Nursing Foundations · Elimination needs

Elimination Needs

Urinary eliminationdefinition

The process of expelling urine from the bladder.

in simple words: Passing urine.

e.g. Average 24-hour output in a healthy adult is about 1500 mL (range 800–2000 mL).

Urine Output Abnormalities

Term	Definition	Key point
Oliguria	<400 mL/24 h	Report; <0.5 mL/kg/h for 2 h is critical
Anuria	<50–100 mL/24 h	Severe reduction
Polyuria	>2500–3000 mL/24 h	Excessive output
Enuresis	Involuntary urination (bedwetting)	Bladder control problem
Micturition	Act of urinating	Not a volume measure

Output terms

OAP

Oliguria – low output (<400 mL/day)
Anuria – almost no output (<50–100 mL/day)
Polyuria – high output (>2500–3000 mL/day)

Elimination Needs · Nursing Foundations

Urinary Catheters

Urinary catheterdefinition

A tube inserted into the bladder to drain urine.

in simple words: Helps urine come out when the patient cannot void.

e.g. Foley, red rubber, Malecot.

Types of Urinary Catheters

Type	Feature	Use
Foley	Self-retaining balloon at tip	Indwelling continuous drainage
Red rubber	Straight, no balloon	Intermittent (in-and-out)
Malecot	Expandable wings at tip	Self-retaining, e.g., suprapubic

Diagram comparing Foley, straight, and condom urinary catheters with their features. — Types of urinary catheters

Catheter Sizes (Fr)

Adult female – 14–16 Fr
Adult male – 16–18 Fr
Infants/children – 5–8 Fr
Gross hematuria with clots – 20–24 Fr three-way for continuous bladder irrigation

Elimination Needs · Nursing Foundations

Catheter Insertion & Care

Female Foley Insertion

CleanBetadine, front to back
LubricateCatheter tip
InsertUntil urine returns
Advance1–2 inches (2.5–5 cm) more
InflateBalloon with sterile water

Catheter Care Key Points

Drainage bag – Always below bladder level; never touch floor
Tubing – Check for kinks if urine stops flowing
Irrigation – Avoid routine; breaks closed system, raises CAUTI risk
Clamping – Not routine; can cause bladder overdistension
Catheter care – Independent nursing intervention (no doctor's order needed)

Elimination Needs · Nursing Foundations

Enema Positions & Types

Enemadefinition

Instillation of a solution into the rectum and sigmoid colon to promote defecation.

in simple words: Fluid is put into the rectum to help pass stool.

e.g. Used for constipation, bowel prep, bowel training.

Positions for Enema

Position	Use	Reason
Left Sims'	Standard	Gravity aids flow into descending/sigmoid colon
Right lateral	Alternative	Less effective
Knee-chest	Alternative	Difficult to maintain
Supine	Not used	Gravity works against flow
Prone	Not used	No gravity assist; poor access
Trendelenburg	Unsafe	Solution flows too rapidly and high

Common Enema Types

Carminative – Relieves gaseous distension; MGW or milk and molasses
Oil-retention – Lubricates and softens hard, dry stool in fecal impaction
Cold (ice water) – Reduces hyperpyrexia
Antihelminthic – Kills and expels intestinal parasites
Purgative – Strong cleansing; complete bowel evacuation
Soap and water – Irritates bowel to stimulate movement

Elimination Needs · Nursing Foundations

Enema Administration & Safety

Enema Administration Steps

PositionLeft Sims'
LubricateTube tip
InsertGently into rectum
InstillBag height: high 30–45 cm; low 7.5 cm
Stop if crampingWait, then resume slower

Safety Points

Vagus nerve – Enema can stimulate vagus → bradycardia; stop if dizzy, lightheaded, nauseated
Hypertonic enema – Contraindicated in dehydrated patients (worsens fluid/electrolyte imbalance)
Colostomy irrigation – Insert catheter/cone about 10 cm (3–4 in) into stoma
Retention enema – Hold solution 30 min or more for medication absorption or stool softening

Elimination Needs · Nursing Foundations

Specimens & Special Care

Midstream urine specimendefinition

A clean-catch urine sample collected after the initial flow has flushed the urethra.

in simple words: Catch urine in the middle of voiding, not the first part.

e.g. Used for urine culture and sensitivity.

Specimen Collection

If patient cannot provide midstream – Obtain sterile specimen via in-and-out catheterization
Guaiac test – Fecal occult blood test (FOBT); blue color = positive
Positive Guaiac – Report promptly; follow-up colonoscopy to find GI bleeding source

Neurogenic Bladder Home Care

Perineal hygiene – Keep clean and dry
Maintain bladder tone – Timed voiding or clean intermittent catheterization
Ambulation – Promotes normal elimination