copyright © 2011 delmar, cengage learning. all rights reserved. chapter 39 elimination

Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Chapter 39

Elimination


Physiology of Elimination

• Urinary– Continence

• Integrity of urinary system

• Nervous control of detrusor muscle

• Competent sphincter mechanism

– Incontinence• Uncontrolled loss of urine


Urinary Elimination

• Structures of urinary tract:– Upper urinary tract

– Lower urinary tract

• Nervous control of detrusor muscle

• Urethral sphincter mechanism


Bowel Elimination

• Structures of gastrointestinal tract

• Intestinal motility and rectal accommodation

• Anal sphincter mechanism


Factors Affecting Elimination

• Age

• Diet

• Exercise

• Medications


Common Alterations in Elimination

• Urinary– Acute urinary incontinence

– Chronic urinary incontinence• Stress

• Instability

• Functional

• Extraurethral

– Urinary retention

(continued)


Common Alterations in Elimination

• Bowel– Constipation

– Diarrhea

– Fecal incontinence


Elimination and the Nursing Process

• Assessment– Health history

– Physical examination

– Diagnostic and laboratory data

(continued)



• Diagnosis– Impaired urinary elimination

– Stress urinary incontinence

– Reflex urinary incontinence

– Urge urinary incontinence

– Functional urinary incontinence

– Total urinary incontinence

(continued)



• Diagnosis– Urinary retention

– Constipation

– Perceived constipation

– Diarrhea

– Bowel incontinence

– Other diagnoses

(continued)



• Planning and outcome identification– NOC for continence and elimination:

• Urinary continence– Control of elimination of urine from bladder

• Urinary elimination– Collection and discharge of urine

(continued)



• Planning and outcome identification– NOC for continence and elimination:

• Bowel continence– Control of passage of stool from bowel

• Bowel elimination– Formation and evacuation of stool

(continued)



• Implementation– Maintain elimination health

• Fluid intake

• Diet

• Lifestyle and prevention– Alcohol and tobacco use

– Stress management

(continued)



• Implementation– Maintain elimination health

• Elimination habits

• Positioning

(continued)



• Implementation– Initiate exercise regimen

• Improves muscle tone

• Increases metabolism

• Stimulates bowels

• Leads to good urine production

– Suggest environmental modifications

(continued)



• Implementation– Initiate behavioral interventions

– Monitor skin integrity

– Apply containment device• Condom catheter

• Incontinent and dribble pads

• Rectal pouch and rectal tube

(continued)



• Implementation– Initiate diet and fluid therapy

– Administer medications

– Perform catheterization• Intermittent self-catheterization

– Administer enemas

(continued)



• Implementation– Initiate rectal stimulation

– Monitor elimination diversions• Urinary

• Bowel

– Monitor surgical management

– Employ complementary therapies

(continued)



• Evaluation– Elimination patterns

• Level of maintenance

• Restoration

– Return to independence

– Ongoing process

copyright © 2011 delmar, cengage learning. all rights reserved. chapter 39 elimination

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