ELIMINATIONP&A

QUICK ANATOMY MOMENT

Kidneys

Ureters

Bladder

Urethra

NORMAL URINE

Volume – approx 250ml-400ml per void - normal production 30ml/hour

-1200-1500cc for average adult per 24 hours

- 500-600 newborns

Color light yellow

Clarity clear without sediment

Odor no odor

FACTORS AFFECTING URINATION

Fluid Intake – influences output and frequency

Hypovolemia- loss of fluid

Nutrition – food content, salt, ETOH, caffeine

Body position – work with gravity

Cognition – dementia/confusion, stroke

FACTORS AFFECTING URINATION (CONT.)

Psychological factors – stress, running water, warm water, privacy

Obstruction – anatomical, disease process

Infection – E. coli

Medications – diuretics

ALTERED URINARY FUNCTION

Dysuria

Polyuria

Oliguria

Urgency

Frequency

ALTERED URINARY FUNCTION (CONT.)

Nocturia

Hematuria

Pyuria

Urinary retention

INCONTINENCE

Stress increased abdominal pressure Functional unable to get to bathroom Total continuous, involuntary

DIAGNOSTICS

Random specimen - does not need to be

sterile

- into container or nun’s

cap

Clean catch - sterile

- three wipes

DIAGNOSTICS (CONT.)

24 hour -kidney function

- must include all urine

- timing

Catheter sample - sterile

- straight cath or indwelling

COLLECTING URINE FROM YOUNG CHILDREN

Catheterization not recommended

Use of collection bag

TESTS Specific gravity - weight or concentration of urine compared to water

- urinometer

- normal adult 1.010 – 1.025

Reagant strips - dipped in urine

- measures substances in urine such as

glucose, proteins &

ketones

TESTS (CONT)

Urinalysis - most common - 20cc-30cc sample

Urine C&S - identify microorganisms - 24 to 48 hours - often related to antibiotic use

URINARY HEALTH PROMOTION

Intake

UTI’s

Muscle tone

URINARY CATHETERS Indications -inability to void, accurate measurement, irrigation,

comfort

Types - straight, indwelling (Foley), triple lumen

Risks - infection, trauma

STRAIGHT CATHETERIZATION Wash hands Check pt ID Explain procedure Position patient Open kit Bottom drape Sterile gloves Top drape Pour betadine on cotton balls Open lubricant Nondominant vs dominant hands Insert and advance Sample if needed Reposition patient, remove gloves,

wash hands document

INDWELLING CATHETERIZATION Wash hands Check pt ID Explain procedure Position patient Open kit Bottom drape Sterile gloves Top drape Test balloon Pour betadine on cotton balls Open lubricant Nondominant vs dominant hands Insert, advance & inflate balloon Sample if needed Reposition patient, strap to leg,

remove gloves, wash hands document

INDWELLING CATHETER (FOLEY)

NURSING RESPONSIBILITIES

Placement and removal

Assessment

Sample collection

Troubleshoot

Irrigate when needed

BLADDER IRRIGATION

OTHER TYPES OF URINARY CATHETERS

Suprapubic Nephrostomy tubes

Condom Catheter

OTHER RELATED URINARY COMPONENTS DialysisHemodialysis

Peritoneal dialysis

Bladder scanner

BOWEL ELIMINATION

FACTORS AFFECTING BOWEL ELIMINATION Nutrition - fiber

- lactose intolerant

- gluten

Fluid intake - 75% water

- ↓fluid intake

Hemorrhoids - enlarged varicose veins

Medication - narcotics

- Fe

- antacids

ALTERED BOWEL FUNCTION Constipation - infrequent, painful, hard, dry

Fecal impaction - accumulation in rectum

- digital disimpaction

Diarrhea - ↑ motility

- medication

Incontinence - involuntary

Distention - inactivity

Disease process - Crohn’s disease, Cystic Fibrosis

DIAGNOSTIC TESTS Specimen

- stool only

- procedure

Occult blood

- Guaiac or Hemoccult

- procedure

Culture

- atypical intestinal organisms

- procedure, O&P

Radiologic - x-ray image of opaque

substance

- barium, laxatives, enemas, NPO

Endoscopy

- visualization of internal structures

-EGD (esophagogastro duodenoscopy)

http://www.youtube.com/watch?v=_qrbzpDA98g&feature=related

SPECIMENS

CHECKING FOR OCCULT BLOOD http://www.youtube.com/watch?v=Pc3MtqUw

FwE

COLONOSCOPY http://www.youtube.com/watch?v=W0fjO0rsC

Iw

ENEMA Purpose – cleansing of large bowel

Small Volume - commercially prepared, oil or water, approx. 150cc

Large Volume - warm tap water or saline,

- 1000cc for adult, 240cc-350cc for child, 15cc-60cc infant

Return Flow - flatus

- 300cc-500cc

- repeat as necessary

ENEMA PROCEDURE

Wash hands ID patient and explain procedure Fill bag with fluid Place patient in left lateral position Place chux Insert lubricated end of enema tubing 3-4

inches into rectum Hang/hold enema bag 12-18 inches above

patient Place on bedpan or BSC or eventually

bathroom Make patient comfortable Wash hands Document

FECAL DIVERSION Procedure

Ostomy

Ileostomy

Colostomy - temporary or permanent

- irrigation

- clothing

- unusual circumstances

STOMA

TYPES OF COLOSTOMIES Ascending Descending

Sigmoid

TYPES OF COLOSTOMIES (CONT.)

Transverse

CARE OF THE COLOSTOMY Assessment - pink, no pain, flush to skin

Cleaning - soap and water

Bag changing - disposable vs reusable

Emotional support

COVER UP