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Elimination

CHAPTER 18

Pg 465-467

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Objectives

• Observe/record significant characteristics of normal urine– Amount– Color– Clarity– Odor

• Identify abnormal characteristics of urine• Identify nursing measures employed with a

patient unable to void

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Objectives

• List nursing measures related to the care of a patient w/ an indwelling catheter to straight drain

• Define “catheter care”

• Observe and record significant characteristics of normal stool– Color Consistency– Amount Odor

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Objectives • Identify abnormal characteristics of stool

– Blood– Mucus– Parasites

• List nursing measures used to promote normal patient elimination– Diet exercise– Fluid intake

• Define “sitz bath”; explain procedure/nursing measures

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Characteristics of Normal Urine and Urine Elimination

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Characteristics…• The normal kidney makes about 15-30 cc’s of

urine qh

• An average adult excretes 1000-1500 cc’s of urine qd

• Factors affecting urine production include:– Amount/type of fluid intake– Age, salt intake– Illness, medications, body temperature– Perspiration, external environment

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Characteristics…

• Urine is normally yellow to amber in color and should be clear w/ no particles

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Urinary patterns

• Frequency – early AM, q 2 – 12 hours, HS

• Factors affecting pattern:– Fluid intake, personal habits– Toilet availability, activity– Work, illness

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General Rules

• … for maintaining normal urinary elimination– Follow universal precautions– Provide assistance as needed (bedpan, urinal,

toilet)– Assume a normal position; don’t forget bedrails!– Provide privacy– Signal light, toilet paper w/in reach – Allow sufficient time

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Rules…

• If difficulty voiding run water, pour warm water over pubic area, place fingers/hand in warm water

• Provide washcloth, towel for peri-care as necessary; assist as necessary

• Offer bathroom, bedpan, urinal at regular intervals

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Observations

• …of urine– Color– Clarity– Amount– Presence of particles– C/O burning, pain, urgency, difficulty

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Urinary Incontinence

• …inability to control passage of urine from bladder– Types – stress (laughing, sneezing, etc.)– Factors – spinal cord injuries, CNS disorder,

aging, confusion, medication, weakened pelvic muscles R/T childbirth or surgery, infection

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Catheters, Catheter Care

• Catheters are rubber/plastic tubes used to drain urine from bladder

• Catheters may be irrigated by introduction of fluid into bladder

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Catheters, Catheter Care

• Indwelling catheters (Foley, retention) have a “balloon” to hold catheter in bladder and facilitate constant drainage of urine

• Straight catheters (red rubber, Robinson) have no “balloon” and are used for one time catheterization or to obtain a sterile urine specimen

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“Fundamentals” of Cath. Care• Universal Precautions• Drainage bag below level of bladder• Drainage tubing should be coiled to prevent

“dragging” of tubing• Tape catheter to inner thigh (female) or

abdominal area (male)• Drainage bag emptied at end of shift (I&O) or

prn• Report/document C/O, discomfort and

characteristics of urine

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Bladder Retraining

• … to develop voluntary control of urination; physician’s order required– Patient uses commode, toilet, urinal at intervals– Patient’s with catheters, catheter is clamped,

released at intervals

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Urine Specimen

• Universal precautions/Medical asepsis

• Sterile/clean container

• Label container accurately

• Keep inside of container sterile/clean

• Collect specimen at specified time

• Must be free of feces and toilet tissue

• Specimen to lab ASAP

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Characteristics of Normal Stool and Stool Elimination

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Characteristics…

• Brown in color

• Soft, formed, shaped like rectum

• Frequency – individualized, usually qd, q 2 – 3 days

• Odor related to bacterial action in intestine

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Observations

• …to report– Color, amount, consistency, odor

• Watery unformed stool indicated diarrhea

• Hard, dry stool indicated constipation

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Factors Affecting Bowel Elimination

• Lack of privacy

• Diet

• Fluids

• Activity

• Medication

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Common Problems of Defecation

• Constipation - passage of hard, dry, stool

• Fecal impaction – prolonged retention, accumulation of feces in rectum

• Diarrhea – frequent passage of loose, watery stool

• Anal (fecal) incontinence – inability to control passage of feces, gas through anus

• Flatulence – having gas, air in intestine

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Comfort/Safety Measures

• Provide bedpan, assist to commode or toilet upon request

• Provide privacy

• Position in normal sitting position – don’t forget bedrails

• Keep client warm, allow time for defecation

• Signal light, TP w/ reach

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Comfort/Safety…

• Stay in room, offer assistance as needed

• Hygiene measures, dispose of feces ASAP

• Offer bedpan, bathroom after meals if client is often incontinent

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Bowel Retraining

• …gaining control of bowel movement, developing regular elimination patterns– Toilet w/ urge (usually after meal, especially

breakfast)– High fiber diet– Increase fluids (2500-3000 cc qd)– Increase activity– Suppository may be ordered to stimulate defeca-

tion

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Rectal Tubes

• …inserted into rectum to relieve flatulence

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Colostomy

• …surgical creation of artificial opening be-tween colon and abdomen– May be permanent or temporary– Stool consistency depends on colostomy

location– Appliance is worn by patient– Odor control is achieved w/ good hygiene,

deodorant

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Ileostomy

• …surgical creation of artifical opening be-tween ilium and abdomen– Liquid feces– Appliance worn by patient– Feces is irritating to skin– Good hygiene, good skin care are necessary

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Stool Specimen

• …feces sample sent to laboratory; studied for fat, microorganisms, worms, other abnormal contents– Universal precautions/Medical asepsis– Specimen must not be contaminated w/ urine– Specimen properly labeled, sent to lab ASAP

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Sitz Bath

• Given to sooth/cleanse rectal area

• May be warm tap water or medicated bath

• Ordered after…– Rectal surgery– Child birth– hemorrhoids