King Saud UniversityKing Saud UniversityCollege of NursingCollege of Nursing

Fundamentals of NursingFundamentals of Nursing

Bowel EliminationBowel Elimination

The Gastrointestinal System The Gastrointestinal System

The Large IntestineThe Large Intestine

Primary organ of bowel eliminationPrimary organ of bowel elimination Extends from the ileocecal valve to the anusExtends from the ileocecal valve to the anus Functions Functions

1.1. Absorption of water & Nutrients.Absorption of water & Nutrients.

2.2. Mucoid protection of the intestinal wall.Mucoid protection of the intestinal wall.

3.3. Formation of feces.Formation of feces.

4.4. Fecal elimination.Fecal elimination.

Process of DefecationProcess of Defecation

When the Peristaltic waves move the feces into When the Peristaltic waves move the feces into the sigmoid colon and rectum, the sensory nerves the sigmoid colon and rectum, the sensory nerves in the rectum are stimulated and the individual in the rectum are stimulated and the individual becomes aware of the need to defecate. becomes aware of the need to defecate.

When the internal anal sphincter relaxes, feces When the internal anal sphincter relaxes, feces move into the anal canal ,the external anal move into the anal canal ,the external anal sphincter is relaxed voluntary.sphincter is relaxed voluntary.

Expulsion of feces is assisted by contraction of the Expulsion of feces is assisted by contraction of the abdominal muscle, and the downward pressure on abdominal muscle, and the downward pressure on the rectum.the rectum.

Factors Influencing Bowel Factors Influencing Bowel EliminationElimination

1.1. Developmental considerationsDevelopmental considerations2.2. Daily patternsDaily patterns3.3. Food and fluidFood and fluid4.4. Activity and muscle toneActivity and muscle tone5.5. Lifestyle, psychological variablesLifestyle, psychological variables6.6. Pathologic conditionsPathologic conditions7.7. MedicationsMedications8.8. Diagnostic studies Diagnostic studies 9.9. Surgery and anesthesiaSurgery and anesthesia

Effect of Medications on StoolEffect of Medications on Stool Aspirin, anticoagulants — pink to red to Aspirin, anticoagulants — pink to red to

black stoolblack stool Iron salts — black stoolIron salts — black stool Antacids — white discoloration or speckling Antacids — white discoloration or speckling

in stoolin stool Antibiotics — green-gray colorAntibiotics — green-gray color

Promoting Regular Bowel HabitsPromoting Regular Bowel Habits

TimingTiming PositioningPositioning PrivacyPrivacy NutritionNutrition ExerciseExercise

– Abdominal muscles strengthening.Abdominal muscles strengthening.– Thigh muscles strengthening.Thigh muscles strengthening.

Copyright 2008 by Copyright 2008 by Pearson Education, Inc.Pearson Education, Inc.

Assessment of Assessment of Fecal EliminationFecal Elimination

Nursing history Nursing history Physical examinationPhysical examination Review of data from any diagnostic testsReview of data from any diagnostic tests

Nursing DiagnosisNursing Diagnosis Bowel IncontinenceBowel Incontinence ConstipationConstipation Risk for ConstipationRisk for Constipation Perceived ConstipationPerceived Constipation DiarrheaDiarrhea

Individuals at High Risk for Individuals at High Risk for ConstipationConstipation

1.1. Patients on bed rest taking constipating Patients on bed rest taking constipating medicines such as medicines such as opioids, iron, antacids.opioids, iron, antacids.

2.2. Patients with reduced fluids or bulk in their Patients with reduced fluids or bulk in their diet.diet.

3.3. Patients who are depressed.Patients who are depressed.

4.4. Patients with central nervous system Patients with central nervous system disease or local lesions that cause pain.disease or local lesions that cause pain.

Nursing Measures for the Nursing Measures for the Patient With DiarrheaPatient With Diarrhea

1.1. Increase the fluid intake ( 8 glasses of water/day)Increase the fluid intake ( 8 glasses of water/day)

2.2. Remove the cause of diarrhea whenever possible Remove the cause of diarrhea whenever possible (e.g., medication).(e.g., medication).

3.3. Limit fatty foods and beverages with caffeine.Limit fatty foods and beverages with caffeine.

4.4. Limit food containing high fibers such as cereals Limit food containing high fibers such as cereals and whole grain breads, raw fruits & vegetables.and whole grain breads, raw fruits & vegetables.

5.5. Give special care to the region around the anus.Give special care to the region around the anus.

6.6. After diarrhea stops, suggest the intake of After diarrhea stops, suggest the intake of fermented dairy products such as yogurt.fermented dairy products such as yogurt.

Methods of Emptying the Colon of Methods of Emptying the Colon of FecesFeces

1.1. Enemas Enemas a. Cleansing Enemaa. Cleansing Enema, , given to given to ::

– Prevents escape of feces during surgeryPrevents escape of feces during surgery– Prepare intestines for certain diagnostic tests e.g Colonoscopy.Prepare intestines for certain diagnostic tests e.g Colonoscopy.– Removes feces in instances of constipation or impactionRemoves feces in instances of constipation or impaction

b. Retention Enema:b. Retention Enema: - Introduces oil or medication into the rectum and sigmoid colon- Introduces oil or medication into the rectum and sigmoid colon

c. Return-flow Enemac. Return-flow Enema - Used primarily to expel flatus in cases of abdominal distension- Used primarily to expel flatus in cases of abdominal distension

2. 2. Rectal suppositoriesRectal suppositories

3. 3. Rectal cathetersRectal catheters

Common Enema SolutionsCommon Enema Solutionsand Actionsand Actions

1.1. Hypertonic (Fleet phosphate)Hypertonic (Fleet phosphate)1.1. Draws water from the intestinal space into the colonDraws water from the intestinal space into the colon

2.2. Hypotonic (tap water)Hypotonic (tap water)1.1. Distends the colonDistends the colon

2.2. Stimulates peristalsisStimulates peristalsis

3.3. Softens fecesSoftens feces

3.3. Isotonic (physiologic normal saline)Isotonic (physiologic normal saline)1.1. Distends the colonDistends the colon2.2. Stimulates peristalsisStimulates peristalsis3.3. Softens fecesSoftens feces

4.4. Soapsuds (pure soap)Soapsuds (pure soap)1.1. Irritate the mucosaIrritate the mucosa2.2. Distends the colonDistends the colon

5.5. Oil (mineral, olive)Oil (mineral, olive)1.1. Lubricates feces and colonic mucosaLubricates feces and colonic mucosa