1. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Chapter 39 Elimination

2. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Physiology of Elimination Urinary –Continence Integrity of urinary system Nervous control of detrusor muscle Competent sphincter mechanism –Incontinence Uncontrolled loss of urine

3. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Urinary Elimination Structures of urinary tract: –Upper urinary tract –Lower urinary tract Nervous control of detrusor muscle Urethral sphincter mechanism

4. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Bowel Elimination Structures of gastrointestinal tract Intestinal motility and rectal accommodation Anal sphincter mechanism

5. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Factors Affecting Elimination Age Diet Exercise Medications

6. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Common Alterations in Elimination Urinary –Acute urinary incontinence –Chronic urinary incontinence Stress Instability Functional Extraurethral –Urinary retention (continued)

7. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Common Alterations in Elimination Bowel –Constipation –Diarrhea –Fecal incontinence

8. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Elimination and the Nursing Process Assessment –Health history –Physical examination –Diagnostic and laboratory data (continued)

9. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Elimination and the Nursing Process Diagnosis –Impaired urinary elimination –Stress urinary incontinence –Reflex urinary incontinence –Urge urinary incontinence –Functional urinary incontinence –Total urinary incontinence (continued)

10. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Elimination and the Nursing Process Diagnosis –Urinary retention –Constipation –Perceived constipation –Diarrhea –Bowel incontinence –Other diagnoses (continued)

11. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Elimination and the Nursing Process Planning and outcome identification –NOC for continence and elimination: Urinary continence –Control of elimination of urine from bladder Urinary elimination –Collection and discharge of urine (continued)

12. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Elimination and the Nursing Process Planning and outcome identification –NOC for continence and elimination: Bowel continence –Control of passage of stool from bowel Bowel elimination –Formation and evacuation of stool (continued)

13. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Elimination and the Nursing Process Implementation –Maintain elimination health Fluid intake Diet Lifestyle and prevention –Alcohol and tobacco use –Stress management (continued)

14. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Elimination and the Nursing Process Implementation –Maintain elimination health Elimination habits Positioning (continued)

15. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Elimination and the Nursing Process Implementation –Initiate exercise regimen Improves muscle tone Increases metabolism Stimulates bowels Leads to good urine production –Suggest environmental modifications (continued)

16. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Elimination and the Nursing Process Implementation –Initiate behavioral interventions –Monitor skin integrity –Apply containment device Condom catheter Incontinent and dribble pads Rectal pouch and rectal tube (continued)

17. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Elimination and the Nursing Process Implementation –Initiate diet and fluid therapy –Administer medications –Perform catheterization Intermittent self-catheterization –Administer enemas (continued)

18. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Elimination and the Nursing Process Implementation –Initiate rectal stimulation –Monitor elimination diversions Urinary Bowel –Monitor surgical management –Employ complementary therapies (continued)

19. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Elimination and the Nursing Process Evaluation –Elimination patterns Level of maintenance Restoration –Return to independence –Ongoing process