Download Bowel Elimination

Bowel Elimination
Susan L. Maiocco
MSN, RN, APN, C
A&P
• Large intestine
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Primary organ of bowel elimination
Extends from ileocecal valve to anus
5’ in length (adult)
3” width at widest to 1” narrowest
Diameter decreases from cecum to anus
Functions
• Absorption of water
• Formation of feces
• Expulsion of feces
A&P
• Waste products of digestion (chyme) move from
small intestine through ileocecal valve to cecum.
• Large intestine absorns 800-1000mL of liquid
daily
– Passes to slow-hard stools
– Too rapid-watery
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Ascending colon
Transverse colon
Descending colon
Sigmoid colon
Definitions
• Feces
– Solid waste products that have reached the distal end of the colon
– Ready for excretion
• Stool
– Feces that have been excreted
• Peristalsis
– Contractions of the muscles of the intestine
– Moves waste products through length of intestine continuously
• Hemorrhoids
– Abnormally distended veins in rectum
• Defecation
– Process of bowel elimination
• Anus
– Opening at end of anal canal
A&P
• ANS
– Innervates muscles of colon
– PSN
• Stimulates movement
– Sympathetic
• Inhibits movement
– These 2 systems function antagonistically
• Mass peristalsis occurs 1-4 times/24 hours after
food has been ingested promoting urge to
defecate
• After passing through sigmoid colon, waste
products enter rectum
• Stopped from exiting by anal sphincters
Defecation
• Emptying of the large
intestine
• External sphincter
– Voluntary control
• Parasympathetic
stimulation
– Internal anal sphincter
relaxes
– Colon contracts
– Fecal mass enters rectum
– Rectum distends
stimulating defecation
reflex
• Valsalva Maneuver
– Bearing down
– Contraindicated in cardiac
patients
• Increases pressure in
abdominal and thoracic
cavities, decreasing
cardiac output
• When bearing down
ceases, pressure lessened,
larger than normal
amount of blood flow to
heart-elevates BP
Factors Affecting Bowel
Elimination
• Developmental Considerations
– Older Adult
• Constipation
• Daily Patterns
• Food/Fluid
• Activity/Muscle tone
– Regular exercise improves GI motility and muscle
tone
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Lifestyle
Psychological variables
Pathologic conditions
Medications
Nursing Process
• Assessment
– History
– Physical Exam
• Inspection, Auscultation, Percussion,Palpation
• Anus/Rectum
– Superficial exam
– Rectal
» Left Sims position
• Stool characteristics
Diagnostic Studies
• Stool collection
– Patient should void first
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– Occult blood
EGD
– Esophagus, stomach, upper duodenum
Colonoscopy
– Rectal, colon, distal small bowel
Sigmoidoscopy
– Distal sigmoid colon, rectum, anal canal
UGI/Small Bowel Series
– Barium swallow-esophagus, stomach, small intestine
Barium EnemaAbdominal US
– Large intestine
MRI
– Detailed anatomic views
• CT Scan
Enemas
• Removes feces from colon
– Relieves constipation
– Prevents involuntary escape of fecal material
during surgery
– Promotes visualization of the intestinal tract
by radiographic or instrument examination
– Helps establish regular bowel function
Enemas
• Cleansing
– 500-1000mL
– Hypotonic (tap water)-distends intestine, increases periatalis,
softens stools
– Isotonic (normal saline)-distends intestine, increases periatalis,
softens stools
– Hypertonic-distends intestine; rritates intestinal mucosa
• Commercial
• Small volume
• Retention
– Oil-lubricates; should be retained for 30 minutes
– Carminative-expels gas; milk/molasses; MgSO4, glycerin, water
– Medicated
– Antihelminthic-destroyes parasites
– Nutritive
• Return flow-expels flatus
– 100-200 mL; repeated 5-6 times
Emptying the Colon of Feces
• Rectal suppositories
• Oral intestinal lavage
– GoLYTELY
– 1-6 hours for clear return
• Digital removal of stool
– Fecal Impaction
• Prolonged retention or accumulation of fecal material that
forms hardened mass
• Liquid feces seepage with no passage of normal stool is sign
of impaction
Bowel Incontinence
• Inability of the anal sphincter to control the
discharge of fecal and gaseous material
• Rectal Indwelling catheter
• Fecal incontinence pouch
Bowel Training Program
• Purpose
– Manipulate factors within a persons control to
produce the elimination of a soft, formed stool
at regular intervals without a laxative
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Food/fluid intake
Exercise
Time
Establishes regular pattern of defecation
Nasogastric Tube
• Decompress or drain the stomach of fluid or
unwanted stomach contents and when conditions
are present in which peristalsis is absent
– Paralytic ileus
– Intestinal obstruction
• Allow GI tract to rest and heal after surgery
• Monitor GI bleeding
• Lavage
Bowel Diversions
• Ostomy
– Opening in abdominal wall for fecal elimination
• Stoma
– Intestinal mucosa brought out to abdominal wall
– Ilieostomy
• Allows liquid fecal content from the ileum to be eliminated
through the stoma
– Colostomy
• Permits formed feces in the colon to exit through the stoma
Ostomies
Bowel Resection & Colostomy
Ostomy Care
• Keep the patient as free of odors as possible
• Inspect stoma regularly
– Color should be dark pink/red
• Note size of stoma
– Protrudes ½- 1”
– Stabilizes 6-8 weeks
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Skin care
Intake/Output
Change appliance
Irrigate prn/order
Patient Education
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Community resources are available for assistance.
Initially encourage patients to avoid foods high in fiber.
Avoid foods that cause diarrhea or flatus.
Drink two quarts of water daily.
Teach about medications.
Teach about odor control (intake of dark green
vegetables).
• Resume normal activity including work and sexual
relations.