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Elimination needs
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Elimination needsElimination
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
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