Elimination needs

Elimination needs
Elimination
 Elimination is just as important to the body as the intake of solids and liquids
 Waste products need to be excreted to maintain normal internal homeostasis
 The body has the following mechanisms to rid of waste
 Through the elimination of urine via the urinary tract
 Via the gastro-intestinal tract as faeces
 Through the lungs as air being exhaled
 Through the skin as sweat
Factors affecting micturition
 Age
 Adults and children are able to control micturition
 Children under 3yrs may not have control over their bowel or bladder
 The elderly may have urinary incontinence
 Privacy
 Comfortable, secure, private, and where possible, known surroundings are more
conducive to urination
 Position: micturition is usually done sitting (or standing depending on the gender)
 The nature of the facility: a clean, comfortable toilet is best
 Mental state: anxiety may alter micturition in a person with normal urination habits
 Health
 Ill health with debilitating effects may effect muscle tone and could lead to incontinence
 Fluid intake: increased fluid intake can result in increased volume and frequency of urination
 Mobility
 Immobility may result in stagnation of urine in the bladder that distends to contain a
large volume of urine

, Altered urinary function
 Urinary retention
 The inability to empty the bladder of urine
 The person is unable to perceive that is bladder is full or unable to relax the bladder
neck and external urethral sphincter to allow urine to pass from the body
 This is a painful condition, and the patient can become agitated
 Occurs as a result of: selling of the meatus during childbirth, gynaecological surgery,
local trauma, obstruction by tumour, enlarged prostrate, UIT or immobility
Nursing interventions to facilitate micturition include
 Relaxation
 Positioning
 Timing
 Nutrition and fluids
 Exercise
 Interventions during bedrest
 Urinary incontinence: the involuntary loss of urine from the bladder
1) Stress incontinence
 Increases abdominal pressure causing involuntary loss of small amounts of urine
 Can be caused by coughing, sneezing, jumping or a weak pelvic floor muscle from obesity
or pregnancy
2) Urge urinary incontinence
 Random involuntary passage of urine after a strong urge to void
 Due to bladder irritation/infection, overdistention of the bladder or the intake of caffeine
or diuretic
3) Reflex urinary incontinence
 Involuntary loss of urine
 Often occurs at ± predictable intervals when a specific bladder volume is reached, and
sphincter control is overcome
 Die to spinal cord impairment or radical pelvic surgery
4) functional urinary incontinence
 The inability of a continent person to reach the toilet in time to avoid unintentional loss
of urine
 Die to sensory, cognitive, psychological, neurovascular or mobility deficit
5) total urinary incontinence
 Continuous, unpredictable loss of urine
 Die to neurological lesion or trauma to the spinal cord or brain
Nursing interventions for urinary incontinence
 Ensure the patient goes to the toilet every 2-3hrs to keep the bladder empty
 Monitor fluid intake and output
 Encourage pectineal exercises/start a bladder rehabilitation programme
 Support incontinent male patient to wear a condom catheter
 Give information regarding special protective underwear for adults
 Protect the skin by keeping it clean and dry
 Catheterise that patient if chronically incontinent
 Limit social withdrawal of patients
 Follow and interprofessional team approach