chapter - 37 bowel elimination

Airgas templateChapter 37
Bowel Elimination
Gastrointestinal Tract
The Large Intestine
Extends from the ileocecal valve to the anus
Functions
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Process of Peristalsis
Contractions occur every 3 to 12 minutes.
Mass peristalsis sweeps occur one to four times each 24-hour period.
One-third to one-half of food waste is excreted in stool within 24 hours.
Variables Influencing Bowel Elimination
Developmental Considerations
Infants: Characteristics of stool and frequency depend on formula or breast feedings.
Toddler: Physiologic maturity is the first priority for bowel training.
Child, adolescent, adult: Defecation patterns vary in quantity, frequency, and rhythmicity.
Older adult: Constipation is often a chronic problem; diarrhea and fecal incontinence may result from physiologic or lifestyle changes.
Foods Affecting Bowel Elimination
Foods with laxative effect: fruits and vegetables, bran, chocolate, alcohol, coffee
Gas-producing foods: onions, cabbage, beans, cauliflower
Effect of Medications on Stool
Aspirin, anticoagulants: pink to red to black stool
Iron salts: black stool
Antibiotics: green-gray color
Inspection: observe contour, any masses, scars, or distention
Auscultation: listen for bowel sounds in all quadrants
Note frequency and character, audible clicks, and flatus.
Describe bowel sounds as hypoactive, hyperactive, absent or infrequent.
Percussion and palpations: performed by advanced practice professionals
Nursing Process: Physical Assessment of the Anus and Rectum
Inspection and palpation
Lesions, ulcers, fissures (linear break on the margin of the anus), inflammation, and external hemorrhoids
Ask the patient to bear down as though having a bowel movement. Assess for the appearance of internal hemorrhoids or fissures and fecal masses.
Inspect perineal area for skin irritation secondary to diarrhea or fecal incontinence.
Diagnostic Studies: Stool Collection
Hand hygiene, before and after glove use, is essential.
Wear disposable gloves.
Do not contaminate outside of container with stool.
Obtain stool and package, label, and transport according to agency policy.
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.
Do not place toilet tissue in the bedpan or specimen container.
Notify nurse when specimen is available.
Diagnostic Studies: Types of Direct Visualization Studies (Endoscopy)
Esophagogastroduodenoscopy
Colonoscopy
Sigmoidoscopy
Diagnostic Studies: Indirect Visualization Studies
Upper gastrointestinal (UGI)
Small bowel series
Diagnostic Studies: Scheduling Diagnostic Tests
1: fecal occult blood test
2: barium studies (should precede UGI)
3: endoscopic examinations
Planning: Patient Outcomes for Normal
Bowel Elimination
Patient 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.
Patient should seek medical evaluation if changes in stool color or consistency persist.
Intervention: Promoting Regular Bowel Habits
Timing
Positioning
Privacy
Nutrition
Exercise
Intervention: Comfort Measures
Apply ointments or astringent (witch hazel).
Use suppositories that contain anesthetics.
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
Intervention: Nursing Measures for the
Patient With Diarrhea
If there is impaction, obtain physician order for rectal examination.
Give special care to the region around the anus.
Intervention: Preventing Food Poisoning
Wash hands and surfaces often.
Use separate cutting boards for foods.
Thoroughly wash all fruits and vegetables before eating.
Do not wash meat, poultry, or eggs to prevent spreading microorganisms to sink and other kitchen surfaces.
Never use raw eggs in any form.
Do not eat seafood raw or if it has an unpleasant odor.
Intervention: Preventing Food Poisoning (cont.)
Use a food thermometer to ensure cooking food to safe internal temperature.
Keep food hot after cooking; maintain safe temperature of 140°F or above.
Give only pasteurized fruit juices to small children.
Intervention: Methods of Emptying the Colon of Feces
Enemas
Intervention: Types of Enemas
Intervention: Retention Enemas
Carminative: help expel flatus from the rectum
Medicated: provide medications absorbed through the rectal mucosa
Anthelmintic: destroy intestinal parasites
Intervention: Bowel-Training Programs
Food and fluid intake, exercise, and time for defecation
Eliminate a soft, formed stool at regular intervals without laxatives.
When achieved, continue to offer assistance with toileting at the successful time.
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
Intervention: Types of Ostomies
Location of Ostomies
Intervention: Colostomy Care
Keep the patient as free of odors as possible; empty the appliance frequently.
Inspect the patient’s stoma regularly.
Note the size, which should stabilize within 6 to 8 weeks.
Keep the skin around the stoma site clean and dry.
Measure the patient’s fluid intake and output.
Explain each aspect of care to the patient and self-care role.
Encourage patient to care for and look at ostomy.
Intervention: Patient Teaching for Colostomies
Explain the reason for bowel diversion and the rationale for treatment.
Demonstrate self-care behaviors that effectively manage the ostomy.
Describe follow-up care and existing support resources.
Report where supplies may be obtained in the community.
Verbalize related fears and concerns.
Demonstrate a positive body image.

chapter - 37 bowel elimination

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