bowel 1 elimination
DESCRIPTION
Kebutuhan Dasar ManusiaTRANSCRIPT
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ByPurwaningsih
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Objectives Describe the normal physiology of bowel eliminationRecognize causes of constipation Discuss assessment and interventions to achieve nursing outcomes for bowel elimination
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GI Tract is a series of hollow mucous membrane lined muscular organsPurpose is to absorb fluids & nutrients, prepare food for absorption & provide storage for feces
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MouthEsophagusStomachSmall Intestine Large IntestineRectumGI Tract Anatomy
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Small intestine
Made up of three parts: ileum, jejunum, and duodenum.
Main function is absorption
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Small intestineSmall intestine
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Colon3 Divisions: Ascending, Transverse, DescendingColon Functions: Absorption, Protection, Secretion, & Elimination (stool and flatus)
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Sigmoid colonStorage of fecesLength varies with ageWhen fecal mass or flatus moves into rectum, it distends and defecation beginsProcess involves involuntary (Internal sphincter) and voluntary control (external sphincter)Valsalva Maneuver- voluntary contraction of abdominal muscles
Rectum
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Physiology Bowel EliminationGI MotilityEnzyme breakdownPeristalsisGastrocolic ReflexMucosal TransportFluids & ElectrolytesWaste(Bisanz, 2007)
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Physiology Bowel EliminationDefecation ReflexSphinctersCNS ImpulsesRectal DistentionMechanical AssistanceAnal Sphincter Muscles(Bisanz, 2007)
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Frequency
Quantity
Quality
Consistency
Ease of PassageCharacteristics Bowel Elimination
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Bristol Stool Scale
Constipation Scoring System http://www.ncbi.nlm.nih.gov/pubmed/864957http:// en.wikpedia.org./wiki/Bristol_stool_Chart Tools for Stools
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AgeInfectionDietFluid IntakePhysical ActivityPsychological factorsPersonal HabitsFactors Affecting Bowel Elimination
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Position during DefecationPainSurgery and AnesthesiaMedicationsFactors Affecting Bowel Elimination
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ConstipationImpactionDiarrheaIncontinenceFlatulenceHemorrhoidsCommon Bowel Elimination Problems
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Definition: decreased normal frequency of defecation accompanied by difficult or incomplete passage of excessively dry stool (Wilkinson, J.M., 2005)
CONSTIPATION
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Poor IntakeFluidsNPO tests, surgeryChoices juice, waterPositioning
Fiber Menu choices fresh fruit, whole grainsCauses - Constipation
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Orthopedic InsultCasts, TractionPain with movementAssistive devices
Other diseases Causes - Constipation
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Open Door Policy Privacy visitation policyBathroom vs. Commode
Disruption of Routine Therapy Tests/SurgeryCauses - Constipation
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Pain MedicationsOpiates P.O. or PCA
Other medications Antacids with aluminum, anticholinergics, calcium channel blockers, phenothiazines, diuretics, sedatives, etc. (Hinrichs, Huseboe, Tang, & Titler, 2001)Causes - Constipation
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Last resort: Bulk-forming Stool softeners Osmotic Laxatives Stimulants Suppository/Enema (Hinrichs, Huseboe, Tang, & Titler, 2001)Laxatives (+/-)
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AssessmentAUDITS: DiagnosisPostoperative DayMedications +/-Bowel Movement RecordedINTERVIEWS: NursesLeadershipPatients
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Pictorial DiaryFluids 8 servingsWhole grains 3 servingsFruits/vegetables 5 servingsExercise 3-4 x/day
Bowel Movement - recordInterventional Tool
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Bowel Elimination Tool (BET)Interventional Tool
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Directions:
Mark your selections with an X
Choose: 8 Glasses of Fluid: Best: Water or Juices; Decaffeinated drinks 3 Servings of Whole grain breads or cereal: Best: Whole wheat, oatmeal, bran cereals 5 Servings of Fruits or Vegetables: Best: Fresh fruits, vegetables with skin Exercise 3-4 times per day Best: Walking, physical therapy, or exercises in bed
Record your BM Difficult___ Easy___ Soft___ Hard___ Complete__
Interventional Tool
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1) Cooperates for Bowel ManagementPartners for care uses toolOut of bed/ exercises 3-4 x dayOverview of diet>15 gm fiber; >1500 cc fluidsPrivacy and respect toileting regime (Moorhead, 2008)Nursing Outcomes
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2) Constipation alleviated as indicated:
Elimination pattern in expected rangeStool soft and formed (soft/hard)Stool easy to pass (easy/difficult)Amount adequate for diet (yes/no)Feeling of evacuation (yes/no) (Moorhead, 2008)
Nursing Outcomes