Bowel Bowel EliminationElimination

Professor Hill, RN, MN, MSG

an Bernardino Valley College

Nursing 102

At The End of This Lecture, The Learner Will..

Explain the role of the GI system in digestion & elimination

Describe factors that influence elimination

Assess bowel elimination through subjective & objective assessments

Discuss 3 elimination problems and the nursing interventions for each

Mouth Digestion begins with mastication

EsophagusPeristalsis moves food into the stomach

Stomach Stores food; mixes food, liquid and digestive juices; moves food into small intestines

Small intestineAbsorption is primary

Large intestineBowel elimination key

Anus Expels feces & flatus from rectum

http://www.youtube.com/watch?v=HA8iL7hs5YY

Factors Affecting Bowel Elimination

Food & fluid Physical activityPsychological factorsBowel habitsMedicationsDiagnostic testsPathological conditionsSurgery & pain

Effects of Aging on GI Tract

Periodontal disease

Decrease in saliva

Decrease in gastric secretions

Smooth muscle changes, decreased esophageal peristalsis

Decreased GI motility

Subjective Assessment Questions

Usual pattern of bowel elimination?

Aids to elimination?

Recent changes in

bowel elimination?

Problems with bowel

elimination?

Physical Assessment

Inspect mouth

AbdomenInspection

Auscultation

Palpation

Stool Characteristics

Color

Odor

Consistency

Shape

Volume

Constituents

Laboratory Tests

Fecal specimens for labMedical asepsis- wear gloves

Obtain specimen, label & seal container

Place container in biohazard bag

Send immediately to lab

Fecal occult blood testing @ bedside (POCT)Medical asepsis

Small amount of stool

Follow instructions per tester

Void firstNO toilet paper!Menstruating?

Diagnostic Studies

Esophagogastroduodenoscopy

(EGD)

Endoscopy

Upper GI series

Barium enema

Sigmoidoscopy

Before:Consent signedNPOLower GI studies: Bowel cleansing

Aftercare:Vital signsThroat sorenessAssess stoolsCathartics to cleanse barium from GI tract

Nursing Care

Upper GI series Barium Enema Flexible Sigmoidoscopy

Constipation (Symptom!)

Slowed gastric motility

Slowed passage of feces in large intestine

Fecal water content absorbed through walls

Result is dry, hard stool

Constipation

Signs: infrequent bowel movements

difficulty passing stools

Excessive straining

Hypoactive bowel sounds

Constipation

Causes:Decreased fiber

Reduced fluid intake

Immobility

Anxiety, depression

Medications

Abuse of laxatives

Delaying defecation

Valsalva Maneuver

Individual bears down

Thoracic/abdominal pressure

Blood flow to atria/ventricles = low CO

Bearing down stops

Large amount of blood returns to heart = BP

Nursing Interventions- Constipation

Provide privacy

Positioning

High fiber intake

Ambulation

Increase fluid intake to 2,000-3,000ml/day

Cathartics & Laxatives

Bulk forming Metamucil Stool swells

Emollient/stool softeners

Docusate sodium (colace)

Water & fat penetrates BM

Saline MOM, Fleet enema

Draws water into intestine

Stimulant Bisacodyl (dulcolax)

Irritate mucosa

Increase motility

Lubricants Mineral oil Coats & softens

feces

Enemas

Instillation of solution into rectum/colon

Promotes peristalsis

Fluid breaks up fecal mass

Stretches the rectal wall

Initiates defecation reflex

Indicated for relief of constipation, Impacted feces, diagnostic test/surgery

Types of Cleansing Enemas

Hypotonic- Tap water- give once onlyNormal Saline -safestHypertonic Solutions- Fleets enemaSoapsuds-castile soapOil retention -lubricate/hold for hours

**Enemas till clear- do not repeat more than 3 times

Enemas

Patient positioning

Preparation of equipment

High enema- cleanses higher up colon12-18 inches above anus

Low enema- cleanses rectum & sigmoid12 inches or lower

Return flow enemas (Harris flush)

Impaction

Collection of hardened feces wedged in rectumCan be palpated by digital examSigns: oozing of diarrhea stool, frequency, rectal painTreatment: oil retention enema, cleansing enemas, suppositories, last resort…Manual removal of impacted feces

Diarrhea

Signs:

Passage of excessively liquid, unformed stools

Contents pass through GI system too quickly = too much fluid & mucous

Causes:Altered GI flora

Enteral nutrition

Food allergies

Food intolerances

Clostridium difficile

Food borne pathogens

Abdominal cramps

HyperactiveBowel sounds

Nausea & vomiting

Fluid & Electrolyte Imbalances

Diarrhea Treatment

Acute diarrhea: oral rehydration therapy,

Chronic diarrhea > 3-4 wks:

Replacement of fluids with electrolytes

Oral if tolerated

If severe, may need IV fluid replacement

Act on GI smooth muscle to slow motility

Paregoric (opiate deriv)

Lomotil

Imodium

Act as an absorbent Kaopectate

In Closing….

http://www.youtube.com/watch?v=Ve_XxOpj-MY

QUESTIONS