Bowel Elimination Parts of the GI system Functions mouth pharynx esophagus stomach small intestine (20-21’) duodenum jejunum ileum large intestine (4-5’) cecum ascending colon transverse colon descending colon sigmoid colon rectum Functions digestion of food elimination of waste

Bowel Elimination Peristalsis in small intestine the peristaltic waves are frequent in large intestine there is mass peristalsis this muscular contraction goes the length of the colon (toward the anus) occurs 2 to 4 times a day strongest during the hour after mealtime

Bowel Elimination Feces Rectum name for the waste products when they reach the sigmoid colon Rectum in the adult is 4 to 6 inches long contains folds of tissue which contain a vein and an artery when the veins become distended (as with repeated pressure) a condition known as hemorrhoids can occur

Bowel Elimination Anal canal most distal portion of the rectum bounded by internal and external sphincter muscles internal sphincter cannot be controlled voluntarily external sphincter under voluntary control

Common Problems Constipation Fecal impaction passage of small, dry, hard stool OR the passage of no stool for a period of time Fecal impaction mass or collection of hard, puttylike feces in the folds of the rectum that cannot be expelled passage of liquid fecal seepage (diarrhea) and no normal stool digital exam by nurse

Common Problems Diarrhea Fecal incontinence passage of liquid feces and an increased frequency of defecation difficult or impossible to control for very long the urge to defecate Fecal incontinence loss of voluntary ability to control fecal and gaseous discharges thru the anal sphincter digestive enzymes are highly irritating to skin

Common Problems Flatulence Hemorrhoids the presence of excessive flatus in the intestines flatus is air or gas in the intestinal tract Hemorrhoids common name: piles symptoms pain itching bleeding

Characteristics of Feces Color brown black, tarry clay-colored green or orange Consistency soft 75% water 25% solid material

Characteristics of Feces Shape normally stool has shape of rectum stringlike or ribbon- like Odor results from action of bacteria in the intestine rotten odor Blood abnormal frank vs occult

Enemas Types Cleansing cleansing retention other large volume enema tap water (TWE) saline (NS) soap solution (SSE)

Enemas Cleansing large volume enema small volume enema 500 to 1500 cc stimulate peristalsis by distention of rectum & colon SSE causes chemical irritation small volume enema Fleet Brand amount of solution 4and 1/2 ounces (135 cc) stimulate peristalsis by a mild chemical irritation and by pulling water into colon (causes distention)

Enemas Retention enema Preparation of patient solution is instilled into rectum and allowed to remain there example: oil retention Preparation of patient hospital gown only fanfold covers then put blanket over patient pad the bed!! left Sim’s position

Enemas Administration of enema hang enema bag lubricate tip with lubricant insert tip into rectum locate anus--have patient take deep breath aim in direction of navel insert 3 to 4 inches hold onto tube control flow with clamp

Enemas Administration of enema if patient c/o cramps or abdominal pain slow, deep breaths thru mouth slow down rate of fluid hold solution as long as possible (5 to 10 min) expel enema into bedpan, BSC, toilet “don’t flush” check for results

Bowel Care Incontinence care Fecal Containment Device (FCD) Prevacare No-Rinse Cleanse Prevacare Extra Protective Ointment if no breakdown Convatec SensiCare for example if pt. has diarrhea 6 or more times a day charged item Fecal Containment Device (FCD)

Bowel Care Fecal disimpaction Flatulence Bowel diversion ostomies not a PCA function Flatulence walking rectal tube Bowel diversion ostomies colostomy ileostomy