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Chapter 37

Bowel Elimination

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Gastrointestinal Tract

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The Large Intestine

• Primary organ of bowel elimination
• Extends from the ileocecal valve to the anus
• Functions
– Absorption of water
– Formation of feces
– Expulsion of feces from the body

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• One-third to one-half of food waste is excreted in stool within 24 hours.Process of Peristalsis • Peristalsis is under control of the nervous system. Copyright © 2015 Wolters Kluwer • All Rights Reserved . • Contractions occur every 3 to 12 minutes. • Mass peristalsis sweeps occur one to four times each 24hour period.

Variables Influencing Bowel Elimination • Developmental considerations • Daily patterns • Food and fluid • Activity and muscle tone • Lifestyle • Psychological variables • Pathologic conditions • Medications • Diagnostic studies • Surgery and anesthesia Copyright © 2015 Wolters Kluwer • All Rights Reserved .

adult: Defecation patterns vary in quantity. • Older adult: Constipation is often a chronic problem.Developmental Considerations • Infants: Characteristics of stool and frequency depend on formula or breast feedings. adolescent. • Toddler: Physiologic maturity is the first priority for bowel training. Copyright © 2015 Wolters Kluwer • All Rights Reserved . • Child. frequency. and rhythmicity. diarrhea and fecal incontinence may result from physiologic or lifestyle changes.

beans. eggs. pasta • Foods with laxative effect: fruits and vegetables.Foods Affecting Bowel Elimination • Constipating foods: cheese. cabbage. chocolate. cauliflower Copyright © 2015 Wolters Kluwer • All Rights Reserved . lean meat. alcohol. coffee • Gas-producing foods: onions. bran.

Effect of Medications on Stool • Aspirin. anticoagulants: pink to red to black stool • Iron salts: black stool • Antacids: white discoloration or speckling in stool • Antibiotics: green-gray color Copyright © 2015 Wolters Kluwer • All Rights Reserved .

• Percussion and palpations: performed by advanced practice professionals Copyright © 2015 Wolters Kluwer • All Rights Reserved . hyperactive. – Describe bowel sounds as hypoactive. audible clicks. or distention • Auscultation: listen for bowel sounds in all quadrants – Note frequency and character. absent or infrequent. any masses.Nursing Process: Physical Assessment of the Abdomen • Inspection: observe contour. and flatus. scars.

and external hemorrhoids – Ask the patient to bear down as though having a bowel movement. ulcers. fissures (linear break on the margin of the anus).Nursing Process: Physical Assessment of the Anus and Rectum • Inspection and palpation – Lesions. – Inspect perineal area for skin irritation secondary to diarrhea or fecal incontinence. Assess for the appearance of internal hemorrhoids or fissures and fecal masses. inflammation. Copyright © 2015 Wolters Kluwer • All Rights Reserved .

• Hand hygiene. • Obtain stool and package. Copyright © 2015 Wolters Kluwer • All Rights Reserved . label. • Wear disposable gloves. • Do not contaminate outside of container with stool. and transport according to agency policy.Diagnostic Studies: Stool Collection • Medical aseptic technique is imperative. before and after glove use. is essential.

• Do not place toilet tissue in the bedpan or specimen container.Diagnostic Studies: Patient Guidelines for Stool Collection • Void first so that urine is not in stool sample. • Defecate into the container rather than toilet bowl. Copyright © 2015 Wolters Kluwer • All Rights Reserved . • Notify nurse when specimen is available.

Diagnostic Studies: Types of Direct Visualization Studies (Endoscopy) • Esophagogastroduodenoscopy • Colonoscopy • Sigmoidoscopy • Wireless capsule endoscopy Copyright © 2015 Wolters Kluwer • All Rights Reserved .

Diagnostic Studies: Indirect Visualization Studies • Upper gastrointestinal (UGI) • Small bowel series • Barium enema • Abdominal ultrasound • Magnetic resonance imaging (MRI) • Abdominal CT scan Copyright © 2015 Wolters Kluwer • All Rights Reserved .

Diagnostic Studies: Scheduling Diagnostic Tests • 1: fecal occult blood test • 2: barium studies (should precede UGI) • 3: endoscopic examinations Noninvasive procedures take precedence over invasive procedures Copyright © 2015 Wolters Kluwer • All Rights Reserved .

fluid.Planning: Patient Outcomes for Normal Bowel Elimination • Patient has a soft. formed bowel movement every 1 to 3 days without discomfort. and exercise is explained. Copyright © 2015 Wolters Kluwer • All Rights Reserved . • Patient should seek medical evaluation if changes in stool color or consistency persist. • The relationship between bowel elimination and diet.

Intervention: Promoting Regular Bowel Habits • Timing • Positioning • Privacy • Nutrition • Exercise – Abdominal settings – Thigh strengthening Copyright © 2015 Wolters Kluwer • All Rights Reserved .

Intervention: Comfort Measures • Encourage recommended diet and exercise. • Use medications only as needed. • Use suppositories that contain anesthetics. Copyright © 2015 Wolters Kluwer • All Rights Reserved . • Apply ointments or astringent (witch hazel).

Intervention: 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 Copyright © 2015 Wolters Kluwer • All Rights Reserved .

• Remove the cause of diarrhea whenever possible (e. medication).Intervention: Nursing Measures for the Patient With Diarrhea • Answer call bells immediately. • If there is impaction. • Give special care to the region around the anus.. obtain physician order for rectal examination.g. Copyright © 2015 Wolters Kluwer • All Rights Reserved .

Copyright © 2015 Wolters Kluwer • All Rights Reserved . • Never use raw eggs in any form. • Wash hands and surfaces often. • Thoroughly wash all fruits and vegetables before eating. or eggs to prevent spreading microorganisms to sink and other kitchen surfaces. • Take items requiring refrigeration home immediately. • Use separate cutting boards for foods. • Do not eat seafood raw or if it has an unpleasant odor. poultry. • Do not wash meat.Intervention: Preventing Food Poisoning • Never buy food with damaged packaging.

) • Use a food thermometer to ensure cooking food to safe internal temperature. maintain safe temperature of 140°F or above. • Keep food hot after cooking.Intervention: Preventing Food Poisoning (cont. • Give only pasteurized fruit juices to small children. Copyright © 2015 Wolters Kluwer • All Rights Reserved .

Intervention: Methods of Emptying the Colon of Feces • Enemas • Rectal suppositories • Oral intestinal lavage • Digital removal of stool Copyright © 2015 Wolters Kluwer • All Rights Reserved .

Intervention: Types of Enemas • Cleansing • Retention – Oil – Carminative – Medicated – Anthelmintic • Large volume • Small volume Copyright © 2015 Wolters Kluwer • All Rights Reserved .

easing defecation • Carminative: help expel flatus from the rectum • Medicated: provide medications absorbed through the rectal mucosa • Anthelmintic: destroy intestinal parasites Copyright © 2015 Wolters Kluwer • All Rights Reserved .Intervention: Retention Enemas • Oil-retention: lubricate the stool and intestinal mucosa.

formed stool at regular intervals without laxatives. and time for defecation – Eliminate a soft.Intervention: Bowel-Training Programs • Manipulate factors within the patient’s control. continue to offer assistance with toileting at the successful time. Copyright © 2015 Wolters Kluwer • All Rights Reserved . exercise. • When achieved. – Food and fluid intake.

Intervention: Nasogastric Tubes • Inserted to decompress or drain the stomach of fluid or unwanted stomach contents • Used to allow the gastrointestinal tract to rest before or after abdominal surgery to promote healing • Inserted to monitor gastrointestinal bleeding Copyright © 2015 Wolters Kluwer • All Rights Reserved .

Intervention: Types of Ostomies • Sigmoid colostomy • Descending colostomy • Transverse colostomy • Ascending colostomy • Ileostomy Copyright © 2015 Wolters Kluwer • All Rights Reserved .

Location of Ostomies Copyright © 2015 Wolters Kluwer • All Rights Reserved .

– Note the size. • Measure the patient’s fluid intake and output. – Keep the skin around the stoma site clean and dry. Copyright © 2015 Wolters Kluwer • All Rights Reserved .Intervention: Colostomy Care • Keep the patient as free of odors as possible. which should stabilize within 6 to 8 weeks. • Inspect the patient’s stoma regularly. • Encourage patient to care for and look at ostomy. empty the appliance frequently. • Explain each aspect of care to the patient and self-care role.

Intervention: Patient Teaching for Colostomies • Explain the reason for bowel diversion and the rationale for treatment. • Report where supplies may be obtained in the community. • Verbalize related fears and concerns. • Demonstrate a positive body image. • Describe follow-up care and existing support resources. • Demonstrate self-care behaviors that effectively manage the ostomy. Copyright © 2015 Wolters Kluwer • All Rights Reserved .