Bowel-Elimination

Front 1

FECAL ELIMINATION
• Fecal or Bowel Elimination

Back 1

• 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

Front 2

Anatomy & Physiology
Main function-

Back 2

Main function-absorption
Large intestine/Colon
Rectum
Anal Sphincter

Front 3

Anatomy & Physiology
Waste Products

Back 3

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

Front 4

Anatomy & Physiology
Water Absorption

Back 4

Water Absorption
-800-1500 ml daily

Front 5

Defecation
• Intrinsic defecation reflex

Back 5

• Intrinsic defecation reflex
– Feces enters rectum, peristalsis initiated

Front 6

Defecation
• Parasympathetic defecation reflex

Back 6

• Parasympathetic defecation reflex
– Rectal nerve fibers stimulated-intensify peristalsis

Front 7

Defecation
• Expulsion of feces

Back 7

• Expulsion of feces
– Abdominal muscles & Diaphragm
– Levator ani muscle of pelvic floor
– Thigh flexion increases abdominal pressure
– Sitting position increases downward pressure
Bowel Elimination

Front 8

Stool/Feces

• Normal Finding

Back 8

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

Front 9

Stool/Feces

• Abnormal Findings
(table 46-1)

Back 9

• Abnormal Findings
-occult blood=test
-fats=pale, greasy
-mucus
-abnormal color=diet
*dairy, meds, food color
-bacteria
-viruses
-worms & parasites

Front 10

Factors affecting bowel elimination

Back 10

• Appetite, indigestion, food
preferences
• Dysphagia, ulcer, gallbladder
disease
• N/V, colitis, IBS
• Flatulence, change in bowel
routine
• Constipation, diarrhea
• Rectal bleeding, hemorrhoids,
fissure

Front 11

Fecal Impaction

Back 11

• 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

Front 12

Enemas: Cleansing

Back 12

*Cleansing-Remove feces:
-before surgery
-test prep
-constipation/impaction

Front 13

Enemas: Hypertonic

Back 13

Hypertonic:
-draws water in
-fleets

Front 14

Enemas: Hypotonic

Back 14

Hypotonic
-stimulates peristalsis
-tap water

Front 15

Enemas: Isotonic

Back 15

Isotonic
-stimulates peristalsis
-Normal saline

Front 16

Enemas: Isotonic

Back 16

Isotonic
-stimulates peristalis
-normal saline
-Soapsuds
* irritate mucosa
* castile soap only

Front 17

Enemas: Rentention

Back 17

-soften & lubricate
-Mineral oil

Front 18

Enemas: Carminative

Back 18

-Releases gas
-Expel flatus

Front 19

Enemas:Return flow

(table 46-4)

Back 19

-Faltus/Abdominal distention
-Repeated 5-6 times

Front 20

Physical Assessment:
Infants

Back 20

breast or formula, lack voluntary control

Front 21

Physical Assessment:
Toddlers

Back 21

voluntary control, appetite

Front 22

Physical Assessment:
child, Adolescent, adult

Back 22

their normal

Front 23

Physical Assessment:
Older adult

Back 23

-decreased physical activity
-decreased GI mobility
-change dietary habits
-laxative or enema abuse

Front 24

Variables

Back 24

-daily patterns
-food & fluid
-activity
-life style
-psych variables
-pathologic variabls
-medications
-surgery/anesthesia
-pain
-pain of defecation

Front 25

Nurses as role models
self assessment

Back 25

• 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

Front 26

Nurses as role models
physical assessment

Back 26

Physical Assessment:
Abdomen
Inspection
• Look first
Auscultation
• Listen x 4 quads
•5 min. by clock
Palpation
• Touch unless painful
Rectum & Anus
• Assess perineum

Front 27

Diagnositc Studies
(Endoscopy)
(Radiography)

Back 27

• Direct Visualization (Endoscopy)
–1 Esophagogastroduodenos-copy
– 2 Colonoscopy
– 3 Sigmoidoscopy
• Indirect Visualization (Radiography)
– 1 Upper G.1.
– 2 Small Bowel Series
– 3 Barium Enema

Front 28

Diagnostic Studies
-scheduling sequence
-Inspection first
-Auscultation
-Palpation

Back 28

• Scheduling Sequence
– Fecal Occult Blood Tests
• Noninvasive first
– Barium studies
– Endoscopic Examination
• Possibly before barium
• Inspection first
• Auscultation
• Palpation

Front 29

Nursing Diagnosis
• Bowel Incontinence

Back 29

• Bowel Incontinence
– Involuntary passage of
formed stool

Front 30

Nursing Diagnosis
• Constipation

Back 30

• Constipation
– Colonic
• Decrease in normal
frequency
– Perceived
• Self diagnosis

Front 31

Nursing Diagnosis
•Diarrhea

Back 31

•Diarrhea
– Frequent liquid stool

Front 32

Nursing Diagnosis
• Self Care Deficit: toileting

Back 32

• Self Care Deficit: toileting

Front 33

Nursing Diagnosis
• Skin integrity, impaired

Back 33

• Skin integrity, impaired
– skin integrity, impaired, risk for

Front 34

Nursing Diagnosis
• Self-esteem, situational low
• other

Back 34

• Self-esteem, situational low
• other

Front 35

Plan and implement nursing
interventions

Back 35

• Independent
– diet/fluid
–exercise
– privacy/relaxation
– establishing/maintaining routine
• training
• retraining
– positioning
– other

Front 36

Medications to Promote
Fecal Elimination

Back 36

•Bulk forming
- Metamucil
• Stool softener
-Colace
• Saline cathartic
-MOM
• Contact cathartic
-Dulcolax
•Lubricant
-Mineral Oil
• CLINICAL INDICATIONS:
• CONTRAINDICATIONS:

Front 37

Diarrhea

Back 37

• Assessment
• Diagnosis
• Goal
•Intervention/Implementation





• Evaluation

Front 38

Constipation: colonic/perceived

Back 38

• Assessment
• Diagnosis
•Intervention/Implementation
– fecal extraction
– enema
• Evaluation

Front 39

Bowel Incontinence

Back 39

• Assessment
• Diagnosis
• Intervention/Implementation
– training/retraining
• Evaluation