elimination

• elimination - the secretion and excretion of physiological waste products by the kidneys and intestines
• the human body eliminates various forms of waste through the skin, kidneys, lungs, and intestines
• bowel elimination is the process of expelling stool or feces
• urinary elimination is the process of expelling urine
• elimination processes are an indirect gauge of general health. inspired elimination may include: anuria, dysuria, polyuria, urinary frequency, and urinary hesitancy
• healthy urinary elimination

  depends on the effective functioning of the upper urinary tract (kidneys and ureters) and the lower urinary tract (bladder, urethra, and pelvic floor)
• physiology of urination

  urine collects in the bladder until pressure stimulates sensory nerve endings, called stretch receptors, in the bladder wall. stretch receptors transmit impulses to the spinal cord - 2nd to 4th sacral vertebrae, causing the internal sphincter to relax and stimulating the urge to void
• factors affecting urinary elimination

  • fluid and food intake
  • muscle tone
  • psychosocial factors
  • pathological conditions
  • surgical and diagnostic procedures
  • medications
• healthy bowel elimination

  complex process that promotes retention of nutrients and important compounds while ridding the body of waste products. alterations in bowel elimination can lead to conditions that range from mild to fatal
• physiology of bowel elimination

  food travels from the mouth to the stomach, where is it broken down into a thick, semifluid mass called chyme. chyme then travels into the duodenum to begin transport through the small and large intestines via peristalsis. nutrients and water are absorbed into the bloodstream and transported to the liver. the portion of chyme not absorbed continues through the large intestine until it is expelled
• factors affecting bowel elimination

  • diet
  • fluid
  • activity
  • defecation habits
  • medications
• loss of control: involuntary release of urine or feces

  leads to: skin breakdown, changes in daily activities and/or social activities
• urinary retention: external sphincter doesn't open for release of urine or blockage of urethra

  leads to: back flow to upper urinary tract, dilation of ureters and renal pelvis, pyelonephritis, and renal atrophy
• bowel retention: ignoring the urge to go or decreased peristalsis

  leads to: leads to retention of stool in the rectum - stool dries and hardens, constipation and impaction
• enuresis = involuntary urination
• nocturnal enuresis (bedwetting) - discrete episodes of urinary incontinence during sleep in children aged 5 and older
• primary enuresis

  A child who has never attained night-time bladder control. More common in boys.
• secondary enuresis

  A child who has experienced a dry period for >6 months before enuresis
• monosymptomatic enuresis

  Occurs only during night-time sleep. with the child remaining dry during the day. Most common.
• polysymptomatic enuresis

  Child has daytime urgency and an occasional daytime accident in conjunction with other conditions, such as sleep apnea, UTI, neurological impairment, constipation, or emotional stress.
• Etiology & Pathophysiology Multiple causes! Motor or sensory disorders or their combination can result in fecal incontinence. Fecal incontinence can be secondary to fecal impaction.
• Diagnostic Studies & Treatment Requires a thorough health history and physical examination (rectal) + appropriate diagnostic studies (sigmoidoscope &/or abd x-ray). Treatment will depend on cause. For example, if incontinence is resulting from non-infectious diarrhea, dietary changes may be advised.
• nursing management

  Collaboration is key!

  Bowel training program

  Maintenance of skin integrity

  Perianal pouching

  Education (diet, hygiene)
• Constipation is a decrease in frequency of BMs from what is usual for the individual; the presence of hard, difficult-to-pas stools; a decrease in stool volume; retention of feces in the rectum; or some combination of these conditions.
• Obstipation = fecal impaction secondary to constipation and is the inability to evacuate large, hard, concrete stool from the rectum. Symptoms include: constipation, rectal discomfort, anorexia, N&V, abdominal pain, paradoxic diarrhea and fecal incontinence.