Download Bowel Elimination Scientific knowledge base

B260: Fundamentals of
Nursing
SCIENTIFIC
KNOWLEDGE BASE
Scientific Knowledge Base
Mouth
Esophagus
Digestion begins with
mastication.
Peristalsis moves
food into the
stomach.
Stomach
Small intestine
Stores food; mixes
Duodenum, jejunum,
food, liquid, and
and ileum
digestive juices;
moves food into small
intestines
Large intestine
Anus
The primary organ of
bowel elimination
Expels feces and
flatus from the
rectum
Scientific Knowledge Base –
Generational Changes
Mouth
Decreased chewing and
decreased salivation,
including oral dryness.
Esophagus
Reduced motility,
especially the lower
third
Stomach
Decrease in acid
secretions, motor
activity, mucosal
thickening, nutrient
absorption
Small intestine
Decreased nutrient
absorption, fewer
absorbing cells
Large intestine
Increase in pouches on
the weakened intestinal
wall - Diverticulosis
Liver
Size decreased
Organs of the Gastrointestinal
(GI) Tract
Segmented and Peristaltic
Waves
Nursing Knowledge Base:
Factors Affecting Bowel Elimination
Age
Diet
Fluid intake
Physical activity
Psychological
factors
Personal habits
Position during
defecation
Pain
Pregnancy
Surgery and
anesthesia
Medications,
laxatives, and
cathartics
Diagnostic tests
Bristol Stool Form Scale
Common Bowel Elimination Problems
Constipation
Impaction
A symptom, not a disease;
infrequent stool and/or hard,
dry, small stools that are
difficult to eliminate
Results from unrelieved
constipation; a collection of
hardened feces wedged in the
rectum that
a person cannot expel
Diarrhea
Incontinence
an increase in the number of
stools and the passage of
liquid, unformed feces
Inability to control passage of
feces and gas to the anus
Flatulence
Hemorrhoids
Accumulation of gas in the
intestines causing the walls to
stretch
Dilated, engorged veins in the
lining of the rectum
Elimination Habits that influence
bowel function
Busy work
Schedule
Lack of privacy
in the hospital
Sights, sounds,
odors of facilities
Embarrassment
using a bedpan
Risk
1. Improper diet
2. Reduced fluid intake
3. Lack of exercise
4. Certain medications
Signs and Symptoms
1. Infrequent bowel movements > 3 days
2. Difficulty passing stools
3. Excessive straining
4. Hard feces
Causes
1. Irregular bowel habits/ignoring the
urge to defecate
2. Chronic illness (Parkinson’s, MS)
3. Low fiber diet high in animal fats
4. Anxiety, depression, cognitive
impairment
5. Lengthy bed rest/lack of exercise
6. Laxative misuse
7. Generational changes
8. Medications
Fecal Impaction
Collection of hardened feces that
becomes wedged in the rectum
Increased number of stools and the passage
of liquid associated with disorders affecting
digestion, absorption, and secretion.
Concerns:
1. Contamination/skin ulceration
2. Fluid, electrolyte, acid-base
imbalance
Causes mild diarrhea to severe colitis
acquired by the use of antibiotics,
chemotherapy, invasive bowel procedures, or
with a health care worker’s hands or direct
contact with environmental surfaces.
• Fecal incontinence – Inability to control
passage of feces
• Flatulence – Gas accumulation
• Hemorrhoids – swollen and inflamed veins
in the anus and lower rectum
Bowel Diversion
• Temporary or permanent artificial
opening in the abdominal wall
• Stoma
• Surgical opening in the ileum or colon
• Ileostomy
• Colostomy
• Double-Barrel
Ulcerative Colitis
Divisions of the Large Intestine
Diversions of the Large Intestine
Continuing and Restorative
Care
• Care of ostomies
• Skin Care is number one priority
• Pouching ostomies
• An effective pouching system protects the skin,
contains fecal material, remains odor free, and is
comfortable and inconspicuous.
• Nutritional considerations
• Consume low fiber for the first weeks.
• Eat slowly and chew food completely.
• Drink 10 to 12 glasses of water daily.
• Patient may choose to avoid gassy foods.
NURSING
ASSESSMENT
Nursing Process: Assessment
Assessment History
Determine usual elimination pattern
Usual stool characteristics
Routines to promote normal elimination
Assessment of artificial aids
Presence or status of bowel diversions
Changes in appetite
Diet history
Description of daily fluid intake
Medication history
Exercise routine
History of pain or discomfort
Abdominal Assessment
Inspect
• All four quadrants for contour,
shape, symmetry, and skin color
Assess
• Bowel sounds in all four
quadrants
Palpate
• For masses or areas of
tenderness
Percussion
• Detect lesions, fluids, or gas
Fecal Occult Blood Testing
Fecal Occult Blood Testing
(cont’d)
Common Radiologic & Diagnostic Tests
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KUB – abdominal X-ray
Upper endoscopy
Ultrasound
Colonoscopy
Flexible Sigmoidoscopy
MRI
Nursing Diagnosis and
Planning
Constipation
Bowel
incontinence
Risk for
Perceived
constipation constipation
Diarrhea
Toileting
self-care
deficit
Patient Goals
1. Patient will set regular defecation habits
2. Patient is able to list proper fluid and food
intake need to achieve elimination
3. Patient implements a regular exercise
program
4. Patient reports daily passage of soft,
formed, brown stool
5. Patient does not report any discomfort
associated with defication
Implementations: Acute Care
• Health promotion
• Promotion of normal defecation
• Establish a routine an hour after a
meal, or maintain the patient’s
routine.
• Sitting position
• Privacy
• Positioning on bedpan
Proper and Improper Position
on a Bedpan
Positioning Immobilized
Patient on Bedpan
Acute Care: Medications
Cathartics and Laxatives
• Short term action of emptying bowel
Antidiarrheal
• Opiate agents decrease intestinal muscle
tone and slow passage of feces
Enemas
• Provide temporary relief of constipation,
emptying the bowel before tests
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Positioning: Left Side-lying (Sims) position
Provide a bedside commode
Administer slowly to help with cramping
Caution against giving more than 3
enemas in a row –
can deplete fluids
and electrolytes
•Exert
osmotic
pressure that
pulls out of
interstitial
spaces
•DO NOT
GIVE to
patients that
are
dehydrated
or infants
Soap Suds
•Hypotonic,
and exerts
lower
osmotic
pressure
than fluid in
interstitial
spaces
Hypertonic Enema
•Safest
Enema
Solutions
•.It exerts the
same
osmotic
pressure as
fluid in
interstitial
spaces
surrounding
the bowel
Tap Water Enema
Normal Saline Enema
Cleaning enemas promote complete
evacuation of feces from the colon.
•Creates
interstitial
irritation to
stimulate
peristalsis
Oil Retention
(Softens)
Carminative
(GAS)
Medicated
Kayexalate
Exchanged Na for K
Enemas
• Enema administration
• Sterile technique is unnecessary.
• Wear gloves.
• Explain the procedure, precautions
to avoid discomfort, and length of
time necessary to retain the
solution before defecation.
• Digital removal of stool
• Use if enemas fail to remove an
impaction.
• This is the last resort for
constipation.
• A health care provider’s order is
necessary to remove an impaction.
Complications of Excessive
Rectal Manipulation
1. Can cause irritation to the mucosa
2. Can cause bleeding
3. Can cause stimulation of the vagus nerve,
which results in a reflex slowing of the
heart
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Used for Suction or Feeding
Measuring for placement
• Tip of nose – earlobe – xiphoid process
• Marking the tube
Placement
• High fowlers
• Swallowing
Securing
Testing placement: Aspirated gastric
contents – pH 0-4
Feeding Risk: Aspiration
• HOB > 30 degrees
• Monitor breathing and bowel sounds
Therapeutic Interventions
• Encourage fluid intake of at least 1500
ml/24hr
• Encourage activity: walk pt in hallway 4
times a day
• Encourage to defect whenever urge is felt
• Assist to BR, BSC or bedpan (put pt in
high Fowlers)
• Provide for privacy
• Encourage to drink hot liquids in AM
• Administer laxatives or enemas as ordered
• Consult with HCP to check for impaction
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