Elimination Process Flashcards
What Are The Factors That Affect Defecation?
•Diet – insoluble and soluble fiber –25 grams daily for women, 38 grams for men •Fluid •Activity •Psychological factors •Defecation habits •Medications •Diagnostic Procedures •Anesthesia/Surgery – paralytic ileus •Pain
What are the Characteristics of Feces?
- Color
- Consistency
- Shape
- Amount
- Odor
- Constituents
What can we learn from stool?
•Red –Hematochezia - fresh blood in stool; associated with lower GI bleeding or rapid upper GI bleeding •Black –Melena (tarry) – associated with slow upper GI hemorrhage, black can also be use of Pepto-Bismol, iron •Grey or Pale – liver disease and decreased bile output (pale, white, white specs can be regular antacid use) •Yellow –gallbladder dysfunction •Green –antibiotic use, green leafy vegetables •Floating stool –Steatorrhea – excess fat
Define Constipation and Fecal Impaction
- Decreased frequency of defecation (less than 3 per week)
- Hard, dry, formed stools
- Mass or collection of hardened feces in folds of rectum.
- Can be recognized by seepage of fecal liquid but no normal stool.
What Causes of Constipation?
- Insufficient fiber intake
- Insufficient fluid intake
- Insufficient activity
- Irregular defecation habits
- Change in daily routine
- Chronic use of laxatives
- Medications
- Habitual denial and ignoring the urge to defecate
- Neurologic problems
- Irritable Bowel Syndrome
- Lack of privacy
What is Physiology of Defecation?
- 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; if timing is appropriate, the internal and external sphincter relax.
- Expulsion of the feces assisted by contraction of the abdominal muscles, thighs and diaphragm.
- Feces moves through the anal canal and expelled through anus.
Diarrhea
Passage of liquid feces and increased frequency of defecation
Causes
•Clostridium difficile – mucoid/foul smelling
•Psychological stress
•Antibiotics
•Iron
- Food allergies
- Colon diseases – Crohn’s
- Cathartics – accelerate defecation
Define Bowel Incontinence
Loss of voluntary ability to control fecal and gaseous discharges
Bowel Incontinence Partial vs Major
- Partial – inability to control flatus or to prevent minor soiling
- Major – inability to control feces of normal consistency
Bowel Incontinence causes
● anal sphincter function impairment
● spinal cord injury
● tumors of external anal sphincter muscle
What are the Primary Sources of Flatulence?
Action of bacteria on chyme in large intestine
Swallowed air (belching/eructation)Gas diffusion between bloodstream and intestine
Causes:
Food – cabbage, onions, excess dietary fiber
Abdominal surgery
Narcotics
What are the NANDA Nursing Diagnoses?
Bowel Incontinence Constipation Risk for Constipation Perceived Constipation Diarrhea
What are the Interventions to Maintain Normal
Fecal Elimination Patterns?
- Privacy
- Timing
- Nutrition and fluids
- Daily activity level
- Positioning – bedside commode, bedpan
- Assess daily medications
- Assess ability to toilet independently & availability of toilet
What are the Desired Outcomes of elimination?
Maintain or restore normal bowel elimination pattern
Maintain or regain normal stool consistency
Prevent associated risks such as fluid and electrolyte imbalance, skin breakdown, abdominal distention and pain
What are the Types of Enemas ?
Cleansing – used to remove feces
Carminative – used to expel flatus
Retention –softens feces
Return-Flow – not as common, used to expel flatus
What are the Related Nursing Diagnosis?
Risk for Deficient Fluid Volume Risk for Impaired Skin Integrity Low Self-esteem Disturbed Body Image Deficient Knowledge (Bowel Training, Ostomy Management) Anxiety
What are the Selected Fecal Elimination Problems?
- Constipation
- Diarrhea
- Bowel incontinence
- Flatulence
- Hemorrhoids
What is flatulence
Presence of excessive flatus in the intestines and leads to stretching and inflation of the intestines
Assessment of Fecal Elimination
Assessing taking nurse history performing physical examination
Nursing History elicits a description of usual feces and any recent changes and collects info
Physical Examination observe abdomen in relation to fecal elimination problems include inspection
Micturition
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 Affecting Voiding
Developmental factors Psychosocial factors Fluid and food intake Medications Muscle tone Pathologic conditions Surgical procedures
Developmental
- Infants can urinate 20 times a day. Will develop urinary control between the ages of 2 and 5 years.
- Preschoolers – teach girls to wipe from front to back.
- School age – enuresis – involuntary passage of urine when control should be established.
- Noctural enuresis – bedwetting. Not a problem until after age 6.
- Older adults – decrease in functioning nephrons; toxicity from medications = decreased urine; nocturia (voiding at night) can signal heart failure
- Urgency and frequency are common – men enlarged prostate; women weakened muscles supporting bladder or weakness of the urethral sphincter. Incomplete emptying.
What are the Selected Urinary Problems?
- Polyuria (diuresis) - high urine output
- Oliguria – low urine output
- Anuria – no urine
- Frequency
- Nocturia – 2 or more times at night
- Urgency- sudden strong desire to void 4 to 5 years old
- Enuresis- involuntary passing of urine
- Retention- bladder becomes overdistended
- UTI- infection
- Dysuria – painful urination
What are the Nursing Assessment of Urinary Function
Assessing includes the nursing history physical relating
Nurse history the nurse determine the clients normal voiding pattern
Physical urinary tract includes a percussion of the kidneys to detect areas
Normal output 60 ml mini output 30 ml
What are the Lab Values BUN & Creatinine?
Lab & Diagnosis • BUN (8-20 mg/dL) & Creatinine (0.5-1.1 mg/dL)
Elevated: Renal failure, impaired renal function, infection/inflammation, obstruction, dehydration, excessive protein intake
Low: Inadequate protein intake, malabsorption syndromes, liver disease
What are the Characteristics of Urine
Volume
Color, clarity
Odor- normal faint aromatic n abnormal offensive
Sterility- normal no microorganisms n abnormal microorganisms presented
pH (4.5-8) normal
Specific gravity (1.010-1.025) normal
Glucose- normal not presented n abnormal presented
Ketone bodies – result from breakdown of fat for energy normal not presented
Blood- normal not presented
NANDA Nursing Diagnosis of urine
- Impaired Urinary Elimination
- Urinary Incontinence
- Urinary Retention
Related Nursing Diagnosis
- 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
What are the General Nursing Interventions
- Promoting fluid intake
- Maintaining normal voiding patterns
- Assisting with toileting
- Preventing urinary tract infections
- Continence (bladder) training
- Assessing medications
Desired Outcomes
- 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 with or without assistive devices
- Contain urine with the appropriate device, catheter, ostomy appliance, or absorbent product
Preventing Urinary Tract
Infections
- Drink 8-10 glasses of water per day
- Practice frequent voiding (every 2 to 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 underclothes
- Don’t be a WWW (wrong way wiper)!
Preventing Urinary Tract
Infections proper tips
- Always wipe the perineal area from front to back following urination or defecation (girls and women)
- Take showers rather than baths if recurrent urinary infections are a problem
Incontinence
Urinary incontinence, or loss of bladder control, is a frustrating problem for more than 13 million Americans. Never knowing when and where you might have an accident can impact everything from work to exercise to your social calendar. Urinary incontinence affects people of either gender but is twice as common in women.
Medications for urinary infection
- In women, certain high blood pressure medicines tend to relax the bladder muscles, contributing to stress incontinence.
- Some types of antidepressants may relieve incontinence, but others can make the symptoms worse.
- And diuretics or “water pills” create more urine, which can intensify any type of incontinence.
How can you Managing Mild Incontinence
-Avoid Caffeine
-Regularly Empty bladder (even if you don’t feel like you need to)
Less fluids
What are some Other Incontinence Therapies
- Biofeedback
- Collagen injections
- Bladder training
- Surgery
Hemorrhoids
Internal vs External
Distended veins in the return
External usually not removed with surgery except if they are very large
Internal tear anal fissure if a blood clot may need to be removed to relieve the pain
Treatment anti inflammatory reduce the swelling
Surgery is called hemorrhoidopexy for removal
