Core Concepts in Med-Surg Nursing: Elimination
Introduction
- Video geared towards med-surg nursing students
- Useful for:
- Fundamentals course
- First med-surg courses
- Adult complex health courses (near graduation/NCLEX preparation)
- Focus: Understanding what happens inside the body for better assessment and care of clients
Elimination Overview
- Definition: Excretion of waste from the body
- GI tract: Feces
- Renal/urinary system: Urine
Bowel Elimination
- Result of food and fluid intake
- Process:
- Absorption in small intestine into bloodstream
- Waste continues to large intestine
- Eliminated through rectum and colon
Urinary Elimination
- Result of kidney processes
- Process:
- Urine flows through urinary tract
- Exits through urinary sphincter, urethra, and meatus
Interrelated Concepts
- Fluid and electrolyte balance
- Tissue integrity
- Nutrition
Concepts of Continence and Incontinence
- Continence: Voluntary control over elimination
- Incontinence: Lack of voluntary control
- Bowel and/or urinary incontinence
- Retention: Inability to excrete stool or urine
Bowel Elimination Continuum
- Normal function: Midpoint
- Diarrhea: Watery, liquid stool
- Constipation: Hard, dry, difficult stool
Risk Factors
- Aging: Decreased peristalsis, weak pelvic muscles
- Neurologic disorders: Stroke, dementia, multiple sclerosis
- Excessive laxative use: Diarrhea
- Infections: Gastroenteritis, Crohn's disease
- IBS: Diarrhea or constipation
Urinary Retention Risk Factors
- Benign prostatic hyperplasia (BPH)
- Spinal cord injuries
- Renal/kidney stones
- Chronic kidney disease
Stool Retention Risk Factors
- Decreased peristalsis
- Inadequate fiber and fluid
- Lack of exercise
- Opioid medications
- Spinal cord/brain injuries
Consequences of Incontinence and Retention
-
Incontinence
- Impaired tissue integrity
- Depression/anxiety
- Fluid and electrolyte imbalances (e.g., fluid volume deficit, hypokalemia)
-
Retention
- Buildup of toxins/waste
- Urinary retention: UTI risk, rare bladder rupture
- Stool retention: Bowel impaction, potential obstruction
Assessment
- Health history and physical exam
- Monitor frequency, amount, and consistency of urine and stool
- Auscultate bowel sounds
- Hyperactive: Diarrhea
- Hypoactive: Constipation
- Palpation for retention
- Diagnostic testing: Urinalysis, culture, imaging, ultrasound, bladder scan, stool culture
Health Promotion
- Adequate nutrition and hydration
- High fiber diet: Fruits, vegetables, whole grains
- 8-12 glasses of water daily
- Toilet when urge occurs
- Bulk-forming laxatives or stool softeners
Interventions
- Diarrhea: Seek medical attention for chronic cases
- Constipation: Client education on diet, fluids, exercise
- Urinary incontinence: Frequent toileting/bladder training
- Urinary retention: Catheterization (intermittent preferred)
Conclusion
- Reach out with questions or comments
- Engage on social media for more content
- Visit Etsy shop for case studies and study guides
These notes summarize the key points from April's video on elimination, providing a foundation for understanding and managing elimination in nursing. For further details and resources, refer to April's provided links.