NUR 2349 Elimination Patterns Discussion

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NUR 2349 Elimination Patterns Discussion

NUR 2349 Elimination Patterns Discussion

 

The elimination patterns of our patients are very important
to know as we continue to assess and do our care plans. How can impaired
elimination affect the integumentary system?

Elimination patterns describe the regulation, control, and removal of by-products and wastes in the body. The term usually refers to the movement of feces or urine from the body.

References

Chai TC, Birder LA. Physiology and pharmacology of the bladder and urethra. In: Partin AW, Dmochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 110.

Koyle MA, Lorenzo AJ. Management of defecation disorders. In: Partin AW, Dmochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 36.

Review Date 10/10/2020

Updated by: Linda J. Vorvick, MD, Clinical Associate Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Definition/Introduction

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Assisting patients with elimination is an essential aspect of the nurse’s role and has important medical significance as well as psychosocial effects on the client’s quality of life.[1]  As the pattern of healthy bowel movements and urination vary in different patient groups, the management for each patient population may differ. Nurses need to assist with healthy elimination patterns to ensure patients are having regular soft bowel movements and adequate urination and to identify abnormal patterns such as flatulence, constipation, diarrhea, incontinence, fecal impaction, hemorrhoids as well as polyuria, anuria, and other abnormalities which can be signs of underlying medical conditions.

Issues of Concern

While there are pharmacologic alternatives to assist with elimination issues, assistance by nurses is often required. For instance, in abdominal pain syndrome and constipation, studies show that abdominal massage appears to increase bowel function, but without the negative effects of laxatives.[2]

Conversely, certain medications can cause constipation, diarrhea, and hinder or exacerbate elimination. Opioids, NSAIDs, antibiotics, anticoagulants, can all induce constipation.[3] It is vital nurses know which patients are at risk for bowel and bladder disruption and monitor them for these issues.

The nursing team must provide strong supportive communication when assisting clients with elimination. A study found that the nurse’s attitudes toward excretion-related nursing care strongly influenced the use of a toilet and physical functions of the elderly.[4] Patients may be reluctant to discuss their bowel and bladder problems due to embarrassment. It is vital that nurses maintain open communication and empathy with their clients and ask questions as well as physically assess patients for signs of bladder and bowel irregularities.[5][6]

Clinical Significance

Elimination issues may occur due to a variety of different medical conditions; for instance, post-surgical patients are at risk for ileus, congenital malformations in infants can cause bowel and bladder disruption, and cancer patients and the elderly can have altered elimination secondary to drugs and therapy.[7][8]

The inability to effectively eliminate waste products from the bowel and bladder may lead to serious medical conditions and can be a psychosocial factor contributing to decreased quality of living.[5] Special consideration is necessary for patients at risk for bowel and bladder dysfunction such as patients with decreased fiber or fluid intake, or those with decreased bulk in their diet, patients on bed rest, those with kidney, CNS, or heart disease, the elderly, infants and cancer patients.[6]

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