Elimination

Clients’ elimination needs are important to their basic care and comfort, as well to as their health. You need to provide appropriate interventions for a client who has an alteration in elimination.

Urinary Issues

One of the most common urinary problems is a urinary tract infection (UTI).

Lower Urinary Tract Issues

• Urethritis, inflammation of urethra
• Cystitis, inflammation of the bladder
• Prostatitis, inflammation of the prostate

Upper Urinary Tract Issues

• Pyelonephritis, inflammation of the pelvis and parenchyma
• Incontinence
  • Stress
  • Reflex
  • Urge
  • Functional

Other Urinary Issues

• Urgency
• Pain or difficulty (dysuria)
• Frequency
• Hesitancy
• Polyuria (large volume at one time)
• Nocturia (excessive at night, interrupting sleep)
• Hematuria (red blood cells in urine)
• Retention

Be familiar with common urinary tests, including the bladder scan at the bedside. It is also important to teach clients how to maintain a healthy urinary tract—provide information and instruction about adequate hydration (1,500–2,000 mL/day), emptying the bladder completely, the impact of caffeine and alcohol, proper personal hygiene, and Kegel exercises. In addition, teach clients to recognize the signs of a UTI.

Foley catheters are used to drain urine. Catheters can cause infection, so it is highly important to use proper sterile techniques when inserting, maintaining, and removing them. You should also know how to perform irrigations of the bladder, eyes, and ears.

Bowel Issues

Be able to recognize potential bowel issues based on the age and health of a client. Common bowel problems include constipation (hard, dry stools that are difficult to pass), impaction (an accumulated mass of stool that cannot be passed), diarrhea (frequent passage of unformed/liquid stool), incontinence (inability to retain urine or stool), flatulence, and hemorrhoids. Bowel problems are diagnosed by abdominal x-ray, upper gastrointestinal (GI) barium test, barium enema, and upper (oral) and lower (rectal) endoscopy.

Treatments include the following:

• Constipation: Increase fluid intake, including hot liquids and fruit juices; advise a high-fiber diet.
• Diarrhea: Understand and treat underlying cause (which may be a virus, reaction to certain foods or medications, GI tract infection, etc.); typically, advise bland foods and a low-fiber diet, as well as to avoid spicy foods, alcohol, and caffeine while symptoms continue.
• Flatulence: Limit gum, carbonated beverages, cabbage, cauliflower, beans, and onions.

Care for ostomies (a surgically created opening in the abdominal wall through which feces can pass) is also an important part of basic care and comfort. Types and locations are as follows:

• Ileostomy: An opening into the distal end of the small intestine
• Colostomy: An opening into the colon

Ostomy care includes regularly assessing the condition of the stoma (the opening), making sure the skin around the stoma is clean and dry, and teaching the client how to care for the ostomy, including proper diet, fluid intake, and hygiene, and how to remove a food blockage.

It is also important to use proper skin care for clients who are incontinent, including the use of barrier creams and ointments. You should also be able to evaluate whether client elimination is restored to normal and whether it’s maintained.