CARE OF THE PATIENT WITH

BODY ELIMINATION DEVIATION

NEHA MAKWANA
NURSING TUTOR
S.S.N.C.C.
 INTRODUCTION

 Normal Elimination Of Urinary And Fecal Wastes Is A

Basic Function Of The Body.

 Elimination is the expulsion of waste products from

the body through the skin, lungs, kidneys and
rectum.
 URINARY ELIMINATION

 Urinary elimination is the removal of waste products

from the body through the urinary system.
PHYSIOLOGY OF URINARY ELIMINATION

 When the urine is collected in the bladder, desire to

void is experienced due to the stimulation of stretch
receptors.
 This sensation occurs when the bladder is filled with
250-450 ml of urine in adults and 50-200 ml in child.
 The stretch receptors transmit the message to the
voiding reflex center in the spinal cord (2nd to 4th
sacral vertebrae).
 If time is appropriate the brain sends message
through spinal cord causing stimulation so that the
urine can be released from the bladder.
 If the time and place are appropriate the external
sphincter relaxes and the urination process takes
place.
 COMPOSITION AND CHARACTERISTICS
OF NORMAL URINE

 COMPOSITION:
▪ Normally the urine consists of 96% of water and 4%
of solutes.
▪ The solutes may be organic or inorganic.
▪ The organic solutes include urea, creatinine,
ammonia and uric acid.

chief
organic urea
solutes
 The inorganic solutes includes sodium chloride,
potassium sulphate, magnesium and phosphorous.

chief
inorganic Sodium
chloride
solutes
 colour

Specific
clarity
gravity

characteristics

PH Odour

Volume
 CHARACTRISTICS:
▪ Colour: normal colour of urine ranges from pale,
straw to amber depending on its concentration.
▪ Clarity: normal urine appears transparent when
freshly voided but becomes turbid (cloudy) upon
standing several minutes in a container.
▪ Odour:
o urine has a characteristics odour.
o the more concentrated the urine the urine
the stronger the odour
o Bacteria in the urine cause an ammonia odour.
o Fruity or sweet odour occurs from acetone in the
patients with diabetes or starvation, due to break
down of fat.
▪ Volume:
o volume of urine varies from one to two liters in 24
hours.
o The urine output depends upon the water intake.
 PH: 4.6 to 8.0.average 6.0 and is slightly acidic.(7
is neural less than 7 is acidic and greater than 7 is
alkaline.)
 Specific gravity: 1.001 to 1.025.
FACTORS INFLUENCING URINATION

Disease Socio cultural Psychological

condition factors factors

Surgical
Muscle tone Fluid balance
procedures

Diagnostic
Medication
examination
 1.DISEASE CONDITION

 Disease processes that affect renal functioning may

result in the production of urine, act of urine
elimination or both.
 Those condition that affect urine volume and quality
are generally categorized as:
Pre renal

renal

Post renal in origin

 Pre renal: causes which occur in conditions such as
dehydration, hemorrhage and congestive heart
failure.
 Renal: direct injury to kidneys. Example: transfusion
reaction, diabetes mellitus
 Post renal in origin: obstruction in the flow of urine
due to calculi, blood clots.
several diseases can affect the ability to micturate.
 2.SOCIOCULTURAL FACTORS

 The degree of privacy needed for urination varies

with cultural norms.
 3. PSYCHOLOGICAL FACTORS

 Anxiety and emotional stress may cause a sense of

urgency and increased frequency of urination.

 Anxiety can prevent a person from being able to

urinate completely and as result the urge to void may
turn shortly after voiding.
 Emotional tension makes it difficult to relax
abdominal and perineal muscles.
 If the external urethral sphincter is not completely
relaxed voiding may be incomplete and urine is
retained in to the bladder.
 4.MUSCLE TONE

 Weak abdominal and pelvic floor muscles impair

bladder contractions and control of the external
urethral sphincter.
 Regular exercise helps to have good muscle tone,
increased body metabolism and good urine
production.
 5. FLUID BALANCE

 The kidney maintain a sensitive balance between

production and excretion of urine.
 If fluids and the concentration of electrolytes and
solutes are in equilibrium, an increase in fluid intake
causes an increases in urine production.
 Ingestion of certain fluids directly affects urine
production and excretion.
 Example: coffee, tea, coca and cola drinks that
contain caffeine promote increased urine formation.
 6.SURGICAL PROCEDURES

 The stress of surgery aggravates the reduction in

urine output.
 Anesthetics and narcotic analgesics may reduce
urine output.
 Surgery of lower abdominal and pelvic structures
can impair orientation because of local trauma to
surrounding tissues.
 The surgical formation of a urinary diversion
temporarily or permanently bypasses the bladder
and urethra as the exit route for urine.
 7. MEDICATION

 Diuretics prevent reabsorption of water and certain

electrolytes to increase urine output.
 Urinary retention may be caused by drugs such as
anticholinergic: example: atropine.
antihistamine: example: Sudafed.
antihypertensive: example: Aldomet.
• Some medicines change the colour of urine.
Example: phenazopyridine (pyridium) gives urine
bright orange to red colour.
 8.DIAGNOSTIC EXAMINATION

 Examination of the urinary system can influence

micturition procedures such as an intravenous
pyelogram(IVP)which requires limiting fluids before
the test.
 A restriction in fluid intake commonly lowers urine
output.
 ALTERATIONS IN URINARY ELIMINATION

 Most patients with urinary problems have

disturbances in the act of micturition, failure to store
urine output.
 DYSURIA

 Experiencing pain or burning during micturition is

referred as dysuria.
 HESITANCY

 It is delay or difficulty in initiating voiding.

 FREQUENCY

 It refer to voiding at frequent intervals more than

usual.
 Examples: in pregnancy frequency occur due to
pressure of uterus on the bladder.
 Total amount of urine voided may be normal.
 URGENCY

 It is the feeling of urge to void at once.

 OLIGURIA

 Decreased out put of urine, less than 500 ml in 24

hours, in spites of normal fluid intake is referred as
oliguria.
 Fluid is lost through other means . Examples:
perspiration, diarrhea, vomiting.
 POLYURIA

 Formation and excretion of excessive amount of

urine( more than 2500-3000 ml in 24 hours ) is called
polyuria.
 NOCTURIA

 Voiding during sleeping hours.

 It is the increased frequency at night that is not the
result of increased fluid intake
 ENURESIS

 It is defined as repeated involuntary passage of urine

in children beyond 4 years or 5 years when voluntary
bladder control is normally acquired.
 It may be nocturnal(involuntary passage during
night) or diurnal(involuntary passage during day
time)
 PYURIA

 Presence of pus in the urine as a result of

inflammatory response.
 INCONTINENCE OF URINE

 Involuntary passage of urine.

 RETENTION OF URINE

 Urine production is normal but there is inability to

empty the bladder or urine even though the bladder
is distended with urine
 URINARY RETENTION

 Urinary retention is inability to empty the bladder or

urinate even through the bladder is distended with
urine.
 It is marked accumulation of urine in the bladder as a
result of the inability of the bladder to empty.
 The urine is produced normally but it is not
eliminated from the bladder.
 Normally urine production slowly fills the bladder and
prevents activation of stretch receptors until it
distends to a certain level of stretch.
 In severe bladder retention the bladder may hold as
much as 2000 to 3000 ml of urine.
 MANIFESTATIONS OF URINARY RETENTION

 Urine continues to collect in the bladder, stretches its

walls and causes,
▪ feelings of pressure
▪ discomfort
▪ tenderness over the symphysis pubis
▪ restlessness,
▪ diaphoresis(sweating).