◼ 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

GI Tract Anatomy
◼ Mouth
◼ Esophagus
◼ Stomach
◼ Small Intestine
◼ Large Intestine
◼ Rectum

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Mouth:
◼ Digestion begins here
◼ Mechanical, chemical breakdown of nutrients
◼ Teeth-Mastication
◼ Salivary secretions-enzymes
◼ Food Bolus ‫مضغة‬

Esophagus:
◼ Hollow, muscular tube for passage of food to stomach
◼ Peristaltic waves, contraction and relaxation of smooth muscle moves food down
to stomach
◼ Sphincter control to prevent reflux

Stomach:
◼ Food is temporarily stored and mechanically and chemically broken down
◼ Secretes HCL, mucus, pepsin, & intrinsic factor(Needed for Vitamin B12
absorption)
◼ Food is converted into chyme

Small intestine:
◼ 1 inch in diameter
◼ 20 feet long
◼ Three divisions: Duodenum, Jejunum, Ileum
◼ Enzymes in small intestine (amylase, lipase, & bile) break down fats, proteins &
carbs into basic elements
◼ Nutrients absorbed in duodenum & jejunum, ileum absorbs vitamins, iron, & bile
salts.

Large intestines:
◼ Lower GI tract
◼ Larger diameter, 5-6 feet in length

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 ◼ 3 divisions: cecum, colon, rectum
◼ Responsible for absorption of water
◼ Primary organ of bowel elimination
◼ Cecum-chyme enters cecum via the ileocecal valve, valve prevents regurg back
to small intestine, cecum ends with appendix

Colon:
◼ 3 Divisions:
Ascending,
Transverse,
Descending
◼ Colon Functions: Absorption,
Protection,
Secretion,
& Elimination (stool and flatus)

Rectum:
◼ 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

Factors Affecting Bowel Elimination:

◼ Age
◼ Infection
◼ Diet
◼ Fluid Intake

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 ◼ Physical Activity
◼ Psychological factors
◼ Personal Habits
◼ Position during Defecation
◼ Pain
◼ Surgery and Anesthesia
◼ Medications

Common Bowel Elimination Problems:

◼ Constipation
◼ Impaction
◼ Diarrhea
◼ Incontinence
◼ Flatulence
◼ Hemorrhoids
Constipation:
◼ More of a symptom than a disorder
◼ Decrease in frequency of BM
◼ Straining & pain on defecation is associated symptoms(Valsalva manuever)
◼ Can be significant heath hazard (increase ICP, IOP, reopen surgical wounds,
cause trauma, cardiac arrhythmias
Impaction:
◼ Results from unrelieved constipation
◼ Collection of hardened feces wedged ‫ عالق‬into rectum
◼ Can extend up to sigmoid colon
◼ Most at risk: confused, unconscious (all are at risk for dehydration).
◼ When a continuous ooze of diarrheal stool develops, impaction should be
suspected
◼ Associated S/S: Loss of appetite, abdominal distention, cramping, rectal pain

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Diarrhea:
◼ Increase in number of stools & the
passage of liquid, unformed stool
◼ Symptom of disorders affecting
digestion, absorption, & secretion of
GI tract
◼ Intestinal contents pass through small
& large intestines too quickly to
allow for usual absorption of water &
nutrients
◼ Irritation can result in increased
mucus secretion, feces become too
watery, unable to control defecation
◼ Excess loss of colonic fluid can result in acid-base imbalances or fluid/electrolyte
imbalances
◼ Can also result in skin breakdown.
Conditions that cause Diarrhea:
◼ Emotional Stress
◼ Intestinal Infection (Clostridium difficile)
◼ Food Allergies
◼ Food Intolerance
◼ Tube Feedings (Enteral)
◼ Medications
◼ Laxatives
◼ Colon Disease
◼ Surgery

Incontinence:
Inability to control passage of feces and gas from the anus
◼ Caused by conditions that create frequent, loose, large volume, watery stools or
conditions that impair sphincter control or function

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Flatulence:
◼ Gas accumulation in the lumen of intestines
◼ Bowel wall stretches and distends
◼ Common cause of abdominal fullness, pain, & cramping
◼ Gas escapes through mouth (belching), or anus (flatus)
Flatus Formation:
◼ Air swallowing
◼ Diffusion of gas from bloodstream into intestines
◼ Bacterial action on unabsorbable CHO (Beans)
◼ Fermentation of CHO (cabbage, onions
◼ Can stimulate peristalsis
◼ Adult forms 400-700 ml of flatus daily
Causes:
◼ Decreased peristalsis
◼ Constipation
◼ Medications
◼ Surgery
◼ Diet
◼ Stress
◼ Decreased activity
Noninvasive Interventions for Flatulence
*Ambulation*
◼ Knee chest position
◼ Glycerin Suppository
◼ Harris Flush
◼ Rectal Tube

Hemorrhoids:

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 ◼ Dilated, engorged veins in the lining of the rectum
◼ External (Clearly visible) or Internal
◼ Caused by straining, pregnancy, CHF, chronic liver disease

Physical Assessment
◼ Inspection- observe contour of abdomen and note visible peristalsis
◼ Auscultation- listen for bowel sounds all quadrants
◼ Percussion- resonant or tympany over hollow organs…dullness over intestinal
obstruction
◼ Palpation- feel for masses, tenderness etc…

Bowel Diversions:
◼ Certain diseases cause conditions that prevent normal passage of feces through
rectum
◼ Creates need for temporary or permanent artificial opening (stoma) in the
abdominal wall.
◼ Surgical openings (ostomy) are most commonly formed in the ileum (ileostomy)
or the colon (colostomy)
◼ Incontinent ostomy- need to wear appliance pouch
◼ Continent ostomy- have control through use of ostomy cap

Ostomy Nursing Considerations:

◼ Patient Education
◼ Care of stoma, appliance selection and use
◼ Body Image considerations

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 ◼ Support groups
◼ Enterostomal
nursing-
specialty within
profession

Nursing Process
Assessment:
◼ Nursing History
◼ Physical
Assessment
◼ Lab Tests
◼ Fecal characteristics
◼ Diagnostic evaluation- Endoscopy, Colonoscopy
Nursing Diagnosis:
◼ Bowel Incontinence
◼ Constipation
◼ Diarrhea
◼ Impaired Skin Integrity
◼ Body Image Disturbance
◼ Altered bowel elimination
◼ Pain

Implementation (Promoting Normal Defecation):

◼ Positioning of patient-squatting
◼ Positioning on bedpan
◼ Use of cathartics, laxatives
◼ Anti-diarrheal agents
◼ Enemas
◼ Digital removal of stool
◼ Ostomy care

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Interventions: Promote Bowel Elimination:
◼ Laxatives and Cathartics
◼ Enemas
◼ Suppositories
◼ Digital Removal

Types of Enemas

Cleansing Retention Return Flow

Enemas:
◼ Cleansing enema
◼ Tap water
◼ Normal saline
◼ Hypertonic Solutions (Fleet’s enema)
◼ Soapsuds
◼ Oil Retention
◼ Medicated enemas (Kayexalate, Lactulose)
◼ Administering a Cleansing enema P&P pg. 1200-1201

Tap Water (TWE)

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 ◼ Amount: 500-1000cc
◼ Action: Distends, increases peristalsis
◼ Time: 15 min.
◼ Indicated: inflamed bowels/irritated colon
◼ Contraindicated: Atonic bowels, fluid restrictions
Normal Saline:
◼ Amount: 500-1000cc
◼ Action: Distends, increases peristalsis
◼ Time: 15 min.
◼ Indicated: Inflamed bowels/irritated colon
◼ Contraindicated: Na retention problems, fluid restrictions.
Soap:
◼ Amount: 500-1000cc (Castile 5ml/1000cc)
◼ Action: Distends, Irritates
◼ Time: 15 min.
◼ Indicated: Constipation
◼ Contraindicated: Prior to rectal exams
Hypertonic
◼ Amount: 70-130 cc solution
◼ Action: Distends/Irritates
◼ Time: 5-10 min.
◼ Indicated: Constipation, convenience
◼ Contraindicated: Dehydration, Na problems
Oil Retention
◼ Amount: 120-200cc
◼ Action: Lubricates
◼ Time: 30 min.
◼ Indicated: Fecal impaction
◼ Contraindication: none

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Colostomy nursing care:
◼ 1. Wash hands.
◼ 2. Apply clean gloves.
◼ 3. Assemble irrigation kit: Attach cone or catheter to irrigation bag tubing.
◼ 4. Fill irrigation bag with 1000 cc tepid tap water
◼ 5. Open clamp and let water from the irrigation bag fill the tubing.
◼ 6. Hang bottom of irrigation bag at height of client’s shoulder, or 18 inches
above the stoma if the client is supine.
◼ 7. Check direction of intestine by inserting a gloved finger into orifice of stoma.
◼ 8. Place irrigation sleeve over stoma and hold in place with belt‫يطوق بحزام‬
◼ 9. Spray inside of irrigation sleeve and bathroom with odor eliminator (usual
dose is two sprays).
◼ 10. Cuff end of irrigation sleeve and place into toilet bowl (if client is in
bathroom) or bedpan (if client is in bed or chair) (see Figure 6-22-5).
◼ 11. Lubricate the cone end of the irrigation tubing and insert into orifice of stoma
through the top opening of irrigation sleeve
◼ 12. Close top of irrigation sleeve over the tubing.
◼ 13. Slowly run water through tubing into colon
◼ 14. Remove cone after all water has emptied out of irrigation bag.
◼ 15. Close end of irrigation sleeve by attaching it to the top of the sleeve.
◼ 16. Encourage client to ambulate to facilitate emptying of remaining stool from
colon.
◼ 17. Remove irrigation sleeve after 20–30 minutes or when stool is no longer
emptying from colon.
◼ 18. Cleanse stoma and skin with warm tap water. Pat dry.
◼ 19. Place gauze pad over stoma to absorb mucus from stoma.
◼ 20. Secure gauze with hypoallergenic tape.
◼ 21. Remove gloves and wash hands.

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