Bowel Elimination PDF

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Bowel Elimination Notes, Professor Martinez...

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Foundat i onsEx am 1 Bowel Elimination 

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Peristalsis: o Autonomic nervous system stimulates/controls peristalsis o Peristaltic rushes: contractions occur ever 3-12 minutes o Mass peristaltic: occur 1-4 times in 24 hours  Propel fecal mass forward  Often occurs after food intake Factors affecting elimination: o Developmental considerations o Daily patterns o Food and fluid o Activity and muscle tone o Lifestyle, psychological variables o Pathologic conditions o Medications o Diagnostic studies o Surgery and anesthesia Developmental considerations: o Infants- characteristics of stool and frequency depend on formula or breast feedings  Breast milk is easier for the intestines to break down and absorb  Breastfed babies have more frequent stools, and the stools are yellow to golden and loose and usually have little odor  With formula or cow’s milk feedings, the infant’s stools vary from yellow to brown, are paste-like in consistency, and have a stronger odor because of the decomposition of protein  Infants have no voluntary control over bowel elimination o Toddler- physiologic maturity is first priority for bowel training o Child, adolescent, adult- defecation patterns vary in quantity, frequency, and rhythm o Older adult- constipation is often a chronic problem; diarrhea and fecal incontinence may result from physiologic or lifestyle changes. Foods affecting bowel elimination: o Constipating foods: processed cheese, lean meat, eggs, pasta o Foods with laxative effect: certain fruits and vegetables (e.g., prunes), bran, chocolate, spicy foods, alcohol, coffee o Gas-producing foods: onions, cabbage, beans, cauliflower Physical assessment of abdomen o Inspect: observe o Auscultation: listen o Percussion: expect echoing sound  Areas of increased dullness may be caused by fluid, a mass, or tumor

Foundat i onsEx am 1 o Palpation: note any muscular resistance, tenderness, enlargement of organs, masses

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Stool collection: o Medical aseptic technique is imperative o Wear disposable gloves o Wash hands before and after glove use o DO NOT contaminate outside of container with stool o Obtain stool and package, label, and transport according to agency policy Guidelines for collecting stool: o Void (urination) first, laboratory study may be inaccurate if the stool contains urine o Defecate into required container, not toilet o Do not place toilet tissue in container o Notify the nurse when specimen is ready o Collect 1 inch of formed stool, 15-30ml of liquid stool Order to schedule stool test *noninvasive procedures take preference over invasive procedures o 1. Fecal occult blood test  Blood in stool that is hidden, cannot be seen on gross examination  Certain conditions: ulcer disease, colon cancer, peptic ulcer, etc.  Black stools generally indicate gastrointestinal bleeding o 2.barium enema  Radiographs that examine the large intestine after rectal installation of barium sulfate o 3. Endoscopic examinations Effects of medications on stool o Can decrease GI motility and may cause constipation o Can cause diarrhea o Change in stool color  Aspirin, anticoagulants: pink to red to black stool  Iron salts: black stool  Antacids: white discoloration or speckling in stool  Antibiotics: green-gray color.  With extensive use of antibiotics, patients are at risk for infection with clostridium difficile (c-diff) bacteria Most formed feces will be found in the sigmoid colon. o Once excreted feces is called stool.

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Most loose feces will be in found in the small intestines.

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Constipation- dry, hard stool; and/or the incomplete passage of stool. o Decreased frequency of defecation o Hard, dry, formed stools o Reports straining (painful defecation) with little result o Decreased frequency of bowel sounds o Straining often results in small amount of bleeding from swollen external hemorrhoids o Feeling of fullness, discomfort (in rectum, abdomen) o Headache Individual at high risk for constipation include: o patients on bed rest who take constipating medications o patients with reduced fluids or bulk in their diet o people who are depressed o Patients with central nervous system disease or local lesions that cause pain. o Patients that habitually ignore the urge to defecate What are the causes of constipation? o Decreased gastrointestinal motility o Use of medications o Decreased fiber in diet o Incomplete emptying of bowel o Decreased fluid intake o Antibiotics o Change in routine o Less active lifestyle (exercise) o Conditions such as diseases within the colon or rectum and injury, or degeneration of o Spinal cord and mega colon (extremely dilated colon) o Can lead to laxative abuse Fecal impaction: build-up of stool in the colon o Mass or collection of hardened feces in folds of rectum o Passage of liquid fecal seepage and no normal stool Cause of fecal impaction o Can result from chronic constipation o May be preceded by oozing of liquid feces- often mistaken for diarrhea

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o Can lead to distended abdomen, abdominal pain, and complete bowel obstruction Methods of Emptying the Colon of Feces o Enemas (fluids)- is the introduction of a solution into the large intestine, usually to remove feces.  The instilled solution distends the intestine and irritates the intestinal mucosa, thus increasing peristalsis. o Cleansing enemas- are given to remove feces from the colon  Common types are tap water, normal saline solutions, soap solution, and hypertonic solution.  Oil-retention enemas: lubricate the stool and intestinal mucosa, making defecation easier.  Carminative enemas: help to expel flatus from the rectum and provide relief from gaseous distention.  Medicated enemas: provide medications that are absorbed through the rectal mucosa.  Anthelmintic enemas: destroy intestinal parasites o Rectal suppositories (capsule) is a conical or oval solid substance shaped for easy insertion into a body cavity and designed to melt at body temperature  Some are fecal softeners, others have a direct action on the nerve endings in the rectal mucosa, and some liberate carbon dioxide when moistened. o Oral intestinal lavage- an oral solution, such as GoLYTELY or Colyte, can be used to cleanse the intestine of feces. This solution is prescribed by the physician and can be administered before diagnostic tests that require a clear bowel for visualization purposes or as a “bowel prep” before intestinal surgery. o Digital removal of stool - of a fecal mass can stimulate the vagas nerve, resulting in a slowed heart rate. If this occurs, stop the procedure immediately, monitor the patient’s heart rate and blood pressure, and notify the physician. Patients outcomes: o Normal Bowel Elimination:  Pt has a soft formed bowel movement every 1 to 3 days without discomfort.  The relationship between bowel elimination and diet, fluid, and exercise is explained.  Pt should seek medical evaluation if changes in stool color or consistency persist. o How do nurses promote regular bowel habits? (rid of constipation)  Timing- encourages toileting at the pt's usual time during the day.  Positioning- sitting upright on a toilet promotes defecation.  Always empty, clean, and return bedpans to the pt's bedside stand promptly  Privacy- always respects the pt's need to be alone while defecating, unless pt's condition makes this impossible.

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Nutrition- may need a dietary analysis to determine which foods and fluids are contributing to their problem and which may help in its treatment.  General dietary recommendations to promote regular defecation include a fluid intake of 2,000 to 3,000mL and high fiber intake. o Increasing fiber intake without sufficient fluid intake can result in severe gastrointestinal problems, including fecal impaction. Exercise- improves gastrointestinal motility and aids in defecation. Encourage patients to exercise regularly three to five times a week Bedside exercises may be helpful for pt who are immobile

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Alterations in Bowel Elimination o Diarrhea- an increase in frequency, and a change in consistency, of stool. o Passage of liquid feces and increased frequency of defecation o Spasmodic cramps, increase frequency of bowel sounds o Urgency with soiling o Reports abdominal pain and cramping What are the causes of diarrhea? o Laxative abuse o Effect of medications/tube feedings o Food intolerance (coarse, greasy, or spicy foods)  Ex. Lactose intolerant o Alteration in normal bacterial flora of the intestine (antibiotic therapy) o Emotional stress o Pathologic conditions (diverticulitis- inflammation of a diverticulum) o Intestinal Infection o Surgical alterations o Colon disease

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o Malabsorption syndromes (the inability of the digestive system to absorb one or more of the major vitamins, minerals or nutrients) o Neoplastic diseases (tumors) o Diabetic neuropathy (damage to nerve cells) o Hyperthyroidism o Food poisoning  *can lead to life-threatening dehydration and electrolyte imbalance Acute diarrhea- may result from a viral or bacterial infection, a reaction to medication, or alterations in diet o Characterized by its sudden onset and lasts several hours to several days o Rehydration is key acute diarrhea Chronic diarrhea- has many possible causes o Typically lasts for more than 3 to 4 weeks o Usually necessitates pharmacologic intervention along with fluid and electrolyte replacement. Bowel incontinence - loss of voluntary ability to control fecal and gaseous discharges Diarrhea: Nursing Considerations o Answer bell calls immediately or ensure that a bedpan or commode is within easy reach. o Remove the cause of diarrhea whenever possible (e.g, medication) o If there is impaction, obtain physician order for rectal examination o Give special care to region around the anus, where skin irritation is common. Keep the area clean and dry. o Use skin creams, moisture barriers, ointment or powders as necessary o After diarrhea stops, suggest the intake of fermented dairy products o Educate patient about food safety Bowel Training Programs o Manipulate factors within the patient's control  Food and fluid intake, exercise, and time of defecation o Eliminate a soft, formed stool at regular intervals without laxatives o When achieved, discontinue use of suppository if one was used Colostomy: o Ostomies can be temporary or permanent Bowel Diversions Ostomies

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Ostomy- opening from the gastrointestinal, urinary, or respiratory tract onto the skin. o Gastrostomy- opening through the abdominal wall into the stomach o Jejunostomy- opening through the abdominal wall into the jejunum o Ileostomy- opening into the ileum (small bowel) o Colostomy- opening into the colon Stoma- opening created by ostomy Location influences character and management of fecal drainage o The farther along, the more formed the stool and the more control possible over frequency of stomal discharge.

Colostomy and Ileostomy Care o Patient with an ostomy needs physical and psychological support both pre/postoperatively. Nursing interventions for Ostomy care: o Keep the patient as free of odors as possible. (empty the ostomy appliance frequently)

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o Inspect the patient's stoma regularly. -->should be dark pink to red and moist. (A pale stoma may indicate anemia, and a dark or purple-blue stoma may reflect compromised circulation or ischemia. o Note the size, which should stabilize within 6 to 8 weeks (most protrude 1/2 to 1 inch from the abdominal surface and may initially appear swollen and edematous. After 6 weeks the edema usually subsides.) o Keep the skin around the stoma site clean and dry. o Measure the patient's fluid intake and output o Explain each aspect of care to the patient and self-care role o Encourage patient to care for and look at ostomy Colostomy patient and family education o Community resources o Encourage patients to avoid food high in fiber o Drink 2 quarts of water daily o Teach hygiene and care o Encourage normal activity. Including work and sex...