Elimination

• Topics


  • Bowel Elimination
  • Urinary Elimination

  
• Learning Outcomes


  • Identify the concepts of elimination
  • Utilize the concept of elimination
  • Determine the concept of elimination
• Feces


  Waste products that have reached the distal end of the colon and are ready for excretion
• Stool


  Excreted feces
• Peristalsis


  Contraction of the circular & longitudinal muscles of the large intestines, occurring every 3 to 12 minutes, moving waste products along the length of the intestines continuously
• Normal Characteristics of Stool


  • Color: Yellow or golden brown
  • Odor: Aromatic
  • Amount: Depends on the bulk of food
  • Consistency: Soft, formed
  • Shape: Cylindrical
  • Frequency: Range 1-2 times/ day
• Defecation


  1. The expulsion of feces from the rectum

  2. May be facilitated voluntarily by contracting the abdominal muscles and by forceful expiration with glottis closed increase the abdominal pressure (Valsalva maneuver)

  3. The fecal matter may take 24 to 48 hours to pass the entire large intestines

  4. 150 to 300 grams of feces is produced daily

  5. The fecal matter consists of unabsorbed food residue, mucus, digestive secretions, water & microorganisms

  6. The fecal matter consists of 75% water & 25% solid
• Alteration on the Characteristics of Stool


  • Acholic Stool: Gray pale or clay-colored stool due to absence of stercobilin caused by biliary obstruction
  • Hematochezia: Passage of stool with bright red blood due to lower gastrointestinal bleeding
  • Melena: Passage of black, tarry stool due to upper GI bleeding
  • Steatorrhea: Greasy, bulky, foul-smelling stool due to indigested fats in hepatobiliary-pancreatic obstruction
• Constipation


  Passage of small dry, small, hard stools
• Intervention: Constipation


  1. Adequate fluid intake: 1,500 to 2,000 mL/day

  2. High fiber diet

  3. Fresh & cooked fruits & vegetables with skin

  4. Whole grain breads & cereals

  5. Fruit & vegetable juices

  6. Establish regular pattern of defecation

  7. Respond immediately to the urge to defecate

  8. Minimize stress

  9. Adequate activity & exercise

  10. Assume a sitting or semi-sitting position
• Fecal Impaction


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


  1. Absence of bowel movement for 3 to 5 days

  2. Passage of liquid fecal seepage

  3. Hardened fecal mass is palpated during digital examination of the rectum

  4. Nonproductive desire to defecate and rectal pain

  5. Anorexia, malaise

  6. Subjective feeling of abdominal fullness or bloating, abdominal distention

  7. Nausea & vomiting

  
• Intervention: Fecal Impaction


  1. Manual extraction or fecal impaction as ordered

  2. Increase fluid intake

  3. Sufficient bulk in diet

  4. Adequate activity & exercise
• Diarrhea


  Frequent evacuation of watery stools, associated with increase gastrointestinal motility, and a rapid passage of fecal contents through the lower gastrointestinal tract
• Intervention: Diarrhea


  1. Replace fluid & electrolyte losses

  2. Small amount of bland foods

  3. Low fiber diet

  4. BRAT diet (banana, rice am, apple, toast)

  5. Avoid excessively hot or cold foods

  6. Potassium-rich foods & fluids (Banana & Gatorade)

  7. Provide good perineal care

  8. Promote rest to reduce peristalsis

  9. Antidiarrheal medications as ordered
• Fecal Incontinence


  Involuntary elimination of bowel contents associated with neurologic, mental or emotional impairment. Diarrhea predisposes a person to fecal incontinence.
• Flatulence


  Presence of excessive gas in the intestines, due to swallowed air, bacterial action in the large intestines & diffusion from blood
• Common Causes of Flatulence


  • Constipation
  • Medications that decrease intestinal motility (codeine, barbiturates)
  • Anxiety
  • Eating gas-forming foods (cabbage, onions, root crops, legumes, cauliflower)
  • Rapid food & fluid ingestion
  • Improper use of drinking straw
  • Excessive drinking of carbonated beverages
  • Gum chewing, candy sucking, smoking
  • Abdominal surgery
• Relieve Flatulence


  1. Avoid gas-forming foods

  2. Provide warm fluid to drink

  3. Early ambulation among postoperative clients

  4. Adequate activity & exercise

  5. Limit carbonated beverages, use of drinking straws & chewing gum

  6. Rectal tube insertion as ordered

  7. Carminative enema as ordered

  8. Administer cholinergic as ordered. Ex. Prostigmin (neostigmine)
• Enema


  Introduction of a solution into the large intestines
• Types of Enema


  • Cleansing enema: Stimulates peristalsis by irritating the colon & rectum and/or distending the intestine with the volume of fluid introduced
  • Retention enema: Retained in the bowel for a long period
  • Return flow enema: Done to expel flatus
• Rectal Suppositories


  Conical or oval solid substance shaped for easy insertion into the body cavity & designed to melt at the body temperature
• Micturition


  The process of emptying the bladder, normally painless
• Factors Affecting Micturition


  • Most children begin to control urination voluntarily at 18 to 24 months of age. Enuresis is the involuntary urination occurs after 24 months.
  • Older people: Diminished kidney to concentrate urine = nocturia, Deceased muscle tone = increased urine frequency, Decreased bladder contractility = urine retention & stasis
  • When body is dehydrated, the kidneys reabsorb fluid = Concentrated urine, Decreased amount of urine
  • With fluid overload, the kidneys excrete a large quantity of dilute urine
  • Caffeine-containing beverages (cola, coffee, tea) have diuretic effect & increase urine production
  • Foods & beverages with high sodium content cause sodium and water reabsorption and retention, decreasing urine formation
  • Voiding is a personal & private act
  • During prolonged periods of immobility, decreased bladder and sphincter tone can result in poor urinary control and urinary stasis
  • Renal & urologic problems can affect both the quantity & quality of urine produced

  
• Drugs that Change Urine Color


  • Anticoagulants: Red color
  • Diuretics: Pale yellow
  • Pyridium: Red-orange
  • Elavil: Blue-green
  • Levodopa: Brown-black
• Normal Characteristics of Urine


  • Color: Amber/straw
  • Odor: Aromatic
  • Turbidity: Clear
  • pH: Slightly acidic (4.6-8)
  • Specific gravity: 1.010 – 1.025
• Problems in Urinary Elimination


  • Altered Urine Composition: Hematuria, Pyuria, Bacteriuria, Albuminuria, Proteinuria, Cylindriuria, Glycosuria, Ketonuria
  • Altered Urine Production: Polyuria, Oliguria, Anuria
  • Altered Urine Frequency: Frequency, Nocturia, Urgency, Dysuria, Hesitancy, Enuresis
  • Urinary incontinence: Total incontinence, Stress incontinence
  • Retention: Accumulation of urine in bladder with associated inability of bladder to empty itself

  
• Interventions to Induce Voiding


  1. Provide privacy

  2. Provide fluids to drink

  3. Assist the patient in anatomical position of voiding

  4. Sever clean, warm, and dry bedpan (female) or urinal (male)

  5. Allow patient to listen to the sound of running water

  6. Dangle fingers in warm water

  7. Pour warm water over perineum

  8. Promote relaxation

  9. Provide adequate time for voiding

  10. Perform Crede's maneuver by applying pressure on the suprapubic area

  11. Administer cholinergic as ordered

  12. Urinary catheterization
• Types of Catheters


  • Intermittent catheter (Straight catheter)
  • Indwelling catheter (Foley catheter)
  • Suprapubic catheter
• Urinary tract infection (UTI) occurs when bacteria enter the urethra and travel up to the bladder, causing inflammation and pain.
• Kidney stones can form when there is an imbalance between calcium, oxalate, phosphorus, uric acid, or other substances in the body.