Bowel Elimination N.F. pgs 680-685

1
Bowel EliminationN.F. pgs 680-685
2
Defecation

• Bowel elimination, the act of expelling stool
  from the body
• Stool is also known as feces

3
Peristalsis

• The rhythmic contractions of intestinal smooth
  muscle that moves fiber, water and nutritional
  wastes into the large intestine

4
Why do we eliminate stool from the body?

• Food gets eaten, digested and eliminated as
  waste, we cannot keep the waste

5
Action that pushes stool out

• Gastrocolic reflex accelerated wave-like
  movements that precede defecation. May have sl.
  Abd. Cramping as the stool is propelled forward,
  packing it into the rectum
• When would you be most likely to gave this?
  After meals

6
What exactly comes out?

• 1) Undigested foods like those containing fiber
  and cellulose. (that which doesnt get digested)
• 2) water is also eliminated

7
Valsalva maneuver

• Forced air against the glottis and contraction of
  the pelvis and abdominal muscles to increase
  abdominal pressure

8
Why should we not perform the valsalva maneuver?

• 1) it slows the hears beat down and can make you
  faint
• 2) if youve had cardiac surgery, it may be
  taxing on the heart postoperatively

9
When is it okay to perform the valsalva maneuver?

• When having a BM. It helps contract the
  abdominal cavity muscles in order to push out the
  stool
• When having a baby, its used to push the baby
  out however (bear-down)..the mom should really
  only keep the abds contracted as to not cause
  bradycardia

10
Stool samples

• Stool is frequently checked for color, odor,
  consistency, shape
• Always record these findings
• Also called HEMOCCULT A.K.A Guaiac

11
How to obtain samples

• Always wear gloves
• Take fresh specimen from hat or diaper
• If testing for blood, use 2 different places of
  stool
• Take specimen from colostomy bag

12
Ways to assess stool

• Collect stool in designated container and send it
  to the lab
• Collection of stool and it is placed on card and
  tested with developer to detect blood
• Rectal exam can be done, usually by Dr. to
  collect stool and check rectum

13
Factors that affect elimination

• Amt and type of food, can have large bulky stool
  if eating fatty foods
• Stool can be the color of the food you last ate
• Some foods cause gas

14
Factors affecting elimination

• Fluid intake, if you dont take in enough, youll
  be constipated d/t water being pulled out of the
  large intestine
• Medication can constipate such as narcotics like
  morphine and codeine, pts need to be put on
  laxative/stool softener such as Colace

15
Factors affecting elimination

• Can be voluntarily controlled, kids hold it in
  and become constipated
• Nerves, tension can cause spasms in intestine
  diarrhea
• Spinal cord injuries can leave pt incontinent,
  bowel regimen must be instituted
• Exercise increases blood flow and may make you
  regular

16
Common alterations in bowel elimination

• Constipation characterized by
• Dry hard stool that is difficult to pass

17
Signs symptoms of constipation

• c/o abd fullness
• c/o pain upon defecation
• Inability to pass stool
• Distended abdomen
• Nausea/vomiting

18
Signs Symptoms for fecal impaction

• Inability to pass stool
• Oozing of stool (around the impacted stool) this
  pt NEEDS a suppository or enema, their problem is
  not fixed because you see liquid stool
• Rectal pressure
• Distended abdomen
• Nausea/vomiting

19
What to do for nausea

• In general
• Eat non-spicy or bland foods such as
• Dry toast
• Crackers
• Sips of water or ginger ale
• Avoid fatty-type, or greasy foods
• Avoid spicy foods
• We can hold solid foods but shouldnt hold
  fluids. If fluids need to be held, pt will need
  an IV
• If pt is at home and is ill, hold food but only
  offer teaspoons of liquid at a time such as 1 tsp
  every 15 minutes

20
Common alterations in bowel elimination

• Fecal impaction when a large hardened mass
  interferes with defecation making it impossible
  to pass the stool voluntarily
• Liquid stool from higher up is the only thing
  that can pass

21
How to check for fecal impaction

• Don the gloves, please
• Use lubrication
• Gently insert 1 finger into the rectum to see if
  there is a mass of hard stool there
• Oil enema may be administered if stool is present

22
Digital

• Dr. or nurse may have to physically remove the
  stool.yuckyes this could be you

23
Digital

• Keep those gloves on
• Lubricate the forefinger of your dominant hand
• Insert the lubricated finger into the rectum to
  the level of the hardened mass
• Move your finger slowly to carefully break up the
  mass
• With-drawl segments of stool placing them in the
  bedpan
• Cont this until stool is reduced
• Very uncomfortable for the pt

24
Surgery

• In some instances, surgical intervention may be
  necessary
• Remind pts NOT to eat the shell of sunflower
  seeds, they turn to concrete and surgery is
  needed to remove them

25
Common alterations in bowel elimination

• Flatus intestinal gases that get expelled from
  the rectum
• Gas can be formed from the fermentation of foods
  mixed with intestinal bacteria, this causes a gas
  to be formed
• Beans cause gas because humans lack the enzyme
  needed to completely digest this particular form
  of carbohydrate

26
Common alterations in bowel elimination

• Diarrhea urgent passage of watery stool usually
  accompanied by cramping
• Diarrhea is a means of eliminating irritating
  substances from tainted foods or intestinal
  pathogens
• NEVER GIVE IMMODIUM to pts with intestinal flu or
  bacteria that has been confirmed you want the
  bacteria or germ to be expellednever stop the
  flow of feces in this case

27
How to treat diarrhea

• Limit consumption of food Give this diet
• B - Bananas
• R - Rice
• A - Applesauce
• T - Toast these are bland
  things
• Investigate side effects of meds, esp. IV meds
• Answer call light promptly
• Contact Dr. for meds

28
Common alterations in bowel elimination

• Fecal incontinence is the inability to control
  the elimination of stool
• Stool may not be watery or loose, can be d/t
  neurological changes
• Pts may be embarrassed by this, support them

29
Measures to promote bowel elimination

• Enemas
• suppository

30
Barium

• Can cause severe constipation following a
  gastrointestinal study
• Pt is given stool softner or laxative such as
  Ducolax to help eliminate the barium in the
  intestine
• If not, stool becomes hard like a rock

31
Enema

• An enema introduces solution into the rectum to
  stimulate bowel activity and cause emptying of
  the lower intestine
• The vessels that lay very close to the rectum are
  important. When you administer the enema
  (FLEETS) you are administering Na and water.
  The outer vessels see the salt from the enema
  and water moves into the rectum walls and brings
  water in the add to the stool that is present.
  Where there is salt, water will

32
Others purposes of an enema

• To cleanse the lower bowel before surgery to the
  bowel
• To help soften feces
• To expel flatus
• To soothe irritated mucous membranes
• To outline the colon during diagnostic x-rays
• To treat worm and parasitic infestations

33
Enemas

• Don gloves, insert tip of enema into the rectum
  about 4 inches in order to pass the anal
  sphincter
• Once you administer the enema SLOWLY, you remove
  the tip and remind the pt to try and hold it in
  for approx 15-20mins
• You would like that shift of fluid to occur, so
  you may need some time
• Upon administering an enema, if pt c/o severe
  pain, STOP IMMEDIATELY, you could perforate the
  intestine

34
Tap water and NS enemas

• These are preferred by the pt d/t the low amt of
  irritation
• Fluid can be warmed to aid in clean-out

35
Soap suds enema

• Castile soap is used
• Lubricating and not irritating

36
Both NS Soap Suds enema

• Require the use of an enema bag
• Set bag up as instructed on packaging
• Raise enema bag up 20 inches higher than the
  clients hip in order to not create too much of a
  flow
• Insert tip of enema into rectum approx. 4 inches

37
What position does the pt lay in to receive an
enema?

• On left side with legs drawn up sl.
• (Sims lateral)

38
Suppository

• Wear gloves
• Give pt privacy, pull curtain or close door
• Place pt on left side with knees sl. Bent
• Tear open lubricant and put onto suppository
• Gently insert suppository into rectum until
  suppository can no longer be visualized
• Tell pt to relax and that procedure is completed,
  while holding supp. In place (by holding finger
  in rectum sl.)
• Remind pt NOT to push out suppository
• Offer assistance to pt when toilet is needed

39
Fecal impaction

• Enlarged, hard mass of stool unable to pass
• Pain and leakage of stool around mass occurs

40
Ways to relieve constipation

• Drugs such as laxatives and stool softner like
  pericolace, once pt goes, colace
• Enemas such as tap water, NS, soap suds
• Diet drink lots and lots of fluids, this keeps
  the stool always soft

41
Methods to relieve flatus r/t constipation

• Insert rectal tube
• Encourage ambulation
• Encourage fluids
• Discourage eating foods high in fat

42
Bowel Training

• Immobile pts may need to have their bowel regimen
  times to meet needs of caregivers
• Some pts receive enemas 1 per day or 1 every
  other day to keep the pt regular
• Some pts receive Lactulose or Fibercon daily to
  stay regular, caregivers can better care the pt

43
Cultures

• Stool specimens may require special packaging in
  order for it to be run through the labfollow
  facility protocol

44
The End