Bowel Elimination

Bowel EliminationRegular elimination is essential for normal body function Bowel function depends on the balance of several factorsElimination patterns and habits vary among individualsSupportive nursing care respects the patients privacy and emotional needs

Gastrointestinal TractPrepare food products for use by the bodys cells,Promote the absorption of fluid and nutrients,Provides for temporary storage of fecesEliminate wastes.

Gastrointestinal TractAbsorbs high volumes of fluids, making fluid and electrolyte balance a key function

GI tract also receives secretions from the gallbladder and pancreas

Gastrointestinal SystemConsist of:MouthEsophagusStomachSmall IntestineLarge IntestineAnus

Factors Affecting Bowel EliminationAgeDietPregnancyFluid intakePhysical ActivityPosition During DefecationPersonal habitsPainMedicationsSurgery or AnesthesiaDiagnostic testsPsychological factors

Alterations in Bowel EliminationConstipation

Impaction

Diarrhea

Flatulence

Hemorrhoids

Incontinence

Bowel DiversionCertain disease cause conditions that prevent normal passage of feces through the rectum

Treatment is a temporary or permanent artificial opening in the abdominal wall (stoma)

Bowel DiversionSurgical opening are created in the:Ileum IleostomyColon Colostomy

The ends of the intestine is brought through the abdominal wall to create the stoma

Bowel DiversionThe patients medical problem and general condition determines the location of a colostomy.

The three types of colostomy construction are: loop, end and double-barrel

Healthy Stoma

OstomiesThe location of an ostomy determines the consistency of stool.

An ileostomy by passes the large intestine stool are frequent and liquid

OstomiesA colostomy of the transverse colon generally results in a more solid, formed stool

The sigmoid colostomy releases a near normal stool

Nursing ProcessAssessmentNursing DiagnosisPlan-Goal and OutcomesImplementationEvaluation

Bowel Elimination: AssessmentNursing History

Physical Assessment

Lab fecal occult blood test (FOBT)

Diagnostic tests: see p.1101

Nursing DiagnosisBowel incontinence

Constipation

Diarrhea

Self-care deficit toileting

Bowel Elimination- Nursing Diagnosis

Constipation r/t pain, discomfort associated with hemorrhoids, aeb no b.m. for 4 days.

Bowel Elimination: PlanningGoals:

Short term - patient will defecate, have relief of discomfort anal area within 24 hours.

Long term - patient will maintain regular bowel elimination for the next 4 weeks

Bowel Elimination: ImplementationAssess for bowel sounds, flatus and defecationAdminister laxatives as orderedAdminister analgesics prnEncourage increased fluid intakeHave patient select high fiber foodsEncourage increased activity/exercise

Bowel Elimination EvaluationEffectiveness of care depends on success in meeting the expected outcomes of care

If a therapeutic relationship is established with the client they will be comfortable in discussing the intimate details associated with bowel elimination

Medication for Bowel EliminationSome medication initiate and facilitate bowel elimination.Cathartics and Laxatives and enemas are used to resolve constipationAntidiarrheal preparations help the patient to resolve diarrhea

Digital Removal of StoolUse for a patient with an impaction, the fecal mass is sometimes to large to pass voluntarilyIf enemas fail the fecal mass is broken up and removed with the fingersA health care providers order is necessary to remove a fecal impaction

Insertion and Maintaining a Nasogastric Tube (NG)A patients condition or situation sometimes require special interventions to decompress the GI tract

Such conditions include: surgery, infections of the GI tract, trauma to the GI tract and conditions in which peristalsis is absent

Insertion and Maintaining a Nasogastric TubeA NG tube is a pliable hollow tube inserted through the patients nasopharynx into the stomachNG intubation has several purpose: decompression, enteral feeding, compression, lavage

A Learning Experience

Meconium to toilet training and problems again in the elderly. Eating at regular time promotes a regular pattern. High fiber, yogurt help while calcium and carbs may not. Increase progesterone slows peristalsis plus effect of growing uterus. Low intake slows peristalisi and leads to dry hard stoolsDecreased movement slows peristalsis.PrivacyDiet, work (avoiding using the bathroom)From hemmorhoidsIron antacids pain meds and antimotility drugs may cause constipatin while antibotics and laxatives will cause diarrhea. NSAID irritate the stomach. Anesthesia slows motility. Bowel surgery may lead to paralytic ileus. Usually have NG tube inserted to suction secretions until peristalisis returns (decreases bloating and discomfort). 11. food allergies, diverticulosis (saclike outpuchings of the mucosa through muscle layers. Diverticulitis when these outpouchings become infected. 12. Colonoscopy: The doctor puts a thin tube that has a light through the rectum and into the colon. This allows the doctor to "see" the lining of the whole colon. Flexible sigmoidoscopy: The doctor puts a thin tube that has a light into the rectum. It allows the doctor to check the rectum and the lower part of the colon. Upper endoscopy: This is more accurate than a barium swallow radiograph and may be performed in a hospital or a doctor's office. The doctor sprays the throat to numb it and then slides a thin, flexible plastic tube called an endoscope down the throat. A tiny camera in the endoscope allows the doctor to see the surface of the esophagus and to search for abnormalities. The doctor may use tiny tweezers (forceps) in the endoscope to remove a small piece of tissue for biopsy. Barium enema: The doctor injects fluid containing a substance called barium into the rectum. Barium allows the doctor to see the colon on an X-ray. Constipation or irregularity, is a condition of the digestive system where a person (or animal) experiences hard feces that are difficult to pass.fecal impaction is a solid, immobile bulk of stool that can develop in the rectum as a result of chronic constipation. a condition in which the sufferer has frequent watery, loose bowel movements Fecal incontinence is the loss of regular control of the bowels Flatulence is the presence of a mixture of gases known as flatus in the digestive tract of mammals expelled from the rectum. Hemorrhoids, which are also called piles, are swollen and inflamed veins in your anus and rectum. Surgically created opening for elimination of digestive waste products.Colostomy: closer to the ascending colon it will be more continuous and liquid. Closer to the sigmoid produces solid fecesCloser to rectum and can be controlled by diet and irrigartion (may not need to wear a collection bag)Proximal stoma is functional. Distal stoma may drain mucous.e. Portion of the ileum brought through the abdomen. Bypasses the large instestine entirely. Drainage is liquid and continuous. kock pouch: creates an internal pouch that the client can drain by inserting a tube.total colectomy with ileoanal resorvoir: removes colon and creates a pouch from the ileum to the rectum. Patient may use the commonde although stool will remain liquid. Transverse loop colostomy supported by a loop ostomy bridge.See page 1182 for more detailsNormal pattern, appearance, change in habits, use of elimination aides, medications, pains or discomfort, emotional state, social history, exercise or mobility. Bowel sounds, abdomenFecal occult blood must be positive on three times to confirm GI Bleeding. Red meat, poultry, fish and some raw vegetable, vitamin C, aspirin and NSAI may cause a false positive