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Bowel Elimantion

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by

Elizabeth E

on 19 November 2013

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Transcript of Bowel Elimantion

Bowel Elimination
I. Anatomy and Physiology
A. Stomach
-stores food, secretes digestive fluids, churns food to aid digestion
and pushes the partially digested food called chyme into the small
intestine, pyloric sphincter
B. Small Intestine
-secretes enzymes that digest proteins and carbs
-responsible for the digestion of food and absorption of nutrients
into the bloodstream
C. Large Intestine
-elimination occurs here
-functions: formation of feces and the expulsion of feces from the
body
-absorbs water (800-1000 ml)


D. Nervous System Control
-PNS stimulates movement
-SNS inhibits movement
-contractions, peristalsis occurs every 3-12 min
-mass peristaltic sweeps occur one to four times every q 24hr
-one third to one half of food waste is excreted in stool
w/i 24 hrs
E. Defecation
-the emptying of the large intestine
-controlled by medulla/spinal cord
-PNS
-rectum becomes distended by fecal mass
-bearing down (valsalva maneuvar) contraindicated for
people with heart problems
-position to defecate (bedpan, HOB, sitting position)
II. Factors Affecting Bowel Elimination
A. Developmental Considerations
>older adult
-chronic constipation, fecal impaction,
-diarrhea, fecal incontinence
B. Daily Patterns
C. Food/Fluid
-2000-3000ml + high-fiber diet facilitates bm
-high fiber increases bulk
D. Activity
-immobility= constipation
E. Lifestyle/Psychological Variables
-privacy
F. Pathologic Conditions
G. Meds
-opiods, antacids, iron sulfate, anticholinergics can
cause constipation
-antibiotics and magnesium cause diarrhea
-anticoagulant and aspirin -> blood in stool
-iron salts (black stool)
-antacids (white specks)
-antibiotic (green)
H. Dx Tests
-NPO
I. Surgery/Anesthesia
-paralytic ileus
>lasts 24-48 hrs
>food and fluids withheld
-anesthesia inhibits peristalsis
III. The Nursing Process
A. Assess
-last bm?inspect, auscultate, percuss, palpate
-stool characteristics, color, amount, odor, consistency,
shape (ribbon like with obstruction)
-constituents:
GOOD: bile, intestinal secretions, epi cells, bact,
inorganic material (calcium, phos) seeds,
meat fibers, fat
BAD: blood, pus, excessive fat, parasites, ova, mucus,
foreign bodies
Dx TEST
-occult blood
-pin worms and ova by tape in the morning
-direct visualization studies (endoscopy)
-indirect visualization studies (radiography)
>give bowel cleanser (Go Lytely, laxative, enema)
>allergies to contrast? pt on blood thinners?
>NPO, informed consent


C. Outcome Id/Planning
-The pt will:
>have a soft, formed BM q 1-3 days
>explain the relationship b/w bowel elimination and
dietary fibers, fluid intake, and exercise
D. Implementing
-promoting regular bm habits
(timing, positioning, privacy, nutrition, exercise)
2-3L of fluids!
-providing comfort measures
>perineal hygiene, sitz bath
>meds
>apply ointments
>laxative for more than 5 days= rebound constipation

Nutrition
Exercise
Laxatives/Cathartics
-dulcolax
-metamucil
-colace
-mom
>make sure they are not abusing these drugs

4.Preventing diarrhea
food safety, meds (imodium, pepto)
replace lost fluids
5. Decreasing Flatulence
-beans, cabbage, onions, cauliflower, beer




8. Managing a NG tube
-allow GI to rest
-decompress or drain stomach
-peristalsis is absent
-oral hygiene is important
-irrigate with 30-60 ml
-nare care

9. Bowel Diversions
-ostomy/stoma
-ileostomy allows liquid fecal content from the ileum of
the small intestine to be eliminated
-colostomy- more formed
Colostomy + Ileostomy CARE
>keep pt free of odors
>empty bag frequently
>note the size
>keep clean and dry
>yeast infections can occur
>monitor i/o
>teaching
>encourage pt to looks at ostomy and care or it

>use silicone based adhesive
>do no irrigate ileostomies
Full transcript