1. ELIMINATION
P&A

2. I drink too much.
The last time I gave a
urine sample, it had an
olive in it.
Rodney Dangerfield

3. Quick Anatomy Moment
 Kidneys
 Ureters
 Bladder
 Urethra

4. Urinary Elimination
Urine formation
Filtration – filters blood
- does not filter out RBC’s & protein
Reabsorption – as needed
Water, electrolytes, glucose
Secretion
H,K ammonia, creatinine,
uric acid
Micturition

5. Normal Urine
 Volume – approx 250ml-400ml per void
 - normal production 30ml/hour
-1200-1500cc for average adult per 24 hours
- 500-600 newborns
 Color
light yellow
 Clarity
clear without sediment
 Odor
no odor

6. Factors Affecting Urination
 Fluid Intake – influences output and frequency
 Hypovolemia- loss of fluid
 Nutrition – food content, salt, ETOH, caffeine
 Body position – work with gravity
 Cognition – dementia/confusion, stroke

7. Factors Affecting Urination (cont.)
 Psychological factors – stress, running water,
warm water, privacy
 Obstruction – anatomical, disease process
 Infection – E. coli
 Medications – diuretics

8. Altered Urinary function
 Dysuria
 Polyuria
 Oliguria
 Urgency
 Frequency

9. Altered Urinary function (cont.)
 Nocturia
 Hematuria
 Pyuria
 Urinary retention

10. Incontinence
 Stress
increased abdominal pressure
 Functional
unable to get to bathroom
 Total
continuous, involuntary

11. Diagnostics
 Random specimen  Clean catch
- does not need to be sterile - sterile
- into container or nun’s cap - three wipes

12. Diagnostics (cont.)
 24 hour  Catheter sample
-kidney function - sterile
- must include all urine - straight cath or indwelling
- timing

13. Collecting urine from young children
 Catheterization not
recommended
 Use of collection bag

14. Tests
 Specific gravity
- weight or concentration of urine compared to water
- urinometer
- normal adult 1.010 – 1.025
 Reagant strips
- dipped in urine
- measures substances in urine such as
glucose, proteins &
ketones

15. Tests (cont)
 Urinalysis
- most common
- 20cc-30cc sample
 Urine C&S
- identify microorganisms
- 24 to 48 hours
- often related to antibiotic use

16. Urinary Health Promotion
 Intake
 UTI’s
 Muscle tone

17. Urinary catheters
 Indications
-inability to void, accurate measurement, irrigation,
comfort
 Types
- straight, indwelling (Foley), triple lumen
 Risks
- infection, trauma

18. Straight catheterization
 Wash hands
 Check pt ID
 Explain procedure
 Position patient
 Open kit
 Bottom drape
 Sterile gloves
 Top drape
 Pour betadine on cotton balls
 Open lubricant
 Nondominant vs dominant hands
 Insert and advance
 Sample if needed
 Reposition patient, remove gloves, wash
hands document

19. Indwelling catheterization
 Wash hands
 Check pt ID
 Explain procedure
 Position patient
 Open kit
 Bottom drape
 Sterile gloves
 Top drape
 Test balloon
 Pour betadine on cotton balls
 Open lubricant
 Nondominant vs dominant hands
 Insert, advance & inflate balloon
 Sample if needed
 Reposition patient, strap to leg, remove
gloves, wash hands document

20. Indwelling catheter (Foley)

21. Nursing Responsibilities
 Placement and removal
 Assessment
 Sample collection
 Troubleshoot
 Irrigate when needed

22. Bladder irrigation

23. Other types of urinary catheters
Suprapubic Nephrostomy tubes
Condom Catheter

24. Other related urinary components
Dialysis  Bladder scanner
Hemodialysis
Peritoneal dialysis

25. Bowel Elimination

26. Factors Affecting Bowel Elimination
 Nutrition
- fiber
- lactose intolerant
- gluten
 Fluid intake
- 75% water
- ↓fluid intake
 Hemorrhoids
- enlarged varicose veins
 Medication
- narcotics
- Fe
- antacids

28. Altered bowel function
 Constipation
- infrequent, painful, hard, dry
 Fecal impaction
- accumulation in rectum
- digital disimpaction
 Diarrhea
- ↑ motility
- medication
 Incontinence
- involuntary
 Distention
- inactivity
 Disease process
- Crohn’s disease, Cystic Fibrosis

29. Diagnostic tests
 Specimen  Radiologic
- stool only - x-ray image of opaque substance
- barium, laxatives, enemas,
- procedure NPO
 Occult blood  Endoscopy
- Guaiac or Hemoccult - visualization of internal
- procedure structures
-EGD (esophagogastro
 Culture
duodenoscopy)
- atypical intestinal
organisms
- procedure, O&P
http://www.youtube.com/watch?v=_qrbzpDA98g&feature=related

30. Specimens

31. Checking for Occult Blood
 http://www.youtube.com/watch?v=Pc3MtqUwFwE

32. Colonoscopy
 http://www.youtube.com/watch?v=W0fjO0rsCIw

33. Enema
 Purpose – cleansing of large bowel
 Small Volume
- commercially prepared, oil or water, approx. 150cc
 Large Volume
- warm tap water or saline,
- 1000cc for adult, 240cc-350cc for child, 15cc-60cc infant
 Return Flow
- flatus
- 300cc-500cc
- repeat as necessary

34. Enema Procedure
 Wash hands
 ID patient and explain procedure
 Fill bag with fluid
 Place patient in left lateral position
 Place chux
 Insert lubricated end of enema tubing 3-4 inches
into rectum
 Hang/hold enema bag 12-18 inches above patient
 Place on bedpan or BSC or eventually bathroom
 Make patient comfortable
 Wash hands
 Document

35. Fecal Diversion
 Procedure
 Ostomy
 Ileostomy
 Colostomy
- temporary or permanent
- irrigation
- clothing
- unusual circumstances

36. Stoma

37. Types of Colostomies
 Ascending  Descending
Sigmoid

38. Types of Colostomies (cont.)
 Transverse

39. Care of the Colostomy
 Assessment
- pink, no pain, flush to skin
 Cleaning
- soap and water
 Bag changing
- disposable vs reusable
 Emotional support