Bowel Elimination

Foundations I N 3305

What is important to know?

GI tract is a hollow mucous membrane-lined muscular organ Function absorb fluid and food

Prepare food for absorption and use by cells Stores feces GI tract absorbs Vast amounts of fluid & secretions from other organs Impairment causes FLUID IMBALANCE

GI TRACT

Digestion starts in the mouth

Masticate food so we can swallow it Salivary secretions dilute and soften bolus

Esophagus is ten inches long and food moves by peristalsis

Sphincters prevent reflux LES antacids decrease reflux and fatty foods and nicotine increase reflux
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Stomach stores and breaks down food by HCL, mucus,pepsin, intrinsic factor

Stomach makes chyme (semifluid liquid)

Small intestine 20 feet long- goes thru slowly, mixes with digestive enzymes Absorption & digestion Impt Large Intestine 5 to 6 feet absorbs water, NaCl, and eliminates feces 2.5 L absorbed daily, bicarbonate is released What is flatus?

Sigmoid portion of colon has feces Rectum for an adult is 6 to 8 inches long Defecation begins when feces moves into rectum What is a Valsalva maneuver?

Factors Affecting Bowel Elimination

Age- newborn, infant, toddler, adolescence, adult, older adult Infection H pylori Diet- What you eat affects peristalsis

Foods high in fiber or bulk are: raw fruits, cooked fruits, greens, raw vegetables, whole grains Gas-producing foods are onions, cauliflower & beans Lactose intolerance
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Factors affecting bowel elimination

Fluid intake:High fluid intake increases peristalsis Physical Activity: increases peristalsis Psychological factors- emotional stress:can have differing effects Personal habits: dietary, exercise, ect. Position during defecation- squatting

Pregnancy: slows peristalisis Surgery and anesthetic

Paralytic ileus

Medications laxatives and cathartics narcotics increase and decrease respectively Diagnostic tests: barium enema for colonoscopy

Constipation

Symptom Decrease in frequency and prolonged or difficult passage of hard dry stools Assess normal defecation pattern Name four causes of constipation Impaction- collection of hardened feces wedged into the rectum

What are signs and symptoms?

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Diarrhea

Increase in number of stools & passage of liquid, unformed feces Can result in volume depletion and electrolyte imbalance Skin irritation Name five conditions that can cause diarrhea

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Common problems with bowel elimination

Fecal incontinence inability to control passage of feces and gas from anus Flatulence gas accumulates in intestine Gets out by mouth or anus Hemorrhoid dilated engorged veins in lining of rectum Bowel diversion Colostomy, ileostomy What impact do the above have on clients?
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Fecal Characteristics

Color Odor Consistency Frequency Amount 150 gm/day Shape constituents

Abnormal color Odor very noxious Liquid or hard <3x day or > once a week Narrow or pencil Blood, pus, worms, foreign bodies
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Nursing Diagnosis

Bowel Incontinence Constipation Constipation, perceived Diarrhea Skin integrity impaired

Defining characteristics for diarrhea Hyperactive BS Frequent stools Hydration status Pain and cramping Red irritated perianal area
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Nursing Interventions

Take time for bowel elimination Promote normal defecation

Squatting position Proper position on the bedpan Cathartics laxatives Antidiarrheal agent Enemas
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Nursing Interventions

Digital removal of the stool What should you monitor closely? NG Tube Bowel training

Retraining to help return to normal bowel elimination High fiber for constipation What types of foods assist with diarrhea? Bulk forming What about foods for clients with ostomies?

Food and fluid

Low fiber such as bread, noodles, rice, eggs, fruit juices

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What foods should clients with ostomies avoid?

Stringy meats, mushrooms, popcorn, broccoli, cauliflower, beans, brussel sprouts

Regular Exercise abd exercises Promote comfort hemorrhoids- local heat flatulence no straws, gum, carbonated beverages, increase walking Skin integrity and promote self-concept
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