Chapter 39 Elimination Fundamentals of Nursing: Standards & Practices, 2E

 Copyright 2002 by Delmar, a division of Thomson Learning 39-2 Physiology of Elimination  Urinary Elimination Continence requires anatomic integrity of the urinary system, nervous control of the detrusor muscle, and competent sphincter mechanism.

 Copyright 2002 by Delmar, a division of Thomson Learning 39-3 Urinary incontinence occurs when abnormalities of one or more factors causes an uncontrolled loss or urine that produces social, physiological, or hygienic difficulties.

 Copyright 2002 by Delmar, a division of Thomson Learning 39-4 Structures of the Urinary Tract  Upper Urinary Tract  Lower Urinary Tract Nervous Control of the Detrusor Muscle Urethral Sphincter Mechanism

 Copyright 2002 by Delmar, a division of Thomson Learning 39-5 Bowel Elimination  Bowel Elimination Structures of the Gastrointestinal Tract Intestinal Motility and Rectal Accommodation Anal Sphincter Mechanism

 Copyright 2002 by Delmar, a division of Thomson Learning 39-6 Factors Affecting Elimination  Age  Diet  Exercise  Medications

 Copyright 2002 by Delmar, a division of Thomson Learning 39-7 Common Alterations in Elimination  Urinary Elimination Acute Urinary Incontinence Chronic Urinary Incontinence Urinary Retention Review Tables 39-1, 39-2, and 39-3 on causes of incontinence and retention.

 Copyright 2002 by Delmar, a division of Thomson Learning 39-8 Common Alterations in Elimination  Bowel Elimination Constipation Diarrhea Fecal Incontinence Review Table 39-4 on health history questions for clients with altered elimination.

 Copyright 2002 by Delmar, a division of Thomson Learning 39-9 Assessment  Health History  Physical Examination  Diagnostic and Laboratory Data  Review Table 39-5: Questions for Clients with Altered Patterns of Urinary Elimination.

 Copyright 2002 by Delmar, a division of Thomson Learning Nursing Diagnosis  Altered Urinary Elimination  Stress Incontinence  Reflex Incontinence  Urge Incontinence  Functional Incontinence  Total Incontinence

 Copyright 2002 by Delmar, a division of Thomson Learning  Urinary Retention  Constipation  Perceived Constipation  Diarrhea  Bowel Incontinence

 Copyright 2002 by Delmar, a division of Thomson Learning Outcome Identification and Planning  Expected outcome criteria include Restore and maintain regular elimination habits. Prevent complications such as infections and altered skin integrity.

 Copyright 2002 by Delmar, a division of Thomson Learning Implementation  Maintain Elimination Health Fluid Intake Lifestyle and Prevention Elimination Habits Positioning Review Procedure 39-1on positioning and removing a bedpan

 Copyright 2002 by Delmar, a division of Thomson Learning  Initiate exercise regimen. Regular exercise leads to good muscle tone and body metabolism. Exercise stimulates the bowels to move regularly and leads to good urine production.  Suggest environmental modifications.

 Copyright 2002 by Delmar, a division of Thomson Learning  Initiate behavioral interventions.  Monitor skin integrity.  Apply a Containment Device Condom Catheter Incontinent and Dribble Pads Rectal Pouch and Rectal Tube Review Procedure 39-2 on applying a condom catheter.

 Copyright 2002 by Delmar, a division of Thomson Learning  Initiate Diet and Fluid Therapy  Administer Medications  Review Table 39-7: Common Anticholinergic/Antispasmodic Medications.

 Copyright 2002 by Delmar, a division of Thomson Learning  Perform Catheterization Intermittent Self-Catheterization Review Procedure 39-3 on performing urinary catheterization on a male client. Review Procedure 39-4 on performing urinary catheterization on a female client. Review Procedure 39-5 on irrigating an open catheter.

 Copyright 2002 by Delmar, a division of Thomson Learning Review Procedure 39-6 on irrigating a closed catheter.  Administer Enemas Review Table 39-8 on types of enemas. Review Procedure 39-7 on administering a large enema. Review Procedure 39-8 on administering a small (mini-) enema.

 Copyright 2002 by Delmar, a division of Thomson Learning  Initiate Rectal Stimulation  Monitor Elimination Diversions Urinary Diversions Bowel Diversions  Monitor Surgical Management Review Procedure 39-9 on changing a colostomy pouch.  Complementary Therapies

 Copyright 2002 by Delmar, a division of Thomson Learning Evaluation  Client’s level of maintenance or restoration of elimination patterns, and return to an appropriate level of independence are indicators of success.