Elimination Process Flashcards
What Are The Factors That Affect Defecation?
•Diet – insoluble and soluble fiber –25 grams daily for women, 38 grams for men •Fluid •Activity •Psychological factors •Defecation habits •Medications •Diagnostic Procedures •Anesthesia/Surgery – paralytic ileus •Pain
What are the Characteristics of Feces?
- Color
- Consistency
- Shape
- Amount
- Odor
- Constituents
What can we learn from stool?
•Red –Hematochezia - fresh blood in stool; associated with lower GI bleeding or rapid upper GI bleeding •Black –Melena (tarry) – associated with slow upper GI hemorrhage, black can also be use of Pepto-Bismol, iron •Grey or Pale – liver disease and decreased bile output (pale, white, white specs can be regular antacid use) •Yellow –gallbladder dysfunction •Green –antibiotic use, green leafy vegetables •Floating stool –Steatorrhea – excess fat
Define Constipation and Fecal Impaction
- Decreased frequency of defecation (less than 3 per week)
- Hard, dry, formed stools
- Mass or collection of hardened feces in folds of rectum.
- Can be recognized by seepage of fecal liquid but no normal stool.
What Causes of Constipation?
- Insufficient fiber intake
- Insufficient fluid intake
- Insufficient activity
- Irregular defecation habits
- Change in daily routine
- Chronic use of laxatives
- Medications
- Habitual denial and ignoring the urge to defecate
- Neurologic problems
- Irritable Bowel Syndrome
- Lack of privacy
What is Physiology of Defecation?
- Peristaltic waves move the feces into the sigmoid colon and the rectum.
- Sensory nerves in rectum are stimulated & individual becomes aware of need to defecate.
- Feces move into the anal canal; if timing is appropriate, the internal and external sphincter relax.
- Expulsion of the feces assisted by contraction of the abdominal muscles, thighs and diaphragm.
- Feces moves through the anal canal and expelled through anus.
Diarrhea
Passage of liquid feces and increased frequency of defecation
Causes
•Clostridium difficile – mucoid/foul smelling
•Psychological stress
•Antibiotics
•Iron
- Food allergies
- Colon diseases – Crohn’s
- Cathartics – accelerate defecation
Define Bowel Incontinence
Loss of voluntary ability to control fecal and gaseous discharges
Bowel Incontinence Partial vs Major
- Partial – inability to control flatus or to prevent minor soiling
- Major – inability to control feces of normal consistency
Bowel Incontinence causes
● anal sphincter function impairment
● spinal cord injury
● tumors of external anal sphincter muscle
What are the Primary Sources of Flatulence?
Action of bacteria on chyme in large intestine
Swallowed air (belching/eructation)Gas diffusion between bloodstream and intestine
Causes:
Food – cabbage, onions, excess dietary fiber
Abdominal surgery
Narcotics
What are the NANDA Nursing Diagnoses?
Bowel Incontinence Constipation Risk for Constipation Perceived Constipation Diarrhea
What are the Interventions to Maintain Normal
Fecal Elimination Patterns?
- Privacy
- Timing
- Nutrition and fluids
- Daily activity level
- Positioning – bedside commode, bedpan
- Assess daily medications
- Assess ability to toilet independently & availability of toilet
What are the Desired Outcomes of elimination?
Maintain or restore normal bowel elimination pattern
Maintain or regain normal stool consistency
Prevent associated risks such as fluid and electrolyte imbalance, skin breakdown, abdominal distention and pain
What are the Types of Enemas ?
Cleansing – used to remove feces
Carminative – used to expel flatus
Retention –softens feces
Return-Flow – not as common, used to expel flatus
What are the Related Nursing Diagnosis?
Risk for Deficient Fluid Volume Risk for Impaired Skin Integrity Low Self-esteem Disturbed Body Image Deficient Knowledge (Bowel Training, Ostomy Management) Anxiety
What are the Selected Fecal Elimination Problems?
- Constipation
- Diarrhea
- Bowel incontinence
- Flatulence
- Hemorrhoids
What is flatulence
Presence of excessive flatus in the intestines and leads to stretching and inflation of the intestines
Assessment of Fecal Elimination
Assessing taking nurse history performing physical examination
Nursing History elicits a description of usual feces and any recent changes and collects info
Physical Examination observe abdomen in relation to fecal elimination problems include inspection
Micturition
Urine collects in the bladder
Pressure stimulates special stretch receptors in the bladder wall
Stretch receptors transmit impulses to the spinal cord voiding reflex center
Internal sphincter relaxes stimulating the urge to void
If appropriate, the conscious portion of the brain relaxes the external urethral sphincter muscle
Urine eliminated through the urethra
Factors Affecting Voiding
Developmental factors Psychosocial factors Fluid and food intake Medications Muscle tone Pathologic conditions Surgical procedures
Developmental
- Infants can urinate 20 times a day. Will develop urinary control between the ages of 2 and 5 years.
- Preschoolers – teach girls to wipe from front to back.
- School age – enuresis – involuntary passage of urine when control should be established.
- Noctural enuresis – bedwetting. Not a problem until after age 6.
- Older adults – decrease in functioning nephrons; toxicity from medications = decreased urine; nocturia (voiding at night) can signal heart failure
- Urgency and frequency are common – men enlarged prostate; women weakened muscles supporting bladder or weakness of the urethral sphincter. Incomplete emptying.
What are the Selected Urinary Problems?
- Polyuria (diuresis) - high urine output
- Oliguria – low urine output
- Anuria – no urine
- Frequency
- Nocturia – 2 or more times at night
- Urgency- sudden strong desire to void 4 to 5 years old
- Enuresis- involuntary passing of urine
- Retention- bladder becomes overdistended
- UTI- infection
- Dysuria – painful urination
What are the Nursing Assessment of Urinary Function
Assessing includes the nursing history physical relating
Nurse history the nurse determine the clients normal voiding pattern
Physical urinary tract includes a percussion of the kidneys to detect areas
Normal output 60 ml mini output 30 ml
