1 Elimination CHAPTER 18 Pg

2 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

3 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 –ColorConsistency –AmountOdor

4 Objectives Identify abnormal characteristics of stool –Blood –Mucus –Parasites List nursing measures used to promote normal patient elimination –Dietexercise –Fluid intake Define “sitz bath”; explain procedure/nursing measures

5 Characteristics of Normal Urine and Urine Elimination

6 Characteristics… The normal kidney makes about cc’s of urine qh An average adult excretes 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

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

8 Urinary patterns Frequency – early AM, q 2 – 12 hours, HS Factors affecting pattern: –Fluid intake, personal habits –Toilet availability, activity –Work, illness

9 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

10 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

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

12 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

13 Catheters, Catheter Care Catheters are rubber/plastic tubes used to drain urine from bladder Catheters may be irrigated by introduction of fluid into bladder

14 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

15 “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

16 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

17 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

18 Characteristics of Normal Stool and Stool Elimination

19 Characteristics… Brown in color Soft, formed, shaped like rectum Frequency – individualized, usually qd, q 2 – 3 days Odor related to bacterial action in intestine

20 Observations …to report –Color, amount, consistency, odor Watery unformed stool indicated diarrhea Hard, dry stool indicated constipation

21 Factors Affecting Bowel Elimination Lack of privacy Diet Fluids Activity Medication

22 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

23 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

24 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

25 Bowel Retraining …gaining control of bowel movement, developing regular elimination patterns –Toilet w/ urge (usually after meal, especially breakfast) –High fiber diet –Increase fluids ( cc qd) –Increase activity –Suppository may be ordered to stimulate defeca- tion

26 Rectal Tubes …inserted into rectum to relieve flatulence

27 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

28 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

29 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

30 Sitz Bath Given to sooth/cleanse rectal area May be warm tap water or medicated bath Ordered after… –Rectal surgery –Child birth –hemorrhoids