Chapter 31: Bowel Elimination

Defecation Defecation: the act of expelling feces from the body Peristalsis: rhythmic contractions of intestinal smooth muscle to facilitate defecation Gastrocolic reflex: increased peristaltic activity occurring during food consumption Valsalva maneuver: increasing abdominal muscle pressure to facilitate defecation

Assessment of Bowel Elimination Elimination patterns- frequency of elimination, effort to expel stool. and any elimination aids used Stool characteristics – color, odor, consistency shape and unusual components (table 31-2)

Common Alterations in Bowel Elimination Constipation- dry hard stool that is hard to pass Primary- inactivity, low fiber intake, insufficient fluid intake, ignoring the urge Secondary-pathological- partial bowel obstruction Iatrogenic-medical tx- prolonged use of narcotics Pseudoconstipation-”think they are constipated”- Chronic purging weakens bowel tone

Common Alterations in Bowel Elimination (cont’d) Fecal impaction-large mass interferes with defecation, cause unrelieved constipation See N G 31-2 page 734 Flatulence- excessive accumulation of intestinal gas Diarrhea-urgent passage of watery stool Fecal incontinence-inability to control elimination

Nursing Measures Treat Constipation Primary constipation- encourage dietary fiber, fruits and vegetables, increase fluid intake Education Laxative abuse due to very bowel- conscious older adults Effects of prolonged use of mineral oil

Measures to Promote Bowel Elimination Two physician-ordered interventions to promote elimination when not naturally occurring Insert a rectal suppository Administer an enema Cleansing enemas Tap water, normal saline Soapsuds, hypertonic saline

Measures to Promote Bowel Elimination (cont’d) Administer an enema (cont’d) Retention enemas Oil retention enema Mineral, cottonseed, or olive oil Retained at least 30 minutes Lubricate and soften stool to ease stool expulsion

Ostomy Care Ileostomy: surgically created opening to the ileum Colostomy: surgically created opening to the colon Providing peristomal care Applying an ostomy appliance(page 751) Draining a continent ileostomy Irrigating a colostomy( page 753)