Chapter 39 Elimination Copyright 2011 Delmar Cengage Learning

Physiology of Elimination • Urinary – Continence • Integrity of urinary system • Nervous

Urinary Elimination • Structures of urinary tract: – Upper urinary tract – Lower urinary

Bowel Elimination • Structures of gastrointestinal tract • Intestinal motility and rectal accommodation •

Factors Affecting Elimination • • Age Diet Exercise Medications Copyright © 2011 Delmar, Cengage

Common Alterations in Elimination • Urinary – Acute urinary incontinence – Chronic urinary incontinence

Common Alterations in Elimination • Bowel – Constipation – Diarrhea – Fecal incontinence Copyright

Elimination and the Nursing Process • Assessment – Health history – Physical examination –

Elimination and the Nursing Process • Diagnosis – – – Impaired urinary elimination Stress

Elimination and the Nursing Process • Diagnosis – – – Urinary retention Constipation Perceived

Elimination and the Nursing Process • Planning and outcome identification – NOC for continence

Elimination and the Nursing Process • Implementation – Maintain elimination health • Fluid intake

Elimination and the Nursing Process • Implementation – Maintain elimination health • Elimination habits

Elimination and the Nursing Process • Implementation – Initiate exercise regimen • • Improves

Elimination and the Nursing Process • Implementation – Initiate behavioral interventions – Monitor skin

Elimination and the Nursing Process • Implementation – Initiate diet and fluid therapy –

Elimination and the Nursing Process • Implementation – Initiate rectal stimulation – Monitor elimination

Elimination and the Nursing Process • Evaluation – Elimination patterns • Level of maintenance

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