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Elimination

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Transcript

dgn 128 - Nursing Foundation II

excretion

nazirah johar

What is elimination?

we will learn about elimination

We will also learn about defecation and micturation. In this presentation we will know what are the factors that will influence defecation and micturation. As a nurse, of course we will learn about our role in performing procedures related to these problems.

outcomes

· General outcomes: Understand the concept of excrement Specific outcomes: 1. Define excrement 2. Explain the factors that affect excrement 3. Perform the procedure related to excrement correctly (Perineum care/penile care, giving and removing bed pan)

excrement

+info

is the process of eliminating or expelling waste matter. Excretion is the process where all the metabolic wastes are removed from the body. Excretion in humans is carried through different body parts and internal organs in a series of processes.

Elimination of liquid and solid wasteis normally routine and uneventful unless a change in habits or illness occurs - signs of illness

elimination of the waste

It is our responsibility to assess the client’s products of elimination (urine and feces) and to observe bladder and bowel function in order to detect elimination disorder

What is the definition of these terms?

· ELIMINATION - excretion of wasteproducts by the skin, kidneys, lungs and intestines.. MICTURATION - is the process of emptying the bladder. It also called voiding or urination. · DEFECATION - is the expulsion of feces from the anus and rectum.

micturation

20%

MICTURATION - is the process of emptying the bladder. It also called voiding or urination.

We have achieved 20% of the lecture. In the next slide we will learn about the normal urine analysis, factors affecting urination, alteration in urinary function and the urine specimen collection

Micturation

+info

The organs of the urinary system include the kidneys, renal pelvis, ureters, bladder, and urethra. The body takes nutrients from food and converts them to energy. After the body has taken the food components that it needs, waste products are left behind in the bowel and the blood. Dont forget to click at the info (the yellow box) to see the function of the organs.

The normal value of urine

What is the test for?

  • COLOR: light yellow or amber
  • CLARITY: clear or transparent
  • ODOR: aromatic, ammonia-like odor (expose to air for a time)
  • VOLUME: 250 – 400 mL at a time
  • SPECIFIC GRAVITY: 1.010 -1.030
  • URINE PH: 4.5 to 6. 5 (slightly acidic)
  • GLUCOSE: not present
  • ALBUMIN: not present

WHAT ARE THE FACTORS AFFECTING URINARY excretion?

The factors are as below. We will discuss on by one

Activity and muscle tone

Effects of aging

Food and fluid intake

Pathological condition

Medication

Psychological variables

Effects of aging

+info

Effects of aging

  • Diminished ability of kidney to concentrate urine may result in nocturia
  • Decreased bladder muscle tone may reduce the capacity of the bladder to hold urine, resulting in increased frequency of urination
  • Decreased bladder contractility leading to urine retention and stasis with increased risk of urinary tract infection
  • Neuromuscular problems, degeneration joint problems, alteration in thought processes, and weakness may interfere with voluntary control of urination and the ability to reach a toilet in time

FOOD AND FLUID INTAKE

  • Individual, family, and sociocultural variables may influence voiding habits.
  • The patient may view voiding as a personal and private act. They need to ask for assistance may lead to embarrassment and/or anxiety.
  • Stress may lead to the voiding of smaller amounts of urine at more frequent intervals.
  • Stress may lead to difficulty emptying the bladder due to its effects on the relaxation of perineal muscles and the external urethral sphincter.

Psychological variables

Activity and muscle tone

PATHOLOGIC CONDITION

Congenital urinary tract abnormalities, polycyctic kidney disease, urinary tract infection, urinary calculi (kidney stones), hypertension, diabetes mellitus, gout, and certain connective tissue disorders lead to altered quantity of urine.

The disease that reduces physical activity or leads to generalized weakness, such as arthritis, Parkinson's disease, and degenerative joint disease interferes with toileting.

Cognitive deficits and psychiatric conditions may interfere with ability or desire to control irination voluntarily.

PATHOLOGIC CONDITION

Fever and diaphoresis (profuse perspiration) lead to conservation of body fluids.

Other pathologic conditions, such as congestive heart failure, may lead to fluid retention and decreased urine output.

High blood glucose levels, such as diabetes mellitus, may lead to increased urine output due to osmotic diuresis.

medication

Abuse of analgesic

Use of some antibiotics

Use of Cholinergic medication

Use of diuretics

Altered urinary functions - incontinence

Urinary incontinence is the unintentional passing of urine. It's a common problem thought to affect millions of people.

· STRESS incontinence – when urine leaks out at times when your bladder is under pressure; for example, when you cough or laugh· URGE incontinence – when urine leaks as you feel a sudden, intense urge to pee, or soon afterwards · OVERFLOW incontinence (chronic urinary retention) – when you're unable to fully empty your bladder, which causes frequent leaking · TOTAL incontinence – when your bladder cannot store any urine at all, which causes you to pass urine constantly or have frequent leaking FUNCTIONAL incontinence - caused by factors outside of the urinary tract

Altered urinary functions - retention

Urinary retention is a condition in which you cannot empty all the urine from your bladder. Urinary retention can be acute—a sudden inability to urinate, or chronic—a gradual inability to completely empty the bladder of urine.

The symptoms of urinary retention can range from severe abdominal pain and the inability to urinate, to few or no symptoms at all. Urinary retention results from either a blockage that partially or fully prevents the flow of urine, or your bladder not being able to maintain a strong enough force to expel all the urine. Medical history, a physical exam, and tests is done to help find the cause of urinary retention. Tests include postvoid residual urine measurement, lab tests, imaging tests, urodynamic tests, and cystoscopy.

Urine specimen collections

Urine ward test

Urine 24 hours

Urine for culture and sensitivity

Urine for inspection

defecation

50%

DEFECATION - is the expulsion of feces from the anus and rectum.

Now, we will learn about the bowel elimination, the stool, factors that influence bowel habit and etc.

key terms

fecal impaction

Constipation

Prolonged retention or an accumulation of fecal material that forms a hardened mass in the rectum

flatus

Intestinal gas

Passage of dry, hard stool

Diarrhea

Hemorroids

Abnormally distended veins in the anal area

Passage of excessively liquid, non formed stool

Anatomy of gastrointestinal tract

  • The GI tract begins with the mouth and continues to the esophagus, the stomach, the small intestine, and the large intestine. It ends at the anus.
  • From the mouth to anus, the GI tract is approximately 9 m (30 feet) long.
  • The small intestine consists of the duodenum, jejunum, and ileum.
  • The large intestine consists of the cecum, colon (ascending and descending, and sigmoid), and rectum.
  • Accessory organ of the GI tract include the teeth, salivary glands, gallbladder, liver, and pacreas

Gastrointestinal tract

Click at the buttons to know what is normal about the stool

Signs of abnormal stool

Factors that influence bowel elimination

MOBILITY

DIET

INTESTINE DIVERSION

MEDICATION

HOW TO RELIEVE CONSTIPATION NATURALLY

Consume a mix of soluble and insoluble fibers.

Drink more water

Exercise more

Make time

Fecal culture and sensitivity (C&S)

Feces for inspections

Feces for Occult Blood

fecal spesimen collection

PURPOSE OF ASSISTING WITH BEDPAN

· Helping patient with the defecation andmicturition process· Measuring patient’s waste product · Inspecting and observing patient’s waste product · Taking the urine and feces sample for lab test (to collect specimen) . To perform bowel and bladder training

Don't forget to offer

Indication

  • Fracture lower extremities
  • Post-surgery
  • Special treatment (CRIB)

nursing management - to be continued

75%

We have reached 75% of the whole lecture. Another 25% will be covered in the next session in the form of demonstration videos.

See you in the next session!

references

  • Lynn, P. (2008) Taylor’s clinical nursing skills, A nursing process approach, 2nd ed.; Wolters Kluwer and Lippincott William & Wilkins; Philadelphia
  • Healthline Media UK Ltd. (Last reviewed on July 15, 2020) 13 home remedies for constipation. Retrieved from https://www.medicalnewstoday.com/articles/318694#_noHeaderPrefixedContent
  • NHS (last reviewed 7 November 2019) Overview of urinary incontinence. Retrieved from https://www.nhs.uk/conditions/urinary-incontinence/
  • NIH. Urinary retention. Retrieved from (https://www.niddk.nih.gov/health-information/urologic-diseases/urinary-retention
  • Robinson,J.(last review on September 07, 2020) What Your Poop Type and Color Mean; Retrieved from https://www.webmd.com/digestive-disorders/ss/slideshow-poop-type-color

to be continued (nursing mangements)

THANKSYOU!