Nursing Measures Related to Elimination Needs of the Patient

Introduction

Elimination patterns are essential to maintain health. The urinary and gastrointestinal systems help in the elimination of body wastes. Elimination is the process of getting rid of something, whether it's waste, errors, or competition. The food and liquids that we take in get digested by the gastrointestinal (GI) system of our body, starting from the mouth, esophagus, stomach, intestine, rectum, and anus, along with accessory organs of digestion (salivary glands, tongue, liver, pancreas, and gall bladder). After digestion and absorption, the liquid wastes are eliminated from the body as urine, whereas the solid as faeces, which is known as bowel elimination. It is also called a bowel movement.

Bladder Distention

Bladder distention is an abnormal enlargement of bladder usually due to retention of urine. Urinary retention is accumulation of urine in the bladder with inability of the bladder to empty completely. Urinary retention can be acute or chronic. Acute urinary retention happens suddenly and lasts only a short time. People with acute urinary retention cannot urinate at all, even though they have a full bladder. Acute urinary retention, a potentially life-threatening medical condition, requires immediate emergency treatment. Acute urinary retention can cause great discomfort or pain.

Chronic urinary retention can be a long-lasting medical condition. People with chronic urinary retention can urinate. However, they do not completely empty all of the urine from their bladders. Often people are not even aware they have this condition until they develop another problem, such as urinary incontinence or a urinary tract infection (UTI), an illness caused by harmful bacteria growing in the urinary tract.

Causes of Urinary Retention

• Urethral obstruction: Conditions such as benign prostatic hyperplasia, urethral stricture, urinary tract stones, cystocele, rectocele, constipation, and certain tumors and cancers can cause an obstruction.
• Urinary retention can result from problems with the nerves that control the bladder and sphincters. Some of the most common causes of nerve problems include vaginal childbirth, brain or spinal cord infections or injuries, stroke multiple sclerosis and pelvic injury or trauma.
• Medications: Various classes of medications can cause urinary retention by interfering with nerve signals to the bladder and prostate. These medications include antihistamines to treat allergies, anticholinergics / antispasmodics to treat stomach cramps, and urinary incontinence antidepressants.
• Weakened bladder muscles: Aging is a common cause of weakened bladder muscles. Weakened bladder muscles may not contract strongly enough or long enough to empty the bladder completely, resulting in urinary retention.
• Anesthesia.
• Fetus in uterus
• Pelvic tumor.

Factors Influencing Urinary Elimination

Fluid and food intake: The healthy body maintains a balance between the account of fluid ingested and the account of fluid eliminated. When fluid intake increases the output also increases.

Socio-cultural: Many individuals, families and socio-cultural variables influence a person's normal voiding habits. For some individuals voiding is a very personal and private act.

Environment: During summer, due to excessive perspiration, urine output is less. During winter, due to lack of perspiration urine output is more.

Psychological Factors: Stress can also interfere with the ability to relax external urethral sphincter. As a result emptying the bladder completely becomes difficult or impossible. Emotional stress causes a sense of urgency and increased frequency of urination.

Medication: Many medications interfere with the normal urination process and may cause retention e.g. diuretics, increase urine formation by preventing the reabsorption of water and electrolytes from the tubules of the kidney into the blood stream.

Muscle Tone and Activity: People who exercise regularly will have good muscle tone, increased body metabolism and good urine production.

Pathological Conditions: Endocrine disorders such as diabetes insipidus increase urine formation.

Sign and Symptoms

The sign and symptoms of urinary retention may include the following and require immediate medical attention:

• Inability to urinate.
• Painful, urgent need to urinate.
• Pain or discomfort in the lower abdomen.
• Bloating of the lower abdomen.
• Stretching of the bladder walls and causing a feeling of pressure.
• Discomfort.
• Tenderness over the symphysis pubis.
• Restlessness.
• Diaphoresis.
• Bladder leakage.
• Small amounts of urine that are expelled.
• Delay when attempting to urinate.
• Anxiety.

Ways of Reliving Bladder Distension

• Help the patient remain in a comfortable position for urination. Some prefer standing, females prefer sitting.
• Local application of hot and cold to perineum by giving sitz bath or using hot water bag or pouring warm water over the perineum.
• Offer bed pan or urinal at regular intervals.
• Make the patient sit and open the tap.
• Provide privacy.
• Taking a warm bath to promote urination.
• Increase physical activity which can boost urination.
• Spent enough time, reassurance and give psychological support.
• A warm enema may induce voiding.
• Give plenty of fluids in the form of lemon juice, tea, coffee, etc.
• If the client fails to pass urine by adopting above measures, medical intervention may be required.
• Bladder drainage, urethral dilation, urethral stents, prostate medications and even surgery are some forms of medical treatments for distended bladder.

Catheterization

Catheterization is a process of drawing urine from the bladder by means of an instrument called a catheter. It is inserted through the urethra under aseptic precaution.

Urinary catheterization is a medical procedure used to drain and collect urine from the bladder. It is process of introducing a catheter into the urinary bladder through urethra using aseptic technique for the purpose of emptying the bladder.

Catheter

Urinary catheters are hollow, flexible tubes used to collect urine from the bladder. Urinary catheters come in many sizes and types. Catheters are tubular instruments that are made of rubber, plastics, metal and glass.

Types

According to Use

• Urethral and supra-pubic,
• Ureteric.

According to the Material

• Metal,
• Gum elastic,
• Rubber,
• Plastic,
• Silicone.

According to the Mode of Working

There are three main types of catheters: indwelling catheters, external catheters, and short-term catheters.

Indwelling Catheter (self- retaining catheters)

HOR An indwelling catheter is a catheter that resides in the bladder. It may also be known as a Foley's catheter. A Foley's catheter is retained by means of a balloon at the tip that is inflated with sterile water. The balloons typically come in two different sizes: 5 cm³ and 30 cm³. They are commonly made in silicone rubber or natural rubber. An indwelling catheter collects urine by attaching to a drainage bag. This type can be useful for short and long periods of time. Sometimes, it is inserted into the bladder through a tiny hole in the abdomen. This type of indwelling catheter is known as a supra-pubic catheter.

Examples:

• Foley's catheter
• Gibbon's catheter
• Malecot's catheter

External Catheters (condom catheters)

A condom catheter is a catheter placed outside the body. It's typically necessary for men who don't have urinary retention problems but have serious functional or mental disabilities, such as dementia. A device that looks like a condom covers the penis head. A tube leads from the condom device to a drainage bag. These catheters are generally more comfortable and carry a lower risk of infection than indwelling catheters. Condom catheters usually need to be changed daily, but some brands are designed for longer use.

Intermittent Catheter (non- self-retaining catheter)

An intermittent catheter/Robinson catheter is a flexible catheter used for short term drainage of urine. These are temporarily inserted into the bladder and removed once the bladder is empty

Examples:

• Simple rubber catheter
• Metallic catheter

A condom catheter is designed with a curved tip that makes it easier to pass through the curvature of the prostatic urethra.

Types of Catheterization

A urinary catheter can be used on a short or long term basis.

Short-term/Intermittent Catheterization

Short-term catheterization may be needed to remove urine from the bladder for a short period of time.

Purposes

• To relieve bladder distension.
• To assess for residual urine after voiding.
• To obtain a sterile specimen.
• To empty bladder prior to delivery or abdominal surgery.