1. Anuradha Perera (B.Sc.N)special
Elimination
Anuradha Perera (B.Sc.N)special

2. Alteration in Bowel Elimination
Diarrhea
Constipation
Incontinence
Fecal Impaction
Flatulence
Diarrhea-_liquid watery stools..deals with the consistency and frequency
Constipation- less then 3 bm/week or what ever is less then the pt. Regular pattern of elimination
Incontinence inability to control fecal discharge thru anal sphincter
Fecal impaction- mass of hardened feces in rectum…recognized by seepage
Flatulence- gas

3. Characteristics of Stool
Volume
Color
Odor
Consistency
Shape
Constituents
Volume - varies
Color- infants yellow, adults brown due to bile pigmentation. In absence of bile stool may be white (clay colored). Diet can effect color blackish if high red meat intake.Blackish stools (Tarry)could be from upper GI bleeding while (frank red)blood is lower GI bleeding. Greenish color if dk. green veg.eaten.
Odor- Odor is due to the bact action of break down of digested foods. Aroma effected by foods digested, blood, pus, or bact. in stool.
Consistency- soft, semisolid, formed, liquidly, hard. Influenced by diet/fluid intake, GI motility or malabsorption.
Shape- depends on condition of colon. Usually tubular (formed to the rectal canal), but varies. Obstructions may produce narrow pencil thin stools, increased time in the colon may produce marble-like stool.
Constituents - waste residue of digestion bile, secretions, bact, fat…abnormal constituents blood, helminths, parasites, mucus...

4. Factors That Influence Bowel Elimination
Age
Fluid Intake & Diet
Daily Routine
Activity
Medications
Health Status
Stress
Age- elderly bowel conscious, infants pass many stools etc.
Fluid/diet- Intake cc/day and high fiber diet promote elimination
Daily routine - time, position, place. Hospital less conducive to bowel elim.
Activity - increases muscle tone and GI motility
Medications- antibiotics can cause diarrhea, opiates (narcotics)constipation, laxatives, antidiarrheals
Health status- tumors, infection of intestines, spinal cord injury
Stress - anxiety-diarrhea, worry-constipation
Dx test- bowel cleansing alters elimin.pattern
Surgery & anesthesia- direct handling of bowels and slowing of peristalsis alter bowel elim.

5. Diet Laxative effect foods: High fiber foods: Legumes (beans)
Spicy & greasy
Bran/Chocolate
Coffee/Alcohol
Raw fruits & vegetables
High fiber foods:
Legumes (beans)
Cereals
Whole grains
Raw Fruits
Vegetables
Fiber is of plant origin, a carbohydrate not digested by the GI tract.
25 grams/day is recommended
High fiber foods increase peristalsis by forming bulk and having the feces move thru quickly.
Laxative effect - will increase the frequency of BM :prunes

6. Assessing Elimination Status
Usual pattern
Changes in bowels
Aids to eliminate
Current problems
Pattern -How often, when
Changes- blood, mucus
Aids - laxatives enemas
Problems - food related, meds, physical, emotional, Artificial orifices, hemorrhoids (abnormally distended veins)..colostomy

7. Physical Assessment
Inspection- observe contour of abd and note visible peristalsis
Auscultation- listen for bowel sounds all quadrants
Percussion- resonant or tympany over hollow organs…dullness over intestinal obstruction
Palpation- feel for masses, tenderness etc…
This is a different sequence for assessing since palpation may disrupt bowel motility and peristalsis

8. Stool Specimen Collection
Routine specimen
Occult blood
Ova & parasite
Timed specimens
Routine-
Use PPE…place in container…pt. Can obtain themselves…use bedpan /don’t place toilet tissue in bedpan….place in labeled container..transport in plastic bag with required lab slip on outside.
Occult blood –hemacult cards/wipes test for blood…may have to be on a special diet several day prior…
O & P lab sends up test tubes use applicator to place stool specimen in test tubes…
Timed test sometimes all stools for 24hr/ or three stools in a row check with lab…

9. Nursing Dx R/T Bowel Elimination?
Nursing Dx
Potential for constipation related to side effects of medication as evidenced by patient’s verbalization I feel blocked up..I haven’t gone in 4 days….. I usually go every morning after my coffee..
Bowel Incontinence related to loss of anal sphincter control as evidenced by inability to control bowels, 2 episodes of “accidents” every shift, pt. States” I feel like a baby and I don’t want to wear diapers”
PAIn
Diarrhea
Impaired skin integrity
FVD

10. Outcome Criteria Pt. will: Develop regular pattern of elimination
Have less episodes of incontinence
Incorporate fluids/diet that promote bowel elimination

11. Interventions to Promote Elimination
Routine
Positioning
Privacy
Comfort
Activity
Diet/Fluids
Routine- Establish reg pattern of elimination at reg times. Pt. needs min. (uninterrupted time). If urge to defecate is constantly ignored the defecation reflex will be lost, causing feces to remain longer in intest., increased water absorption, making feces hard and difficult to pass. Use communication skills to discuss bowel patterns.
Positioning- comfortable position needed. Squatting position common. Assess need for elevated toilet, commode,
Privacy- considered a very private act. Use BR if possible, pull drapes close doors.
Comfort- provide quiet, comfortable as possible place.
Activity- needed to promote GI activity and maintain reg. frequency.Teaching related to inactivity and constipation. Exercises for immobile client. Exercises to strengthen abd. and perineal muscles used for defecation.T & P ROM
Diet/Fluids - High fiber foods, 2000cc fluids/day

12. Interventions: Promote Bowel Elimination
Laxatives and Cathartics
Enemas
Suppositories
Digital Removal
Cathartics/laxatives - drugs that induce emptying of the intest. Habitual use of laxatives lead to constipation and irreg. frequency.Prep for procedures
Cathartics have stronger effects.
Enemas- solution introduced into the lg. Intest. For the purpose of removing feces.
Suppositories - bullet shaped substance inserted into the rectum beyond the anal sphincter where it melts to aid in elimination.
Digital removal- with prolonged retention of feces, fecal impaction occurs preventing passage of normal stool. Liquid fecal seepage around hard stool can occur. Oil retention enema is given prior to digital removal to soften stool.

13. Enema Administration PPE Position L Sims Linen protector
Receptacle (bedpan, commode, toilet)
IV pole
Lubricant
Enema bag with solution
Tissue paper

14. Enema Administration Position L Sims Insert lubricated tip 4”
Bag raised 18-20” above anal canal
Administer slowly - 10 min.
Administration is individualized.
Pt. holds for 15 min.
L sims -water flows more easily into descending colon
Temp of solution usually above body temp to increase peristalsis. Except for retention enemas which we want to be held therefore they are given at below body temp.
If cramping occurs…lower bag, stop flow…take deep breaths

15. Evaluation Solution given Amount expelled Characteristics of stool
Passing of flatus
Unusual findings blood, helminthes, pus etc.
Client reaction: change in skin color, VS changes, fatigue

16. Medications Effecting Bowel Elimination
Laxatives- induce emptying of GI tract
Antidiarrheal- slow peristalsis, Pepto Bismol, Kaopectate
Codeine/morphine/iron- cause constipation
Antibiotics-may cause diarrhea
Opiates: paragoric, lomotil- habit forming

17. Flatulence Causes: Decreased peristalsis Diet Stress Constipation
Medications
Surgery
Diet
Stress
Decreased activity
Decreased activity

18. NonInvasive Interventions for Flatulence
*Ambulation*
Knee chest position

19. Evaluation of Bowel Function
Achievement of regular defecation habits
Patient’s understanding of normal elimination
Maintenance of adequate food and fluid intake
Regular exercise program
Comfort
Skin integrity