Bowel Elimination Chapter 49

Physiology of Defecation Elimination of waste products of digestion from the body is essential to health Excreted waste products are referred to as feces or stool

Defecation Defecation is the process of elimination of waste. Feces Causes distention of rectum Stimulates stretch receptors

Characteristics of Feces Tab 49-1 pg. 1357 Color Consistency Shape Amount Odor Constituents

Factors Affecting Bowel Elimination Developmental Diet Activity Psychological Defecation habits

Factors Affecting Bowel Elimination Medications Diagnostic procedures Anesthesia and Surgery Pathological conditions Pain

Constipation Decreased frequency of defecation Hard, dry, formed stools Causes

Fecal Impaction Mass or collection of hardened feces in folds of rectum Passage of liquid fecal seepage and no normal stool Causes Treatments

Diarrhea Passage of liquid feces and increased frequency of defecation Causes Concerns??? Client teaching (pg. 1358)

Bowel (Fecal) Incontinence Loss of voluntary ability to control fecal and gaseous discharges Causes

Flatulence AKA “gas” May lead to gastric distension

Assessment (pg. 1355) Normal bowel patterns Changes in bowel habits History of elimination problems Bowel elimination aids, including diet, exercise, medications, etc Focused physical assessment Stool appearance Diagnostic studies Stool specimens (pg. 818-820) in lab

Nursing Process Nursing Diagnoses

Nursing Process Goals Interventions

Interventions to Promote Regular Defecation Privacy Timing Nutrition/fluids Constipation Diarrhea (client teaching pg. 1358) Flatulence Exercise Positioning

Implementing: Teaching about Medications Laxatives Suppositories Antidiarrheal medications Antiflatulence medications

Enemas Cleansing Retention Return-flow

Cleansing Enema Hypotonic Isotonic Hypertonic Water moves out of colon after it stimulates peristalsis Isotonic No fluid movement in or out of the colon Hypertonic Attracts water into colon causing distention Small volume

Retention Enema Retained for prolonged period (1–3 hrs.) Softens feces Lubricates

Return-Flow Enema Expel gas Relieve abd. Distention 100-200 ml water or saline Allow solution to flow back into container

Administering Enemas Guidelines (pg. 1362-1365) Per clinical learning lab

Bowel Training Programs Indications Phases

Mrs. Phillip case study In a small group, discuss the Mrs. Phillip’s case study.