Bowel-Elimination
Terms
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FECAL ELIMINATION
⬢ Fecal or Bowel Elimination -
• Fecal or Bowel Elimination
– Eliminates waste
– Critical to human functioning
– Individual patterns vary
– Alterations effect:
• Fluid & electrolyte balance
• Nutritional status
• Skin integrity
• Comfort and self-concept -
Anatomy & Physiology
Main function- -
Main function-absorption
Large intestine/Colon
Rectum
Anal Sphincter -
Anatomy & Physiology
Waste Products -
Waste products
-chyme-enters colon
-feces-exits colon
-stool-after excretion
-Peristalisis every 3-12 min
-Mass peristalisis sweeps are 1-4 times in 24hrs
-1/3 to 1/2 food wastes excreted in stool in 24hr
-rest in next 24-48hrs
-flatus also eliminated -
Anatomy & Physiology
Water Absorption -
Water Absorption
-800-1500 ml daily -
Defecation
⬢ Intrinsic defecation reflex -
• Intrinsic defecation reflex
– Feces enters rectum, peristalsis initiated -
Defecation
⬢ Parasympathetic defecation reflex -
• Parasympathetic defecation reflex
– Rectal nerve fibers stimulated-intensify peristalsis -
Defecation
⬢ Expulsion of feces -
• Expulsion of feces
– Abdominal muscles & Diaphragm
– Levator ani muscle of pelvic floor
– Thigh flexion increases abdominal pressure
– Sitting position increases downward pressure
Bowel Elimination -
Stool/Feces
⬢ Normal Finding -
Stool/Feces
⬢ Normal Finding
-Brown color
-Formed consistency
-Normal odor
-25% of feces:
*fat, protein, bile salts, undigested roughage
-75% of feces= water
-cylindrical shape -
Stool/Feces
⬢ Abnormal Findings
(table 46-1) -
⬢ Abnormal Findings
-occult blood=test
-fats=pale, greasy
-mucus
-abnormal color=diet
*dairy, meds, food color
-bacteria
-viruses
-worms & parasites - Factors affecting bowel elimination
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⬢ Appetite, indigestion, food
preferences
⬢ Dysphagia, ulcer, gallbladder
disease
⬢ N/V, colitis, IBS
⬢ Flatulence, change in bowel
routine
⬢ Constipation, diarrhea
⬢ Rectal bleeding, hemorrhoids,
fissure - Fecal Impaction
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⬢ Collection of hardened feces in rectum
⬢ Passage of liquid seepage without normal stool
⬢ Symptoms -desire to defecate, rectal pain,
distended abdomen, N/V, anorexic
⬢ Prevention is best
⬢ Enemas-oil retention & cleansing
⬢ May require physician order for manual removal - Enemas: Cleansing
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*Cleansing-Remove feces:
-before surgery
-test prep
-constipation/impaction - Enemas: Hypertonic
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Hypertonic:
-draws water in
-fleets - Enemas: Hypotonic
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Hypotonic
-stimulates peristalsis
-tap water - Enemas: Isotonic
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Isotonic
-stimulates peristalis
-normal saline
-Soapsuds
* irritate mucosa
* castile soap only - Enemas: Rentention
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-soften & lubricate
-Mineral oil - Enemas: Carminative
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-Releases gas
-Expel flatus -
Enemas:Return flow
(table 46-4) -
-Faltus/Abdominal distention
-Repeated 5-6 times -
Physical Assessment:
Infants - breast or formula, lack voluntary control
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Physical Assessment:
Toddlers - voluntary control, appetite
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Physical Assessment:
child, Adolescent, adult - their normal
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Physical Assessment:
Older adult -
-decreased physical activity
-decreased GI mobility
-change dietary habits
-laxative or enema abuse - Variables
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-daily patterns
-food & fluid
-activity
-life style
-psych variables
-pathologic variabls
-medications
-surgery/anesthesia
-pain
-pain of defecation -
Nurses as role models
self assessment -
• Self Assessment
– Normal pattern without discomfort
– Responds to normal urge
– Increase fiber, fluid in diet
– Identify way to increase fiber & fluid
– Exercise 3-4 times weekly
– Responds to changes in stool-seeks
medical advice as appropriate -
Nurses as role models
physical assessment -
Physical Assessment:
Abdomen
Inspection
⬢ Look first
Auscultation
⬢ Listen x 4 quads
⬢5 min. by clock
Palpation
⬢ Touch unless painful
Rectum & Anus
⬢ Assess perineum -
Diagnositc Studies
(Endoscopy)
(Radiography) -
• Direct Visualization (Endoscopy)
–1 Esophagogastroduodenos-copy
– 2 Colonoscopy
– 3 Sigmoidoscopy
• Indirect Visualization (Radiography)
– 1 Upper G.1.
– 2 Small Bowel Series
– 3 Barium Enema -
Diagnostic Studies
-scheduling sequence
-Inspection first
-Auscultation
-Palpation -
• Scheduling Sequence
– Fecal Occult Blood Tests
• Noninvasive first
– Barium studies
– Endoscopic Examination
• Possibly before barium
• Inspection first
• Auscultation
• Palpation -
Nursing Diagnosis
⬢ Bowel Incontinence -
• Bowel Incontinence
– Involuntary passage of
formed stool -
Nursing Diagnosis
⬢ Constipation -
• Constipation
– Colonic
• Decrease in normal
frequency
– Perceived
• Self diagnosis -
Nursing Diagnosis
⬢Diarrhea -
•Diarrhea
– Frequent liquid stool -
Nursing Diagnosis
⬢ Self Care Deficit: toileting - ⬢ Self Care Deficit: toileting
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Nursing Diagnosis
⬢ Skin integrity, impaired -
• Skin integrity, impaired
– skin integrity, impaired, risk for -
Nursing Diagnosis
⬢ Self-esteem, situational low
⬢ other -
⬢ Self-esteem, situational low
⬢ other -
Plan and implement nursing
interventions -
• Independent
– diet/fluid
–exercise
– privacy/relaxation
– establishing/maintaining routine
• training
• retraining
– positioning
– other -
Medications to Promote
Fecal Elimination -
⬢Bulk forming
- Metamucil
⬢ Stool softener
-Colace
⬢ Saline cathartic
-MOM
⬢ Contact cathartic
-Dulcolax
⬢Lubricant
-Mineral Oil
⬢ CLINICAL INDICATIONS:
⬢ CONTRAINDICATIONS: - Diarrhea
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⬢ Assessment
⬢ Diagnosis
⬢ Goal
⬢Intervention/Implementation
⬢ Evaluation - Constipation: colonic/perceived
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• Assessment
• Diagnosis
•Intervention/Implementation
– fecal extraction
– enema
• Evaluation - Bowel Incontinence
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• Assessment
• Diagnosis
• Intervention/Implementation
– training/retraining
• Evaluation