Bowel EliminationNUR101 Fall 2010Lecture # 23K. Burger, MSEd, MSN, RN, CNE

PPP By: Sharon Niggemeier RN MSN

Anatomy & Physiology• Function of Large intestine: absorption

• Extends from Ileocecal valve to anus

• Chyme

• Peristalsis & Mass peristalsis

Act of Defecation

• Defecation reflex

• Valsalva maneuver

• Defecation

Alteration in Bowel Elimination

• Diarrhea

• Constipation

• Incontinence

• Fecal Impaction

• Flatulence

Characteristics of Stool

• Volume

• Color

• Odor

• Consistency

• Shape

• Constituents

Factors That Influence Bowel Elimination

• Age

• Fluid Intake & Diet

• Daily Routine

• Activity

• Medications

• Health Status

• Stress

Diet

• High fiber foods

• Legumes (beans)

• Cereals

• Whole grains

• Raw Fruits

• Vegetables

• Laxative effect foods

• Spicy & greasy

• Bran/Chocolate

• Coffee/Alcohol

• Raw fruits & vegetables

Assessing Elimination Status

• Usual pattern

• Changes in bowels

• Aids to eliminate

• Current problems

Physical Assessment • Inspection- observe contour of abd and

note visible peristalsis• Auscultation- listen for bowel sounds all

quadrants• Percussion- resonant or tympany over

hollow organs…dullness over intestinal obstruction

• Palpation- feel for masses, tenderness etc…

Stool Specimen Collection

• Routine specimen

• Occult blood

• Ova & parasite

• Timed specimens

Nursing Dx R/T Bowel Elimination

?

Outcome Criteria

• Pt. will:

• Develop regular pattern of elimination

• Have less episodes of incontinence

• Incorporate fluids/diet that promote bowel elimination

Interventions to Promote Elimination

• Routine• Positioning• Privacy• Comfort• Activity • Diet/Fluids

Interventions: Promote Bowel Elimination

• Laxatives

• Enemas

• Suppositories

• Digital Removal

Types of Enemas

C lean s in g R eten tion R etu rn F low

Typ es o f E n em as

Enema Solutions

• Tap water (Hypotonic)

• Normal saline (Isotonic)

• Soap

• Hypertonic

• Oil

Tap Water (TWE)

• Amount: 500-1000cc• Action: Distends, increases peristalsis• Time: 15 min.• Indicated: inflamed bowels/irritated

colon• Contraindicated: Atonic bowels, fluid

restrictions

Normal Saline

• Amount: 500-1000cc

• Action: Distends, increases peristalsis

• Time: 15 min.

• Indicated:Inflamed bowels/irritated colon

• Contraindicated: Na retention problems, fluid restrictions

Soap (SSE)

• Amount: 500-1000cc (Castile 5ml/1000cc)

• Action: Distends, Irritates

• Time: 15 min.

• Indicated: Constipation

• Contraindicated: Prior to rectal exams

Hypertonic

• Amount: 70-130 cc solution

• Action: Distends/Irritates

• Time: 5-10 min.

• Indicated: Constipation, convenience

• Contraindicated: Dehydration, Na problems

Oil Retention

• Amount: 120-200cc

• Action: Lubricates

• Time: 30 min.

• Indicated: Fecal impaction

• Contraindication: none

Enema Administration

• PPE

• Position L Sims

• Linen protector

• Receptacle (bedpan, commode, toilet)

• IV pole

• Lubricant

• Enema bag with solution

• Tissue paper

Enema Administration

• Position L Sims

• Insert lubricated tip 4”

• Bag raised 18-20” above anal canal

• Administer slowly - 10 min.

• Administration is individualized.

• Pt. holds for 15 min.

Evaluation

• Solution given

• Amount expelled

• Characteristics of stool

• Passing of flatus

• Unusual findings blood, helminthes, pus etc.

• Client reaction: change in skin color, VS changes, fatigue

Medications Effecting Bowel Elimination

• Laxatives- induce emptying of GI tract

• Antidiarrheal- slow peristalsis

• Codeine/morphine/iron- cause constipation

• Antibiotics-may cause diarrhea

Flatulence

Causes:

• Decreased peristalsis

• Constipation• Medications• Surgery

• Diet

• Stress

• Decreased activity

NonInvasive Interventions for Flatulence

*Ambulation*

• Knee chest position

Invasive Interventions for Flatulence

• Glycerin Suppository

• Harris Flush

• Rectal Tube