Download Chapter 45: Bowel Elimination

Chapter 45
Bowel Elimination
Mosby items and derived items © 2005 by Mosby, Inc.
Gastrointestinal Tract
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Mouth
Esophagus
Stomach
Small intestine
Large intestine
Anus
Defecation
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Factors Affecting Bowel
Elimination
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Age
Diet
Fluid intake
Physical activity
Psychological factors
Personal habits
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Factors Affecting Bowel
Elimination (cont'd)
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Position during defecation
Pain
Pregnancy
Surgery and anesthesia
Medications
Diagnostic tests
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Common Problems
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Constipation
Impaction
Diarrhea
Incontinence
Flatulence
Hemorrhoids
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Alterations
• Bowel diversions: ostomies
– Loop colostomy
– End colostomy
– Double-barrel colostomy
– Alternative procedures
• Psychological considerations
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Assessment: Nursing History
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Elimination pattern
Characteristics of stool
Routines
Use of medications or enemas
Presence of bowel diversion
Changes in appetite
Diet and fluid intake
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Assessment: Nursing History
(cont'd)
• Prior medical history and use of
medications
• Emotional state
• Exercise patterns
• Presence of discomfort
• Social history
• Mobility and dexterity
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Client Assessment
• Physical examination
– Mouth
– Abdomen
– Rectum
– Fecal specimens
• Diagnostic examinations
• Client expectations
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Nursing Diagnoses
• Bowel incontinence
• Constipation
• Diarrhea
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Planning
• Goals and outcomes
– Client sets regular defecation habits
– Client implements a regular exercise
program
• Setting priorities
• Continuity of care
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Implementation:
Health Promotion
• Positioning
• Privacy
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Implementation: Acute Care
• Medications
– Cathartics and laxatives
– Antidiarrheal agents
• Enemas: tap water, saline,
hypertonic, soapsuds, oil retention,
other
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Enemas
• Types: tap water, saline, hypertonic,
soapsuds, oil retention, other
• Administration: client preparation,
equipment
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Implementation: Acute Care
(cont'd)
• Digital removal of stool
• Insertion and maintenance of a
nasogastric tube
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Ostomy Care
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Irrigation
Pouching
Skin barriers and care
Nutritional considerations
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Implementation: Restorative Care
• Bowel training
• Maintenance of proper fluid and food
intake
• Promotion of regular exercise
• Hemorrhoid care
• Maintenance of skin integrity
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Evaluation
• Client care
• Client expectations
Mosby items and derived items © 2005 by Mosby, Inc.