Transcript Unit 16 Elimination

Elimination
CHAPTER 18
Pg 465-467
1
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
2
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
– Color
– Amount
Consistency
Odor
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Objectives
• Identify abnormal characteristics of stool
– Blood
– Mucus
– Parasites
• List nursing measures used to promote
normal patient elimination
– Diet
– Fluid intake
exercise
• Define “sitz bath”; explain procedure/nursing
measures
4
Characteristics of Normal Urine
and Urine Elimination
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Characteristics…
• The normal kidney makes about 15-30 cc’s of
urine qh
• An average adult excretes 1000-1500 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
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Characteristics…
• Urine is normally yellow to amber in color
and should be clear w/ no particles
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Urinary patterns
• Frequency – early AM, q 2 – 12 hours, HS
• Factors affecting pattern:
– Fluid intake, personal habits
– Toilet availability, activity
– Work, illness
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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
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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
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Observations
• …of urine
– Color
– Clarity
– Amount
– Presence of particles
– C/O burning, pain, urgency, difficulty
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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
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Catheters, Catheter Care
• Catheters are rubber/plastic tubes used to
drain urine from bladder
• Catheters may be irrigated by introduction
of fluid into bladder
13
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
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“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
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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
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Urine Specimen
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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
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Characteristics of Normal Stool
and Stool Elimination
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Characteristics…
• Brown in color
• Soft, formed, shaped like rectum
• Frequency – individualized, usually qd, q 2 –
3 days
• Odor related to bacterial action in intestine
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Observations
• …to report
– Color, amount, consistency, odor
• Watery unformed stool indicated diarrhea
• Hard, dry stool indicated constipation
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Factors Affecting Bowel Elimination
• Lack of privacy
• Diet
• Fluids
• Activity
• Medication
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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
22
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
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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
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Bowel Retraining
• …gaining control of bowel movement,
developing regular elimination patterns
– Toilet w/ urge (usually after meal, especially
breakfast)
– High fiber diet
– Increase fluids (2500-3000 cc qd)
– Increase activity
– Suppository may be ordered to stimulate defecation
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Rectal Tubes
• …inserted into rectum to relieve flatulence
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Colostomy
• …surgical creation of artificial opening between 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
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Ileostomy
• …surgical creation of artifical opening between ilium and abdomen
– Liquid feces
– Appliance worn by patient
– Feces is irritating to skin
– Good hygiene, good skin care are necessary
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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
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Sitz Bath
• Given to sooth/cleanse rectal area
• May be warm tap water or medicated bath
• Ordered after…
– Rectal surgery
– Child birth
– hemorrhoids
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