Chapter 17: Urinary and Bowel Elimination

In urinary elimination, nurses must establish baseline function by monitoring intake and output, with normal urine output defined as minimum 30 milliliters per hour, and by evaluating urine characteristics including color, clarity, and odor to detect infections or abnormalities. The chapter addresses common urinary alterations including urinary tract infections, which present with dysuria and urgency but may manifest atypically in older adults as confusion or delirium without fever, and various types of incontinence such as urge incontinence from an overactive bladder, stress incontinence from weakened pelvic floor muscles, overflow incontinence from bladder outlet obstruction, functional incontinence from mobility limitations, and reflex incontinence from neurological injury. Catheterization requires strict aseptic technique and ongoing prevention of catheter-associated urinary tract infections through timely removal, daily perineal hygiene, and proper drainage bag positioning. Urinary diversions including ureterostomies and ileal conduits require careful stoma assessment, with healthy stomas appearing red and moist while dark, dusky appearance signals necrosis requiring immediate intervention. Bowel elimination assessment considers multiple factors including age, dietary fiber intake, physical activity level, medications such as opioids that cause constipation and antibiotics that disrupt normal flora, and psychological stress. Bowel alterations include constipation progressing to fecal impaction with the warning sign of continuous liquid stool leakage, and diarrhea causing dehydration and electrolyte imbalances. Bowel diversions or ostomies are classified as ileostomies producing liquid output with high fluid loss risk or colostomies with consistency varying by anatomical location, and require vigilant stoma monitoring for color changes indicating compromised circulation or anemia. Restorative care emphasizes early mobilization, high-fiber and high-fluid diets, scheduled toileting with pelvic floor exercises for urinary function, and bowel training programs avoiding long-term laxative dependence. Enema administration technique includes left lateral positioning and solution selection based on patient hydration status and age.