1. Alterations in Elimination GI Elimination Urinary Elimination

2. Alterations in Elimination Normal Position Thigh Flexion

3. Factors affecting GI Elimination Age Young Elderly smooth muscle tone of colon Abdominal muscle tone Anal sphincter control

4. Factors affecting GI Elimination Diet Bulk/fiber intake Digestion Spicy foods Eating schedules/routines

5. Factors affecting GI Elimination Fluid Intake 2000 – 3000 ml/day Mobility/Immobility Psychological Consideration Life-style Considerations Early bowel training Availability of toilet facilities Embarrassment Privacy issues Time management

6. Factors affecting GI Elimination Medications side effects GI medications Diagnostic Procedures Preparing the pt Barium studies

7. Factors affecting GI Elimination Anesthesia and Surgery Abdominal surgery Paralytic ileus Pathologic conditions altered sensory stimulation/sensation Impaired mobility/decreased physical strength/stamina

8. Factors affecting GI Elimination Irritants Pain

9. Common GI Elimination Problems Constipation **Always identify the client’s normal bowel elimination pattern**

10. Constipation: contributing factors Irregular defecation habits Laxative abuse/enema abuse Psychological stress Diet Fluid intake Age Disease processes

11. Constipation: complications of Bowel obstruction Vagal Response Fecal impaction Hemorrhoids

12. Constipation: Treatment Medications Fluid intake Diet Activity Prevention

13. Common GI Elimination Problems Diarrhea Treatment Complications

14. Common GI Elimination Problems Bowel incontinence Flatulence Treatment: Position »side lying for rectal tube »Prone with knees flexed under abdomen

15. Flatulence: Treatment Decreased amt of swallowed air: Carbonated beverages Straws Gum Hard candies NGT for decompression of abdomen

16. Common GI Elimination Problems Hemmorrhoids (piles)

19. Nursing Process

20. Factors Affecting Urinary Elimination Growth and Development Young Elderly Psychosocial factors privacy “normal position” sufficient time running water

21. Factors Affecting Urinary Elimination Fluid/food intake Medications Muscle tone/immobility Pathologic conditions Surgical/diagnostic procedures

22. Common Urinary Elimination Problems Definition of normal: 30 ml/hour 45 ml in 5 hours 200 ml in 2 hours How much is “normal” for each voiding? What would be abnormal?

23. Common Urinary Elimination Problems Voiding Patterns Polyuria diuresis Large fluid intake, ingestion of diuretic Other s/s: polydipsia dehydration wt loss BP changes

24. Common Urinary Elimination Problems Oliguria and anuria etiology: low fluid intake*** Renal, Cardiac Pathology Frequency and nocturia etiology: fluid intake UTI Pregnancy Renal pathology Diuretic therapy

25. Common Urinary Elimination Problems Urgency Etiology: UTI Decreased perineal muscle tone Dysuria Etiology: UTI, urinary catherization

26. Urinary Incontinence Total Stress Urge, Functional Reflex*** Urinary retention with overflow**

27. Common Urinary Elimination Problems Neurogenic Bladder Urinary retention tx: »normal position, running water, etc. »catherize