chapter 31 bowel elimination - islamic university of...

Chapter 31

Bowel Elimination Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Asepsis 1 First semester 19 - 20

Islamic University of Gaza Faculty of Nursing

2 Bader A. EL Safadi BSN , MSc Fundamental of Nursing – B Bowel Elimination

Defecation

Defecation (bowel elimination):

Is the act of expelling feces (stool) from the body.

To do so, all structures of the gastrointestinal tract,

especially the components of the large intestine (also

referred to as the bowel or colon), must function in a

coordinated manner (Fig. 31-1).

In the large intestine, a remarkable volume of water is

removed from the remnants of digestion, causing the

bowel's contents to become a consolidated mass of

residue before being eliminated.

First semester 19 - 20


Figure 31-1 • The large intestine



Peristalsis

Peristalsis

Means the rhythmic contractions of intestinal

smooth muscle that facilitate defecation.

Peristalsis moves fiber, water, and nutritional

wastes along the ascending, transverse,

descending, and sigmoid colon toward the

rectum.

Gastrocolic reflex:

Increased peristaltic activity occurring during

eating



The gastrocolic reflex usually precedes defecation.

Its accelerated wavelike movements, sometimes perceived as slight abdominal cramping, push stool forward, packing it within the rectum.

As the rectum distends, the person feels the urge to defecate.

Stool is eventually released when the anal sphincters relax.

Valsalva maneuver (closing the glottis and contracting the pelvic and

abdominal muscles to increase abdominal pressure)

It facilitates Defecation process

Several dietary, physical, social, and emotional factors can influence the bowel's mechanical function (Table 31-1).


6 Bader A. EL Safadi BSN , MSc Fundamental of Nursing – B Bowel Elimination First semester 19 - 20


Assessment of Bowel Elimination

A comprehensive assessment of bowel elimination

involves collecting data about the client’s elimination

patterns (bowel habits) and the actual characteristics of

the feces.

Elimination Patterns

It is essential to determine the client's usual patterns,

including frequency of elimination, effort required to

expel stool, and what elimination aids, if any, he or she

uses.

Stool Characteristics

Color, odor, consistency, shape, unusual components


8 Bader A. EL Safadi BSN , MSc Fundamental of Nursing – B Bowel Elimination First semester 19 - 20


Common Alterations in Bowel Elimination

Constipation

Is an elimination problem characterized by dry, hard

stool that is difficult to pass. Various accompanying signs

and symptoms include the following:

Complaints of(C/O ) abdominal fullness or bloating

Abdominal distention

Complaints of(C/O ) rectal fullness or pressure

Pain on defecation

Decreased frequency of bowel movements

Inability to pass stool

Changes in stool characteristics such as oozing liquid

stool or hard small stool



The incidence of constipation tends to be high among

those whose dietary habits lack adequate fiber (such as

not eating sufficient raw fruits and vegetables, whole

grains, seeds, and nuts).

Dietary fiber, which becomes undigested cellulose, is

important because it attracts water within the bowel,

resulting in bulkier stool that is more quickly and

easily eliminated.

Constipation is classified into one of four distinct types

(primary, secondary, iatrogenic, and pseudo

constipation), according to the underlying cause.



1. Primary or simple constipation

Is well within the treatment domain of nurses.

It results from lifestyle factors such as inactivity,

inadequate intake of fiber, insufficient fluid intake, or

ignoring the urge to defecate.

2. Secondary constipation

Is a consequence of a pathologic disorder such as a

partial bowel obstruction.

It usually resolves when the primary cause is treated.

Types of Constipation



3. Iatrogenic constipation

Occurs as a consequence of other medical treatment.

For example, prolonged use of narcotic analgesia tends

to cause constipation.

These and other drugs slow peristalsis, delaying transit

time.

The longer the stool remains in the colon, the drier it

becomes, making it more difficult to pass.

4. Pseudoconstipation (perceived constipation):

A term used when clients believe they are

constipated even though they are not (often overuse

laxatives, suppositories or enemas).



Fecal impaction

Occurs when a large, hardened mass of stool

interferes with defecation, making it impossible for

the client to pass feces voluntarily.

Result from unrelieved constipation, retained barium

from an intestinal x-ray, dehydration, and weakness

of abdominal muscles.

Clients with a fecal impaction usually report a

frequent desire to defecate but an inability to do so.

Some clients with an impaction pass liquid stool,

which they may misinterpret as diarrhea.



Flatulence or flatus :

Excessive accumulation of intestinal gas, results from:

1. swallowing air while eating or slow peristalsis

2.gas that forms as a byproduct of bacterial

fermentation in the bowel.

Vegetables such as cabbage, cucumbers, and onions are

commonly known for producing gas. Beans are other

gas formers.

Regardless of its cause, flatus may be expelled rectally,

thus reducing intestinal accumulation and distention.



Diarrhea is :

“The urgent passage of watery stool and commonly is

accompanied by abdominal cramps”.

Simple diarrhea usually begins suddenly and lasts for

a short period.

Other associated signs and symptoms include nausea

and vomiting and blood or mucus in the stools.

Usually diarrhea is a means of eliminating an irritating

substance such as tainted food or intestinal pathogens.

Diarrhea may also result from emotional stress,

dietary indiscretions, laxative abuse, or bowel

disorders.



Fecal incontinence:

is the inability to

control the elimination

of stool.

It does not necessarily

imply that stool is

loose or watery,

although that may be

the case.



Measures to Promote Bowel Elimination

Nurses commonly use two interventions( inserting

suppositories and administering enemas) to promote

elimination when not naturally occurring or when the

bowel must be cleansed for other purposes, such as

preparation for surgery and endoscopic or x-ray

examinations

1. Insert a rectal suppository

2. Administer an enema

“ An enema introduces a solution into the rectum”



Inserting a Rectal Suppository

Medications released from the suppository can have

local or systemic effects.

Depending on the drug, local effects may include

softening and lubricating dry stool, irritating the wall of

the rectum and anal canal to stimulate smooth muscle

contraction, and liberating carbon dioxide, thus

increasing rectal distention and the urge to defecate.

Lie on side with lower leg straightened out and upper leg bent

forward toward stomach.



Administering an Enema

An enema introduces a solution into the rectum to :

1. Cleanse the lower bowel (most common reason).

2. Soften feces.

3. Expel flatus.

4. Soothe irritated mucous membranes.

5. Outline the colon during diagnostic x-rays.

6. Treat worm and parasite infestations.


20 Second semester 15 - 16 Bader A. EL Safadi BSN , MSc Fundamental of Nursing – B Bowel Elimination

Cleansing Enemas

It is used to remove feces from the rectum (Table 31-3).

Solution Amount (ml) Mechanism of Action

Tap water 500-1000 Distends rectum, moistens

stool

Normal saline 500-1000 Distends rectum, moistens

stool

Soap and water 500-1000 Distends rectum, moistens

stool, irritates local tissue

Hypertonic saline

(ie: Fleets)

120 Irritates local tissue and draws

water into the bowel

Mineral, olive, or

cottonseed

120-180 Lubricates and softens

stool


Retention enemas

o A retention enema uses a solution held within the

large intestine for a specified period, usually at least

30 minutes.

o Some retention enemas are not expelled at all.

o One type of retention enema is called an oil retention

enema because the fluid instilled is mineral,

cottonseed, or olive.

o Oils lubricate and soften the stool, so it can be

expelled more easily.



Ostomy Care

A client with an ostomy (surgically created

opening to the bowel or other structure) requires

additional care for promoting bowel elimination.

Types of Ostomies

1. ileostomy (surgically created

opening to the ileum)

2. colostomy (surgically created

opening to a portion of the

colon; Fig. 31-4).



Locations of intestinal Ostomies



Most persons with an ostomy, also called ostomates,

wear an appliance (bag or collection device over the

stoma) to collect stool.

Depending on the type and location of the ostomy,

client care may involve providing peristomal care,

applying an appliance, draining a continent ileostomy,

and, for clients with a colostomy, administering

irrigations through the stoma.



Figure 31-5 • An ostomy appliance: faceplate and pouch .



Ostomy Care

Preventing skin breakdown is a major

challenge in ostomy care.

Enzymes in stool can quickly cause

excoriation (chemical injury of skin).

Providing peristomal care Applying an ostomy appliance

Draining a continent ileostomy

Irrigating a colostomy


chapter 31 bowel elimination - islamic university of...

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