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Bowel Elimination Health Occupations February 2012 Objectives/Duty Tasks • Task1201- Assist the resident/patient in bowel training • Task 1506 -Report nausea, vomiting, pain, inability to swallow, bowel movement changes such as color, diarrhea, or constipation. (gastrointestinal conditions) • 1603 Demonstrate intervention strategies to prevent abuse and neglect. • Label structures of the digestive system • Describe the functions of the digestive system • Describe normal defecation • List observations to be made about defecation • Explain how to promote safety and comfort during defecation More Objectives • Identify the factors that affect bowel elimination • Explain why enemas are given • Demonstrate competence in assisting resident/patient in toileting Vocabulary • Bowel movement/Defecation • Constipation • Dehydration • Diarrhea • Enema • Fecal impaction • Fecal incontinence • • • • • • • • Feces/stool Flatus/flatulence Ostomy Illeostomy Colostomy Stoma Peristalsis suppository Functions of the Digestive System • Ingestion- eating • Digestion- food broken down into small particles • Absorption- vitamins and nutrients are absorbed • Elimination- body expels waste products of metabolism The Mouth • Around the teeth and through the gums - look out stomach, here it comes ! • Digestion begins here • The teeth – • The Salivary Glands - Esophagus • • • • Collapsible Muscular Mucous lined 10 inches long Stomach • • • • • Expandable sac Gastric juices Chyme 2-4 hours Pyloric Sphincter Small Intestine • • • • • Nutrient absorption 20 feet long Large surface area Villi Ducts for pancreatic juices/bile Liver • Produces bile • Aids in fat digestion Gallbladder • Muscular sac - under the liver • Stores/ concentrates bile • Bile released from the GB into the Small Intestine Pancreas • Secretes digestive enzymes • Proteases - proteins • Lipase - fats • Amylase –starches Large Intestine • AKA Colon • 5 feet long • Absorbs water from food that can not be digested The End of the Line • Rectum • 2 inch long canal • Serves as a holding area for stool • Anus • 2 sphincters ( ring muscles) control defecation KITSES • Animation of Digestive system • http://kitses.com/animation/swfs/digestion.s wf Normal Bowel Movements • • • • • Defecation Feces Stool Frequency Timing • color– Diet- affects color – Diseases- affects color • Shape • Consistency • Odor NA Observations • Notice – Color – Amount – consistency – Frequency – Odor – Shape – Complaints of pain/discomfort Factors Affecting Bowel Elimination • • • • • • • • Privacy Habits Diet Fluids Activity Drugs Disability Age Comfort and Safety • in packet- complete this slide using Box 20-1 page 377 Effects of Aging on Bowel Elimination • Complete this slide on the back of your PowerPoint packet using Page 377 in text packet as a reference Constipation • Passage of a hard dry stool • Caused by feces moving slowly through the bowel • Stools large or marble sized • Caused by low fiber diet, inactivity, medications, resisting the urge to defecate. Aging, certain diseases Fecal Impaction • Prolonged retention of feces in rectum • The longer the feces sits in the rectum the harder the feces gets • Feces becomes hard or putty like – Abdominal discomfort, nausea, cramping, rectal pain • Digital exam( not an NA function) • Digital removal of impaction ( not an NA function) Diarrhea • Frequent passage of liquid stools • Feces move through bowel rapidly reduces time for fluid absorption • Sometimes causes fecal incontinence • causes – infection, drugs, irritating foods, pathogens in food Care for residents/patients with diarrhea • Respond to elimination needs promptly • Dispse of stools promptly, using infection control measures • Good skin care liquid stools can be irritating to the skin • Risk of dehydration – flushed, dry sskin, headache , dizziness, oliguria , concentrated urine, coated skin Fecal Incontinence • Inability to control the passage of feces or flatus through the anus – Intestinal diseases – Nervous system diseases – Fecal impaction – Diarrhea – Some medications – dementia/ mental health disorders Care for people with Fecal Incontinence • Bowel Training • Help with toileting after meals and every 2-3 hrs. • Incontinence products to keep linens and garments clean • Good skin care Flatulence • Gas and air are normal in stomach and intestines • Expelled through mouth and anus • Gas and air through anus is called flatus • Flatulence is excessive flatus • • • • • • Causes Swallowing air Bacterial action of the intestines Gas forming foods Constipation Medicines that decrease peristalsis Bowel surgeries Bowel Training Goals • Gain control of bowel movements • Develop a regular pattern of elimination – Note resident’s normal time for elimination – Usually after a meal – Toilet resident at the same time each day after a meal – Also-high fiber diet, warm liquids, activity and privacy Enemas • Introduction of fluid into rectum and lower colon • Ordered by the physician, NP, PA Ostomies • Surgically created opening • In digestive system the opening is on the abdomen • Named by where in the intestine the opening is created – Colostomy- large intestine – Illeostomy – small intestine Care • Prevent skin irritation • Change ostomy pouch