chapter 39 elimination fundamentals of nursing: standards & practices, 2e
TRANSCRIPT
Chapter 39
Elimination
Fundamentals of Nursing: Standards & Practices, 2E
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Physiology of Elimination
Urinary Elimination• Continence requires anatomic integrity
of the urinary system, nervous control of the detrusor muscle, and competent sphincter mechanism.
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• Urinary incontinence occurs when abnormalities of one or more factors causes an uncontrolled loss or urine that produces social, physiological, or hygienic difficulties.
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• Structures of the Urinary Tract Upper Urinary Tract Lower Urinary Tract
• Nervous Control of the Detrusor Muscle
• Urethral Sphincter Mechanism
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Bowel Elimination
Bowel Elimination• Structures of the Gastrointestinal Tract• Intestinal Motility and Rectal
Accommodation• Anal Sphincter Mechanism
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Factors Affecting Elimination
AgeDietExerciseMedications
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Common Alterations in Elimination
Urinary Elimination• Acute Urinary Incontinence• Chronic Urinary Incontinence• Urinary Retention• Review Tables 39-1, 39-2, and 39-3 on
causes of incontinence and retention.
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Common Alterations in Elimination
Bowel Elimination• Constipation• Diarrhea• Fecal Incontinence• Review Table 39-4 on health history
questions for clients with altered elimination.
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Assessment
Health HistoryPhysical ExaminationDiagnostic and Laboratory DataReview Table 39-5: Questions for
Clients with Altered Patterns of Urinary Elimination.
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Nursing Diagnosis
Altered Urinary EliminationStress IncontinenceReflex IncontinenceUrge IncontinenceFunctional IncontinenceTotal Incontinence
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Urinary RetentionConstipationPerceived ConstipationDiarrheaBowel Incontinence
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Outcome Identification and Planning
Expected outcome criteria include• Restore and maintain regular
elimination habits.• Prevent complications such as
infections and altered skin integrity.
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Implementation
Maintain Elimination Health• Fluid Intake• Lifestyle and Prevention• Elimination Habits• Positioning• Review Procedure 39-1on positioning
and removing a bedpan
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Initiate exercise regimen.• Regular exercise leads to good muscle
tone and body metabolism.• Exercise stimulates the bowels to
move regularly and leads to good urine production.
Suggest environmental modifications.
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Initiate behavioral interventions.Monitor skin integrity.Apply a Containment Device
• Condom Catheter• Incontinent and Dribble Pads• Rectal Pouch and Rectal Tube• Review Procedure 39-2 on applying a
condom catheter.
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Initiate Diet and Fluid TherapyAdminister MedicationsReview Table 39-7: Common
Anticholinergic/Antispasmodic Medications.
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Perform Catheterization• Intermittent Self-Catheterization• Review Procedure 39-3 on performing
urinary catheterization on a male client.• Review Procedure 39-4 on performing
urinary catheterization on a female client.• Review Procedure 39-5 on irrigating an
open catheter.
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• Review Procedure 39-6 on irrigating a closed catheter.
Administer Enemas• Review Table 39-8 on types of enemas.• Review Procedure 39-7 on administering
a large enema.• Review Procedure 39-8 on administering
a small (mini-) enema.
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Initiate Rectal StimulationMonitor Elimination Diversions
• Urinary Diversions• Bowel Diversions
Monitor Surgical Management• Review Procedure 39-9 on changing a
colostomy pouch.Complementary Therapies
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Evaluation
Client’s level of maintenance or restoration of elimination patterns, and return to an appropriate level of independence are indicators of success.