ELIMINATION

URINARY ELIMINATION
ANATOMY AND PHYSIOLOGY

ANATOMY
FEMALE STRUCTURES MALE STRUCTURES

 96% WATER 4% SOLUTES

URINE

ORGANIC SOLUTES
UREA* AMMONIA CREATININE URIC ACID
SODIUM (Na) CHLORIDE (Cl) MAGNESIUM (Mg) PHOSPHORUS (Phos) SODIUM CHLORIDE (NaCl)*

INORGANIC SOLUTES

Fluid Diet Response to urge Stress Psychosocial factors Activity Pathological conditions Medications Developmental level Medical Diagnosis or Surgery

FACTORS AFFECTING URINARY ELIMINATION

ALTERATIONS IN URINARY ELIMINATION

Urinary Retention Urinary Incontinence
functional reflex stress total urge

Enuresis
nocturnal enuresis diurnal enuresis

ALTERATIONS CONT.
Nocturia Frequency Urgency Dysuria Hesitancy Polyuria Suppression
anuria oliguria

DIAGNOSTIC TEST
Culture and sensitivity KUB IVP Cystoscopy Blood test
BUN (7-18 mg/dl) Creatinine (.6-1.2 mg/dl)

Urinalysis (type of specimens)

ASSESSMENT OF URINATION
frequency amount color odor character specific gravity ph abnormal constituents discomfort

NURSING INTERVENTIONS TO PROMOTE U. E.

intake & output position hygiene privacy sitz catheterize medications kegels exercise

CATHETERIZATION
STRAIGHT RETENTION OR FOLEY QUICK CATH LUMENS
SINGLE-STRAIGHT DOUBLE-RETENTION TRIPLE-IRRIGATION

SIZE OF CATHETERS
RANGE FROM # 8-24 CHILD # 8-10 FEMALE # 14-16 MALE # 16-18 TURP # 22-24 BALLOONS 5-30 cc

Nursing Interventions
Insertion of catheters Maintenance of caths Specimens from caths Removing catheters Irrigation procedure Residual urine Suprapubic catheters

URINARY DIVERSION

Cutaneous Ureterostomy Ileal Conduit Ureterosigmoidostomy Ureteroileosigmoidostomy Kock Pouch (Continent Vesicostomy)

NURSING DIAGNOSES
ALTERED URINARY ELIMINATION INCONTINENCE URINARY RETENTION PAIN BODY IMAGE DISTURBANCE

BOWEL ELIMINATION

ANATOMY
Small intestine (ileum) Ileocecal valve Cecum Ascending Transverse Descending Sigmoid Rectum Anus

PHYSIOLOGY
Peristalsis Water absorption Storage Secretion of mucus

DEFECATION
Parasympathetic reflex Defecation reflex Assessment of stool
pattern color consistency/shape blood Odor

Bowel Diversions
Stoma, drainage, skin condition

FACTORS AFFECTING BE
Age Diet / Fluids Exercise Stress Schedule Medications Environment Anesthesia/Surgery Diagnostic Test Pathology Irritants Pain

ALTERED BE
Constipation Fecal Impaction Diarrhea Incontinence Flatulence Hemorrhoids

DIAGNOSTIC TEST
Guaiac test Hematest Hemoccult Proctoscopy Proctosignoidoscopy Colonoscopy

PHYSICAL ASSESSMENT
Inspection
Four quadrants Nine regions

Auscultation Percussion Palpation

MEDICATIONS
Cathartics (laxative)
Bulk forming Lubricant Wetting agent Stimulant/irritant Saline
Carminative Return Flow Cooling Medication

Suppository Enema
Cleansing Hypertonic Oil

ENEMA ADMINISTRATION
PROCEDURE
HIGH VS. LOW AGE POSITION

SOLUTIONS
HYPOTONIC HYPERTONIC ISOTONIC VOLUME CONSIDERATION

BOWEL DIVERSIONS
Ileostomy Ascending Colostomy Transverse Colostomy Descending Colostomy

TYPES OF CONSTRUCTION
Loop Double Barrel End Temporary Permanent

NURSING INTERVENTIONS
Psychological needs Nutritional needs Hygiene needs Maintenance Teaching

SPECIMEN COLLECTION
Urine
Midstream Sterile/Culture 24 hour Drug

Stool
Blood/Parasite

Technique Documentation

NURSING DIAGNOSES
CONSTIPATION DIARRHEA INCONTINENCE ALTERED ELIMINATION BODY IMAGE DISTURBANCE

THE END!!!