Lesson 5d

Bowel
Elimination
Bowel Elimination
■ 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
Colon
■ 3 Divisions: Ascending,
Transverse,
Descending

■ Colon Functions:
Absorption, Protection,
Secretion, &
Elimination (stool and
flatus)
Flatus Formation
■ Air swallowing
■ Diffusionof 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
Factors Affecting Bowel
Elimination
■ Age

■ Infection

■ Diet

■ Fluid Intake

■ 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 maneuver)
■ Canbe significant heath
hazard (increase ICP, IOP,
reopen surgical wounds, cause
trauma, cardiac arrhythmias)
Impaction
■ Results from unrelieved
constipation
■ Collection of hardened feces
wedged into rectum
■ Can extend up to sigmoid colon
■ Most at risk: depilated, 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
Diarrhea
■ Increase in number of
stools & the passage of
liquid, unformed stool
■ Symptom of disorders
affecting digestion,
absorption, & secretion
of GI tract
■ Intestinalcontents
pass through small &
large intestines too
quickly to allow for
usual absorption of
water & nutrients
Diarrhea
■ 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
■ Canalso 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
Flatulence
■ Gas accumulation in the lumen of
intestines
■ Bowel wall stretches and distends
■ Common cause of abdominal fullness,
pain, & cramping
■ Gasescapes through mouth (belching), or
anus (flatus)
Hemorrhoids
■ Dilated, engorged veins in the lining of the
rectum
■ External (Clearly visible) or Internal
■ Caused by straining, pregnancy, CHF,
chronic liver disease
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
■ Careof skin & stoma,
appliance selection and
use
■ BodyImage
considerations
■ 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 and
Acute Care Management
■ Positioning of patient-squatting

■ Positioning on bedpan

■ Use of cathartics, laxatives

■ Anti-diarrheal agents

■ Enemas

■ Digital removal of stool

■ Ostomy care

■ Fecal Incontinence Devices

■ Fiber & Fluids

Common Laxatives &
Cathartics
■ Metamucil-bulk forming
■ Colace, Surfak-emollient or wetting agent
■ Fleets, MOM. Mag Sulfate-saline agent
■ Dulcolax, Ex-Lax, Castor oil- stimulant cathartic
■ Haley’s MO, mineral oil- Lubricant
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
Clicker Question
■ 1. A newly admitted client states that he has
recently had a change in medications and reports that
stools are now dry and hard to pass. This type of bowel
pattern is consistent with:

■ A. Abnormal defecation

■ B. Constipation

■ C. Fecal impaction

■ D. Fecal incontinence

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Clicker Question
■ 2. To maintain normal elimination patterns in the
hospitalized client, you should instruct the client to
defecate 1 hour after meals because:

■ A. The presence of food stimulates peristalsis.

■ B. Mass colonic peristalsis occurs at this time.

■ C. Irregularity helps to develop a habitual pattern.

■ D. Neglecting the urge to defecate can cause diarrhea.

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