NUR 205 WEEK 6

Elimination-the excretion of waste products

Normal value 30ml of urine per hour

Types of urinary incontinence

 Stress-leakage of small amounts of urine during physical movement
 Urge-leakage of large amounts of urine at unexpected times, including during sleep
 Overactive bladder- urinary frequency and urgency, with or without urge incontinence
 Functional- Untimely urination because of physical disability, external obstacles, or
cognitive problems that prevent a person from reaching toilet
 Overflow- unexpected leakage of small amounts of urine b/c of full bladder
 Mixed- usually occurrence of stress and urge incontinence together
 Transient-leakage that occurs temporarily because of a situation that will pass
(infection, taking a new medication, colds with coughing)

Alterations in Elimination
 Control
o Incontinence- loss of control of either urine or bowel movement
 Retention
o Unintentional retention of urine or stool
o Can occur at any age
o Usually caused by obstructions, inflammation, or ineffective neuromuscular
activation
 Discomfort
o Process of elimination should normally be painless or free of discomfort
o Usually associated with inflammation
o Occurs with UTI’s
 Neoplasms
o Tumors that can have an effect on urinary or bowel elimination
o Benign and malignant neoplasms of the prostate often lead to blockage of
urinary flow in men
o Tumors can also occur in the kidney or bladder
 Organ Failure
o Kidney failure
o Renal failure
Consequences
 Incontinence-Potential for skin breakdown and falls
 Urinary retention- pain, chronic bladder infection, and bladder distention, urinary reflux
(backflow of urine), renal atrophy
 Complete loss of renal function- inability to remove toxins and metabolic waste, fluid,
electrolyte, and acid-base disturbance
 Excessive fecal retention-pain, loss of appetite, nausea, vomiting

Risk Factors
 Advanced age
 Individuals with altered cognition, impaired mobility
 The debilitated
 Injuries or pathophysiology affecting neurologic system, spine, or pelvic organs
 General anesthetic and opioid patients

Examination findings
 Inspection
o Abdominal or bladder distention
o Redness, lesions, or discharge in genitalia
o Redness or lesions or perianal area
o Very dark urine
o Black or tarry stool – GI bleeding
o Loose stools (diarrhea)
 Auscultation
o An absence of sound may be associated with paralytic ileus
o Hyperactive bowel sounds may be noted with gastrointestinal inflammation or
with an intestinal obstruction
o Auscultation is not indicated in urinary assessment
 Palpation
o Abdominal distention
o Rectal palpation to check for masses, lesions, or impacted stool

Diagnostic Tests
 Urinalysis
 Renal function tests
 Culture
 Occult blood
Primary Prevention
 Environmental factors- avoiding contaminated water & food
 Maintain hydration
 Dietary fiber
 Physical activity
 Maintenance of regular toileting practice

Secondary Prevention
 Occult blood testing
 Colonoscopy

Procedures and Surgical interventions involving urinary elimination

 Dialysis-for acute or chronic renal failure
o Filtrates blood to remove toxins through external process
o Hemodialysis-dialysis machine filter’s patient’s blood
o Peritoneal- a dialysate solution is introduced into peritoneal cavity that absorbs
toxins over several hours, solution and waste are then removed
 Urinary Catheterization
 Removing renal calculi (kidney stones)
 Nephrectomy (surgical removal of kidney)
 Prostate surgery
 Bladder surgeries- treats prolapsed bladder or bladder cancer
 Urinary diversion- creates a stoma for urinary output

Procedures and surgical interventions involving bowel elimination

 Colectomy-removing a portion of the bowel
 Colostomy/ileectomy-
 Rectal prolapse repair
 Hemorrhoidectomy
 Fecal collection systems- (flexible tube in rectum to collect liquid stool in patients with
incontinence)

Interrelated concepts
 Nutrition
 Fluid and electrolytes
 Acid-base balance
 Mobility
 Cognition
Exemplars
 Urolithiasis
o Presence of stones called calculi within the urinary tract
o Can lead to hematuria (blood in urine) and impaired kidney function
 Benign prostate hyperplasia
o Enlargement of the prostate gland
o Commonly seen among age 60+
o Can obstruct urine flow creating urinary retention
o Common symptoms include frequency of urination, difficulty starting urinary
flow, and a weak urinary stream
 UTI
o 2nd most common bacterial infection in individuals
o nausea, vomiting, chills, suprapubic or low back pain, bladder spasms, dysuria,
burning with urination, frequency, urgency, hesitancy
o common in pregnant women, females, and older men
 Renal failure
o Partially or complete cessation of kidney function
 Constipation
 Diarrhea
o Associated with loss of water and electrolytes so dehydration and electrolyte
imbalance can occur, especially in infants, children, and older adults
 Colorectal cancer
o Warning signs- change in bowel
 Gastritis
 Pyelonephritis
 Ulcerative colitis