Alterations in Elimination GI Elimination Urinary Elimination

Alterations in Elimination

•GI Elimination

•Urinary Elimination

Alterations in Elimination

Normal Position

Thigh Flexion

Factors affecting GI Elimination

Age

Young

Elderly

smooth muscle tone of colon

Abdominal muscle tone

Anal sphincter control

Factors affecting GI Elimination

Diet

Bulk/fiber intake

Digestion

Spicy foods

Eating schedules/routines

Factors affecting GI Elimination

Fluid Intake2000 – 3000 ml/day

Mobility/ImmobilityPsychological ConsiderationLife-style Considerations

Early bowel trainingAvailability of toilet facilitiesEmbarrassmentPrivacy issuesTime management

Factors affecting GI Elimination

Medications

side effects

GI medications

Diagnostic ProceduresPreparing the pt

Barium studies

Factors affecting GI Elimination

Anesthesia and SurgeryAbdominal surgeryParalytic ileus

Pathologic conditionsaltered sensory stimulation/sensation

Impaired mobility/decreased physical strength/stamina

Factors affecting GI Elimination

Irritants

Pain

Common GI Elimination Problems

Constipation

**Always identify the client’s normal bowel elimination pattern**

Constipation: contributing factors

Irregular defecation habits

Laxative abuse/enema abuse

Psychological stress

Diet

Fluid intake

Age

Disease processes

Constipation: complications of

Bowel obstruction

Vagal Response

Fecal impaction

Hemorrhoids

Constipation: Treatment

Medications

Fluid intake

Diet

Activity

Prevention

Common GI Elimination Problems

Diarrhea

Treatment

Complications

Common GI Elimination Problems

Bowel incontinence

Flatulence

Treatment:

Position » side lying for rectal tube » Prone with knees flexed under

abdomen

Flatulence: Treatment

Decreased amt of swallowed air:

Carbonated beverages

Straws

Gum

Hard candies

NGT for decompression of abdomen

Common GI Elimination Problems

Hemmorrhoids (piles)

Nursing Process

Factors Affecting Urinary Elimination

Growth and DevelopmentYoungElderly

Psychosocial factorsprivacy“normal position”sufficient timerunning water

Factors Affecting Urinary Elimination

Fluid/food intake

Medications

Muscle tone/immobility

Pathologic conditions

Surgical/diagnostic procedures

Common Urinary Elimination Problems

Definition of normal: 30 ml/hour

45 ml in 5 hours

200 ml in 2 hours

How much is “normal” for each voiding?

What would be abnormal?

Common Urinary Elimination Problems

Voiding Patterns

Polyuria diuresisLarge fluid intake, ingestion of diuretic

Other s/s:

polydipsia

dehydration

wt loss

BP changes

Common Urinary Elimination Problems

Oliguria and anuriaetiology:

low fluid intake***Renal, Cardiac Pathology

Frequency and nocturiaetiology:

fluid intakeUTIPregnancyRenal pathologyDiuretic therapy

Common Urinary Elimination Problems

Urgency

Etiology:UTI

Decreased perineal muscle tone

Dysuria

Etiology:

UTI, urinary catherization

Urinary Incontinence

Total

Stress

Urge, Functional

Reflex***

Urinary retention with overflow**

Common Urinary Elimination Problems

Neurogenic Bladder

Urinary retention

tx: »normal position, running water,

etc.»catherize