Overview
This lecture covers key nursing interventions and assessment points for clients with urinary and bowel elimination issues, including diagnostics, care strategies, and the effects of medications and procedures.
Bladder and Bowel Elimination Assessment
- Success in bladder training is indicated by less than one urinary accident per week.
- Risk factors for persistent diarrhea include irritable bowel syndrome, high dairy intake, and antibiotic use.
- Colostomy irrigation is needed to maintain bowel function in some clients with a colostomy.
- Blood in stool is commonly evaluated with a fecal occult blood test.
Catheter and Urinary Interventions
- Intermittent catheters are recommended for clients with paraplegia to facilitate urinary elimination.
- For clean catch urine specimens, wipe front to back with a sanitary wipe.
- Dark, tea-colored urine can result from alcohol consumption.
- Dry mucous membranes indicate dehydration.
- Loss of bladder tone in older adults increases the risk of urinary leakage.
Diagnostic and Surgical Procedures
- Cystometric testing measures bladder capacity, pressure, and the point when urge to urinate begins.
- A nephrostomy tube after kidney stone removal is temporary.
- Ureteral stents are used for ureter obstruction from stones.
Incontinence and Retention
- Stress incontinence presents as urine leakage following coughing.
- Enlarged prostate raises the risk for urinary retention.
- A UTI left untreated can lead to pyelonephritis (kidney infection).
Elimination Patterns and Diet
- High fiber diets are encouraged for constipation; narcotic pain medications increase risk of constipation.
- Antibiotics can cause diarrhea by disrupting healthy gastrointestinal bacteria.
- Constipation is defined as bowel movements occurring less than every three days.
Procedures and Techniques
- For enemas, position the client on their left side with the right knee flexed.
- The first step for nasogastric tube decompression is to ensure the client is sitting.
- Pale yellow, clear urine is expected from a functioning indwelling catheter.
At-Risk Populations and Other Considerations
- Uncircumcised infants, school-age children, and older adults are at increased risk for urinary elimination alterations.
- Vitamin K is produced naturally in the large intestine.
- The urinary tract eliminates waste and excess fluid from the body.
- Temporary ileostomies allow the colon to heal post-surgery.
Key Terms & Definitions
- Colostomy irrigation — Procedure to flush the colon through a colostomy to manage waste.
- Fecal occult blood test — Test to detect hidden blood in stool.
- Cystometric testing — Diagnostic test measuring bladder’s capacity and pressure.
- Nephrostomy tube — Temporary tube placed in the kidney for urine drainage.
- Ureteral stent — Tube inserted to keep the ureter open, usually after stone obstruction.
- Pyelonephritis — Kidney infection that can develop from untreated UTI.
Action Items / Next Steps
- Review dietary recommendations and medication effects on elimination.
- Practice correct positioning and technique for elimination procedures.
- Study diagnostic tests for elimination disorders and associated rationales.