Introduction
-Regular elimination of bowel waste products is essential for normal body functioning.
-Alterations are early signs problems in the gastrointestinal tract or other body systems.
-Supportive nursing care respects a patient's privacy and emotional needs.
Factors influencing bowel elimination
age
diet
fluid intake
physical activity
psychological factors
personal habits
position during defecation
pain
pregnancy
surgery and anesthesia
medications
diagnostic tests
Common bowel elimination problems
constipation, impaction, diarrhea, incontinence, flatulence, hemorrhoids
A newly admitted patient states that he has recently had a change in medications and reports that stools are now dry and hard to pass. This type of bowel pattern is consistent with:
Constipation
Physical assessment
Mouth, Abdomen, Laboratory texts, Fecal specimens, Diagnostic examinations
Some diagnoses that apply to patients with elimination problems include:
Bowel Incontinence, Constipation, Risk for Constipation, Diarrhea, Lack of Knowledge of Dietary Regime
Goals and outcomes
Incorporate elimination habits or routines
-Reinforce routines that promote health
-Consider preexisting concerns
Cathartics and laxatives
Cathartics have a stronger and more rapid effect on the intestines than laxatives.
Suppositories may act more quickly than oral medications
Antidiarrheal agents
Opiates used with caution
To maintain normal elimination patterns in the hospitalized patient, you should instruct the patient to defecate 1 hour after meals because:
mass colonic peristalsis occurs at this time
Continuing and Restorative Care (1 of 2)
Care of ostomies, Irrigating a colostomy, Pouching ostomies, Nutritional considerations, Psychological Considerations
Continuing and Restorative Care (2 of 2)
Bowel training, Maintenance of proper fluid and food intake, Promotion of regular exercise, Management of the patient with fecal incontinence or diarrhea, Maintenance of skin integrity
Patient outcomes
Develop a therapeutic relationship. Evaluate a patient's level of knowledge. Determine the extent to which the patient accomplishes normal defecation.
Ask the patient to describe changes in diet, fluid intake, and activity to promote bowel health.
Safety Guidelines For Nursing Skills
-Instruct patients who self-administer enemas to use the side-lying position.
-If a patient has cardiac disease or is taking cardiac or hypertensive medication, obtain a pulse rate, because manipulation of rectal tissue stimulates the vagus nerve and some
Peristalsis
Involuntary waves of muscle contraction that keep food moving along in one direction through the digestive system.
Stomach preforms three tasks
storage of swallowed food and liquid mixing of food with digestive juices in a substance called chyme, and regulated emptying of its contents into small intestine
chyme
Partially digested, semiliquid food mixed with digestive enzymes and acids in the stomach.
Small intestine has three sections
duodenum, jejunum, ileum
duodenum and jejunum
absorb most of the nutrients and electrolytes
ileum
absorption of certain vitamins, irons, and bile salts
Functions of large intestine
absorption
secretion
elimination
Colon absorbs
1.5 L of water daily
ileus
loss of peristalsis with resulting obstruction of the intestines
Diarrhea is associated disorders affecting
digestion, absorption, secretion in GI tract
fecal impaction
the prolonged retention and buildup of feces in the rectum
fecal incontinence
the inability to control the passage of feces and gas through the anus
C. difficile
can cause mild diarrhea to severe colitis
hand sanitizer can't be used
flatulence
gas in the stomach or intestines
celiac disease
disease caused by sensitivity to gluten
hemorrhoids
swollen, twisted, varicose veins in the rectal region
stoma
opening
ileostomy
the surgical creation of an artificial excretory opening between the ileum, at the end of the small intestine, and the outside of the abdominal wall
colostomy
the surgical creation of an artificial excretory opening between the colon and the body surface
ileoanal pouch anastomosis
Pouch is a reservoir for wastes which are eliminated from the anus.
fecal occult blood test (FOBT)
clinical lab test for presence of small amounts of blood in feces; also called hemoccult test or stool guaiac test
Fecal immunochemical test (FIT)
Use antibodies to detect blood in the stool
detects human-globin protein-- specific for colonic blood loss
(Doesn't work for blood loss proximal to colon)