Review Ch. 13 Elimination
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The healthy adult produces about _____ of urine a day.
1500 ml (3 pints)
Normal urine is parel yellow, straw-colored, or amber. It is clear with no particles. A faint odor is normal.
Painful or difficult urination.
Blood in the urine.
Frequent urination at night.
Scant amount of urine, less than 500 ml in 24 hours.
Abnormally large amounts of urine.
Voiding at frequent intervals.
The need to void at once.
Changes with aging
- Bladder muscles weaken. Bladder size decreases. It holds less urine. Urinary frequency or urgency may
- Urinary incotinence (inability to control the passage of urine from the bladder) may occur.
- In men, the prostate gland enlarges. This puts pressure on the urethra. Difficulty urinating or frequent
- Persons with incontinence may need bladder training programs. Sometimes catheters are needed.
- Common Disorder
- - Urinary retention- When the person does not empty the bladder completely.
- - Urinary tract infection (UTIs) - are common. Microbes can enter the sustem through the urethra.
- -- Cystitis is a bladder (cyst) infection (itis). It is caused by bacteria. Urinary frequency, urgency,
- pain or burning on urination, blood or pus in the urine, foul-smelling urine, and fever may occur.
- if untreated, cystitis can lead to pyelonephritis.
- -- Pyelonephritis is inflammation (itis) of the kedney (nephr) pelvis (pylo). Cloudy urine may contain
- pus, mucus, and blood. Chils, fever, back pain, adn nausea adn vomiting occur.
- - Renal calculi - are kidney (renal) stones (calculi). Bedrest, immobility, and poor fluid intake are risk
- factors. Paninful, frequent, and urgent urinationmay occur. So can blood in the urine.
- - Renal failure - is when the kidneys do not function or are severely impaired. Waste products are not
- removed from the blood. The body retains fluid. Heart failure and hypertension easily resulot. Renal
- failue may be acute or chronic. The person is very ill.
Are used by persons who cannot be out of bed. Women use bedpans for voiding and bowel movements. Men use them for bowel movements.
A fracture pan has a thin rim. It is only about 1/2-inch deep at one end. The smaller end is placed under th buttocks. Fracture pas 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 frature
- After hip replacement surgery
- By persons with osteoporoses
- By persons with painful joints.
- - Men use urinals to void.
- - The urinal hooks to the bed rail within the man's reach.
- - Remind men to hang urinals on bed rails and to signal after using them.
A chair or wheelchair with an opening for a bedpan or container.
The loss of bladder control. It may be temporary or permanent.
Urine leaks during exercise and certain movements. Urine loss is small (less than 50 ml). Often called dribbling, it occurs with laughing, sneezing, coughing, lifting, or other activities.
Urine is lost in response t a sudden, urgent need to void. The person cannot get to a toilet in time.
Urine leaks when the bladder is too full. The person feels like the bladder is not empty. The person only dibbles or has a weak urine stream.
The person has bladder control but cannot use the toilet in time. Immobility, restraints, unaswered signal lights, no signal light within reach, and not knowing where to find the bathroom are causes.
Urine is lost at predictable interval. urine is lost when the bladder is full. The person does not feel the need to void.
- Encourage voiding at scheduled intervals.
- More than one type of incontinence can be present. This is called mixed incontinence.
A tube used to drain or inject fluid through a body opening.
- Inserted through the urethra into the bladder, a urinary catherter drains urine. An indwelling catheter (retention or Foley catheter) is left in the bladder. A doctor or nurse inserts teh catheter (catheterization).
- Some people are too weak or disabled to use the bedpan, urinal, commode, or toilet. For them, catheters can promote comfort and prevent incontinence. However, they are a last resort for incontinence. Catheters do not treat the cause of incontinence.
- Persons with catheters are at high risk for infection.
Measures for Indwelling Catheters
- Keep the drainage bag below the bladder.
- Attach the drainage bag to the bed frame, back of the chair, or lower part of an IV pole. Never attach
the dainage bag to the bed rail.
- Do not let the drainage bag rest on the floor. This can contaminate the system.
- Use a separate measuring container for each person.
- - A closed drainage system is used for indwelling catheters. Nothing can enter the system from the
- catheter to the drainage bag. The urinary system is sterile.
- - Condom catheres are often used for incontinent men. They also are called external catheters, Texas
- catheters, and urinary sheaths. A condom catheter is a soft sheath that slides over the penis.
Bladder training programs help some persons with urinary incontinence. Some persons need bladder training after indwelling catheter removal.
There are two basic methods for 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 person has a catheter. The catheter is clamped to prevent urine flow from the bladder. It is
usually clamped for 1 hour at first. Over time, it is clamped for 3 to 4 hours. Urine drains when the
catheter is unclamped. When the catheter is removed, voiding is encouraged every 3 to 4 hours or as
directed by the nurse and the care plan.
Ask the person not to have a bowel movement when collecting a urine specimen. The specimen must not contain feces.
Ask the person to put toilet tissue in th toilet or wastebasket. Unire and stool specimens must not contain tissue.
- The random urine specimen is collected for a urinalysis. No special measures are needed. It is collected at any time.
- The midstream specimen is also called a clean-voided specimen or a clean-catch specimen. This reduces the number of microbes in the urethral area.
Bowel elimination is the excretion of wastes from the gastrointestinal (GI) system. The partially digested foods and fluids are called chyme.
Feces refers to the semisolid mass of waste products in the colon that are expelled through the anus. Feces move through the intestines by peristalsis. Peristalsis is the alternating contraction and relaxation of intestinal muscles.
Defecation (bowel movement) is the process of excreting feces from the rectum through the anus. Stool refers to excreted feces.
- Common Disorders
- Constipation - is the passage of a hard, dry stool. The person usually strains to have a bowel movement. Stools are large or marble-size. Constipation occurs when feces move slowly through the bowel. Common causes include a low-fiber diet, ignoring the urge to defecate, decreased fluid intake, inactivity, drugs, aging, and certain diseases.
- 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. The person cannot defecate. More waater is absorbed from already hard feces.
- Diarrhea- Is the frequient passage of liquid stools. Feces move through the intestines rapidly. The need to defecate is urgent.
- Fecal incontinence - Is the inability to control the passage of feces and gas through the anus.
- Flatulence - Is the excessive formation of gas or air in the stomach and intestines. Gas and air passed through the anus is called flatus.
Stools are normally brown, soft, formed, most, and shaped like the rectum.
- Factors affecting bowel elimination.
- Drinking 6 to 8 glasses of water daily promotes normal bowel elimination. Warm fluids-coffee, tea, hot cider and warm water - increase peristalsis.
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.
A suppository is a cone-shaped, solid drug that is inserted into a body opening. It melts at body temperature. A nurse inserts a rectal suppository into the rectum. A bowel movement occurs about 30 minutes later.
The introduction of fluid into the rectum and lower colon.
- An enema. Doctors order enemas to remove feces and to relieve constipation, fecal impaction, or flatulence.
- Enemas are dangerous for older persons adn those with certain heart and kidney diseases.
- The doctor orders the type of enema and the enema solution. The solution depends on the enema's purpose:
- - Cleansing enemas - clean the bowel of feces and flatus. They relieve constipation and fecal
- impaction. The doctor orders a soapsuds, tap-water, or saline solution. Usually 500 to 1000 ml of
- solution is given.
- - Small-volume enemas - irritate and distend the rectum. This causes defecation. They are often
- ordered for constipation or when the bowel does not need complete cleansing. They contain about 120 ml of solution.
- - Oil-retention enemas - relieve constipation and fecal impactions. The oil is retained for 30 to 60
- minutes or longer (1 to 3 hours). Retaining oil softens feces and lubricates the rectum. This lets
- feces pass with ease. Most oil-retention enemas involve mineral, olive, or cottonseed oil.
A surgically created opening.
Ostomy. The opening is called a stoma. The person wears a pouch over the stoma to collect feces and flatus.
A surgically created opening (stomy) between the colon (colo) and abdominal wall. Part of the colon is brought out onto the abdominal wall, and a stoma is made. Feces and flatus pass through the stoma, not the anus. With a permanent colostomy, the diseased part of teh colon is removed. A temporary colostomy gives the diseased or injured sbowel time to heal.
Is a surgically created opening between the ileum (small intestine) and the abdominal wall.
An ileostomy. Part of the ileum is brought out onto the abdominal wall, and a stoma is made. The entire colon is removed. Liquid feces drain constantly from an ileostomy. Water is not absorbed because the colon was removed.
Ostomy pouches are changed every ____ days and when it leaks.
3 to 7
Showers and baths are delayed 1 or 2 hours after a new pouch is applied. Do not flush pouches down the toilet. Follow center policy for disposing of them.
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