| Unit 12 Elimination Chapter 1 Urinary Elimination Factors influencing urinary habits Each person has unique urinary habits. Many of these are learned in childhood, others are learned later in life. To assess the individual in relation to urinary function, the following needs to be considered: ● Diet and fluid intake The amount and type of food are major factors that influence the output of urine. Some foods, in particular those containing protein and sodium, affect the amount of urine formed. Coffee, for example, increases urine formation. ● Activity level Physical activity is necessary to maintain good muscle tone. ● Developmental level The level of growth and development also affects the pattern of urination. ● Pathologic conditions A wide variety of conditions can increase or decrease urination. ● Medication Some medications can cause changes in the production of urine, in both amount and character. ● Others For a pregnant woman, frequency is increased because of big uterus forcing bladder. Assessment of Urine Volume and frequency Normal volume of urine for an adult is about 1000 to 2000 ml/day. It is usual to void 3 to 5 times a day in the daytime. Color Normal urine is straw colored or amber colored. The latter is most likely early in the morning when it is most concentrated. Odor Normal urine has a characteristic faint aromatic odor. A strong odor may be indicative of some problems, such as an infection, or the ingestion of certain medications. Specific gravity Specific gravity is the weight or degree of concentration of a substance compared with that of an equal volume of another. The normal range for specific gravity of urine is 1.010 to 1.025. Clarity Normal urine is clear or transparent. Urine may become cloudy due to the presence of mucus or pus. PH Normal urine is slightly acid, with a pH ranging from 4.5 to 7.5. Abnormal Urinary Elimination Urinary retention Urinary retention is the accumulation of urine in the bladder and inability of the bladder to empty itself. Because urine production continues, retention results in distention of the bladder. With urinary retention, some adult bladders may distend to hold 3000 to 4000 ml of urine. Urinary incontinence Urinary incontinence is a temporary or permanent inability of the external sphincter muscles to control the flow of urine from the bladder. It is the opposite of retention. If the bladder is totally emptied during incontinence it is referred to as complete incontinence; if not totally emptied it is referred to as partial incontinence (e.g., dribbling). Interventions of Urinary Elimination Retention Measures that assist the patient to maintain a normal voiding pattern, the same as general measures, are applicable when dealing with urinary retention. If retention occurs postoperatively, ensure that prescribed analgesics are given as directed. When voiding difficulties often occur because of pain in the incision area, it is usefull to relieve pain. Besides, urinary catheterization can be carried out to prevent skin from ulcer. Incontinence The following bladder training programs can be used to reduce the problem of incontinence: ● Psychologic nursing ● As a protective measure, apply protector pads to keep the bed linen dry and provide specially made waterproof underwear to contain the urine and decrease the patient’s embarrassment. ● Irrigating outside for ambulatory or bedridden male patients whose incontinence cannot be controlled, application of a condom and catheter to the penis permits collection of the urine in a bag. ● Establish a regular voiding schedule and help the patient to maintain it. ● Regulate fluid intake ● Increase physical activity This can improve muscle tone and blood circulation, thus helping the patient to control voiding. ● Encourage perineal exercises This can increase the tone of muscles concerned with micturition, in particular the perineal and abdominal muscles. Periodic tightening of the perineal muscles and intentionally stopping and restarting of the urine stream can also assist a patient in gaining voiding control. ● For patients who have bladder flaccidity (weak, soft, and lax bladder muscles), manual exertion of pressure on the bladder may be necessary to force urine out. ● Urinary catheterization may be necessary if other measures are in vain. Urinary Catheterization Urinary catheterization is the introduction of a tube (a catheter) through the urethra into the urinary bladder. Chapter 2 Fecal Elimination Factors affecting fecal elimination ● Education Education can influence the attitude and the habit of fecal elimination, for example, defecation can usually be ignored because of less of privacy. ● Age Age affects not only the character of fecal elimination but also its control. The very young are unable to control elimination until the neuromuscular system is developed. ● Diet Food is a major factor affecting fecal elimination. Sufficient bulk (cellulose, fiber) in the diet is necessary to provide fecal volume. ● Fluid Fluid intake also affects fecal elimination. ● Exercise Exercise programs help people of all ages to maintain muscle tone. ● Psychologic stressors Excessive stress can affect fecal elimination. ● Life-style The individual’s life-style influences fecal elimination in a number of ways. ● Medications Some drugs have side effects that can interfere with normal elimination. Some cause diarrhea; others, such as large doses of some tranquilizers and repeated administration of morphine and codeine, cause constipation. ● Pattern of defecation The time of defecation and the amount of feces expelled are as individual as the frequency of defecation. ● Some diseases Large intestine cancer can produce constipation, while malabsorption syndromes can lead to diarrhea. Abnormal Fecal Elimination Constipation Constipation refers to the passage of small, dry, hard stool or the passage of no stool for a period of time. It occurs when the movement of feces through the large intestine is slow, thus allowing time for additional reabsorption of fluid from the large intestine. Fecal incontinence Incontinence refers to loss of voluntary ability to control the fecal and gaseous discharges through the anal sphincter. The incontinence may occur at specific times, such as after meals, or it may occur irregularly. Interventions for Fecal Elimination Constipation ● Increase the patient’s daily fl高级职称考试网uid intake, or have the patient take a hot drink when arising. ● Include bulk in the diet by having the patient eat prunes, raw fruit, bran products, and the like. ● Increase the person’s physical activity if possible. ● Provide a regular time for fecal evacuation, such as after breakfast each day or at the person's usual time. ● Provide for privacy and comfort. Offer a warm bedpan to bedridden patients, and assist them to assume a high Fowler’s position with knees flexed. Curtain off the area, and allow them privacy and time to relax. ● Promote measures to relieve tension, and try to prevent factors that make the patient suppress the urge to defecate. Enemas Types of enemas Enemas can be classified retention and non-retention enemas. Non-retention enemas include cleansing enemas, a large and a small number of non-retention enemas. ● A large number of non-retention enemas A large number of non-retention enemas are given to clean as much of the large bowel as possible. They can remove constipation or flatus, clean the intestine, relief poison and reduce body temperature. ● A small number of non-retention enemas A small number of non-retention enemas are used to clean only the rectum and sigmoid colon. They are suitable for children, the elderly, pregnant women, postoperative patients of abdomen. ● Retention enemas Retention enemas are administered for various reasons. Retention enemas lubricate the rectum and sigmoid colon and soften feces, making defecation easier. They can treat intestinal infectin and calm down, when medicine is absorbed by bowel mucosa. ● Cleansing enemas Cleansing enemas act primarily by stimulating peristalsis through irritation of the colon and rectum and through distention by volume. Guidelines for administering enemas ● The temperature of the enema solution is normally 39 to 41℃, 28 to 32℃ to low the temperature, 4℃ to heat illness. ● The amount of solution to be administered depends on the kind of enema and the age and size of the person. ● When an enema is administered, the patient usually assumes the left lateral position so that the sigmoid colon is below the rectum, thus facilitating instillation of the fluid. ● The distance to which the tube is inserted depends on the age and size of the patient. In adults, it is normally inserted 7 to 10 cm. In children it is inserted 4 to 7 cm. | 
