CONCEPT OF ELIMINATION

Group Members

Abdul Razzaq
Shahbaz Sajjad
Hamza Javeed
Alishba Tanveer
Objects

By the end of the session students will be able to :

1. Review the basic anatomy of digestive system .
2. Define the elimination pattern .
3. Discuss the common problems bowel elimination.
4. Identify the nursing care for common problems of fecal
elimination.
5. Discuss common problems of Urinary system.
6. Identify the nursing interventions for common urinary problems.
7. Discribe factors that can alter the urinary function
8. Discuss nursing care for alteration in elimination pattern
Anatomy of digestive system

Human GI system is composed of

 Mouth
 Pharynx
 Larynx
 Esophagous
 Stomach (accessory organ)
 Small intestine
 Large intestine
 Anus
Elimination pattern

Definition : The ability to get rid of waste from the body OR

The expulsion of waste from body is known as elimination
Elimination pattern discribe the regulation , control and removal of
by products and wastes in the body . The term usually refers to
movement of feces and urine and sweat from the body .

Bowel elimination
It is also known as defecation . Bowel elimination is natural process
critical to human functioning in which body excretes wastes
products of digestion . OR. Defecation is the act of feces (stool)
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Large intestine (colon ) is about 125 – 150 cm long and it has seven parts : cecum ,
ascending , transverse ,and descending ,sigmoid colon,rectum and anus .
The colon forms the pouches callled haustra . The large intestine is a muscular tube
lined with mucous membrane . The muscles are circular and longitudinal to facilitate
parietals movement.

Types of colon movement

Haustral Churing : involves back and forth movement of chyme with in the colon.
Colon Peristalsis: is relatively sluggish movement of chyme along the colon .
Mass Peristalsis :is powerful muscular movement along the colon .
 Defecation Process

Defecation is intinited by two reflexes

1. When feces enter the rectum , it’s distention gives signals to mesenteric plexus to
intiate Peristalsis movement in the descending , sigmoid colon ,and rectum.
2. The internal sphincter in the anus relaxes and defecation occurs by opening the extenal
sphincter.

Characristics of Feces
3. Feces ( Healthy People) soft , brown , moist and firmed , Distinct ordor
Factors affecting the ordor or appearance
Certain foods , Medications, illness or infection
 Abnormal Feces

 Black : tarry stool may indicate of bleeding from upper gastrointestinal

tract or drug .
 Red : may indicate of bleeding from lower gastrointestinal tract .
 Pale: may indicate to mal absorption .
 Greeen : may indicate intestinal infection .
 Dry hard: dehydration decreased intestinal motility .
 Pus: bacterial infection
Factors Promoting Elimination

 Stress free environment

 Ability to follow personal bowel habits , privacy
 High fiber diet
 Normal fluid intake ( fruit juice , warm liquids)
 Exercise ( walking )
 Ability to assume squatting position
 Properly administered laxatives
 Factors Impairing Elimination

 Emotional anxiety
 Failure to heed defecation reflex ,
 Lack of time and privacy
 High carbohydrates and high fat diet
 Reduced fluid intake
 Immobility and inactivity
 Overuse of cathartics narcotics analgesic
 Inability to squat because of immobility , musculoskeletal deformity ; pain during
defecation .
 Physical Assessment

 Inspection – observe contour of abdomen and note visible Peristalsis

 Auscultation – listen for bowel sounds in all quadrants
 Percussion – Resonant or tympany over hollow organs dullness over intestinal obstruction
 Palpation – Feel for masses , tenderness etc

Nursing Diagnosis
 Bowel incontinence related to facal impaction
 Risk for constipation insufficient fiber intake
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 Diarrhea related to spoiled food

 Self esteem disturbances related to bowel
Nursing Interventions to promote normal Bowel
Elimination
 privacy
 Timing – Patients should be encouraged to defecate when the urge to defecate is
recongized
 Nutrition and fluids – High fiber foods , 2000 cc fluid per day
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 Exercise – Ambulation helps to stimulate normal mobility and therefore should

be encouraged in post surgical patients
 Positioning – Comfortable position needed . Squatting position common .
Nursing interventions for constipation patients
 Increase fluid intake . Instruct the patient to drink fruid juices
 Include fibre in the diet with foods
 Administration of laxatives
 Admission of Enema
 Nursing intervations For patients With
diarrhea
 Encourage intake of food and fluids
 Eating small amount of bland food
 Avoid excessively hot or cold Fluids and and highly spicy food and high fiber food that can
aggravate diarrhea

Nursing intervations Of Fecap impaction

 Diet (Fibers , lactose and fructose)
 Reduce caffeine intake
 Anal hygiene / skin care
 Dugital removal of stool
 Plan and Implementation

 Promotion of regular bowel habbits

 Promotion of normal defecation
 Dogital removels of stool
 Maintenance of proper food and fluids
 Promtion of regular exercise

Intervations
 Cathatics / Laxatives : Drugs that include emptying of the interesting. Habitual
use of laxatives leads to constipation and irregular frequency.
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 Enemas : solution introduced into lower lower bowel by way of rectum for the
purpose of removing feces.
 Suppositories : bullet shaped substance inserted into the rectum beyond the anal
sphincter where it melts to aid in elimination .
 Digital removels – with prolonged retention of feces ,fecal impaction occurs
preventing passege of normal stool . Oil retention enema is given piror to digital
removel of sofften stool .
 Anatomy of Renal system

 The renal system is composed of

2 kidneys
2 ureters
1 urinary bladder
1 urethera
Structure of kidneys
Kidneys are pairs of organ
Shape : bean shaped Size : 11cm long ,5 cm wide ,3 cm thick .
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 Weight: 150 g
 Location : The kidneys are lie on the posterior abdominal wall ,
One on each side of the vertebral column .
 Position : It is situated at T 12 - L 3
 Longitudinal section of kidneys shows following parts
 capsule
 Cortex
 Medulla
 Hilium ( 3)
 Urinary system

 The urinary system consists of organs that produces and excretes urine from
body.
 Urine contians waste : mostly excess water , salts and nitrogen compounds .
 Primary organs are kidneys .
 Normal adult bladder can store UpTo .5 liters
 Also responsible for regulating blood volume and blood pressure.
 Regulates electrolytes.
 Urine

 The formation óf urine has 3 processess , filtration , reabsorption and tubular secretion .
 Urine consits of 95 % water and 5 % solid Substances .
 The need of urine to urinate is usually felt at 300 – 350 ml of urine in the bladder .
 Thypically 1000- 1500ml is voided daily.

Urination
 Micturation , voiding ,and urination all refer to the process of emptying the urinary
bladder
 Stretch receptors special sensory nerve endings in the bladder wall that is stimulated
when pressure is felt from the collection of urine Adult 250 – 450 ml children 50 – 200ml
 Factors affecting voiding

 Growth and development. Psychological factors

 Fluid and food intake Medication
 Muscle tone and activity Pathological conditions
 Surgical and diagnostic procedures
Common Urinary Elimination Problems
1. Urinaey retention
2. Urinary tract infection
3. Urinary incontinence
 Altered Urinary Elimination

Frequency : is the voiding more than normal with frequent intervals.

Nocturia : is voiding two or three times at night .
Urgency : is the feeling 9f person must void .
Dysuria : means voiding that is either painful or difficulty .
Enuresis : is defined as involuntary urination.
Urinary incontinence : involuntary urination . Systems not a disease .
Urine retention : accumulation of urine in the bladder and becomes over distended .
Hypospadias : is a birth congenital defect in which the opening of urethra is on the
underside of the pinus.
 Assessing Urinary Function

 Determine normal voiding pattern and frequency .

 Appearance of urine
 Recent changes .
 Past or current problems with urination ( burning , urgency etc )
 Presence of an ostomy
 Factors influencing elimination patterns .
 Assessment

ursinghistory
Voiding Pattern , description of urine for any Channing
Urinary Elimination Problems
Presence of Urinary diversion
Physical assessment ; inspection , palpation , percussion and auscultation

Assessing Urine
Color : transparent
Normal kidney produce urine at the rate of 40 – 60 ml / hour or 1500 -2000ml/ day
Sterility : no microorganisms
Glucose : not present
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 Blood : not present

 Epithelial cells not present
 Measuring urine output
 Collecting urine specimen .
Nursing Diagnosis
 Altered urinary Elimination related to bladder neck obstruction
 Stress incontinence related to relaxation of sphincter .
 Risk for infection related to Urinary retention
 Self easteem disturbances related to urinary incontinence
 Planning

 Maintain normal voiding pattern.

 Regain normal urine output.
 Prevent infection
 Maintaining normal urinary elimination.
 Promote fluid intake
 Assessing with toileting
 Practice frequent voiding process .....
 Strengthening pelvic floor muscles
 Manual bladder compression &kegal exercise.
 Managing urinary Incontinence

 Bladder training – requires that the clien5 postpone voiding,

resiat or inhibit the sensation urgency , and void according to
a timetable rather than according to urge to void . The goal is
to length6 the intervals between urination to correct the
Client’ s habit of frequent urination .
 Habit training : also referred to as timed voiding or
scheduled toileting . There is no attempt to motivate to client
to delay voiding is the urger occurs .
SUMMARY
Any Question
Thank you
Reference: KOZIER & ERB’S Fundamental Of Nursing By Audrey Berman,
Shirlee J. Snyder