Hey guys, welcome back to my channel. I have another core concepts video for you today. Remember, this is a series geared toward med-surg nursing, but it is a great series if you're in a fundamentals course, but also awesome if you're just now starting your first med-surg course.
And even if you're in an adult complex health course and you're nearing graduation and taking NCLEX, this is a great series to review things that you've previously learned. So again, this is a back to the basics series in which we really are just trying to understand what is happening inside the body so that we can better assess and care for clients with acute and chronic conditions. So welcome if you're new here or welcome back if you're joining us again. And my name is April.
I'm excited to be here with you today. Today's core concept video is going to be on elimination. So elimination is defined as the excretion of waste from the body by the GI tract as feces and the renal or urinary system as urine. Now, when we think about bowel elimination, this is going to occur as a result of food and fluid that we put into our body.
And of course, as that fluid or food flows through our GI tract, that it's going to be absorbed from the small intestine into our bloodstream. And then anything that is waste is going to continue into the large intestine and be eliminated from the body through the rectum of the colon. Urinary elimination also occurs as a result of multiple kidney processes, and it's going to end with the passage of urine through the urinary tract.
So of course, when we feel that urge to urinate, our bladder is full, urine is going to flow through the urinary sphincter, the urethra, and then finally out the meatus. There are three interrelated concepts for elimination. fluid and electrolyte balance, tissue integrity, and nutrition.
Now we have discussed all of those previously in core concepts videos. If you missed those videos, or if you would just like a refresher and you've already viewed them, they will be linked in the description box below. Now, as adults, we definitely desire to have voluntary control over both bowel and urinary elimination, and this is called continence.
However, there are some adults in which they have incontinence. Now it could be incontinence for bowel and bladder control. or it could be one or the other.
Now we also have to talk about retention. So sometimes clients suffer from retention of urine or retention of stool. So the inability to excrete either stool or urine or both. So let's talk first about bowel elimination.
So of course, this slide should look familiar. We look at continuums a lot in the core concept series. So for bowel elimination, of course, we have a continuum.
So we hope that clients are sitting right here in the middle with normal bowel function. However, many clients will be very, very far on one side with watery, very, very liquid stool, which is called diarrhea, or they will be very far on the opposite end of the continuum with very hard, dry, difficult to pass stool known as constipation. And we do categorize bowel elimination based on the consistency of the fecal matter, which is diarrhea or constipation.
Now, when we think about risk factors. First and foremost, aging is going to be a risk factor for either urinary or bowel elimination issues. Because of decreased peristalsis, we can see constipation problems.
And as pelvic floor muscles weaken, we can see urinary incontinence problems. There are neurologic disorders that can result in incontinence as well. So stroke, dementia, multiple sclerosis is another.
And then excessive use of laxatives can cause diarrhea. And then diarrhea can also be caused by infections of the bowel, such as gastroenteritis and chronic inflammatory bowel diseases like Crohn's disease. Also irritable bowel syndrome, we know can cause both diarrhea and constipation.
So clients suffering from IBS often have one or the other. Now, when we think about urinary retention, benign prostatic hyperplasia, so BPH contributes to urinary retention. spinal cord injuries, of course, renal or kidney stones, and then chronic kidney disease, especially end stage kidney disease, where the kidneys are just not able to even produce urine anymore. For stool retention, we just talked about decreased peristalsis, but also inadequate fiber and fluid intake, lack of exercise, certain medications such as opioid medications cause constipation, and then spinal cord or brain injuries can also cause stool retention. There are many, many physiologic and psychological consequences of incontinence and retention.
So for incontinence, we can see damage to tissue integrity. So as clients have bowel, sorry, stool or urine that is touching their skin, especially for any lengthy period of time, we can see impaired tissue integrity. Depression and anxiety because of the inability to control bowel or bladder habits. Maybe you have adults that are needing to wear adult diapers, and that really is a term that we try not to use around those clients because it does feel degradating to them.
So it can induce depression or anxiety to not be able to manage your bowel or your bladder. Diarrhea can lead to fluid and electrolyte imbalances, in particular, fluid volume deficit and hypokalemia. Now for bowel and urinary retention.
Anytime we have retention of feces or urine, we do have a buildup of toxins or waste in our body. Now, although it is not very common at all, if the bladder were to become excessively overfilled due to urinary retention, it could rupture. But more commonly with urinary retention, we do see urinary tract infections. So as that urine is retained in the bladder and it sits and sits and sits, it becomes a great medium for bacteria to invade. Hence, we get a urinary tract infection.
Bowel impaction is also a result of feces retention, and that can ultimately lead to a partial or a complete bowel obstruction, which could be life-threatening. As far as assessment, so again, a good health history. From a physical exam perspective, we do want to take a look at the perineal area and the buttocks, again, looking for that skin integrity breakdown, monitoring frequency, amount, and consistency of urine and stool, and then documenting those assessments. For bowel sounds, we want to listen to bowel sounds in all four quadrants and hyperactive bowel sounds.
Usually we hear with diarrhea and hypoactive bowel sounds are heard with constipation. And then we can also palpate both the bladder and the bowel for any retention. For diagnostic testing, urinalysis and culture can give us a lot of information about infection or specific gravity or osmolality.
anything that we're looking for related to especially retention of urine. Now, imaging and ultrasound can tell us if we have anything that could be obstructing the bladder or the bowel. And then a bedside bladder scan is what we often use as nurses just to assess how much urine is in that bladder. And then stool culture can also tell us about infections. From a health promotion perspective, we do want to be promoting adequate nutrition and hydration.
So from a diet perspective, that means lots of fiber. So high fiber diet to prevent constipation. That's going to be fruits, vegetables, whole grains. And then of course, eight to 12 glasses of water daily. Now, other things that we can do to promote elimination in adults is to toilet when the urge occurs.
So don't hold in urine. Don't hold in stool. When you feel the need to go to the bathroom and toilet, we need for that to happen.
And then for constipation. Bulk forming laxatives or stool softeners can help, I guess, moderate out or have consistency with bowel movements. Now, as far as interventions for diarrhea, if it's chronic and ongoing, then we do want to seek medical attention and decide, discover what that underlying cause is so it can be treated.
Remember that diarrhea can very quickly lead to acid base imbalance, fluid imbalance, and electrolyte imbalance. For constipation. Often we just need client education.
So what does the diet look like? You know, is the client drinking enough fluids? Could they possibly be taking a stool softener?
Are they exercising enough? A lot of times just some good client education. For urinary incontinence, frequent toileting. This is also called bladder training. So every one or two hours training the body to empty the bladder is helpful.
And then for urinary retention, urinary catheterization. That could be an in and out or a intermittent catheterization, or it could be an indwelling. Now we do know that we always want to do the least invasive procedures first.
So it may be that you start with intermittent catheterization, which also has less risk for infection than an indwelling catheter, but there might come a time when it does need to be left in. Okay, guys, that's all I have for you today on elimination. Hopefully this was helpful. If you have any questions or comments, please don't hesitate to leave them below, or you can certainly reach out to me on Twitter, Instagram, or via email. Now, if you're not following me on Twitter, I am posting every single day on both Twitter and Instagram, and I would love to have you follow me over there for practice NCLEX style questions, test taking strategies and tips, and just other nursing student inspiration.
Also, if you haven't checked out my Etsy shop, I have case studies and study guides for all of the core concepts. And I would be happy to have you over there. There will be a link to that Etsy shop in the description box as well. Have a wonderful day and I will see you in the next core concepts.