ELIMINATION

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ELIMINATION
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URINARY ELIMINATION

• ANATOMY AND PHYSIOLOGY

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ANATOMY

• FEMALE STRUCTURES
• MALE STRUCTURES

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URINE

• 96 WATER
• 4 SOLUTES
• ORGANIC SOLUTES
• UREA
• AMMONIA
• CREATININE
• URIC ACID
• INORGANIC SOLUTES
• SODIUM (Na)
• CHLORIDE (Cl)
• MAGNESIUM (Mg)
• PHOSPHORUS (Phos)
• SODIUM CHLORIDE (NaCl)

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FACTORS AFFECTING URINARY ELIMINATION

• Fluid
• Diet
• Response to urge
• Stress
• Psychosocial factors
• Activity
• Pathological conditions
• Medications
• Developmental level
• Medical Diagnosis or Surgery

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ALTERATIONS IN URINARY ELIMINATION

• Urinary Retention
• Urinary Incontinence
• functional
• reflex
• stress
• total
• urge
• Enuresis
• nocturnal enuresis
• diurnal enuresis

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ALTERATIONS CONT.

• Nocturia
• Frequency
• Urgency
• Dysuria
• Hesitancy
• Polyuria
• Suppression
• anuria
• oliguria

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DIAGNOSTIC TEST

• Culture and sensitivity
• KUB
• IVP
• Cystoscopy
• Blood test
• BUN (7-18 mg/dl)
• Creatinine (.6-1.2 mg/dl)
• Urinalysis (type of specimens)

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ASSESSMENT OF URINATION

• frequency
• amount
• color
• odor
• character
• specific gravity
• ph
• abnormal constituents
• discomfort

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NURSING INTERVENTIONS TO PROMOTE U. E.

• intake output
• position
• hygiene
• privacy
• sitz
• catheterize
• medications
• kegels exercise

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CATHETERIZATION

• STRAIGHT
• RETENTION OR FOLEY
• QUICK CATH
• LUMENS
• SINGLE-STRAIGHT
• DOUBLE-RETENTION
• TRIPLE-IRRIGATION

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SIZE OF CATHETERS

• RANGE FROM 8-24
• CHILD 8-10
• FEMALE 14-16
• MALE 16-18
• TURP 22-24
• BALLOONS 5-30 cc

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Nursing Interventions

• Insertion of catheters
• Maintenance of caths
• Specimens from caths
• Removing catheters
• Irrigation procedure
• Residual urine
• Suprapubic catheters

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URINARY DIVERSION

• Cutaneous Ureterostomy
• Ileal Conduit
• Ureterosigmoidostomy
• Ureteroileosigmoidostomy
• Kock Pouch (Continent Vesicostomy)

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NURSING DIAGNOSES

• ALTERED URINARY ELIMINATION
• INCONTINENCE
• URINARY RETENTION
• PAIN
• BODY IMAGE DISTURBANCE

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BOWEL ELIMINATION
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ANATOMY

• Small intestine (ileum)
• Ileocecal valve
• Cecum
• Ascending
• Transverse
• Descending
• Sigmoid
• Rectum
• Anus

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PHYSIOLOGY

• Peristalsis
• Water absorption
• Storage
• Secretion of mucus

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DEFECATION

• Parasympathetic reflex
• Defecation reflex
• Assessment of stool
• pattern
• color
• consistency/shape
• blood
• Odor
• Bowel Diversions
• Stoma, drainage, skin condition

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FACTORS AFFECTING BE

• Anesthesia/Surgery
• Diagnostic Test
• Pathology
• Irritants
• Pain

• Age
• Diet / Fluids
• Exercise
• Stress
• Schedule
• Medications
• Environment

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ALTERED BE

• Constipation
• Fecal Impaction
• Diarrhea
• Incontinence
• Flatulence
• Hemorrhoids

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DIAGNOSTIC TEST

• Guaiac test
• Hematest
• Hemoccult
• Proctoscopy
• Proctosignoidoscopy
• Colonoscopy

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PHYSICAL ASSESSMENT

• Inspection
• Four quadrants
• Nine regions
• Auscultation
• Percussion
• Palpation

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MEDICATIONS

• Cathartics (laxative)
• Bulk forming
• Lubricant
• Wetting agent
• Stimulant/irritant
• Saline
• Suppository
• Enema
• Cleansing
• Hypertonic
• Oil

• Carminative
• Return Flow
• Cooling
• Medication

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ENEMA ADMINISTRATION

• PROCEDURE
• HIGH VS. LOW
• AGE
• POSITION
• SOLUTIONS
• HYPOTONIC
• HYPERTONIC
• ISOTONIC
• VOLUME CONSIDERATION

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BOWEL DIVERSIONS

• Ileostomy
• Ascending Colostomy
• Transverse Colostomy
• Descending Colostomy

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TYPES OF CONSTRUCTION

• Loop
• Double Barrel
• End
• Temporary
• Permanent

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NURSING INTERVENTIONS

• Psychological needs
• Nutritional needs
• Hygiene needs
• Maintenance
• Teaching

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SPECIMEN COLLECTION

• Urine
• Midstream
• Sterile/Culture
• 24 hour
• Drug
• Stool
• Blood/Parasite
• Technique
• Documentation

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NURSING DIAGNOSES

• CONSTIPATION
• DIARRHEA
• INCONTINENCE
• ALTERED ELIMINATION
• BODY IMAGE DISTURBANCE

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THE END!!!