Bowel Elimination
Review Nursing DX for Urinary and Bowel Elimination
Small Intestine
Primary organ of bowel
Digestion/absorption
Extends from stomach to ileocecal valve
Functions
- Digestion
- Absorption
Large Intestine
Primary organ of bowel elimination
Extends from the ileocecal valve to the anus
- Functions
- Completion of absorption
- Manufacture of some vitamins
- Formation of feces
- Expulsion of feces from the body
Process of Peristalsis
Peristalsis is under control of the nervous system
Contractions occur every 3 to 12 minutes
Mass peristalsis sweeps occur 1 to 4 times each 24-hour period
One-third to one-half of food waste is excreted in stool within 24 hours
Act of Defecation
Emptying of large intestine
Valsalva Maneuver- Pt.s who have hx. of heart attack of strokes should take a stool
softener every day.
- Act of bearing down
- Temporarily reduces heart rate, then increase blood pressure
Variables Influencing Bowel Elimination
Stress
Meds- Stool softeners and laxatives are local meds.
Mobility
Intake
Age
Co-morbidities
Developmental Considerations
Infantscharacteristics of stool and frequency depend on formula or breast feedings
Toddlerphysiologic maturity is first priority for bowel training
Child, adolescent, adultdefecation patterns vary in quantity, frequency, and rhythmicity
Older AdultConstipation is often a chronic problem; diarrhea and fecal incontinence
may result from physiologic or Lifestyle changes.
Foods Affecting Bowel Elimination Constipation occurs when bowel movements are 2-3 days
are out of the norm.
Constipating foodscheese, lean meat, eggs,
pasta
Foods with laxative effectfruits and vegetables,
bran, spicy foods, chocolate, alcohol, coffee
Gas-producing foodsonions, cabbage, beans,
cauliflower, apples, bananas
Effect of Medications on Stool
Aspirin, anticoagulantspink to red to black stool
Iron saltsblack or green stool
Antacidswhite discoloration or speckling in stool
Antibioticsgreen-gray color
Opioids, antidepressant, anticholinergics antipsychotics, antiparkinsonian agentsconstipation
Focused Nursing Assessment
Usual pattern- Hypo bowel sounds within 4 hours post-surgery. If there are sounds within
8 hours, call the doctor. Sounds should be normal within 24 hours.
Stool characteristics
Self-care
Recent changes
Problems- hx and current
Use of medications
Presence of appliances
Food and fluid intake
Physical Assessment of the Abdomen
Inspection
Auscultation
Percussion and
Palpation- performed by advanced practice professionals
Physical Assessment of the Anus and Rectum
Lesions, ulcers, fissures (linear break on the margin of the anus), inflammation, and
external hemorrhoids
Ask the patient to bear down as though having a bowel movement.
Assess for the masses. Appearance of internal hemorrhoids or fissures and fecal
Inspect perineal area for skin irritation secondary to diarrhea or fecal incontinence
Diagnostic Studies
Stool Collection- Hemocult checks for old blood (bleeding from the upper GI)
Direct visualization studies
Indirect visualization studies
Occult blood
Stool Collection
Medical aseptic technique is imperative
Wear disposable gloves
Wash hands before and after glove use
Do not contaminate outside of container with stool
Obtain stool and package, label, and transport according to agency policy
Indirect Visualization Studies- Pt. should be NPO. The Dr. must do the educating/teaching. The
nurse only gathers the signature.
Upper gastrointestinal (UGI)
Small bowel series
Barium enema
Abdominal ultrasound
Magnetic resonance imaging (MRI)
Abdominal CT scan
Types of Direct Visualization Studies
(Endoscopy)
Esophagogastroduodenoscopy (EGD)
Colonoscopy- Age 50 and up unless the pt. has mitigating factors.
Sigmoidoscopy
Wireless capsule endoscopy
If you suspect bowel perforation with internal bleeding, checks vitals every hour. Look
for bowel distention (which is a late indication). Pt. will be SOB due to compression of
the lungs).
Scheduling Tests
Fecal occult blood test
Barium studies (should precede UGI)
Endoscopic examinations
Noninvasive procedures take precedence over invasive procedures
Promoting Regular Bowel Habits
Nurses promote/teach
Timing
Positioning
Privacy
Nutrition/fluids
Exercise
Abdominal settings
Thigh strengthening
Comfort Measures
Encourage recommended diet and exercise.
Ensure complete cleansing after each bowel movement.
Use medications only as needed.
Apply ointments or astringent (witch hazel).
Use suppositories that contain anesthetics.
Common Bowel Elimination Problems
Constipation
Impaction
Diarrhea
Incontinence
Flatulence
Hemorrhoids
Individuals at High Risk for Constipation
Patients on bedrest taking constipating medicines
Patients with reduced fluids or bulk in their diet
Patients who are depressed
Patients with central nervous system disease or local lesions that cause pain while
defecating
POD #1- Post Op Day 1
Q: Who should not be out of bed POD #1?
A: Patient with massive blood loss
*To give a pt. an enema, position them on their left side due to the position of the sigmoid colon.
Q: Can you bowel train someone with a colostomy?
A: Yes.
Methods of Emptying Stool
Enemas
Rectal suppositories
Oral intestinal lavage
Digital removal of stool
Types of Enemas
Cleansing
Retention
Oil
Carminative
Medicated
Anthelmintic
Large volume
Small volume
Bowel-Training Programs
Manipulate factors within the patients control.
- Food and fluid intake
- Exercise
- Time for defecation
- Eliminate a soft, formed stool at regular intervals without laxatives.
When achieved, continue to offer assistance with toileting at the successful time.
Nursing Measures for the Patient with Diarrhea
Answer bell calls immediately
Remove the cause of diarrhea whenever possible (e.g., medication)
If there is impaction, obtain physician order for rectal examination
Give special care to the region around the anus
After diarrhea stops, suggest the intake of fermented dairy products
Nasogastric Tubes
Paralytic Ileus or intestinal obstruction
Drain stomach of contents
Used to allow the GI tract to rest before or after abdominal surgery to promote healing
Inserted to monitor GI bleeding
Instill solutions into stomach
Must check placement
Types of Colostomies
Sigmoid colostomy
Descending colostomy
Transverse colostomy
Ascending colostomy
Ileostomy
Colostomy Care
Keep the patient as free of odors as possible; empty the appliance frequently.
Inspect the patients stoma regularly.
- Note the size, which should stabilize within 6 to 8weeks.
- Keep the skin around the stoma site clean and dry.
Measure the patients fluid intake and output.
Explain each aspect of care to the patient and self-care role.
Encourage patient to care for and look at ostomy.
Patient Teaching for Colostomies
Explain the reason for bowel diversion and the rationale for treatment.
Demonstrate self-care behaviors that effectively manage the ostomy
- Focus on skin prep and skin care
Describe follow-up care and existing support resources.
Report where supplies may be obtained in the community.
Verbalize related fears and concerns.
Demonstrate a positive body image
