Exam 4- Bowel elimination

small intestine

digestion & absorption of nutrients

large intestine

absorption of water and elimination of water


under control of NScontraction every 3-12 minutes the rhythmic smooth muscle contraction of intestinal wall


Internal sphincter involuntaryExternal sphincter voluntary

Valsalva maneuver

voluntary contraction of abd muscles while force expiration against a closed airway

medication effect on stool

Aspirin, anticoagulants: pink to red to black stoolIron salts: black stoolBismuth subsalicylate used to treat diarrhea can also cause black stools.Antacids: white discoloration or speckling in stoolAntibiotics: green-gray color

sequence for abdominal assessment

inspection, auscultation, percussion, palpation

physical assessment of 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.

Hemoccult (Guaiac) test; FecalOccult Blood Test (FOBT)

Stool for occult (hidden) blood


black tarry stool- MAY indicatepresence of blood.


*Screening for Colorectal Cancer(50 yrs and over should start gettingcolonoscopy)Colonoscopy-preps: clear liquid diet,ingestion of a gallon of bowel cleanser24 hrs before. (Fleet or cleansing enema).NPO 8 hrs prior to procedure

Preventing food poisoning

1)Never buy food with damaged packaging.2)Take items requiring refrigeration home immediately.3)Wash hands and surfaces often.4)Use separate cutting boards for foods.5)Thoroughly wash all fruits and vegetables before eating.6)Do not wash meat, poultry, or eggs to prevent spreading microorganisms to sink and other kitchen surfaces.7)Never use raw eggs in any form.8)Do not eat seafood raw or if it has an unpleasant odor.9)Use a food thermometer to ensure cooking food to safe internal temperature.10)Keep food hot after cooking; maintain safe temperature of 140°F or above.11) Give only pasteurized fruit juices to small children.

Methods of emptying the colon of feces

EnemasRectal suppositoriesOral intestinal lavageDigital removal of stool

Enemas position

Left side-lying with knees bent, sigmoid colon bends to left.

Bowel- training programs

Manipulate factors within the patient's control.1) Food and fluid intake, exercise, and time for defecation 2)Formed stool at regular intervals without laxatives.When achieved, continue to offer assistance with toileting at the successful time.

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


Inserted to decompress or drain the stomach of fluid or unwanted stomach contentsUsed to allow the gastrointestinal tract to rest before or after abdominal surgery to promote healingInserted to monitor gastrointestinal bleeding


Opening made to allow passage of urine or stoolPiece of intestine is brought out onto the client's abdomen.Lacks nerve ending (Doesn't hurt to touch)colostomy, ileostomy

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.

Nursing interventions to prevent and relieve constipation

Adequate fluid intake (minimum 1500 ml/day of water and/or juices)Higher fiber dietEstablish regular pattern to defecateRespond immediately to the urge to defecate: toileting, bedpan, bedside commode, privacyAssume sitting or squatting positionPromote adequate activity and exerciseMinimize stressAdminister laxatives as ordered

Laxatives types

Chemical irritants- provide chemical stimulation to intestinal wall- increase peristalsis . Example. Dulcolax, castor oil, senokot (senna)Stool lubricants - mineral oilStool softeners - Colace (Sodium Docusate)Bulk formers - MetamucilOsmotic agents - Milk of magnesia