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Chapter 37 Urinary and Bowel Elimination
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Chapter 37 Urinary and Bowel Elimination. 37-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Urinary Elimination.

Dec 19, 2015

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Page 1: Chapter 37 Urinary and Bowel Elimination. 37-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Urinary Elimination.

Chapter 37

Urinary and Bowel Elimination

Page 2: Chapter 37 Urinary and Bowel Elimination. 37-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Urinary Elimination.

37-2Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Physiology of Urinary Elimination

Urinary Elimination (voiding, urination)• The kidneys form the urine.• The ureters carry urine to the bladder.• The bladder acts as a reservoir for the urine.• The urethra is the passageway for the urine

to exit the body.

Page 3: Chapter 37 Urinary and Bowel Elimination. 37-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Urinary Elimination.

37-3Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Physiology of Urinary Elimination

Continence in the Adult • Anatomic integrity of the urinary system• Nervous control of the detrusor muscle• Competent sphincter mechanism

Urinary Incontinence• Uncontrolled loss of urine • Abnormalities of one or more factors

Page 4: Chapter 37 Urinary and Bowel Elimination. 37-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Urinary Elimination.

37-4Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Physiology of Urinary Elimination

Structures of the Upper Urinary Tract• Kidneys • Nephrons• Parenchyma• Hilus of kidney• Renal pelvis• Ureter

Page 5: Chapter 37 Urinary and Bowel Elimination. 37-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Urinary Elimination.

37-5Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Physiology of Urinary Elimination

Both the renal pelvis and ureters consist primarily of smooth muscle.

Peristalsis (muscular contraction) moves urine from the upper to the lower urinary tract.

Occurs during the prolonged phases of bladder filling and storage.

Page 6: Chapter 37 Urinary and Bowel Elimination. 37-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Urinary Elimination.

37-6Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Physiology of Urinary Elimination

Structures of the Lower Urinary Tract• Bladder• Detrusor (smooth muscle bundles in the

upper portion of the bladder)• Urethra (sphincter mechanism)• Pelvic muscles (slow-twitch fibers and fast-

twitch fibers)

Page 7: Chapter 37 Urinary and Bowel Elimination. 37-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Urinary Elimination.

37-7Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Physiology of Urinary Elimination

Nervous Control of the Detrusor Muscle• Central nervous system• Peripheral nervous system• Sympathetic nervous system• Parasympathetic nervous system• Micturition center

Page 8: Chapter 37 Urinary and Bowel Elimination. 37-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Urinary Elimination.

37-8Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Physiology of Urinary Elimination

Urethral Sphincter Mechanism• Urethral compression• Bladder filling• Urinary storage• Urethral tension• Supportive structures

Page 9: Chapter 37 Urinary and Bowel Elimination. 37-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Urinary Elimination.

37-9Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Physiology of Bowel Elimination

Continence • Consistency of the stool (fecal material)• Intestinal motility• Compliance and contractility of the rectum • Competence of the anal sphincters

Page 10: Chapter 37 Urinary and Bowel Elimination. 37-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Urinary Elimination.

37-10Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Physiology of Bowel Elimination

Structures of the Gastrointestinal Tract (alimentary canal) Related to Bowel Elimination• Small intestine• Ileocecal valve• Large bowel (colon)• Ileocecal sphincter• Anal sphincter

Page 11: Chapter 37 Urinary and Bowel Elimination. 37-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Urinary Elimination.

37-11Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Physiology of Bowel Elimination

Intestinal Motility and Rectal Accommodation• Rectal filling • Rectal contractions• Rectal accommodation• Postponement of defecation• Constipation

Page 12: Chapter 37 Urinary and Bowel Elimination. 37-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Urinary Elimination.

37-12Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Physiology of Bowel Elimination

Anal Sphincter Mechanism• Internal and external sphincters• Striated muscle fibers• Sensory receptors

Page 13: Chapter 37 Urinary and Bowel Elimination. 37-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Urinary Elimination.

37-13Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Factors Affecting Elimination

Age Diet Exercise Medications

Page 14: Chapter 37 Urinary and Bowel Elimination. 37-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Urinary Elimination.

37-14Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Common Alterations in Elimination

Urinary Elimination• Acute urinary incontinence• Chronic urinary incontinence

Page 15: Chapter 37 Urinary and Bowel Elimination. 37-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Urinary Elimination.

37-15Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Common Alterations in Elimination

Stress Urinary Incontinence (SUI)• Uncontrolled loss of urine caused by

physical exertion in the absence of a detrusor muscle contraction

• Associated with urethral hypermobility or intrinsic sphincter deficiency

Page 16: Chapter 37 Urinary and Bowel Elimination. 37-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Urinary Elimination.

37-16Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Common Alterations in Elimination

Urgency and Urge Urinary Incontinence (overactive bladder syndrome)• Involuntary leakage accompanied by urge to

void

Functional Urinary Incontinence• Altered mobility, manual dexterity• Ability to access toilet• Cognitive changes

Page 17: Chapter 37 Urinary and Bowel Elimination. 37-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Urinary Elimination.

37-17Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Common Alterations in Elimination

Extraurethral Incontinence• Uncontrolled loss of urine that exists when

the sphincter mechanism has been bypassed

Page 18: Chapter 37 Urinary and Bowel Elimination. 37-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Urinary Elimination.

37-18Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Common Alterations in Elimination

Urinary Retention• Bladder outlet obstruction• Deficient detrusor muscle

Page 19: Chapter 37 Urinary and Bowel Elimination. 37-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Urinary Elimination.

37-19Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Alterations in Bowel Elimination

Constipation Diarrhea Fecal Incontinence

Page 20: Chapter 37 Urinary and Bowel Elimination. 37-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Urinary Elimination.

37-20Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Bowel Retention

Constipation is infrequent and difficult passage of hardened stool.• Dietary factors, dehydration• Inadequate dietary bulk• Diverticular disease• Neuropathic conditions• Functional limitations

Page 21: Chapter 37 Urinary and Bowel Elimination. 37-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Urinary Elimination.

37-21Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Bowel Retention

Fecal Impaction• Bolus of hardened stool• Further slows colonic transit time and

passage of further fecal contents

Page 22: Chapter 37 Urinary and Bowel Elimination. 37-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Urinary Elimination.

37-22Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Bowel Retention

Perceived constipation is influenced by psychological and emotional stress.

Page 23: Chapter 37 Urinary and Bowel Elimination. 37-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Urinary Elimination.

37-23Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Alterations in Bowel Elimination

Diarrhea is the passage of liquefied stool with increased frequency and consistency.

Page 24: Chapter 37 Urinary and Bowel Elimination. 37-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Urinary Elimination.

37-24Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Alterations in Bowel Elimination

Primary Causes of Diarrhea• Malabsorption syndromes• Inflammatory bowel disease• Short bowel syndrome• Side effects of drugs• Laxative or enema misuse

Infectious diarrhea is caused by a pathogen.

Page 25: Chapter 37 Urinary and Bowel Elimination. 37-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Urinary Elimination.

37-25Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Alterations in Bowel Elimination

Bowel (fecal) Incontinence• Dysfunction of the anal sphincter• Disorders of the delivery of stool to the

rectum• disorders of rectal storage• Anatomic defects

Page 26: Chapter 37 Urinary and Bowel Elimination. 37-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Urinary Elimination.

37-26Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Assessment

Health History• Elimination habits• Type of incontinence• Complicating factors• Bladder and bowel management strategies

used by client

Page 27: Chapter 37 Urinary and Bowel Elimination. 37-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Urinary Elimination.

37-27Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Assessment

Physical Examination• Mental status• Mobility and dexterity• Inspection of perineum for skin integrity• Inspection of vaginal vault • Pelvic support• Perineal sensation• Perianal area, digital rectal exam

Page 28: Chapter 37 Urinary and Bowel Elimination. 37-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Urinary Elimination.

37-28Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Assessment

Diagnostic and Laboratory Data• Urinalysis• Stool culture• Defecography• Anorectal ultrasonography

Page 29: Chapter 37 Urinary and Bowel Elimination. 37-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Urinary Elimination.

37-29Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Nursing Diagnoses

Impaired Urinary Elimination Stress Urinary Incontinence Reflex Urinary Incontinence Urge Urinary Incontinence Functional Urinary Incontinence Urinary Retention

Page 30: Chapter 37 Urinary and Bowel Elimination. 37-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Urinary Elimination.

37-30Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Nursing Diagnoses

Constipation Perceived Constipation Diarrhea Bowel Incontinence

Page 31: Chapter 37 Urinary and Bowel Elimination. 37-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Urinary Elimination.

37-31Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Other Nursing Diagnoses

Low Self-Esteem Deficient Knowledge Risk for Infection Risk for Impaired Skin Integrity Toileting Self-Care Deficit

Page 32: Chapter 37 Urinary and Bowel Elimination. 37-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Urinary Elimination.

37-32Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Outcome Identification and Planning

Target outcomes center around restoring and maintaining regular elimination habits and preventing complications.

Page 33: Chapter 37 Urinary and Bowel Elimination. 37-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Urinary Elimination.

37-33Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Implementation

Maintain Elimination Health• Fluid intake• Diet• Lifestyle and Prevention

Page 34: Chapter 37 Urinary and Bowel Elimination. 37-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Urinary Elimination.

37-34Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Implementation

Lifestyle and Prevention• Alcohol and tobacco use• Stress management• Weight reduction• Elimination habits• Positioning

Page 35: Chapter 37 Urinary and Bowel Elimination. 37-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Urinary Elimination.

37-35Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Implementation

Lifestyle and Prevention• Initiate pelvic muscle exercise regimen• Bladder training for urge incontinence• Management of urinary retention• Management of functional urinary

incontinence• Suggest environmental modifications

Page 36: Chapter 37 Urinary and Bowel Elimination. 37-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Urinary Elimination.

37-36Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Implementation

Lifestyle and Prevention • Initiate behavioral intentions• Monitor skin integrity

Page 37: Chapter 37 Urinary and Bowel Elimination. 37-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Urinary Elimination.

37-37Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Implementation

Apply a Containment Device• Condom catheter• Incontinence and dribble pads• Rectal pouch and rectal tube

Initiate Diet and Fluid Therapy

Page 38: Chapter 37 Urinary and Bowel Elimination. 37-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Urinary Elimination.

37-38Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Implementation

Administer Medications• Over the Counter (OTC)• Prescription

Page 39: Chapter 37 Urinary and Bowel Elimination. 37-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Urinary Elimination.

37-39Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Implementation

Perform Catheterization Intermittent Catheterization

Page 40: Chapter 37 Urinary and Bowel Elimination. 37-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Urinary Elimination.

37-40Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Implementation

Administer Enemas• Cleanse the lower bowel• Assist in evacuation• Instill medication

Initiate Rectal Stimulation

Page 41: Chapter 37 Urinary and Bowel Elimination. 37-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Urinary Elimination.

37-41Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Implementation

Various types of enema equipment and solutions

Page 42: Chapter 37 Urinary and Bowel Elimination. 37-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Urinary Elimination.

37-42Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Implementation

Monitor Elimination Diversions• Urinary Diversions

- Ileal conduit- Continent urinary diversion

• Bowel Diversions- Ileostomy- Colostomy- Ileoanal reservoir

Page 43: Chapter 37 Urinary and Bowel Elimination. 37-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Urinary Elimination.

37-43Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Implementation

Surgical Management• Bladder suspension• Artificial urinary sphincter device• Implanted devices• Surgical reconstruction• Surgical closure of fistulae and ectopia• Endoscopy, other procedures to alleviate

obstruction or dyssynergia

Page 44: Chapter 37 Urinary and Bowel Elimination. 37-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Urinary Elimination.

37-44Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Implemenation

Complementary Therapies• Holistic approach to effective elimination of

waste products and toxins- Diuretics- Antimicrobials- Antiseptics- Stimulants and Cathartics

Page 45: Chapter 37 Urinary and Bowel Elimination. 37-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Urinary Elimination.

37-45Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Evaluation

Client’s level of maintenance or restoration of elimination patterns and return to an appropriate level of independence

Prevention of skin breakdown and infection

Client understanding of procedures and self-care