ELIMINATION URINARY ELIMINATION ANATOMY AND PHYSIOLOGY ANATOMY FEMALE

ELIMINATION

URINARY ELIMINATION • ANATOMY AND PHYSIOLOGY

ANATOMY • FEMALE STRUCTURES • MALE STRUCTURES

URINE • 96% WATER • 4% SOLUTES – ORGANIC SOLUTES • • UREA* AMMONIA CREATININE URIC ACID – INORGANIC SOLUTES • • • SODIUM (Na) CHLORIDE (Cl) MAGNESIUM (Mg) PHOSPHORUS (Phos) SODIUM CHLORIDE (Na. Cl)*

• • • FACTORS AFFECTING URINARY ELIMINATION Fluid Diet Response to urge Stress Psychosocial factors Activity Pathological conditions Medications Developmental level Medical Diagnosis or Surgery

ALTERATIONS IN URINARY ELIMINATION • Urinary Retention • Urinary Incontinence – – – functional reflex stress total urge • Enuresis – nocturnal enuresis – diurnal enuresis

ALTERATIONS CONT. • • Nocturia Frequency Urgency Dysuria Hesitancy Polyuria Suppression – anuria – oliguria

DIAGNOSTIC TEST • • • Culture and sensitivity KUB IVP Cystoscopy Blood test – BUN (7 -18 mg/dl) – Creatinine (. 6 -1. 2 mg/dl) • Urinalysis (type of specimens)

ASSESSMENT OF URINATION • • • frequency amount color odor character specific gravity ph abnormal constituents discomfort

NURSING INTERVENTIONS TO PROMOTE U. E. • • intake & output position hygiene privacy sitz catheterize medications kegel’s exercise

CATHETERIZATION • • STRAIGHT RETENTION OR FOLEY QUICK CATH LUMENS – SINGLE-STRAIGHT – DOUBLE-RETENTION – TRIPLE-IRRIGATION

SIZE OF CATHETERS • • • RANGE FROM # 8 -24 CHILD # 8 -10 FEMALE # 14 -16 MALE # 16 -18 TURP # 22 -24 BALLOONS 5 -30 cc

Nursing Interventions • • Insertion of catheters Maintenance of caths Specimens from caths Removing catheters Irrigation procedure Residual urine Suprapubic catheters

URINARY DIVERSION • • • Cutaneous Ureterostomy Ileal Conduit Ureterosigmoidostomy Ureteroileosigmoidostomy Kock Pouch (Continent Vesicostomy)

NURSING DIAGNOSES • • • ALTERED URINARY ELIMINATION INCONTINENCE URINARY RETENTION PAIN BODY IMAGE DISTURBANCE

BOWEL ELIMINATION

ANATOMY • • • Small intestine (ileum) Ileocecal valve Cecum Ascending Transverse Descending Sigmoid Rectum Anus

PHYSIOLOGY • • Peristalsis Water absorption Storage Secretion of mucus

DEFECATION • Parasympathetic reflex • Defecation reflex • Assessment of stool – – – pattern color consistency/shape blood Odor • Bowel Diversions – Stoma, drainage, skin condition

FACTORS AFFECTING BE • • Age Diet / Fluids Exercise Stress Schedule Medications Environment • • • Anesthesia/Surgery Diagnostic Test Pathology Irritants Pain

ALTERED BE • Constipation • Fecal Impaction • Diarrhea • Incontinence • Flatulence • Hemorrhoids

DIAGNOSTIC TEST • • • Guaiac test Hematest Hemoccult Proctoscopy Proctosignoidoscopy Colonoscopy

PHYSICAL ASSESSMENT • Inspection – Four quadrants – Nine regions • Auscultation • Percussion • Palpation

MEDICATIONS • Cathartics (laxative) – – – Bulk forming Lubricant Wetting agent Stimulant/irritant Saline • Suppository • Enema – Cleansing – Hypertonic – Oil – – Carminative Return Flow Cooling Medication

ENEMA ADMINISTRATION • PROCEDURE – HIGH VS. LOW – AGE – POSITION • SOLUTIONS – HYPOTONIC – HYPERTONIC – ISOTONIC – VOLUME CONSIDERATION

BOWEL DIVERSIONS • • Ileostomy Ascending Colostomy Transverse Colostomy Descending Colostomy

TYPES OF CONSTRUCTION • • • Loop Double Barrel End Temporary Permanent

NURSING INTERVENTIONS • • • Psychological needs Nutritional needs Hygiene needs Maintenance Teaching

SPECIMEN COLLECTION • Urine – Midstream – Sterile/Culture – 24 hour – Drug • Stool – Blood/Parasite • Technique • Documentation

NURSING DIAGNOSES • • • CONSTIPATION DIARRHEA INCONTINENCE ALTERED ELIMINATION BODY IMAGE DISTURBANCE

THE END!!!