Transcript Elimination The Gastrointestinal and Genitourinary Systems

ELIMINATION
THE
GASTROINTESTINAL
AND
GENITOURINARY
SYSTEMS
Lisa Flatt, RN, MSN, CHPN
THE GI TRACT
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Lower GI tract
 The
Large intestine consists of:
 ____________
 ____________
 ____________
Sigmoid Colon
 Rectum & Anus
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QUESTIONS
Where does the majority of bowel absorption
take place?_____________________
 Can you voluntarily contract and relax the anal
sphincters?_____________________
 Is the GI tract sterile?_____________
 Where is the peritoneum?_________
 Is the peritoneal area sterile?_______
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FUN FACTS!
Surgery that involves the bowel is considered
“unclean” because the bowel contents and
flora contain a large amount of bacteria, that if
spread to the peritoneum cause peritonitis.
 How would a patient develop peritonitis if they
have abdominal surgery – that does not involve
the bowel? (like a C-section)
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ALL ABOUT POOP
Feces/fecal matter/bowel movement /stool–
what are some other terms patients may use?
 “Normal stool” is soft, firm, brown and formed
 Abnormal consistency: diarrhea, constipated
(hard, rock-like), flakey, fulminant, frothy, liquid
 “Abnormal” colors: white, yellow, green, red,
black, clay-colored, chalk-colored
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6 PROBLEMS WITH INTESTINAL ELIMINATION
Constipation
 Diarrhea
 Fecal impaction
 Flatulence – aka fart
 Incontinence
 Helminths--worms
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THE GU TRACT
Kidneys
 Ureters
 Bladder
 Urethra
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THE COMPLICATED & CONVOLUTED KIDNEY
Nephron – the functional unit of the kidney
 Glomeruli- filters wastes; absorption, resorption
and reabsorption of fluids & electrolytes =
initial production of urine
 Loop of Henle – tubular system in the glomeruli
(descending & ascending) that transport the
urine, it starts as H2O and becomes more
acidic as it moves down the loop
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QUESTIONS
What is the difference between the male and
female urethra?________________________
 What does UTI stand for?________________
 Is a UTI in a male or female considered an
emergency and very serious? _________
Why?_____________________________
 Is the Urinary Tract sterile?____________
 Is urinary function usually decreased as a result of
the loss of one kidney?_________
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MORE QUESTIONS…….
Define Pyelonephritis __________________
 Can upper urinary tract infections be
considered life-threatening?_____________
 Are lower UTI’s more common in men or
women?_____________________
 How are they treated?______________
 What are some drug classifications used to
treat UTI’s?___________
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ALL ABOUT PEE
Urine/Making water/ pee pee/ wee wee – can
you think of any other names?
 “Normal” appearance – clear and light yellow in
color
 “Abnormal” findings - blood, sediment, mucus
or calculi (stones), brown color, foul smelling,
sluggish (thick)
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QUESTIONS
What can dark colored urine
indicate?_____________
 What if urine is bloody/red colored?_______
 Who is at the highest risk for urinary retention?
____Why?__________________
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7 PROBLEMS WITH URINARY ELIMINATION
Retention
 Urgency
 Frequency
 Incontinence
 Nocturia
 Polyuria
 Enuresis
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FACTORS THAT AFFECT GI AND GU ELIMINATION
Sex
 Age & Developmental Level
 Individual Preferences and patterns (dietary
habits)
 Physical condition
 Cultural, spiritual and/or religious factors
 Socioeconomic factors
 Environmental factors
 Psychological factors
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BABY POOP – AND PEE PEE
Meconium – dark green sticky mucousyprotects bowel in utero
 Breast – yellow and seedy (colostorum)
 Formula – brown, formed (poop less)
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CHILDREN ELIMINATION
Brown, formed and regular
 Potty trained
 Regression – stressors, new babies in the
house
 Loss of some function - activity
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ADULT ELIMINATION
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Soft, brown
Incontinent
Constipated
Peristalsis – slow down (gastroparesis, biopsy)
Mental – obsessed
Regular – for that person
Dependent on laxatives
BPH- retention, difficulty start and stop
Neurogenic bladder – urinary retention
Caffeine is a cathartic
FACTORS AFFECTION ELIMINATION
How do the various stages of life affect
elimination?_________________________
 What affect can activity have on intestinal
elimination?_________________________
 What affect does physical condition have on
intestinal elimination?__________________
 What affect does diet have on intestinal
elimination?__________________________
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IMPLICATIONS……
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PAGE 35-39
Activity, diet, fluids, fibers all affect bowel status
Using laxatives, enemas, suppositories can lead to inability to
poop on own
Diuretics – rid body of excess fluid, increase urination
Stool softeners – make soft NOT laxatives
Sleep - regularity
Stress – diarrhea or constipation
Abdominal and pelvic muscle tone - continence
Catheterization – sphincter muscle damage – leaking or
retention
Rectal tube – for fecal elimination (diarrhea) – other systems
Depression and other mental illness
NURSING ASSESSMENT OF THE GI SYSTEM
How often do you have a BM?
 What does it look like?
 Do you use laxatives regularly? Stool softeners?
 When was your LBM?
 Do you pass gas?
 Do you stomach pain? Does your abdomen feel
hard or distended?
 Bowel sounds in all quadrants?
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NURSING ASSESSMENT OF THE GU SYSTEM
How often do you urinate?
 Do you pee at night?
 Do you have pain with urination?
 Do you dribble/leak? Incontinent?
 What color is it?
 What does it smell like? Is it foul?
 Do you see mucus, stones or sediment? Milky?
 Do you see any red? Blood streaks?
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PROBLEM
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Constipation
Diarrhea
Fecal impaction
Flatulence
Incontinence
Helminths
WHAT TO DO
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Fluids, laxatives, stool softeners,
activity
Clear liquids, fiber, medications, stool
sample
Disimpact, enema, suppository
Beano, fiber
Attends, Depends, bowel and bladder
program, muscle strengthening,
Kegel’s
Kill the worms!
PROBLEMS, PROBLEMS, PROBLEMS
PROBLEM
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Frequency
Nocturia
Urgency
Dysuria
Enuresis – define length of
dry time
Incontinence
Retention
Polyuria
WHAT TO DO
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B&B program, UTI/labs/tests
B&B program, decrease
fluids prior to sleeping
B&B program, UTI/labs/tests
UTI/labs/tests
Labs/tests
B&B program, Kegel’s
Labs/tests/BPH
Asses fluids, diabetes,
labs/tests/UTI
PROBLEMS, PROBLEMS, PROBLEMS
DISEASE/CONDITION
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UTI –
BPH –
Incontinence –
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Functional
Overflow
Reflex
Total
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CAUSE AND TREATMENT
Retention –
Urinary suppression -
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Urinary Tract Infection –
bacteria or fungus
Prostate, aging process
Varies with type
BPH, sphincter valve issues,
catatonia (mental issues),
spinal cord injuries
Kidneys no longer make
urine
DISEASES/CONDITIONS OF THE URINARY TRACT
Other Stuffs
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Disease: Cancer & chemotherapy use– degradation of
mucosal lining, diarrhea, blood, poor absorption,
constipation
Diarrhea **8 or more liquid stools in one day*
Parasites, worms, medications, foods, stress, diet,
IBS, Chron’s, CDIFF!!!!!!!!!
Incontinence – drugs, sphincter control, diseases
(tumors), stress, abuse, sneezing (haha)
Neurogenic bladder – full bladder does not stimulate
the need to pee
Urinary Devices and Interventions
Urostomy
 Stents
 Foley catheters
 Coude catheters
 Condom catheters
 Urine pouches – U bags – Pee Pouches
 Straight catheterization
 Suprapubic catheters
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GI Devices and Interventions
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Colostomy
Ileostomoy
Jejunostomy
Gastrostomy tube
Flexible Sigmoidoscopy
Upper GI
Lower GI
Rectal Tubes
Bowel Management Systems
Enemas
Cleansing enemas “Fleets”
 Irrigation enemas – colonic irrigation
 Medicated enemas
 Carminative enema - flatus expellation enema
 Oil retention enema
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Output
Less than 30 ml of urine per hour is decreased
 Monitor urine output every 6-8-12-24 hours
 Record BM’s
 Emesis
 NG Output
 Liquid stool
 Bed sheet soaked in perspiration
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Intake
Fluids
 Foods with high water
 IV and PO Fluids
 Tube feedings
 Free water with tube feedings
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Tests- GI and GU
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BUN and Creatinine
Urinary pH
Ketones
Specific Gravity
Urinalysis
Urine culture and sensitivity
Occult Blood
Blood
Urobilinogen
Stool tested for wormies, cdiff, bacteria, ova and parasites
Xrays/CT scans/Ultrasounds/Intravenous pyelogram IVP/MRI
Cystoscopy
Pyelogram
The Nursing Process
Assessment – Analyze
 Nursing Diagnosis
 Planning
 Implementing
 Evaluating
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Scenario
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74 y/o man, daily laxative use, constipated history, medications: lasix,
metformin, cholesterol, metoprolol, poor diet
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Analyze: hx constipation, BP, diabetic, cholesterol issues, diet issues, decreased
activity, laxative abuse
Nursing Dx: Constipation related to daily laxative usage
Plan: Client will: increase activity by walking 4 blocks daily, decrease laxative use
to 3 times weekly, follow diet as recommended by dietician, increase fluids to 2
liters per day, use stool softeners daily, increase fiber intake to 20 gm/day,
Implement: Obtain dietary consult; Obtain PT/OT consult; Instruct on how to
measure fluid intake and healthy fluid options; Instruct on s/s of constipation;
instruct on s/s normal BM; instruct of side effects of medications including:
lasix, laxatives and other medications; instruct on daily walk; instruct on keeping
7 day –diet-fluid-exercise-blood sugar log -- all accomplished in two weeks
Evaluation: Patient & family verbalizes side effects of laxative use and other
medications; return demonstration of exercises; Shows 7 day log and able to
analyze areas that are strengths and weaknesses; compliant with diabetic diet
and diet as recommended by dietician; verbalizes healthy fluid options; verbalize
free of s/s constipation