainage devices Performing urinary catheterizations Performing bladder irrigations
Preventing UTI
o o o o o o o
Drink 8 glasses of water/day Practice frequent voiding (every 2-4 hours) Avoid use of harsh soaps, bubble bath, powder, or sprays in the perineal area Avoid tight fitting clothing Wear cotton rather than nylon undercloths Always wipe the perineal area from front to back following urination or defecation Take a shower rather than baths if recurrent UTI
Nursing Care of client w/ an indwelling catheter
o o o
Encourage large amounts of fluid intake Intake of foods that create acidic urine Perineal care
o o o o o o •
•
Change catheter and drainage system only when necessary Catheter only when necessary Maintain sterile closed-drainage system Remove catheter as soon as possible Follow good hand hygiene Prevent fecal contamination
Interventions to maintain urinary flow through drainage system
o o o o o o o o o o o
Ensure tubing free of obstructions Ensure tubing not clogged Ensure there is no tension on catheter or tubing Ensure gravity drainage maintained Ensure no loops in tubing below entry Keep drainage receptacle below level of client's bladder Ensure closed drainage system Observe flow of urine Input and output q2-3 hours Note color, odor and abnormal constituents If sediment present, check more frequently
Nursing Care of Client w/ urinary diversion
o o o o
Assess I&O Note any changes in urine color, odor or clarity (mucous shreds are commonly seen in the urine of client with an ileal diversion) Frequent assess the condition of the stoma and the surrounding skin Consult with the wound ostomy continence nurse (WOCN)
Feca l E lim inat ion Physiology of Defecation
o o o o o o o o •
•
•
•
Factors that influence fecal elimination
o o o o o o o o o o o o o o o o o o
Color; brown (golden) Consistency Shape Amount Odor Constituents
Selected fecal elimination problem
o o o o
Constipation Diarrhea Bowel incontinence Flatulence
Constipation Decreased frequency of defecation Hard, dry, formed stool Straining at stools Painful defecation Causes include:
• • •
Insufficient fiber and fluid intake Insufficient activity Irregular habits
Fecal impaction
o o o
•
Developmental stage Diet Fluid Activity Psychologic factors Defecation habits Medications Diagnostic procedures Anesthesia Surgery Pathologic conditions Pain
Characteristics of Feces
o o o o o
•
Peristaltic waves move the feces into the sigmoid colon and the rectum Sensory nerves in rectum are stimulated Individual becomes aware of need to defecate Feces move into the anal canal when the internal and external sphincter relax External anal sphincter is relaxed voluntarily if timing is appropriate Expulsion of the feces assisted by contraction of the abdominal muscles and the diaphragm Moves the feces through the anal canal and expelled through anus Facilitated by thigh flexion and a sitting position
Mass or collection of hardened feces in folds of rectum Passage of liquid fecal seepage and no normal stool Causes usually:
• •
Poor defecation habits Constipation
Diarrhea
o o o
Passage of liquid feces and increased frequency of defecation Spasmodic cramps, increased bowel sounds Fatigue, weakness, malaise, emaciation
o •
•
o
•
•
Impaired functioning of anal sphincter or nerve supply Neuromuscular diseases Spinal trauma Tumor
Excessive flatus in intestines Leads to stretching and inflation of intestines Can occur from variety of causes: Foods Abdominal surgery Narcotics
Assessment of fecal elimination
o
•
• • • •
• • • o
•
Loss of voluntary ability to control fecal and gaseous discharges Generally associated with
Flatulence
o o o
•
Stress, medication, allergies, intolerance of floor fluids, disease of colon
Bowel incontinence
o o
•
Major causes:
Nursing History
• • • • • •
Ascertains the client's normal pattern Description of usual feces Recent changes Past problems with elimination Presence of an ostomy Factors influencing elimination pattern
Physical Examination
• • • •
Examination of the abdomen, rectum, and anus Auscultation precedes palpation because palpation alters peristalsis Inspection of feces for color, consistency, shape, amount, odor, abnormal constituents Review any data obtained from relevant diagnostic tests
Review of data from any diagnostic tests
•
Stool exam or fecalysis
NANDA nursing Diagnosis
o o o o o
Bowel incontinence Constipation Risk for constipation Perceived constipation Diarrhea
Related Nursing Diagnosis
o o o o o o
Risk for deficient fluid volume Risk for impaired skin integrity Low self-esteem Disturbed body image Deficient knowledge (bowel training, ostomy management) Anxiety
Desired outcomes
o o o
Maintain or restore normal bowel elimination pattern Maintain or regain normal stool consistency Prevent associated risks such as fluid volume
General nursing interventions
o o o o
Promoting reg. Defecation Teaching about medications Decreasing flatulence Administering enemas
•
Measures to maintain normal fecal elimination pattern
o o o o o •
Privacy Timing Nutrition and fluids Exercise Positioning
Common enema solution and actions
o
Hypertonic (fleet phosphate)
o
Hypotonic (tap water)
• • • •
o
o •
Distends the colon Stimulates peristalsis Soften feces
Soapsuds (pure soap)
• •
Irritates mucosa
•
Lubricates feces and colonic mucosa
Distends the colon
Oil
Cleansing
• • •
Prevent Escape of feces during surgery Prepare Intestines for certain diagnostic tests Removes feces in instances of constipation or impaction
Carminative and return flow
o
Retention
•
Used primarily to expel flatus
Stoma care for clients with an ostomy Normal stoma should appear red and may bleed slightly when touched Assess the peristomal skin for irritation each time the appliance is changed Treat any irritation or skin breakdown immediately Keep skin clean by washing off any excretion and drying thoroughly Protect skin, collect stool, and control odor with ostomy appliance
Ur inar y E li minat ion Process of urination
o
•
Softens feces
o
o o o o o
•
Stimulates peristalsis
Types of enemas
o
•
Distends the colon
Isotonic (physiologic saline)
• • • o
Draws water into colon
Depends on the effective functioning of
• • • •
Upper Urinary Tract (kidneys, ureters) Lower Urinary Tract (bladder, urethra, pelvic floor) Cardiovascular system Nervous system
Urine formation
o
Proximal convoluted tubule
o
Loop of Henle
o
• • •
Most of water and electrolytes are reabsorbed Solutes such as glucose reabsorbed here Other substance secreted
Distal convoluted tubule
• o
• • • •
•
•
•
o o o o o o
Ureters bladders
Urine collects in the bladder Pressure stimulates special stretch receptors in the bladder wall Stretch receptors transmit impulses to the spinal cord voiding reflex center Internal sphincter relaxes stimulating the urge to void If appropriate, the conscious portion of the brain relaxes the external urethral sphincter muscle Urine eliminated through the urethra
Factors influencing urinary elimination
o o o o o o o
Developmental factors Psychosocial factors Fluid and food intake Medication Muscle tone Pathologic conditions Surgical and diagnostic procedures
Selected urinary problems
o o o o o o o o o
Polyuria - urinates a lot of times Oliguria - urinates a bit, anuria - doesn't urinate at all Frequency or nocturia - urinating every night that disturbs sleeping Urgency - cant wait to urinate Dysuria - painful urination Enuresis - bed wetting Incontinence - urinated, can't control Retention - cant urinate, catheterize Neurogenic bladder
Nursing assessment of urinary function
o
o
•
Calyces of the renal pelvis
Process of Micturition
o
•
Additional water and sodium reabsorbed here under control of hormones
Formed urine then moves to:
Nursing History
• • • •
Normal voiding patterns - should urinate 2-4hours interval Appearance of urine Recent changes - in urine or in pattern Past or current problems
Physical assessment
• • • •
Percussion of kidneys and bladder to detect tenderness Inspect urethral meatus for swelling, discharge, inflammation Skin color, texture, turgor, signs of irritation Edema
Assessing urine
• • •
Measuring urine output Measuring residual urine Diagnostic tests
Blood urea nitrogen Creatinine
Characteristics of normal urine
o o o
96% water and 4% solutes Organic solutes include urea, ammonia, creatinine, uric acid Inorganic solutes include sodium, chloride, potassium sulfate, magnesium, and phosphorus
Characteristics of Urine
o
Volume
o o o o o o o o •
NANDA nursing diagnosis
o o o o o o o •
•
•
•
•
Color, clarity Odor Sterility pH Specific gravity Glucose Ketone bodies Blood Impaired urinary elimination Functional urinary incontinence Reflex urinary incontinence - involuntary loss of urine Stress urinary incontinence - too much laughing may cause urge to urinate Total urinary incontinence - continuous and unpredictable passage Urge urinary incontinence Urinary retention
Related nursing diagnosis
o o o o o o o o o
Risk for infection Low self-esteem Risk for impaired skin integrity Self-care deficit Risk for deficient fluid volume or excess fluid volume Disturbed body image Deficient knowledge Risk for caregiver role strain Risk for social isolation
Desired outcome
o o o o o
Maintain or restore a normal voiding pattern Regain normal urine output Prevent associated risks such as infection, skin breakdown, fluid and electrolyte imbalance, and lowered self-esteem Perform toilet activities independently w/ or w/o assistive devices Contain urine w/ the appropriate device, catheter
General nursing intervention
o o o o o o o o o o o
Promote fluid intake Maintaining normal voiding pattern Assisting with toileting Preventing urinary tract infections Managing urinary incontinence Continence (bladder) training Pelvic muscle exercises Maintaining skin integrity Applying external urinary drainage devices Performing urinary catheterizations Performing bladder irrigations
Preventing UTI
o o o o o o o
Drink 8 glasses of water/day Practice frequent voiding (every 2-4 hours) Avoid use of harsh soaps, bubble bath, powder, or sprays in the perineal area Avoid tight fitting clothing Wear cotton rather than nylon undercloths Always wipe the perineal area from front to back following urination or defecation Take a shower rather than baths if recurrent UTI
Nursing Care of client w/ an indwelling catheter
o o o
Encourage large amounts of fluid intake Intake of foods that create acidic urine Perineal care
o o o o o o •
•
Change catheter and drainage system only when necessary Catheter only when necessary Maintain sterile closed-drainage system Remove catheter as soon as possible Follow good hand hygiene Prevent fecal contamination
Interventions to maintain urinary flow through drainage system
o o o o o o o o o o o
Ensure tubing free of obstructions Ensure tubing not clogged Ensure there is no tension on catheter or tubing Ensure gravity drainage maintained Ensure no loops in tubing below entry Keep drainage receptacle below level of client's bladder Ensure closed drainage system Observe flow of urine Input and output q2-3 hours Note color, odor and abnormal constituents If sediment present, check more frequently
Nursing Care of Client w/ urinary diversion
o o o o
Assess I&O Note any changes in urine color, odor or clarity (mucous shreds are commonly seen in the urine of client with an ileal diversion) Frequent assess the condition of the stoma and the surrounding skin Consult with the wound ostomy continence nurse (WOCN)
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