by purwaningsih. objectives describe the normal physiology of bowel elimination recognize causes of...
TRANSCRIPT
![Page 1: By Purwaningsih. OBJECTIVES Describe the normal physiology of bowel elimination Recognize causes of constipation Discuss assessment and interventions](https://reader033.vdocument.in/reader033/viewer/2022051621/56649e2b5503460f94b18ff1/html5/thumbnails/1.jpg)
ByPurwaningsih
![Page 2: By Purwaningsih. OBJECTIVES Describe the normal physiology of bowel elimination Recognize causes of constipation Discuss assessment and interventions](https://reader033.vdocument.in/reader033/viewer/2022051621/56649e2b5503460f94b18ff1/html5/thumbnails/2.jpg)
Objectives
Describe the normal physiology of bowel
elimination
Recognize causes of constipation
Discuss assessment and interventions to achieve
nursing outcomes for bowel elimination
![Page 3: By Purwaningsih. OBJECTIVES Describe the normal physiology of bowel elimination Recognize causes of constipation Discuss assessment and interventions](https://reader033.vdocument.in/reader033/viewer/2022051621/56649e2b5503460f94b18ff1/html5/thumbnails/3.jpg)
GI Tract is a series of hollow mucous membrane lined muscular organs
Purpose is to absorb fluids & nutrients, prepare food for absorption & provide
storage for feces
![Page 4: By Purwaningsih. OBJECTIVES Describe the normal physiology of bowel elimination Recognize causes of constipation Discuss assessment and interventions](https://reader033.vdocument.in/reader033/viewer/2022051621/56649e2b5503460f94b18ff1/html5/thumbnails/4.jpg)
Mouth
Esophagus
Stomach
Small Intestine
Large Intestine
Rectum
GI Tract Anatomy
![Page 5: By Purwaningsih. OBJECTIVES Describe the normal physiology of bowel elimination Recognize causes of constipation Discuss assessment and interventions](https://reader033.vdocument.in/reader033/viewer/2022051621/56649e2b5503460f94b18ff1/html5/thumbnails/5.jpg)
![Page 6: By Purwaningsih. OBJECTIVES Describe the normal physiology of bowel elimination Recognize causes of constipation Discuss assessment and interventions](https://reader033.vdocument.in/reader033/viewer/2022051621/56649e2b5503460f94b18ff1/html5/thumbnails/6.jpg)
![Page 7: By Purwaningsih. OBJECTIVES Describe the normal physiology of bowel elimination Recognize causes of constipation Discuss assessment and interventions](https://reader033.vdocument.in/reader033/viewer/2022051621/56649e2b5503460f94b18ff1/html5/thumbnails/7.jpg)
Small intestine
• Made up of three parts: ileum, jejunum, and duodenum.
• Main function is absorption
![Page 8: By Purwaningsih. OBJECTIVES Describe the normal physiology of bowel elimination Recognize causes of constipation Discuss assessment and interventions](https://reader033.vdocument.in/reader033/viewer/2022051621/56649e2b5503460f94b18ff1/html5/thumbnails/8.jpg)
Small intestineSmall
intestine
![Page 9: By Purwaningsih. OBJECTIVES Describe the normal physiology of bowel elimination Recognize causes of constipation Discuss assessment and interventions](https://reader033.vdocument.in/reader033/viewer/2022051621/56649e2b5503460f94b18ff1/html5/thumbnails/9.jpg)
![Page 10: By Purwaningsih. OBJECTIVES Describe the normal physiology of bowel elimination Recognize causes of constipation Discuss assessment and interventions](https://reader033.vdocument.in/reader033/viewer/2022051621/56649e2b5503460f94b18ff1/html5/thumbnails/10.jpg)
![Page 11: By Purwaningsih. OBJECTIVES Describe the normal physiology of bowel elimination Recognize causes of constipation Discuss assessment and interventions](https://reader033.vdocument.in/reader033/viewer/2022051621/56649e2b5503460f94b18ff1/html5/thumbnails/11.jpg)
![Page 12: By Purwaningsih. OBJECTIVES Describe the normal physiology of bowel elimination Recognize causes of constipation Discuss assessment and interventions](https://reader033.vdocument.in/reader033/viewer/2022051621/56649e2b5503460f94b18ff1/html5/thumbnails/12.jpg)
Colon
3 Divisions: Ascending, Transverse, Descending
Colon Functions: Absorption, Protection, Secretion, & Elimination (stool and flatus)
![Page 13: By Purwaningsih. OBJECTIVES Describe the normal physiology of bowel elimination Recognize causes of constipation Discuss assessment and interventions](https://reader033.vdocument.in/reader033/viewer/2022051621/56649e2b5503460f94b18ff1/html5/thumbnails/13.jpg)
![Page 14: By Purwaningsih. OBJECTIVES Describe the normal physiology of bowel elimination Recognize causes of constipation Discuss assessment and interventions](https://reader033.vdocument.in/reader033/viewer/2022051621/56649e2b5503460f94b18ff1/html5/thumbnails/14.jpg)
Sigmoid colon Storage of feces Length varies with age When fecal mass or flatus moves into
rectum, it distends and defecation begins
Process involves involuntary (Internal sphincter) and voluntary control (external sphincter)
Valsalva Maneuver- voluntary contraction of abdominal muscles
Rectum
![Page 15: By Purwaningsih. OBJECTIVES Describe the normal physiology of bowel elimination Recognize causes of constipation Discuss assessment and interventions](https://reader033.vdocument.in/reader033/viewer/2022051621/56649e2b5503460f94b18ff1/html5/thumbnails/15.jpg)
Physiology – Bowel Elimination
GI MotilityEnzyme breakdownPeristalsisGastrocolic Reflex
Mucosal TransportFluids & ElectrolytesWaste(Bisanz, 2007)
![Page 16: By Purwaningsih. OBJECTIVES Describe the normal physiology of bowel elimination Recognize causes of constipation Discuss assessment and interventions](https://reader033.vdocument.in/reader033/viewer/2022051621/56649e2b5503460f94b18ff1/html5/thumbnails/16.jpg)
Physiology – Bowel Elimination
Defecation Reflex
• Sphincters
• CNS Impulses
• Rectal Distention
• Mechanical Assistance
Anal Sphincter Muscles(Bisanz, 2007)
![Page 17: By Purwaningsih. OBJECTIVES Describe the normal physiology of bowel elimination Recognize causes of constipation Discuss assessment and interventions](https://reader033.vdocument.in/reader033/viewer/2022051621/56649e2b5503460f94b18ff1/html5/thumbnails/17.jpg)
Frequency
Quantity
Quality
Consistency
Ease of Passage
Characteristics – Bowel Elimination
![Page 18: By Purwaningsih. OBJECTIVES Describe the normal physiology of bowel elimination Recognize causes of constipation Discuss assessment and interventions](https://reader033.vdocument.in/reader033/viewer/2022051621/56649e2b5503460f94b18ff1/html5/thumbnails/18.jpg)
Bristol Stool Scale
Constipation Scoring System http://www.ncbi.nlm.nih.gov/pubmed/864957
http:// en.wikpedia.org./wiki/Bristol_stool_Chart
Tools for Stools
![Page 19: By Purwaningsih. OBJECTIVES Describe the normal physiology of bowel elimination Recognize causes of constipation Discuss assessment and interventions](https://reader033.vdocument.in/reader033/viewer/2022051621/56649e2b5503460f94b18ff1/html5/thumbnails/19.jpg)
o Ageo Infectiono Dieto Fluid Intakeo Physical Activityo Psychological factorso Personal Habits
Factors Affecting Bowel Elimination
![Page 20: By Purwaningsih. OBJECTIVES Describe the normal physiology of bowel elimination Recognize causes of constipation Discuss assessment and interventions](https://reader033.vdocument.in/reader033/viewer/2022051621/56649e2b5503460f94b18ff1/html5/thumbnails/20.jpg)
Position during Defecation Pain Surgery and Anesthesia Medications
Factors Affecting Bowel Elimination
![Page 21: By Purwaningsih. OBJECTIVES Describe the normal physiology of bowel elimination Recognize causes of constipation Discuss assessment and interventions](https://reader033.vdocument.in/reader033/viewer/2022051621/56649e2b5503460f94b18ff1/html5/thumbnails/21.jpg)
ConstipationImpactionDiarrheaIncontinenceFlatulenceHemorrhoids
Common Bowel Elimination Problems
![Page 22: By Purwaningsih. OBJECTIVES Describe the normal physiology of bowel elimination Recognize causes of constipation Discuss assessment and interventions](https://reader033.vdocument.in/reader033/viewer/2022051621/56649e2b5503460f94b18ff1/html5/thumbnails/22.jpg)
Definition: decreased normal frequency of defecation
accompanied by difficult or incomplete passage of excessively
dry stool (Wilkinson, J.M., 2005)
CONSTIPATION
![Page 23: By Purwaningsih. OBJECTIVES Describe the normal physiology of bowel elimination Recognize causes of constipation Discuss assessment and interventions](https://reader033.vdocument.in/reader033/viewer/2022051621/56649e2b5503460f94b18ff1/html5/thumbnails/23.jpg)
Poor IntakeFluidsNPO – tests, surgeryChoices – juice, waterPositioning
Fiber Menu choices – fresh fruit,
whole grains
Causes - Constipation
![Page 24: By Purwaningsih. OBJECTIVES Describe the normal physiology of bowel elimination Recognize causes of constipation Discuss assessment and interventions](https://reader033.vdocument.in/reader033/viewer/2022051621/56649e2b5503460f94b18ff1/html5/thumbnails/24.jpg)
Orthopedic Insult Casts, Traction Pain with movement Assistive devices
Other diseases
Causes - Constipation
![Page 25: By Purwaningsih. OBJECTIVES Describe the normal physiology of bowel elimination Recognize causes of constipation Discuss assessment and interventions](https://reader033.vdocument.in/reader033/viewer/2022051621/56649e2b5503460f94b18ff1/html5/thumbnails/25.jpg)
Open Door Policy ↓ Privacy – visitation policy
Bathroom vs. Commode
Disruption of Routine Therapy
Tests/Surgery
Causes - Constipation
![Page 26: By Purwaningsih. OBJECTIVES Describe the normal physiology of bowel elimination Recognize causes of constipation Discuss assessment and interventions](https://reader033.vdocument.in/reader033/viewer/2022051621/56649e2b5503460f94b18ff1/html5/thumbnails/26.jpg)
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
![Page 27: By Purwaningsih. OBJECTIVES Describe the normal physiology of bowel elimination Recognize causes of constipation Discuss assessment and interventions](https://reader033.vdocument.in/reader033/viewer/2022051621/56649e2b5503460f94b18ff1/html5/thumbnails/27.jpg)
Last resort: Bulk-forming → Stool softeners → Osmotic Laxatives → Stimulants →
Suppository/Enema (Hinrichs, Huseboe, Tang, & Titler, 2001)
Laxatives (+/-)
![Page 28: By Purwaningsih. OBJECTIVES Describe the normal physiology of bowel elimination Recognize causes of constipation Discuss assessment and interventions](https://reader033.vdocument.in/reader033/viewer/2022051621/56649e2b5503460f94b18ff1/html5/thumbnails/28.jpg)
Assessment
AUDITS: • Diagnosis• Postoperative
Day• Medications +/-• Bowel
Movement Recorded
INTERVIEWS: • Nurses•
Leadership• Patients
![Page 29: By Purwaningsih. OBJECTIVES Describe the normal physiology of bowel elimination Recognize causes of constipation Discuss assessment and interventions](https://reader033.vdocument.in/reader033/viewer/2022051621/56649e2b5503460f94b18ff1/html5/thumbnails/29.jpg)
Pictorial Diary Fluids – 8 servings Whole grains – 3 servings Fruits/vegetables – 5 servings Exercise – 3-4 x/day
Bowel Movement - record
Interventional Tool
![Page 30: By Purwaningsih. OBJECTIVES Describe the normal physiology of bowel elimination Recognize causes of constipation Discuss assessment and interventions](https://reader033.vdocument.in/reader033/viewer/2022051621/56649e2b5503460f94b18ff1/html5/thumbnails/30.jpg)
Bowel Elimination Tool (BET)
Interventional Tool
![Page 31: By Purwaningsih. OBJECTIVES Describe the normal physiology of bowel elimination Recognize causes of constipation Discuss assessment and interventions](https://reader033.vdocument.in/reader033/viewer/2022051621/56649e2b5503460f94b18ff1/html5/thumbnails/31.jpg)
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
![Page 32: By Purwaningsih. OBJECTIVES Describe the normal physiology of bowel elimination Recognize causes of constipation Discuss assessment and interventions](https://reader033.vdocument.in/reader033/viewer/2022051621/56649e2b5503460f94b18ff1/html5/thumbnails/32.jpg)
1) Cooperates for Bowel Management
• Partners for care – uses tool
• Out of bed/ exercises – 3-4 x day
• Overview of diet
>15 gm fiber; >1500 cc fluids
• Privacy and respect – toileting regime
(Moorhead, 2008)
Nursing Outcomes
![Page 33: By Purwaningsih. OBJECTIVES Describe the normal physiology of bowel elimination Recognize causes of constipation Discuss assessment and interventions](https://reader033.vdocument.in/reader033/viewer/2022051621/56649e2b5503460f94b18ff1/html5/thumbnails/33.jpg)
2) Constipation alleviated as indicated:
Elimination pattern in expected range
Stool 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