Overview
- Adequate elimination of body waste is an essential function to sustain life.
- Inadequate bladder and bowel elimination ultimately affects the body's delicate balance of fluids, electrolytes, and acid–base level.
- Various clinical means are available to help assess and maintain adequate elimination status.
- Factors that affect bowel and bladder elimination status include food and fluid intake; age; psychological barriers; medications; activity level; personal hygiene habits; educational level; cultural practices; pathology of the renal, urinary, or gastrointestinal system; surgery; hormonal variations; muscle tone of supporting organs and structures; and concurrent medical problems, such as decreased cardiac output or motor disturbances.
- Alterations in bowel and bladder elimination mandate careful assessment and monitoring of the upper and lower abdomen, as well as of amounts and appearance of body excretions.
- Procedures related to adequate bladder elimination usually require the use of sterile technique to prevent contamination of the highly susceptible urinary tract.
- Because clients on peritoneal dialysis or hemodialysis are using final means of adequate renal excretion, the nurse must perform these procedures with precision.
- Peritoneal dialysis can be continuous ambulatory (CAPD), continuous cycler-assisted (CCPD), or nocturnal intermittent (NIPD), depending upon degree of remaining kidney function.
- Various concentrations of dialysate affect osmolality, rate of fluid removal, electrolyte balance, solute removal, and cardiovascular stability.
- Elimination is very personal to the client; therefore, privacy and professionalism should be maintained when assisting clients with elimination needs.
- Clients with colostomies frequently experience body image and self-concept alterations. Psychological support and teaching are crucial in resolving these problems.
- All procedures involving elimination of body waste require the use of gloves and occasionally other protective barriers.
- When planning a procedure, the nurse should determine whether same-sex or opposite-sex contact with genitalia is culturally offensive to the client.
- Some major nursing diagnostic labels related to elimination are impaired urinary elimination, urinary retention, bowel incontinence, constipation, diarrhea, risk for impaired skin integrity, and urinary incontinence (functional, reflex, urge, stress, or total).
- For procedures that can be delegated to unlicensed assistive personnel, emphasis should be placed on procedural accuracy so that correct determinations can be made concerning the client's diagnosis and progress.