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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