ELIMINATION PATTERN

By
Syed Yousaf Shah
 Lecture Outline
A. Urinary elimination
1.Discuss the concept of elimination.
2. Discuss the process of micturition
3. Recognize age related differences in urinary elimination
4. Describe alterations in normal voiding pattern
5. Describe the factors that can alter urinary elimination
6. Discuss nursing assessment of urinary elimination
7. Discuss nursing diagnosis and intervention for altered
urinary function
8. Describe nursing intervention to promote normal urinary
elimination
9. Develop a CM –NCP for urinary elimination conditions

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B. Bowel elimination
10. Explain the process of defecation.
11. Recognize age related differences in bowel elimination.
12. Identify factors that affect bowel elimination.
13. Describe the manifestations of altered bowel elimination.
14. Discuss nursing assessment of bowel function.
15. Identify nursing diagnosis related to altered bowel elimination.
16. Describe nursing interventions to promote normal bowel function

17. Develop a concept map NCP related to the nursing diagnosis.

18. Discuss nursing intervention for bowel and bladder training
programs for the client.

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 Elimination
The act of discharging or excreting waste
products or foreign substances from the body.

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 Micturition
The discharge of urine.

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 Voiding
To discharge or emit <void urine>.

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 Defecation
The discharge of faeces from the body.

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 Constipation
• a condition in which there is difficulty in
emptying the bowels, usually associated with
hardened faeces.

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 Diarrhea
• a condition in which faeces are discharged
from the bowels frequently and in a liquid
form.

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 Incontinence
involuntary urination or defecation.

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 Urosepsis
• Urosepsis is a form of sepsis that involves the
urogenital organs and is a complication of
urinary tract infection and prostate infection.

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 Infection (UTI)
• A urinary tract infection (UTI) is an infection in
any part of your urinary system — your
kidneys, ureters, bladder and urethra.

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 Exercise (kegel)
• (kegel exercises) exercises for women
designed to improve the ability to hold urine.

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 Hydrotherapy
• Hydrotherapy, or water therapy, is the use of
water (hot, cold, steam, or ice) to relieve
discomfort and promote physical well-being.

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 Age related differences in urinary
elimination
Aging affects all of the body systems including the urinary
system.

With age the bladder opening weakens which may result

in urinary incontinence and dribbling.

A decrease in bladder muscle tone occurs that leads to

urinary retention and infections.

The aging kidneys’ ability to filter waste and concentrate

urine decreases

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 Factors That Maintain Normal Urine
Elimination

• The body usually eliminates urine every two-three

hours if fluid intake is adequate.
• The body needs 2,000-3,000 mL of fluid each day.
Provide adequate fluids, especially water and fruit
juices.
• It is the In-Home Aide's responsibility to determine
where and how often the client usually voids.
• Try to follow established routines and respect the
client’s privacy.
• Assist client to the bathroom when requested; at least
every two-three hours while he is awake.
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 Normal Urine Characteristics

• Normal urine is a straw yellow color and is clear

and free of sediment or mucous.
• The usual amount voided is 200-300 mL five to six
times a day; or 1,000 to 1, 500 mL every 24
hours; however, this amount varies by individual.
• Frequency of urination depends on fluid intake.
• Most people void at least every three hours while
awake.
• Certain liquids such as coffee or some
medications can change the color or odor of
urine.
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Conditions That May Cause Abnormal
Urine Elimination
• Several conditions can cause abnormal urine
elimination.
• An infection of the kidneys or bladder can cause
incontinence, frequency changes, a sense of
urgency, and burning when urinating.
• Confusion is a common sign of a urinary tract
infection in the elderly client.
• Blood tinged or cloudy foul smelling urine are
also symptoms.
• Complaints of mid-back or pain over the bladder
may occur with some infections.
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 FACTORS
AFFECTING ELIMINATION
• Age
• Diet
• Exercise
• Medications

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 Bowel Elimination
• Many diseases and conditions affect bowel
function.
• Although many alterations in bowel
elimination patterns may be observed, this
discussion is limited to three common
alterations: constipation, diarrhea, and fecal
incontinence.

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 ASSESSMENT
• The nursing assessment of elimination is
based on a client interview, evaluation of an
objective log or record of urinary or fecal
elimination patterns, focused physical
examination, and review of diagnostic
laboratory data.

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 NURSING DIAGNOSIS
• Impaired Urinary Elimination
• Stress Urinary Incontinence
• Reflex Urinary Incontinence
• Urge Urinary Incontinence

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 OUTCOME IDENTIFICATION
AND PLANNING
• The targeted outcomes for clients with
alterations in elimination patterns center
around restoring and maintaining regular
elimination habits and preventing potential
associated complications such as infections
and altered skin integrity.

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• Interventions to respond to the client’s
physical needs relating to maintaining skin
health and fluid volume balance need to be
developed, as well as strategies to address the
client’s psychosocial needs, such as countering
deficient knowledge, enhancing self-esteem,
and reducing or controlling anxiety.

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• Client teaching is also a critical factor in planning
care for clients with urinary and fecal complications.
The nurse’s role in educating clients concerning proper
diet and exercise regimens to maintain urinary and fecal
health is also an important aspect of planning care.

• When ostomies are involved, clients and their families

will need instruction and demonstration on proper care
and the warning signs of infection.

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 IMPLEMENTATION
• Maintain Elimination Health
• Fluid Intake
• Diet
• Lifestyle and Prevention
• Elimination Habits
• Positioning
• Initiate Exercise Regimen

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 EVALUATION
• Evaluating the effectiveness of the nursing
interventions is an ongoing process.
• The client’s level of maintenance or
restoration of elimination patterns and return
to an appropriate level of independence are
indicators of success.

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