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Urinary and Bowel Elimination Lecture

Lecture by: Maggie Keil MNe, RN

Objective One: Physiology of Urinary Elimination


Taylor: Pages 1132-1134-Read On Your Own

Objective Two: Factors Affecting Urinary Elimination


Taylor: Pages 1134-1136-Read On Your Own

Objective Three: Plan Of Care To Promote Urinary Elimination


Taylor: Pages 1136-1173

Plan Of Care
Assessing Diagnosing Planning Implementing Evaluating

Assessing
Nursing History Physical Assessment

Assessing(Nursing History)
Functional Issues Associated With Urinary or Fecal Incontinence: Mental Status Mobility and Dexterity

Focused Assessment Guide Urinary Elimination


Usual Patterns Of Urinary Elimination

Recent Changes in Urinary Elimination

Aids to Elimination

Present or Past Occurrence of Voiding Difficulties

Presence of Artificial Orifices

Health History Questions for Clients/Altered Elimination


Determine Duration of Problem

Determine Type of Urinary Incontinence

Identify Complicating Factors of Urinary Incontinence

Identify Bladder Management program

Factors to Assess-Influence Urinary Elimination


Fluid Intake

Loss of Body Fluid

Nutrition

Position

Psychological Factors

Obstruction Of urine flow Infection

Factors to Assess-Influence Urinary Elimination


Hypotension

Neurologic Injury

Decreased Muscle tone

Pregnancy

Surgery

Medications

Urinary Diversions

Indications Of Sexual Abuse

Assessment-Terms- Describe Additional Urinary Problems


Anuria

Dysuria

Frequency

Glycosuria

Nocturia

Oliguria

Assessment-Terms- Describe Additional Urinary Problems


Polyuria

Proteinuria

Pyuria

Suppression

Urgency

Assessing (Physical Assessment)


Kidneys

Bladder

Urethral Orifice

Skin Integrity and Hydration

Vaginal Vault

Urine

Diagnostic And Lab Data

Assessing (Diagnostic And Lab Data)


Dipstick Urinalysis

Microscopic Urinalysis

Urine Culture and Sensitivity

Urodynamic Studies

Cytoscopy

IVP

Retrograde Pyelography

Ultrasonography

Diagnosing (Urinary Function As Problem)


Impaired Urinary Elimination

Stress Urinary Incontinence

Reflex Urinary Incontinence

Urge Urinary Incontinence

Functional Urinary Incontinence

Urinary Retention

See Nursing Dx common Problems For Related To and M/B in Text

Diagnosing(Urinary Function As The Etiology)


Anxiety

Risk for Infection

Impaired Skin Integrity

Knowledge Deficit

Noncompliance

Pain

Self-Esteem Disturbance

Sexual Dysfunction

Sleep Pattern Disturbance Toileting Self-Care Deficit

Planning
Produce urine output about equal to fluid intake

Maintain fluid and electrolyte imbalance

Empty the bladder continually at regular intervals

Report ease of voiding

Maintain skin integrity

Implementing
Client Teaching

Promote Normal Urination

Promoting Fluid Intake

Diet

Lifestyle and Prevention

Stress Management

Strengthening Muscle Tone/Initiate Exercise

Implementing
Environmental Modifications

Management Of Urinary Retention

Management Of Urinary Incontinence

Evaluating
Produce a sufficient quantity of urine to maintain fluid, electrolyte, and acid-base balance

Empty the bladder completely at regular intervals without discomfort

Evaluating (Continued)
Develop a plan to modify any factors that contribute to current urinary problems that might adversely affect urinary functioning in the future Correct unhealthy urinary habits, such as delaying voiding, drinking insufficient fluids, or abusing diuretics

Objective Four: A&P Of Bowel Elimination


Taylor: Pages 1182-1184

Objective Five: Factors That Affect Bowel Elimination


Taylor: Pages 1185-1188

Objective Six: Plan Of Care To Promote Bowel Elimination


Taylor: Pages 1188-1206,1213

Plan Of Care
Assessing Diagnosing Planning Implementing Evaluating

Assessing (Nursing History)


Usual Pattern Of Bowel Elimination

Aids To Elimination

Recent Changes in Bowel Elimination

Problems With Bowel Elimination

Presence of Artificial Orifices

Nursing History Questions/Altered Elimination


Determine Type of Fecal Incontinence

Identify Complicating Factors of Fecal Incontinence

Identify Bowel Management Program

Assessment (Physical Assessment)


Mental Status

Mobility and Dexterity

Abdomen

Anus and Rectum

Stool Characteristics

Warning Signs

Assessment (Diagnostic And Laboratory Tests)


EGD

Colonscopy

Sigmoidoscopy

Upper GI and Small Bowel Series

Stool Culture

Defecography

Diagnosing (Bowel Elimination As The Problem)


See Nursing Diagnosing Diagnoses For Common Problems For R/T and M/B Constipation

Perceived Constipation

Diarrhea

Bowel Incontinence

Diagnosing (Bowel Elimination As The Etiology)


Altered Nutrition: Less Than Body Requirements

Anxiety

Body Image Disturbance

Fluid Volume Deficit

Impaired Skin Integrity

Diagnosing (Bowel Elimination As The Etiology)Continued


Ineffective Individual Coping

Knowledge Deficit

Pain

Self-Care Deficit

Self-Esteem Disturbance

Sexual Dysfunction

Planning
Have a soft, formed bowel movement every 1 to 3 days without discomfort Explain the relationship between bowel elimination and dietary fiber, fluid intake, and exercise Relate the importance of seeking medical evaluation if changes in stool color or consistency persist

Implementing
Client Teaching Promoting Regular Bowel Habits Nursing Management Of Fecal Incontinence Preventing And Treating Constipation

Preventing and Treating Diarrhea Decreasing Flatulence

Promoting Regular Bowel Habits


Timing

Positioning

Privacy

Nutrition

Age

Lifestyle

Exercise

Nursing Management Of Fecal Incontinence


Manipulation of Environment

Preventing and Treating Constipation


Teaching About Nutrition

Teaching About Cathartics And Laxatives

Enemas

Preventing And Teaching Diarrhea


Initial Management Of Diarrhea

Teaching About Nutrition

Teaching About Antidiarrheal Medication

Rectal Pouch

Decreasing Flatulence
Tympanities

Gas-Producing Foods

Movement

Positioning

Rectal Tube

Evaluating
Verbalize the relationships among bowel elimination and nutrition, fluid intake, exercise and stress management Develop a plan to modify any factors that contribute to current bowel problems or that might adversely affect bowel functioning in the future.

Have A Nice Weekend! Best Wishes On Your Test! Mrs. Keil