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Elimination Pattern
By
S f M ihSarfraz Masih
MScN, Post RN BScN, DCC, RN
Principal
Karachi King’s College of Nursing, Karachi
9/21/2013 1Sarfraz Masih, Karachi
Learning Objectives By the end of this pattern, the learners will be able to 1 Describe the elimination pattern1. Describe the elimination pattern. 2. Discuss the anatomy and physiology of urinary
and bowel eliminationand bowel elimination.3. Define the term elimination. 4 Explain the importance of the pattern4. Explain the importance of the pattern.5. Discuss the factors affecting on elimination.6 Discuss developmental consideration6. Discuss developmental consideration. 7. Formulate NCP and integrate in caring the
patients with elimination disorderspatients with elimination disorders.
9/21/2013 2Sarfraz Masih, Karachi
Why to Study Elimination Pattern (EP)?Why to Study Elimination Pattern (EP)?
Urinary and Bowel functions
Individual’s habits in terms of excretory regularityregularity
Use of aids to maintain elimination.
S i t l di h t ttit dSocietal dichotomous attitude
Each person has his/ her own normal pattern of elimination
9/21/2013 3Sarfraz Masih, Karachi
Why to Study Elimination Pattern (EP)?
Elimination problems
h l & h lImpact on physical & psycho‐ social aspects
Nurses’ Roles
9/21/2013 4Sarfraz Masih, Karachi
EliminationElimination
It refers to the excretion of waste and nonIt refers to the excretion of waste and non digested products of the metabolic processesprocesses.
(C 1997)(Cox, 1997)
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Importance of EliminationImportance of Elimination
Maintenance in balance ofMaintenance in balance of fluids, electrolytesynutrition
Elimination is interrelated functioning of GISUSNSSkin
9/21/2013 6Sarfraz Masih, Karachi
Factors Affecting on EliminationFactors Affecting on Elimination
Age
Circadian rhythms
CultureCulture
Diet
Activity
Stress
Environment
DrugsDrugs
9/21/2013 7Sarfraz Masih, Karachi
M i F f Eli i tiMain Focus of Elimination
Urinary Elimination
Bowel Elimination
9/21/2013 8Sarfraz Masih, Karachi
Urinary Elimination Desire to void (250 ‐450 ml)
Stimulation of voiding reflex centre
Midb i d PMidbrain and Pons
Inhibition of voiding reflex centre & pudental nerveInhibition of voiding reflex centre & pudental nerve
Relaxation of external sphincter & contraction ofRelaxation of external sphincter & contraction of urinary bladder
Voiding 9/21/2013 12Sarfraz Masih, Karachi
Urine Volume
Normal kidney functions
Amount of food and fluid intake
Environmental temperaturep
Requirements of other organs
Presences of open woundsPresences of open wounds
Out put by other areas
Medications
Hormones roles
9/21/2013 14Sarfraz Masih, Karachi
Bowel Elimination Receiving of chyme
Movement of chymeGastrocolic reflex
Duodenocolic reflexDuodenocolic reflex
Defecation reflexDefecation reflex
DefecationDefecation
9/21/2013 20Sarfraz Masih, Karachi
Developmental ConsiderationsDevelopmental Considerations Human life span encompassesp p
Infancy Toddler and preschoolerToddler and preschooler School age childAdolescentAdolescent Young adult Middl d ltMiddle adult Older adult
9/21/2013 21Sarfraz Masih, Karachi
InfantInfant Urinary Elimination
Mature kidney functions until 6 months – 1 year
Nervous system control is also inadequate tillNervous system control is also inadequate till
1 year
V idi i ti l t d b ld iVoiding is stimulated by cold air
8 ‐ 10 times (100‐ 400 ml)
9/21/2013 22Sarfraz Masih, Karachi
InfantBowel Elimination
Intestinal muscles and elastic tissues are poor developeddevelopedNervous system is adequateWater and electrolytes absorption is functionalWater and electrolytes absorption is functional but immatureIntestines are proportionally longer than adults p p y gDigestive enzymes can break down only simple foods.
f l l dMeconium is first material eliminated. Characteristic of stool depend on type of feed. B ttl f d i f t t ti tiBottle‐fed infants are more prone to constipation
9/21/2013 23Sarfraz Masih, Karachi
Toddler and PreschoolerToddler and PreschoolerKidneys are able to conserve water and concentrate urine by 2 years
Nervous and GIS are maturing.Nervous and GIS are maturing.
Urine and bowel elimination are attained by 2 – 3 yearsby 2 – 3 years
Toilet training
Parents’ role
Enema and laxatives
9/21/2013 Sarfraz Masih, Karachi 24
School‐ Age ChildSchool‐ Age Child
Urinary system is functioning maturelyy y g y
UTI are common
GIS functioning matures during theGIS functioning matures during the school years
9/21/2013 Sarfraz Masih, Karachi 25
AdolescentAdolescent No noticeable differences in urinary li i ielimination
Intestines grow in length and width
Intestinal muscles become thicker and stronger g
This developmental stage is important in developing bowel habitsdeveloping bowel habits
9/21/2013 Sarfraz Masih, Karachi 26
Young AdultYoung AdultNo noticeable differences in urinary yelimination
Rate of passage of feces depend on natureRate of passage of feces depend on nature of intake and routine work
Hemorrhoids are possibleHemorrhoids are possible
9/21/2013 Sarfraz Masih, Karachi 27
Middle AdultMiddle Adult
Adequate daily fluid intake
Gradual decrease in the number of nephronsp
Bladder tone diminishes
Digestive enzymes begin to decreaseDigestive enzymes begin to decrease
9/21/2013 Sarfraz Masih, Karachi 28
Older AdultOlder Adult
Renal functioning is slow down
BPH in males
Continuing decrease in digestive enzymesContinuing decrease in digestive enzymes and questionable changes in absorption
Main factors for GIS and USMain factors for GIS and US Immobility
M di tiMedications
9/21/2013 Sarfraz Masih, Karachi 29
How to Assess Elimination Pattern?
1. Is there stool leakage when pt. coughs, sneezes, or laughs?or laughs?
Bowel Incontinence2. Is there involuntary passage of stool? y p gBowel Incontinence 3. Does pt. take laxative on a routine basis?Colonic Constipation, Perceived Constipation4. Has the number of bowel movements
d d?decreased? Constipation, colonic constipation
9/21/2013 Sarfraz Masih, Karachi 30
How to Assess Elimination Pattern?
5. Are bowel movements are increased? DiarrheaDiarrhea6. Is there increased frequency of voiding?Altered urinary elimination StressAltered urinary elimination, Stress
incontinence, Urge incontinence7. Is there dribbling of urine when the pt.
l h hlaughs, sneezes, or coughs? Stress incontinence8 O th d t id i f lt i th t bl8. Once the need to void is felt, is the pt. able
to reach toilet in time? Urge incontinenceUrge incontinence
9/21/2013 Sarfraz Masih, Karachi 31
How to Assess Elimination Pattern?
9. Is there a decreased awareness of the need to id?void?
Reflex incontinence, total incontinence
10. Does the pt. void in small amounts?
Urge incontinence, urinary retention
11.Is there urine flow without bladder distention?
Total incontinenceTotal incontinence
12. Is there decreased urine output?
Urinary retentionUrinary retention
9/21/2013 Sarfraz Masih, Karachi 32
EnemaIntroduction of fluid into the rectum
Types of Enemas ypCleansing enemas
Soften the stool & stimulate peristaltic movementsSoften the stool & stimulate peristaltic movements
Soapsuds enemas
Irritation of bowel lining & stimulation of PeristalticIrritation of bowel lining & stimulation of Peristaltic Movements (PMs)
Oil retention enemasOil retention enemas
Lubricating the bowel lining & stool
Commercial enemasCommercial enemas
Irritation of intestinal mucosa & stimulation of PMs9/21/2013 Sarfraz Masih, Karachi 33
Bladder TrainingBladder Training
Bladder training is a process to teach the individual to manage and to empty their
bladder without the need for an instrument.
It is generally used for stress incontinence, urge incontinence or a combination of theurge incontinence or a combination of the two (called mixed incontinence).
Bladder training can take 3 to 12 weeksBladder training can take 3 to 12 weeks.
9/21/2013 Sarfraz Masih, Karachi 34
Advantages of Bladder Trainingg g
Lengthen the amount of time between bathroom trips.
Increase the amount of urine, a bladder can hold.
Improve individual control over the urge toImprove individual control over the urge to urinate.
9/21/2013 Sarfraz Masih, Karachi 35
Methods of Bladder Training
Kegel exercises
lDelay urination
Scheduled bathroom trips
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Bowel TrainingBowel Training
Digital stimulationDigital stimulation
Kegel exercises
i f db kBiofeedback
(Lehrer, 2007)
(http://www.nlm.nih.gov/medlineplus/ency/article/003971.htm)/ )
9/21/2013 Sarfraz Masih, Karachi 37