Micturation

• Urinary Elimination

  Maintain homeostasis in the body by maintaining volume and composition. Another term is Micturation.
• Micturition


  The act of expelling urine from the bladder. Also called urination or voiding.
• Micturition process


  1. Urine collects in the bladder

  2. Pressure stimulates stretch receptors in bladder wall

  3. Urge to urinate

  4. Parasympathetic nervous system initiates voiding

  5. Sympathetic nervous system inhibits voiding
• The micturition reflex is involuntary, but it can be inhibited by higher brain centers.
• Urinary Process


  1. Kidneys filter waste and water from blood

  2. Urine collects in bladder
• Factors affecting voiding


  • Developmental factors
  • Psychological factors
  • Fluid and food intake
  • Medications
  • Muscle tone
  • Pathologic conditions
  • Surgical and diagnostics procedures
• Normal Characteristics of Urine

  • Amount in 24hrs: 1,200-1500 ml
  • Color: amber/straw
  • Odor: aromatic
  • Transparency: Clear
  • pH: slightly acidic (4.6-8, average 8)
  • Specific gravity: 1.010-1.025
  • Glucose/ketone bodies/blood: Not Present
• Problems in Urinary Elimination

  • Altered Urine Composition: RBC, WBC, Pus, Albumin, Protein, Casts, Glucose, Ketones
  • Altered Urine Production: Polyuria, Oliguria, Anuria
  • Altered Urinary Frequency: Frequency, Nocturia, Urgency, Dysuria, Enuresis, Pollakiuria
  • Urinary Incontinence: Total, Stress, Urge, Functional, Reflex
  • Urinary Retention
• Clinical signs of urinary retention

  • Discomfort in pubic area
  • Bladder distention
  • Inability to void or frequent voiding of small volumes
  • Disproportionately small output vs fluid intake
  • Increasing restlessness and need to void
• Nursing Interventions to induce voiding

  1. Provide privacy

  2. Provide fluids

  3. Assist in voiding position

  4. Provide warm bedpan/urinal

  5. Allow listening to running water

  6. Dangle fingers in warm water

  7. Pour warm water over perineum

  8. Promote relaxation

  9. Provide adequate time

  10. Perform Crede's maneuver

  11. Administer cholinergics

  12. Urinary catheterization (last resort)
• Urinary Catheterization


  Placement of a tube through the urethra for bladder emptying or indwelling
• Purposes of Catheterization


  • Relieve bladder distention
  • Instill medications
  • Irrigate bladder
  • Measure hourly urine output
  • Obtain sterile urine specimen
  • Measure residual urine
  • Manage incontinence
  • Promote healing post-operatively
  • Empty bladder for procedures
• Equipment for Catheterization


  • Sterile catheter
  • Catheterization kit: gloves, drapes, antiseptic, cleansing balls, forceps, syringe, water, lubricant, specimen container
• Removal of Indwelling Foley Catheter

  1. Prompt removal after no longer needed to decrease UTI risk

  2. Monitor voiding for 24-48 hours after removal
• Defecation


  Expulsion of feces from anus and rectum. Also called bowel movement.
• Normal Characteristics of Stool

  • Color: yellow/golden brown
  • Odor: aromatic
  • Amount: 150-300 g/day
  • Consistency: soft, formed
  • Shape: cylindrical
  • Frequency: 1-2 per day to 1 every 2-3 days
• Alterations in Stool Characteristics

  • Acholic stool: gray/pale/clay-colored
  • Hematochezia: bright red blood
  • Melena: black, tarry
  • Steatorrhea: greasy, bulky, foul-smelling
• Constipation


  Passage of small, dry, hard stools or no stool for a period of time
• Nursing Interventions for Constipation

  1. Adequate fluid intake

  2. High fiber diet

  3. Establish regular defecation pattern

  4. Respond to urge to defecate

  5. Minimize stress

  6. Adequate activity and exercise

  7. Assume sitting/semi-squatting position

  8. Administer laxatives as ordered
• Types of Laxatives


  • Chemical irritants
  • Stool lubricants
  • Bulk formers
  • Stool softeners
• Constipation


  Passage of small, dry, hard stools or the passage of no stool for a period of time
• Nursing interventions to prevent and relieve constipation

  1. Adequate fluid intake

  2. High fiber diet to provide bulk to the stool

  3. Establish regular pattern of defecation

  4. Respond immediately to the urge to defecate

  5. Minimize stress

  6. Adequate activity and exercise promote muscle tone and facilitate peristalsis

  7. Assume sitting or semi-squatting position

  8. Administer laxatives as ordered
• Types of Laxatives


  • Chemical irritants (e.g. Dulcolax, castor oil, senakot)
  • Stool lubricants (e.g. mineral oil)
  • Bulk Formers (e.g. Metamucil)
  • Stool softeners (e.g. Colace)
  • Osmotic agents (e.g. Milk of magnesia, Duphalac)
• Fecal Impaction


  Mass or collection of hardened, putty-like feces in the folds of the rectum. The stool lodged or stuck in the rectum, the person is unable to voluntarily evacuate the stool.
• Nursing interventions to relieve Fecal Impaction

  1. Manual extraction or fecal disimpaction as ordered

  2. Increase fluid intake

  3. Sufficient bulk in diet

  4. Adequate activity and exercise
• Diarrhea


  Frequent evacuation of watery stools. It is associated with increased gastrointestinal motility, and a rapid passage of fecal contents through the lower gastrointestinal tract
• Nursing interventions to relieve Diarrhea

  1. Replace fluid and electrolyte losses

  2. Provide good perianal care

  3. Promote rest to reduce peristalsis

  4. Provide small amount of bland diet, low fiber diet, BRAT diet (banana, rice, apple, toast)

  5. Avoid excessive hot or cold fluids

  6. Provide potassium rich foods and fluid (e.g. banana, gatorade)

  7. Administer antidiarrheal medications as ordered (demulcents, absorbents, astringents)
• Flatulence


  Presence of excessive gas in the intestines, due to swallowed air, bacterial action in the large intestine and diffusion from blood
• Common causes of flatulence

  • Constipation
  • Codeine, barbiturates and other medications that decrease intestinal motility
  • Anxiety
  • Eating gas forming foods (e.g. cabbage, legumes, root crops)
  • Rapid food or fluid ingestion
  • Excessive drinking of carbonated beverages
  • Improper use of straw
  • Gum chewing, candy sucking, smoking
  • Poomina surgery- causes decreased peristaisis
• Nursing Interventions for Flatulence

  1. Avoid gas forming foods

  2. Provide warm fluids to drink to increase peristalsis

  3. Adequate activity and exercise

  4. Limit carbonated beverages, use of straws and chewing gums

  5. Rectal tube insertion as ordered

  6. Carminative enema as ordered

  7. Administer cholinergic as ordered (e.g. prostigmin)
• Fecal Incontinence


  Involuntary elimination of bowel contents; often associated with neurologic, mental, or emotional impairments due to dysfunction of the anal sphincter
• Enema


  Solution introduced into the rectum and large intestine to distend the intestine, sometimes to irritate the intestinal mucosa, thereby increase peristalsis and excretion of feces and flatus
• Types of Enemas


  • Cleansing enema
  • Carminative enema
  • Retention enema
  • Return-flow enema
• Purposes of Enemas


  • To relieve constipation
  • To relieve flatulence
  • To administer medication
  • To evacuate feces in preparation for diagnostic procedure or surgery
• Contraindications for Enemas

  • Appendicitis
  • Intestinal obstruction
  • Increase intracranial pressure
• Cleansing Enema


  Intended to remove feces, stimulates peristalsis by irritating the colon and rectum and/or by distending the intestine with the volume of fluid introduced
• Commonly used solutions for Cleansing Enemas

  • Hypertonic - saline
  • Hypertonic enema - fleet phosphate enema
  • Hypotonic - tap water
  • Isotonic - normal saline
  • Soap suds -irritates mucosa, distends colon
  • Mineral oil - lubricates the feces and the colonic mucosa
• High Enema


  Given to cleanse as much of the colon as possible, client should be in left lateral position to the dorsal recumbent then to the right lateral so that the solution can follow the large intestine; 1000 ml Of solution
• Low Enema


  Used to clean the rectum and sigmoid colon only; client maintains left lateral position during administration. 500ml of solution is introduced
• Factors governing the force of enema flow

  • Height of solution container - 30 to 49 cm (12 to 18 in) - the higher the faster
  • Size of the tubing- larger size, the faster
  • Viscosity of the fluid- thicker, slower
  • Resistance of the rectum -+= slower