Elimination The Gastrointestinal and Genitourinary Systems

1. EliminationThe Gastrointestinal and Genitourinary Systems Lisa Flatt, RN, MSN, CHPN

2. Lower GI tract • The Large intestine consists of: • ____________ • ____________ • ____________ • Sigmoid Colon • Rectum & Anus The GI tract

3. Where does the majority of bowel absorption take place?_____________________ Can you voluntarily contract and relax the anal sphincters?_____________________ Is the GI tract sterile?_____________ Where is the peritoneum?_________ Is the peritoneal area sterile?_______ Questions

4. Surgery that involves the bowel is considered “unclean” because the bowel contents and flora contain a large amount of bacteria, that if spread to the peritoneum cause peritonitis. How would a patient develop peritonitis if they have abdominal surgery – that does not involve the bowel? (like a C-section) Fun Facts!

5. Feces/fecal matter/bowel movement /stool– what are some other terms patients may use? “Normal stool” is soft, firm, brown and formed Abnormal consistency: diarrhea, constipated (hard, rock-like), flakey, fulminant, frothy, liquid “Abnormal” colors: white, yellow, green, red, black, clay-colored, chalk-colored All about Poop

6. Constipation Diarrhea Fecal impaction Flatulence – aka fart Incontinence Helminths--worms 6 problems with intestinal elimination

7. Kidneys Ureters Bladder Urethra The GU Tract

8. Nephron – the functional unit of the kidney Glomeruli- filters wastes; absorption, resorption and reabsorption of fluids & electrolytes = initial production of urine Loop of Henle – tubular system in the glomeruli (descending & ascending) that transport the urine, it starts as H2O and becomes more acidic as it moves down the loop The Complicated & Convoluted Kidney

9. What is the difference between the male and female urethra?________________________ • What does UTI stand for?________________ • Is a UTI in a male or female considered an emergency and very serious? _________ Why?_____________________________ • Is the Urinary Tract sterile?____________ • Is urinary function usually decreased as a result of the loss of one kidney?_________ Questions

10. Define Pyelonephritis __________________ Can upper urinary tract infections be considered life-threatening?_____________ Are lower UTI’s more common in men or women?_____________________ How are they treated?______________ What are some drug classifications used to treat UTI’s?___________ More Questions…….

11. Urine/Making water/ pee pee/ wee wee – can you think of any other names? “Normal” appearance – clear and light yellow in color “Abnormal” findings - blood, sediment, mucus or calculi (stones), brown color, foul smelling, sluggish (thick) All about Pee

12. What can dark colored urine indicate?_____________ What if urine is bloody/red colored?_______ Who is at the highest risk for urinary retention? ____Why?__________________ Questions

13. Retention Urgency Frequency Incontinence Nocturia Polyuria Enuresis 7 problems with urinary elimination

14. Sex • Age & Developmental Level • Individual Preferences and patterns (dietary habits) • Physical condition • Cultural, spiritual and/or religious factors • Socioeconomic factors • Environmental factors • Psychological factors Factors that affect Gi and GU Elimination

15. Meconium – dark green sticky mucousy- protects bowel in utero Breast – yellow and seedy (colostorum) Formula – brown, formed (poop less) Baby poop – and pee pee

16. Brown, formed and regular Potty trained Regression – stressors, new babies in the house Loss of some function - activity Children elimination

17. Soft, brown Incontinent Constipated Peristalsis – slow down (gastroparesis, biopsy) Mental – obsessed Regular – for that person Dependent on laxatives BPH- retention, difficulty start and stop Neurogenic bladder – urinary retention Caffeine is a cathartic Adult elimination

18. How do the various stages of life affect elimination?_________________________ What affect can activity have on intestinal elimination?_________________________ What affect does physical condition have on intestinal elimination?__________________ What affect does diet have on intestinal elimination?__________________________ Factors affection elimination

19. Activity, diet, fluids, fibers all affect bowel status Using laxatives, enemas, suppositories can lead to inability to poop on own Diuretics – rid body of excess fluid, increase urination Stool softeners – make soft NOT laxatives Sleep - regularity Stress – diarrhea or constipation Abdominal and pelvic muscle tone - continence Catheterization – sphincter muscle damage – leaking or retention Rectal tube – for fecal elimination (diarrhea) – other systems Depression and other mental illness Implications…… page 35-39

20. How often do you have a BM? What does it look like? Do you use laxatives regularly? Stool softeners? When was your LBM? Do you pass gas? Do you stomach pain? Does your abdomen feel hard or distended? Bowel sounds in all quadrants? Nursing Assessment of the GI system

21. How often do you urinate? Do you pee at night? Do you have pain with urination? Do you dribble/leak? Incontinent? What color is it? What does it smell like? Is it foul? Do you see mucus, stones or sediment? Milky? Do you see any red? Blood streaks? Nursing assessment of the gu system

22. Problem What to do • Constipation • Diarrhea • Fecal impaction • Flatulence • Incontinence • Helminths • Fluids, laxatives, stool softeners, activity • Clear liquids, fiber, medications, stool sample • Disimpact, enema, suppository • Beano, fiber • Attends, Depends, bowel and bladder program, muscle strengthening, Kegel’s • Kill the worms! Problems, problems, problems

23. Problem What to do • Frequency • Nocturia • Urgency • Dysuria • Enuresis – define length of dry time • Incontinence • Retention • Polyuria • B&B program, UTI/labs/tests • B&B program, decrease fluids prior to sleeping • B&B program, UTI/labs/tests • UTI/labs/tests • Labs/tests • B&B program, Kegel’s • Labs/tests/BPH • Asses fluids, diabetes, labs/tests/UTI Problems, problems, problems

24. Disease/condition Cause and treatment • UTI – • BPH – • Incontinence – • Functional • Overflow • Reflex • Total • Retention – • Urinary suppression - • Urinary Tract Infection – bacteria or fungus • Prostate, aging process • Varies with type • BPH, sphincter valve issues, catatonia (mental issues), spinal cord injuries • Kidneys no longer make urine Diseases/conditions of the urinary tract

25. Other Stuffs • Disease: Cancer & chemotherapy use– degradation of mucosal lining, diarrhea, blood, poor absorption, constipation • Diarrhea **8 or more liquid stools in one day* • Parasites, worms, medications, foods, stress, diet, IBS, Chron’s, CDIFF!!!!!!!!! • Incontinence – drugs, sphincter control, diseases (tumors), stress, abuse, sneezing (haha) • Neurogenic bladder – full bladder does not stimulate the need to pee

26. Urinary Devices and Interventions • Urostomy • Stents • Foley catheters • Coude catheters • Condom catheters • Urine pouches – U bags – Pee Pouches • Straight catheterization • Suprapubic catheters

27. GI Devices and Interventions • Colostomy • Ileostomoy • Jejunostomy • Gastrostomy tube • Flexible Sigmoidoscopy • Upper GI • Lower GI • Rectal Tubes • Bowel Management Systems

28. Enemas • Cleansing enemas “Fleets” • Irrigation enemas – colonic irrigation • Medicated enemas • Carminative enema - flatus expellation enema • Oil retention enema

29. Output • Less than 30 ml of urine per hour is decreased • Monitor urine output every 6-8-12-24 hours • Record BM’s • Emesis • NG Output • Liquid stool • Bed sheet soaked in perspiration

30. Intake • Fluids • Foods with high water • IV and PO Fluids • Tube feedings • Free water with tube feedings

31. Tests- GI and GU • BUN and Creatinine • Urinary pH • Ketones • Specific Gravity • Urinalysis • Urine culture and sensitivity • Occult Blood • Blood • Urobilinogen • Stool tested for wormies, cdiff, bacteria, ova and parasites • Xrays/CT scans/Ultrasounds/Intravenous pyelogram IVP/MRI • Cystoscopy • Pyelogram

32. The Nursing Process • Assessment – Analyze • Nursing Diagnosis • Planning • Implementing • Evaluating

33. Scenario • 74 y/o man, daily laxative use, constipated history, medications: lasix, metformin, cholesterol, metoprolol, poor diet • Analyze: hx constipation, BP, diabetic, cholesterol issues, diet issues, decreased activity, laxative abuse • Nursing Dx: Constipation related to daily laxative usage • Plan: Client will: increase activity by walking 4 blocks daily, decrease laxative use to 3 times weekly, follow diet as recommended by dietician, increase fluids to 2 liters per day, use stool softeners daily, increase fiber intake to 20 gm/day, • Implement: Obtain dietary consult; Obtain PT/OT consult; Instruct on how to measure fluid intake and healthy fluid options; Instruct on s/s of constipation; instruct on s/s normal BM; instruct of side effects of medications including: lasix, laxatives and other medications; instruct on daily walk; instruct on keeping 7 day –diet-fluid-exercise-blood sugar log -- all accomplished in two weeks • Evaluation: Patient & family verbalizes side effects of laxative use and other medications; return demonstration of exercises; Shows 7 day log and able to analyze areas that are strengths and weaknesses; compliant with diabetic diet and diet as recommended by dietician; verbalizes healthy fluid options; verbalize free of s/s constipation