NURS1100 Week 6 Urinary and Bowel Elimination PDF

6 URINARY AND BOWEL ELIMINATION URINARY ELIMINATION Factors Affecting Urinary Elimination Category Factors - Infants/toddlers: Underdeveloped sphincter control causes involuntary Age elimination. - Elderly: Weak pelvic muscles and redu...

6 URINARY AND BOWEL ELIMINATION URINARY ELIMINATION Factors Affecting Urinary Elimination Category Factors - Infants/toddlers: Underdeveloped sphincter control causes involuntary Age elimination. - Elderly: Weak pelvic muscles and reduced bladder elasticity lead to incontinence, urgency, and nocturia. Surgical - Complications from surgeries affecting the urinary system. - Hydration: Promotes normal elimination; dehydration leads to concentrated urine. Fluid Intake - Alcohol/Caffeine: Act as diuretics, causing increased urine production and urgency. - Cultural, gender, and religious norms influence privacy, voiding practices, and Sociocultural willingness to seek help, affecting comfort and frequency of elimination. - Tests like pyelograms/cystograms can irritate the bladder, causing discomfort or Diagnostics urgency, and induce anxiety, which may alter elimination patterns. Medications - Diuretics: Increase urine output. -Antidepressants: May cause retention by affecting bladder muscle or nerve function. Pathological - Renal diseases Conditions - Neurologic conditions affecting control and function. - Stress and anxiety can overstimulate the bladder (urgency/frequency) or cause Psychological retention (muscle tension). Nursing Assessment of Urine (ACCO Framework) Aspect Details - Measure intake and output in millilitres (mL). Amount - For catheterized patients: use a graduated container or measuring "hat" at eye level. - Normal: pale straw to amber. Colour - Red colour: Could indicate bleeding. - Dark yellow: May indicate dehydration. - Normal: transparent. - Cloudy or whitish-yellow: May indicate WBCs or bacterial Clarity presence. - Turbidity could suggest infection. - Normal: Slight ammonia odour Odour - Strong odour may indicate infection or metabolic changes. NURS1100 WEEK 6 URINARY AND BOWEL ELIMINATION 1 Urine Collection & Specimens Aspect Details - Use a urinary collection bag or a graduated container. Collection Methods - Measuring hats can be placed in the toilet for direct voiding. Midstream/Clean Voided - Cleanse the perineal area with an antiseptic wipe. Specimen - Void a small amount, then collect urine in a sterile specimen cup. - Urinalysis: Random specimen collected in a clean cup. Urine Specimen Types - Clean voided midstream: Sterile specimen cup. - Urine Culture & Sensitivity: Should be stored in the refrigerator. Urinary Elimination Management Aspect Description Promote Fluid Encourage adequate hydration unless restricted. Intake Maintain Normal Assist patients to maintain normal routines and provide necessary help to access the bathroom. Voiding Patterns UTI Prevention Ensure frequent toileting, proper perineal care, and adequate fluid intake. Manage Urinary - Provide privacy and reduce anxiety. Retention - Use in-and-out catheters if necessary. Bedpans Used when patients are unable to get out of bed. Urinals Allows patients to void while standing. - Condom catheters: Good for incontinence. - Indwelling catheters: Used for surgical or wound care. - Straight/in-and-out catheters: Drain the bladder and are then removed. - Suprapubic catheters: Surgically inserted. Additional Notes -Leg bag option: Can be used for mobile patients. Catheters -Bag placement: Keep the drainage bag lower than the bladder, off the floor, and never attached to bed rails. Rationale: Keeping the drainage bag lower than the bladder is specifically to prevent backflow of urine into the bladder. Backflow can introduce bacteria into the bladder, increasing the risk of urinary tract infections (UTIs) and other complications. Ensuring proper placement also supports efficient drainage. -Maintain sterility: Ensure sterility if the catheter is disconnected from the drainage bag. NURS1100 WEEK 6 URINARY AND BOWEL ELIMINATION 2 Types of Catheters Key Type Description Usage Considerations Non-invasive; External device Ensure proper fit; Condom used for for males, fits monitor for skin Catheter incontinence or over penis. irritation. limited mobility. For retention, Straight Temporary Use sterile urine samples, or Catheter (in insertion to drain technique; avoid pre-procedure and out) urine. frequent reuse. emptying. Indwelling Continuous High UTI risk; Foley catheter with drainage for requires regular Catheter retention surgery, severe monitoring. balloon. retention. Surgically Long-term use for Lower UTI risk; Suprapubic inserted into the urethral injury or maintain insertion Catheter bladder. chronic issues. site hygiene. BOWEL ELIMINATION Nursing Knowledge Base on Defecation Aspect Details - Begins with contractions in the colon moving stool toward the anus. Process of - Stool reaches rectum, causing relaxation of sphincters and Defecation signaling awareness of the need to defecate. - 1–3 bowel movements per day. Stool characteristics: Normal - Soft, brown, and formed. Defecation - Cylindrical shape. - Aromatic odor. - May contain small undigested roughage. - External sphincter muscle constricts when urge to defecate is Impact of ignored. Ignoring the Urge - Urge disappears temporarily but returns after a few hours. Consequences of - Rectum expands to accommodate more feces. Repeated - Loss of sensitivity to the need to defecate. Inhibition - Can lead to constipation. NURS1100 WEEK 6 URINARY AND BOWEL ELIMINATION 3 Characteristics of Normal and Abnormal Stool (ACCO Framework) Aspect Normal Abnormal Varies with constipation (reduced) or Amount 100–400 g/day diarrhea (increased). Red or black (indicates bleeding), Colour Brown yellow (malabsorption), green (diet or bile issues). Hard and dry (constipation), watery Consistency Soft, formed (diarrhea), mucus (infection/inflammation). Strong or foul odour (indicates Odour Aromatic malabsorption or inflammatory conditions). Pencil-thin (obstruction), irregular Shape Cylindrical shapes. Small amounts of Undigested food, blood, pus, or Constituents undigested mucus. roughage Common Alterations in Bowel Elimination Abnormality Description Dry, hard stool, often due to reduced water intake, Constipation inactivity, or poor diet. Severe constipation resulting in hardened stool Fecal Impaction lodged in the rectum, causing blockage. Increased stool frequency, often watery; caused Diarrhea by infection, diet, or digestive disorders. Bowel Loss of control over passage of feces and gas, Incontinence linked to muscle or nerve damage. Excessive intestinal gas, causing bloating or Flatulence discomfort; related to diet or digestive disturbances. NURS1100 WEEK 6 URINARY AND BOWEL ELIMINATION 4 Stool Specimens Aspect Details - Check for blood (when internal bleeding is Purpose suspected). - Analyze for fat, microbes, or parasites. - Stool must not be contaminated with urine. Sample Handling - Use proper collection tools to avoid contamination. - Bright red blood: From hemorrhoids, cuts, or abrasions in the anal area, or bleeding in the lower Causes of Blood GI tract. in Stool - Melena (black and tarry): Indicates bleeding in the stomach or upper GI tract. - Used to detect hidden or unseen blood in stool. Occult Blood - Screens for small amounts of bleeding (e.g., colon Testing cancer). 1. Remove contents from package and wear gloves. 2. Prevent sample from falling into the toilet using a clean collection device. 3. Pass stool into the container or newspaper. Steps for 4. Use the scoop to collect stool and transfer to Collection specimen cup. 5. Dispose of remaining stool and clean hands thoroughly. 6. Label and store sample appropriately before testing. Nursing Interventions: Management of Bowel Elimination Aspect Details Fluid and Food - Maintain 1500–2000 mL of fluid per day. Intake - Include sufficient dietary fiber to support regular bowel movements. Exercise - Engage in daily physical activity to promote peristalsis and prevent constipation. - Manage pain with proper diet and adequate fluid intake. Hemorrhoid Care - Soften stool to reduce strain. Bowel Retraining - Establish a routine by defecating at the same time each day to retrain bowel habits. Privacy - Provide privacy as bowel elimination can be embarrassing for some individuals. - Clean skin after incontinence to prevent irritation. Skin Integrity - Use barrier creams to protect against breakdown. Medications Administer cathartics, laxatives, or enemas as needed to relieve constipation or manage bowel issues. NURS1100 WEEK 6 URINARY AND BOWEL ELIMINATION 5 Assisting with Bowel Elimination Aspect Details - May be difficult for those with muscular weakness or mobility Sitting Position issues. - Ensure comfort and proper alignment. Positioning on - Raise the head of the bed (HOB) to 30 degrees to promote Bedpan comfort and ease of elimination. Ambulation - Encourage ambulation to the washroom if the patient is able. - Offer options such as a bedpan, commode chair, or toilet to Providing Choices promote dignity and independence. - Assess the stool and patient’s skin condition after Post-Elimination elimination. Care - Dispose of stool appropriately and provide perineal care. Incontinence Products and Associated Risks Aspect Details - Garment Protectors: Used for urinary and/or bowel incontinence (e.g., adult briefs, protective underwear, incontinence pads, bed pads, waterproof covers) Incontinence Products - Encourage regular toileting to reduce reliance. - Ensure proper skin care and perineal hygiene to prevent complications. - Loss of skin integrity and increased risk of pressure injuries. Risks (Skin) - Increased risk of falls (e.g., rushing to the toilet). - Higher likelihood of UTIs and other infections. - Loss of dignity and self-esteem. - Negative body image and reduced sense of well-being. Risks (Self-Esteem) - Feelings of embarrassment, frustration, anger, or fear of judgment. - Social isolation and restriction of activities. - Depression and guilt. NURS1100 WEEK 6 URINARY AND BOWEL ELIMINATION 6