1 second semester 15 - 16 chapter 31 bowel elimination bader a. el safadi bsn, msc fundamental of...

1Second semester 15 - 16

Chapter 31

Bowel Elimination

Bader A. EL Safadi BSN , MSc Fundamental of Nursing – B Bowel Elimination

2Second semester 15 - 16 Bader A. EL Safadi BSN , MSc Fundamental of Nursing – B Bowel Elimination

DefecationDefecation (bowel elimination):

is the act of expelling feces (stool) from the body. To do so, all structures of the gastrointestinal tract,

especially the components of the large intestine (also referred to as the bowel or colon), must function in a coordinated manner (Fig. 31-1).

In the large intestine, a remarkable volume of water is removed from the remnants of digestion, causing the bowel's contents to become a consolidated mass of residue before being eliminated.


Figure 31-1 • The large intestine


Peristalsis Peristalsis is :

The rhythmic contractions of intestinal smooth muscle that facilitate defecation.

Peristalsis moves fiber, water, and nutritional wastes along the ascending, transverse, descending, and sigmoid colon toward the rectum.

gastrocolic reflex:Increased peristaltic activity occurring during

food consumption


The gastrocolic reflex usually precedes defecation.

Its accelerated wavelike movements, sometimes perceived as slight abdominal cramping, push stool forward, packing it within the rectum.

As the rectum distends, the person feels the urge to defecate.

Stool is eventually released when the anal sphincters relax.

Valsalva maneuver "bear down" : increasing abdominal muscle pressure to facilitate defecationSeveral dietary, physical, social, and emotional

factors can influence the bowel's mechanical function (Table 31-1).


Assessment of Bowel EliminationElimination Patterns

It is essential to determine the client's usual patterns, including frequency of elimination, effort required to expel stool, and what elimination aids, if any, he or she uses.

Stool CharacteristicsColor, odor, consistency, shape, unusual

components


Common Alterations in Bowel Elimination

Constipation : Is an elimination problem characterized by dry, hard stool that is difficult to pass. Various accompanying signs and symptoms include the following:

Complaints of(C/O ) abdominal fullness or bloatingAbdominal distentionComplaints of(C/O ) rectal fullness or pressurePain on defecationDecreased frequency of bowel movementsInability to pass stoolChanges in stool characteristics such as oozing liquid

stool or hard small stool


The incidence of constipation tends to be high among those whose dietary habits lack adequate fiber (such as not eating sufficient raw fruits and vegetables, whole grains, seeds, and nuts).

Dietary fiber, which becomes undigested cellulose, is important because it attracts water within the bowel, resulting in bulkier stool that is more quickly and easily eliminated.

Constipation is classified into one of four distinct types (primary, secondary, iatrogenic, and pseudo constipation), according to the underlying cause.


1. Primary or simple constipation Is well within the treatment domain of nurses. It results from lifestyle factors such as inactivity,

inadequate intake of fiber, insufficient fluid intake, or ignoring the urge to defecate.

2. Secondary constipationIs a consequence of a pathologic disorder such

as a partial bowel obstruction.It usually resolves when the primary cause is

treated.

Types of Constipation


3. Iatrogenic constipation As a consequence of other medical treatment.

For example, prolonged use of narcotic analgesia tends to cause constipation.

These and other drugs slow peristalsis, delaying transit time.

The longer the stool remains in the colon, the drier it becomes, making it more difficult to pass.

4. Pseudoconstipation (perceived constipation):A term used when clients believe they are

constipated even though they are not (often overuse laxatives, suppositories or enemas).

Types of Constipation (cont‘d)


Common Alterations in Bowel Elimination (cont’d)

Fecal impaction occurs when a large, hardened mass of stool interferes

with defecation, making it impossible for the client to pass feces voluntarily.

result from unrelieved constipation, retained barium from an intestinal x-ray, dehydration, and weakness of abdominal muscles.

Some clients with an impaction pass liquid stool, which they may misinterpret as diarrhea.


Flatulence or flatus :Excessive accumulation of intestinal gas, results from

swallowing air while eating or sluggish peristalsis.

gas that forms as a byproduct of bacterial fermentation in the bowel.

Vegetables such as cabbage, cucumbers, and onions are commonly known for producing gas. Beans are other gas formers.



Diarrhea is :The urgent passage of watery stool and commonly is accompanied by abdominal cramps.

Simple diarrhea usually begins suddenly and lasts for a short period.

Other associated signs and symptoms include nausea and vomiting and blood or mucus in the stools.

Usually diarrhea is a means of eliminating an irritating substance such as tainted food or intestinal pathogens.

Diarrhea may also result from emotional stress, dietary indiscretions, laxative abuse, or bowel disorders.



Fecal incontinence: is the inability to control the elimination of stool.


Measures to Promote Bowel EliminationTwo physician-ordered interventions to promote

elimination when not naturally occurring or when the bowel must be cleansed for other purposes, such as preparation for surgery and endoscopic or x-ray examinations

1. Insert a rectal suppository

2. Administer an enemaCleansing enemas

o Tap water, normal saline o Soapsuds, hypertonic saline

Retention Enemas


Measures to Promote Bowel Elimination (cont’d)

Inserting a Rectal SuppositoryMedications released from the suppository can have local or systemic effects. Depending on the drug, local effects may include softening and lubricating dry stool, irritating the wall of the rectum and anal canal to stimulate smooth muscle contraction, and liberating carbon dioxide, thus increasing rectal distention and the urge to defecate.



Administering an EnemaAn enema introduces a solution into the rectum to :

1. Cleanse the lower bowel (most common reason).

2. Soften feces.

3. Expel flatus.

4. Soothe irritated mucous membranes.

5. Outline the colon during diagnostic x-rays.

6. Treat worm and parasite infestations.


Cleansing EnemasIt is used to remove feces from the rectum (Table 31-3).

SolutionAmount (ml)Mechanism of Action

Tap water500-1000Distends rectum, moistens stool

Normal saline500-1000Distends rectum, moistens stool

Soap and water500-1000Distends rectum, moistens stool, irritates local tissue

Hypertonic saline (ie: Fleets)

120 Irritates local tissue and draws water into the bowel

Mineral, olive, or cottonseed

120-180Lubricates and softensstool


Administer an enema (cont’d)

Retention enemas

o Oil retention enema

Mineral, cottonseed, or olive oil

Retained at least 30 minutes

Lubricate and soften stool to ease stool expulsion



Ostomy CareA client with an ostomy (surgically created

opening to the bowel or other structure; requires additional care for promoting bowel elimination.

Types of Ostomies 1. ileostomy (surgically created opening to the ileum)

2. colostomy (surgically created opening to a portion of the colon; Fig. 31-4).


Locations of intestinal Ostomies


Most persons with an ostomy, also called ostomates, wear an appliance (bag or collection device over the stoma) to collect stool.

Depending on the type and location of the ostomy, client care may involve providing peristomal care, applying an appliance, draining a continent ileostomy, and, for clients with a colostomy, administering irrigations through the stoma.


Figure 31-5 • An ostomy appliance: faceplate and pouch.


Ostomy CarePreventing skin breakdown is a major

challenge in ostomy care. Enzymes in stool can quickly cause

excoriation (chemical injury of skin).Providing peristomal care

Applying an ostomy applianceDraining a continent ileostomyIrrigating a colostomy


Nursing ImplicationsConstipationRisk for ConstipationPerceived ConstipationDiarrheaBowel IncontinenceToileting Self-Care DeficitSituational Low Self-Esteem

1 second semester 15 - 16 chapter 31 bowel elimination bader a. el safadi bsn, msc fundamental of...

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