Bladder Elimination
1. Describe the anatomy and physiology of the urinary system.
The urinary system's function is to filter blood and create urine as a waste byproduct. The organs of the urinary system include the kidneys, renal pelvis,
ureters, bladder and urethra.
The body takes nutrients from food and converts them to energy. After the body
has taken the food components that it needs, waste products are left behind in
the bowel and in the blood.
The kidney and urinary systems help the body to eliminate liquid waste called
urea, and to keep chemicals, such as potassium and sodium, and water in
balance. Urea is produced when foods containing protein, such as meat, poultry,
and certain vegetables, are broken down in the body. Urea is carried in the
bloodstream to the kidneys, where it is removed along with water and other
wastes in the form of urine.
2. Identify the variables that influence urination.
Factors in a patient's history that normally affect urination are age, environmental
factors, medication history, psychological factors, muscle tone, fluid balance,
current surgical or diagnostic procedures, and presence of disease conditions.
3. Develop nursing diagnoses that correctly identify urinary problems responsive to
nursing therapy.
A. Impaired urinary elimination RT sensory motor impairment / UTI / Anatomic
obstruction
B. Functional Urinary Incontinence RT altered environmental factors / sensory,
cognitive, or mobility deficits
C. Stress Urinary Incontinence RT over distention between voiding / Weak pelvic
muscles & structural supports
D. Urinary Retention RT High urethral pressure caused by weak detrussor/
Inhibition of reflex arc/ Strong sphincter/ Blockage
4. Describe the manifestations and causes of:
I.
Transient incontinence
Appears suddenly, present for 6 months or less, caused by treatable factors,
delirium, restraints, acute illness, metabolic conditions, fecal impaction
II.
Stress incontinence
Occurs when laughing, sneezing or other physical activities, loss of less than 50
mL of urine, common after childbirth and in postmenopausal women, most
common in women over 50
III.
Urge incontinence
Associated with abrupt and urgent need to void, most common in elderly
IV.
Overflow incontinence
Feeling that the bladder has not completely emptied, small amounts of urine lost
involuntarily associated with an over distended bladder, voiding difficulties, such
as dribble or weak stream, urge to void frequently, including at nigh
V.
Mixed incontinence
May have features of two or more types of incontinence Ex: Stress and urge
incontinence common
VI.
Functional incontinence
Unable to reach the toilet because of physical limitations, loss of memory or
disorientation or environmental barriers
VII.
Total incontinence
Almost continuous urinary leakage, Priority: keep the patient dry and the skin
intact, least common type
Bowel Elimination
1. Describe the physiology of bowel elimination
Large intestine primary organ of bowel elimination. Extends from the ileocecal
valve(mouth) to the anus. GI Tract is a series of hollow mucous membrane lined
muscular organs. Purpose is to absorb fluids & nutrients, prepare food for
absorption & provide storage for feces.
2. Identify variables that influence bowel elimination
Developmental considerations, daily pattern, food and fluid, activity and muscle
tone, lifestyle, physiological changes, pathologic conditions, medications-iron&
opioids causes constipations, surgery and anesthesia.
3. Develop two nursing diagnoses that identify bowel elimination problems amenable to
nursing intervention
A. “Constipation r/t low fiber diet and inactivity AEB painful defecation, abdominal
distention.”
B. High risk for constipation: bed rest, reduced fluids, depressed, local lesions
4. Identify appropriate nursing interventions to promote regular bowel habits
A. Desired Patient Outcomes:
i. Patient has a soft, formed bowel movement every 1 to 3 days without discomfort
ii. The relationship between bowel elimination and diet, fluid, and exercise is
explained
B. Promoting Regular Bowel Habits:
Timing, positioning, privacy, nutrition, exercise, abdominal settings, thigh
strengthening