Fundamental of nursing

Unit Eleven and Twelve

Objectives:
Describe the function of the lower intestinal tract. Identify the factors that influence in the fecal
elimination and pattern of elimination. Distinguish normal from abnormal characteristics o feces. Differentiate common fecal elimination problem. Identify common causes and effect of fecal elimination problems. Relate common intervention to specific fecal problem

Cont
Describe essential nursing care of patient with

ostomies. Describe the process of urination. Identify factors that influence urinary elimination. Describe diagnostic measure to assess kidney function. Develop nursing diagnosis related to urinary elimination Describe nursing intervention to maintain normal urinary elimination.

Anatomy of GIT

Physiology of defecation:
The large intestine extend from the
ileocecal valve to the anus, is a muscular tube lined with mucous membrane.

125 to 150 cm in length.

 Function of colon: Absorption of water and nutrient.( Na,

1500ml daily). Protection of intestinal wall. (Acid, adherence). Fecal elimination.

 Flatus: is largely air and by product of digestion of carbohydrate. Defecation: is the expulsion of feces from the anus and rectum. the frequency of defecation is highly individual vary from several time per day or three time per weeks. When feces move into sigmoid, the sensory nerves are stimulated. The expulsion of feces is result from relaxation of internal and external sphincter and by contraction of abdominal muscle and diaphragm which increase abdominal pressure.

 Feces: normal feces are made of about

75% water and 25% solid material. if they feces propelled very quickly along the large intestine there is not time for most water in the chyme to be absorbed and feces will be more fluid.

Feces: are normally brown, chiefly due to

presence of sterocoblin and urobilin. Which are derived from bilirubin and another factor effect of color is bacteria

Type of peristalsis movement

1 . Haustral movement. 2. peristalsis 3. mass peristalses

Abnormal feces:
Clay or white color may indicate of absence of

bile or bile obstruction. Black, tarry stool may indicate of bleeding from upper gastrointestinal tract or drug. Red: may indicate of bleeding from lower gastrointestinal tract. Pale may indicated to mal absorption. Green may indicate intestinal infection. Dry, hard: dehydration decreased intestinal motility. Pus: bacterial infection.

Factor that effect of defecation:

1. Development: infant, meconium is the first fecal material passed by the newborn, normally up to 24 hr after newborn. Its black, tarry, odorless which contains mucous. 2. Infant pass stool frequently often each after feeding, because intestine immature. 3. Toddlers, school age and adult. 4. Diet: sufficient bulk in the diet (cellulose, fiber) is necessary to provide fecal bulk.

Cont
5. Fluid: the reduce fluid intake may cause Harding of stool; healthy fecal elimination requires 2000 to 3000ml/ day. 6. Activity: stimulate peristalsis, thus facilitating movement of chyme along the colon. 7. Psychological factor: some people who are anxious or angry increased peristalsis activity and subsequent diarrhea and other individual may cause constipation by depress peristalsis. 8. Defecation habit: early bowl training may establish habit of the defecation.

9. medication habit

Cont
10. Pain. 11. Pathological condition: spinal cord injury and head injury can decrease sensory stimulation for defecation.

Common fecal elimination problem:

constipation: Is defined as three bowl movement per
week, this infers the passage of small, dry, hard stool for period of time.

Characteristics for constipation:

Decreased frequency of defecation. Hard, dry stool. Straining of stool, painful defecation. Report rectal fullness. Abdominal pain, cramps and distention. Use laxatives. Decreased appetite. Headache.

 Causes factor contribute to

constipation:
Insufficient fiber intake. Insufficient activity or mobility. Insufficient fluid intake. Irregular defecation habits. Chronic use laxatives. Emotional disturbance depression or mental confusion. Medication such as iron salts.

 b) Fecal impaction: Fecal impaction is a mass or collection of

hardened, puttylike feces in the folds of the rectum. Impaction result from prolonged retention and accumulation of the fecal material.

Sign and symptom:

Liquid production of the feces seep. Generalized feeling of illness. Rectal pain. Abdominal distention. Nausea and vomiting occur.

 ) Diarrhea: Refers to the passage of liquid feces and

increased frequency of defecation. It result from rapid movement of fecal content through the large intestine.

 Causes of diarrhea: Psychological stress ( anxiety). Medication (antibiotic). Allergy of food. Desease of the colon.

 Bowl diversion ostomies:

Ostomy: is an opening on the abdominal wall for the elimination of feces or urine.

There are many types of ostomies:

Gastrostomy: is an opening through the abdominal wall in to the stomach. Jejunostomy: is an opening through abdominal wall in to jejunum. Ileostomy: is an opening in to the ileum. Colostomy: is an opening in the colon.

 Assessment: Nursing history:

Defecation pattern, description of feces and any changes, fecal elimination problem, presence and management of ostomies. Factor effecting elimination.

Physical examination: inspect for color,

consistency, shape a mount odor and presence of abnormal constitute Diagnostic study: direct visualization techniques, lapratory test, stool for occult blood.

 Nurses need to give client the following

instruction: Defecate in a clean bedpan. Dont contaminate the specimen if possible by urine. Dont replace the toileting paper in the bedpan. Notify the nurse after defecation.

Nursing diagnosis: Bowl incontinence related to fecal impaction. Constipation related to immobility. Risk for constipation insufficient fiber intake. Diarrhea related to spoiled food. Risk for fluid volume deficit related to diarrhea. Risk for impaired skin integrity related to colostomy. Self esteem disturbances related to bowl diversion.

 Planning:
Maintain normal bowl elimination pattern. Maintain normal stool consistency.

Implementation: Promote regular defecation by: Privacy Timing. Nutrition: high fiber diet Increase fluid intake to 2L per day. Exercise Positioning: squatting position best facilities defecation.

Teaching about medication. Antidiarrhreal medication or laxative medication. Administrating enema: is a solution introduced in the rectum and the large intestine. Decreasing flatulus by avoid gas producing food, exercise, moving in bed and ambulation. Bowel training program. ostomy management by stoma color, size and shape, bleeding and amount and type of feces.

 . Kidneys: the paired kidneys are situated

on either side of the spinal column, behind the peritoneal cavity. Function of kidneys:
urine formation by three process filtration,
reabsorbtion and excretion. removes urea from blood removes water and inorganic salts from blood regulates blood acid/base by varying pH of urine Production of vitamin D

Synthesis of erythropoietin

 b. Ureters: The Ureters are from 25 to 30 cm long in the

adult and 1.25cm in diameter. The lower end enters the bladder. C. Bladder: Is a hollow, muscular organ Functions as temporary reservoir urine storage Full bladder can contain 0.5 -1 liter of urine

. Urethra: The Male Urethra Extends from neck of urinary bladder To tip of penis (1820 cm) The Female Urethra Is very short (35 cm) Extends from bladder to vestibule External urethral orifice is near anterior wall of vagina

 Urination: Micturation, voiding and urination all refer

to the process of emptying the urinary bladder. urine collects in the bladder until the pressure stimulates special sensory nerve ending in the bladder wall called stretch receptors.

 Alteration urine production: Polyuria: refer to the production of abnormally

large amount of urine by the kidneys. Polydepsia: excessive fluid intake may be associated with diabetes. Diuresis: another term of production large amount of urine. Oliquria: is low urine output less than 500ml/ day. Anuria: lack of urine production less than 30 ml / day

 Altered urinary elimination: Frequency: is the voiding more than normal with frequent
intervals. Nocturia: is voiding two or three time at night. Urgency: is the feeling of person must void. Dysuria: means voiding that is either painful or difficulty. Enuresis: is defined as involuntary urination. Urinary incontinence: involuntary urination. Symptom not a disease. Urine retention: accumulation of urine in the bladder and become over distended

 Assessment: Nursing history: Voiding pattern, description of urine for

any changing. Urinary elimination problem. Presence of urinary diversion. 2. Physical assessment: inspection, palpation, percussion and auscultation.

 Assessing urine:

Color: straw, transparent. Amount: 1200 1500ml/d. Sterility: no microorganism present. Glucose: not present. Blood: not present. Ketone bodies: not present. Epithelial cell not present. Measuring urine output. Colleting urine specimen.

 Nursing diagnosis: Altered urinary elimination related to

bladder neck obstruction. Stress incontinence related to relaxation of sphenicter. Risk for infection related to urinary retention. Self esteem disturbances related to urinary incontinence.

 Planning: Maintain normal voiding pattern. Regain normal urine output. Prevent infection.

Intervention: Maintaining normal urinary elimination: Promote fluid intake. Maintain normal voiding habit. Assisting with toileting. Preventing urinary tract infection: Increased fluid intake. Practice frequent voiding process. Avoid any harsh soap. Girls should always wipe the perineal area from front to back.