Alterations in Elimination

1. Alterations in Elimination GI Elimination Urinary Elimination

2. Alterations in Elimination Normal Position Thigh Flexion

3. Factors affecting GI Elimination • Age Young Elderly smooth muscle tone of colon Abdominal muscle tone Anal sphincter control

4. Factors affecting GI Elimination • Diet Bulk/fiber intake Digestion Spicy foods Eating schedules/routines

5. Factors affecting GI Elimination • Fluid Intake 2000 – 3000 ml/day • Mobility/Immobility • Psychological Consideration • Life-style Considerations Early bowel training Availability of toilet facilities Embarrassment Privacy issues Time management

6. Factors affecting GI Elimination • Medications side effects GI medications • Diagnostic Procedures • Preparing the pt • Barium studies

7. Factors affecting GI Elimination • Anesthesia and Surgery Abdominal surgery Paralytic ileus • Pathologic conditions altered sensory stimulation/sensation Impaired mobility/decreased physical strength/stamina

8. Factors affecting GI Elimination • Irritants • Pain

9. Common GI Elimination Problems • Constipation **Always identify the client’s normal bowel elimination pattern**

10. Constipation: contributing factors • Irregular defecation habits • Laxative abuse/enema abuse • Psychological stress • Diet • Fluid intake • Age • Disease processes

11. Constipation: complications of • Bowel obstruction • Vagal Response • Fecal impaction • Hemorrhoids

12. Constipation: Treatment • Medications • Fluid intake • Diet • Activity • Prevention

13. Common GI Elimination Problems • Diarrhea Treatment Complications

14. Common GI Elimination Problems • Bowel incontinence • Flatulence Treatment: Position • side lying for rectal tube • Prone with knees flexed under abdomen

15. Flatulence: Treatment Decreased amt of swallowed air: • Carbonated beverages • Straws • Gum • Hard candies NGT for decompression of abdomen

16. Common GI Elimination Problems • Hemmorrhoids (piles)

19. Nursing Process

20. Factors Affecting Urinary Elimination • Growth and Development Young Elderly • Psychosocial factors privacy “normal position” sufficient time running water

21. Factors Affecting Urinary Elimination • Fluid/food intake • Medications • Muscle tone/immobility • Pathologic conditions • Surgical/diagnostic procedures

22. 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?

23. Common Urinary Elimination Problems • Voiding Patterns • Polyuria diuresis • Large fluid intake, ingestion of diuretic • Other s/s: polydipsia dehydration wt loss BP changes

24. Common Urinary Elimination Problems • Oliguria and anuria etiology: low fluid intake*** Renal, Cardiac Pathology • Frequency and nocturia etiology: fluid intake UTI Pregnancy Renal pathology Diuretic therapy

25. Common Urinary Elimination Problems • Urgency Etiology: UTI Decreased perineal muscle tone • Dysuria Etiology: UTI, urinary catherization

26. Urinary Incontinence • Total • Stress • Urge, Functional • Reflex*** • Urinary retention with overflow**

27. Common Urinary Elimination Problems • Neurogenic Bladder • Urinary retention tx: • normal position, running water, etc. • catherize