ELIMINATION S GUIDE

• Defecation


  The process of eliminating waste material, primarily feces, from the body through the rectum and anus
• Diet


  The types and quantities of food and beverages consumed by an individual, which can affect digestive health and elimination patterns
• Fluids


  Liquids consumed orally, which are essential for hydration, digestion, and maintaining normal bowel function
• Activity


  Physical movements and exercise, which can stimulate gastrointestinal motility and promote regular bowel movements
• Personal habits


  Individual behaviors related to toileting practices, dietary choices, and lifestyle factors that can influence digestion and elimination
• Privacy


  The state of being free from observation or intrusion during toileting activities, which can enhance relaxation and facilitate the defecation process
• Age-related changes


  Physiological and functional alterations that occur in the gastrointestinal system with advancing age, which can affect digestion, absorption, and elimination
• Infectious diseases


  Illnesses caused by microorganisms such as bacteria, viruses, or parasites, which can affect the gastrointestinal tract and lead to symptoms such as diarrhea, vomiting, and abdominal pain
• Diabetes


  A chronic metabolic disorder characterized by high blood sugar levels, which can affect gastrointestinal function and lead to symptoms such as constipation, diarrhea, or gastroparesis
• Pain


  An unpleasant sensory and emotional experience associated with actual or potential tissue damage, which can affect bowel habits and defecation patterns
• Pelvic floor trauma


  Injury or damage to the muscles, ligaments, or nerves of the pelvic floor, which can lead to urinary or fecal incontinence and affect bowel control
• Illness/surgery


  Medical conditions or surgical procedures that can impact gastrointestinal function and lead to changes in digestion, absorption, or elimination
• Enteral feeding


  Administration of nutrition through a tube directly into the gastrointestinal tract, which can affect bowel function and stool consistency
• Medications


  Substances used to treat or manage medical conditions, which can have side effects that affect gastrointestinal motility, stool consistency, or bowel habits
• Genitourinary (GU) system


  Includes the kidneys, ureters, bladder, and urethra
• Kidney function


  1. Filtration of blood to remove waste products and excess substances

  2. Regulation of electrolyte balance

  3. Regulation of blood pressure

  4. Production of hormones such as erythropoietin and renin
• Ureters


  Long, muscular tubes that transport urine from the kidneys to the urinary bladder
• Bladder


  Hollow, muscular organ that serves as a reservoir for storing urine until it is expelled from the body
• Urethra


  Tube that connects the bladder to the external environment
• Factors influencing urination


  • Bladder distension
  • CNS control
  • Voluntary control
  • Fluid intake
  • Diuretics
• Common age-related changes in the urinary system

  • Physiological changes in lower urinary tract
  • Decreased bladder capacity
  • Decreased bladder contractility
  • Increased nocturia (frequency to pee)
  • Increased urinary incontinence
• Urinary tract infection (UTI)

  Bacterial infection that can lead to complications such as kidney damage, sepsis, and recurrent infections
• Common signs/symptoms of UTI

  • Dysuria (pain or burning during urination)
  • Urinary frequency
  • Urinary urgency
  • Hematuria (blood in urine)
• Nurses should be concerned about catheter-associated urinary tract infections (CAUTIs) due to their associated morbidity, mortality, and healthcare costs
• Types of incontinence


  • Stress incontinence
  • Urge incontinence
  • Overflow incontinence
• Patients who may experience nocturia

  • Older adults
  • Patients with heart failure
• Patients who may experience urinary retention

  • Men more than women
  • Older adults
  • Men with benign prostatic hyperplasia (BPH)
  • Men due to prostate issues
• Patients who may require a urinary diversion

  • Patients undergoing radical cystectomy for bladder cancer
  • Patients with congenital abnormalities of the urinary tract
  • Patients in palliative care
• Patients who may require renal failure treatment

  • Patients with end-stage renal disease (ESRD)
  • Patients with acute kidney injury (AKI) requiring dialysis
  • Patients with chronic kidney disease (CKD)
• Ways nurses can prevent UTIs

  • Encouraging adequate hydration
  • Promoting good perineal hygiene
  • Encouraging regular voiding
  • Assessing and managing urinary catheters
• Age-related changes impacting elimination


  • Decreased bladder capacity and muscle tone
  • Increased risk of urinary incontinence and urinary retention
  • Decreased kidney function and ability to concentrate urine
  • Increased risk of urinary tract infections (UTIs) and kidney stones
  • Changes in bowel habits
• Psychosocial/cultural considerations regarding elimination

  • Cultural beliefs and practices related to toileting habits and hygiene
  • Psychological factors such as embarrassment, anxiety, or depression related to incontinence or urinary dysfunction
  • Impact of urinary and bowel dysfunction on self-esteem, body image, and quality of life
• Important assessment pieces for a GU assessment

  • History of urinary symptoms
  • Medical history
  • Abdominal inspection
  • Abdominal distension
• Normal characteristics of urine

  • Pale yellow to amber color
  • Clear or transparent appearance
  • Mild odor
  • pH typically between 4.6 and 8.0
  • Specific gravity of 1.005 to 1.030
  • Absence of blood, protein, glucose, ketones, bilirubin, and leukocytes
• Urinalysis


  Common urine test
• Common nursing diagnoses associated with elimination

  • Impaired Urinary Elimination
  • Risk for Infection
  • Bowel Incontinence
• Common education pieces for patients

  • Hygiene practices
  • Fluid intake
  • Bladder and bowel habit training
  • Medication management
• Common health promotion strategies for nurses

  • Encouraging healthy lifestyle behaviors
  • Providing education on bladder and bowel habits
• Catheterization


  Used for acute urinary retention, monitoring urinary output, and urinary incontinence management
• Importance of catheter care

  • Preventing infection