Bowel-and-Bladder-Elimination by ashrafp

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									    Urinary Elimination
         The urinary system:

             •   Removes waste products from the blood

             •   Maintains the body’s water balance

   NORM AL URINATION
         The healthy adult produces about 1500 ml (milliliters) or 3 pints of urine a day.
         Factors affecting urine production include:

             •   Age

             •   Disease

             •   Amount and kinds of fluid ingested

             •   Dietary salt

             •   Body temperature and perspiration

             •   Drugs
         Frequenc y of urination is affected by:

             •   The amount of fluid intake, habits, and available toilet facilities

             •   Activity, work, and illness
         The person’s elimination needs are assessed.

             •   A care plan is developed to ensure that these needs are met.
         Normal urine:

             •   Is pale yellow, straw-colored, or amber

             •   Is clear with no particles

             •   Has a faint odor
         Observe urine for color, clarity, odor, amount, and particles.
         Bedpans are used by:

             •   Persons who cannot be out of bed

             •   W omen for voiding and bowel movements

             •   Men for bowel movements


         Fracture pans are used:
            •   By persons with casts

            •   By persons in traction

            •   By persons with limited back motion

            •   After spinal cord injury or surgery

            •   After a hip fracture

            •   After hip replacement surgery
        Men use urinals to void.

            •   The man stands if possible.

            •   Some sit on the side of the bed.

            •   The man may lie in bed.

            •   Some men need support when standing.

            •   You may have to place and hold the urinal for some.
        Persons unable to walk to the bathroom often use commodes.

            •   Some commodes are wheeled into bathrooms and placed over toilets.

   URINARY INCONTINENCE
        The basic types of incontinence are:

            •   Stress incontinence

            •   Urge incontinence

            •   Overflow incontinence

            •   Functional incontinence

            •   Reflex incontinence

            •   Mixed incontinence
        If incontinence is a new problem, tell the nurse at once.
        The following may be needed:

            •   Good skin care and dry garments and linens

            •   Promoting normal urinary elimination

            •   Bladder training

            •   Catheters
            •   Incontinence products to help keep the person dry
        Incontinence is linked to abuse, mistreatment, and neglect.

            •   Remember, incontinence is beyond the person’s control.

            •   If you find yourself becoming short-tempered and impatient, talk to the nurse at once.

            •   The person has the right to be free from abuse, mistreatment, and neglect.
        Persons with dementia may:

            •   Void in the wrong places

            •   Remove incontinence products and throw them on the floor or in the toilet

            •   Resist staff efforts to keep them clean and dry

   CATHETERS
        Inserted through the urethra into the bladder, a urinary catheter drains urine.

            •   A straight catheter drains the bladder and then is removed.

            •   An indwelling catheter (retention or Foley catheter) is left in the bladder.
        Catheterization is the process of inserting a catheter.


        Catheters are used for the following reasons:

            •   Before, during, and after surgery

            •   For people too weak or disabled to use the bedpan, urinal, commode, or toilet

            •   To protect wounds and pressure ulcers from contact with urine

            •   To allow hourly urinary output measurements

            •   As a last resort for incontinence

            •   For diagnostic purposes
        You will care for persons with indwelling catheters.
        Drainage s ystems

            •   A closed drainage s ystem is used for indwelling catheters.
                     Nothing can enter the system from the catheter to the drainage bag.
            •   Some people wear leg bags when up.

            •   The drainage bag is always lower than the bladder.
        If a drainage s ystem is disconnected accidentally:
            •   Tell the nurse at once.

            •   Do not touch the ends of the catheter or tubing.

            •   Practice hand hygiene and put on gloves.

            •   W ipe the end of the tube with an antiseptic wipe.

            •   W ipe the end of the catheter with another antiseptic wipe.

            •   Do not put the ends down.

            •   Do not touch the ends after you clean them.

            •   Connect the tubing to the catheter.

            •   Discard the wipes into a biohazard bag.

            •   Remove the gloves and practice hand hygiene.
        Leg bags are changed to drainage bags when the person is in bed.
        Drainage bags are emptied and measured:

            •   At the end of every shift

            •   W hen changing from a leg bag to a drainage bag

            •   W hen changing from a drainage to a leg bag

            •   W hen the bag is becoming full
        To apply condom catheters (external catheters, Texas catheters, urinary sheaths):

            •   Follow the manufacturer’s instructions.

            •   Thoroughly wash the penis with soap and water.

            •   Dry the penis before applying the catheter.

            •   Condom catheters are self-adhering or applied with elastic tape.

            •   Never use adhesive tape to secure catheters.

   THERE ARE TWO BASIC TYPES OF BLADDER TRAINING


        The person uses the toilet, commode, bedpan, or urinal at certain times.

            •   The person is given 15 or 20 minutes to start voiding.

            •   The rules for normal elimination are followed.
        The person has a catheter.
             •   The catheter is clamped to prevent urine flow from the bladder.

             •   Urine drains when the catheter is unclamped.

             •   W hen the catheter is removed, voiding is encouraged every 3 to 4 hours or as
                 directed by the nurse and the care plan.

   THE PERSON WITH A UROSTOMY
         Sometimes the bladder is surgically removed.
         A new pathway for urine to leave the body is created.

             •   It is called a urinary diversion.

             •   The nurse provides care after surgery.

             •   You may care for persons with long-standing urostomies.
         A pouch is applied over the stoma.

             •   Urine drains through the stoma into the pouch.

             •   Urine drains constantly into the pouch.

   DIALYSIS
         W hen the kidneys fail:

             •   Little or no urine is produced.

             •   Body waste and excess fluid collect in the blood.

             •   The person dies if the waste and fluid are not removed.
         Dialysis is the process that removes excess fluid and waste from the blood.

             •   Hemodialysis

             •   Peritoneal dialysis




   QUALITY OF LIFE
         Illness, disease, and aging can affect the private act of voiding.
         Residents often depend on the nursing staff to assist with elimination needs.
         You must protect the person’s privac y.


    Bowel Elimination

      Bowel elimination is the excretion of wastes from the gastrointestinal system.
         Factors affecting bowel elimination include:
            • Privacy
            • Habits
            • Age
            • Diet and fluids
            • Exercise and activity
            • Drugs
    NORM AL BOWEL ELIMINATION
Feces move through the intestines by peristalsis.
Feces move through the large intestine to the rectum.
Feces are stored in the rectum until excreted from the body.
Defecation (bowel movement) is the process of excreting feces from the rectum through the anus.
Frequency and time of bowel movements vary from person to person.
Stools are normally brown, soft, formed, moist, and shaped like the rectum.
                •    They have a normal odor.
Observe and report the following:
                •    Color

                •    Amount

                •    Consistency

                •    Presence of blood or mucus

                •    Odor

                •    Shape

                •    Frequenc y of defecation

                •    Complaints of pain or discomfort

    FACTORS AFFECTING BOWEL ELIMINATION
The nurse considers the following factors when using the nursing process to meet the person’s
elimination needs:

                •    Privacy

                •    Habits
                •   Diet

                •   Fluids

                •   Activity

                •   Drugs

                •   Aging

                •   Disability

     COMMON PROBLEMS
Constipation is the passage of a hard, dry stool.
                •   Constipation occurs when feces move slowly through the bowel.
A fecal impaction is the prolonged retention and buildup of feces in the rectum.
                •   Feces are hard or putty-like.

                •   Fecal impaction results if constipation is not relieved.
Diarrhea is the frequent passage of liquid stools.
                •   Feces move through the intestines rapidly.

                •   Fluid lost through diarrhea is replaced.

                •   If fluid is not replaced, dehydration occurs.

                •   Dehydration can lead to death.
Fecal incontinence is the inability to control the passage of feces and gas through the anus.
                •   Fecal incontinence affects the person emotionally.

                •   The person with fecal incontinence may need:
                        Bowel training
                        Help with elimination after meals and every 2 to 3 hours
                        Incontinence products to keep garments and linens clean
                        Good skin care
Flatulence is the excessive formation of gas or air in the stomach and intestines.
                •   Gas and air passed through the anus is called flatus.

                •   If flatus is not expelled, the intestines distend.
                           Abdominal cramping or pain, shortness of breath, and a swollen abdomen
                              occur.

     BOWEL TRAINING HAS TWO GOALS:
To gain control of bowel movements
To develop a regular pattern of elimination
               •   Fecal impaction, constipation, and fecal incontinence are prevented.

    ENEM AS
Doctors order enemas:
               •   To remove feces

               •   To relieve constipation, fecal impaction, or flatulence

               •   To clean the bowel of feces before certain surgeries and diagnostic procedures
The doctor orders the enema solution.
The solution depends on the enema’s purpose.
               •   Tap-water enema (obtained from a faucet)

               •   Saline enema (a solution of salt and water)

               •   Soapsuds enema (SSE)

               •   Small-volume enema

               •   Oil-retention enema
Do not give enemas that contain drugs.
Cleansing enemas:
               •   Clean the bowel of feces and flatus

               •   Relieve constipation and fecal impaction

               •   Are needed before certain surgeries and diagnostic procedures

               •   Tap-water enemas can be dangerous.

               •   The saline enema solution is similar to body fluid.

               •   Soapsuds enemas irritate the bowel’s mucous lining.
Small-volume enemas irritate and distend the rectum.
               •   They are often ordered for constipation.

               •   They are ordered when the bowel does not need complete cleansing.
Oil-retention enemas relieve constipation and fecal impactions.
    THE PERSON WITH AN OSTOMY
An ostomy is a surgically created opening.
                •   The opening is called a stoma.

                •   The person wears a pouch over the stoma to collect stools and flatus.
Colostomy
                •   W ith a permanent colostomy, the diseased part of the colon is removed.

                •   A temporary colostom y gives the diseased or injured bowel time to heal.

                •   The colostom y site depends on the site of disease or injury.

                •   Stool consistenc y depends on the colostom y site.

                •   Skin care prevents skin breakdown around the stoma.
Ileostomy
               •    The entire colon is removed.

               •    Liquid stools drain constantly from an ileostom y.

               •    The ileostom y pouch must fit well.

               •    Stools must not touch the skin.

               •    Good skin care is required.
Ostomy pouches are emptied when stools are present.
               •    The pouch is opened when it balloons or bulges with flatus.

               •    The drain is wiped with toilet tissue before it is closed.

               •    The pouch is changed every 3 to 7 days and when it leaks.

               •    Odors are prevented.

               •    The person can wear normal clothes.

               •    Showers and baths are delayed for 1 to 2 hours after applying a new pouch.

               •    Do not flush pouches down the toilet.
    QUALITY OF LIFE
Protect the person’s rights.
Assist with bowel elimination as directed by the nurse and the care plan.
Do all you can to protect the person’s right to privacy.
Residents have the right to personal choice.

								
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