1. Bowel Elimination NUR101 Fall 2010 Lecture # 23 K. Burger, MSEd, MSN, RN, CNE PPP By: Sharon Niggemeier RN MSN

2. Anatomy & Physiology Function of Large intestine: absorption Extends from Ileocecal valve to anus Chyme Peristalsis & Mass peristalsis

3. Act of Defecation Defecation reflex Valsalva maneuver Defecation

4. Alteration in Bowel Elimination Diarrhea Constipation Incontinence Fecal Impaction Flatulence

5. Characteristics of Stool Volume Color Odor Consistency Shape Constituents

6. Factors That Influence Bowel Elimination Age Fluid Intake & Diet Daily Routine Activity Medications Health Status Stress

7. Diet High fiber foods Legumes (beans) Cereals Whole grains Raw Fruits Vegetables Laxative effect foods Spicy & greasy Bran/Chocolate Coffee/Alcohol Raw fruits & vegetables

8. Assessing Elimination Status Usual pattern Changes in bowels Aids to eliminate Current problems

9. 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…

10. Stool Specimen Collection Routine specimen Occult blood Ova & parasite Timed specimens

11. Nursing Dx R/T Bowel Elimination ?

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

13. Interventions to Promote Elimination Routine Positioning Privacy Comfort Activity Diet/Fluids

14. Interventions: Promote Bowel Elimination Laxatives Enemas Suppositories Digital Removal

15. Types of Enemas

16. Enema Solutions Tap water (Hypotonic) Normal saline (Isotonic) Soap Hypertonic Oil

17. Tap Water (TWE) Amount: 500-1000cc Action: Distends, increases peristalsis Time: 15 min. Indicated: inflamed bowels/irritated colon Contraindicated: Atonic bowels, fluid restrictions

18. Normal Saline Amount: 500-1000cc Action: Distends, increases peristalsis Time: 15 min. Indicated:Inflamed bowels/irritated colon Contraindicated: Na retention problems, fluid restrictions

19. Soap (SSE) Amount: 500-1000cc (Castile 5ml/1000cc) Action: Distends, Irritates Time: 15 min. Indicated: Constipation Contraindicated: Prior to rectal exams

20. Hypertonic Amount: 70-130 cc solution Action: Distends/Irritates Time: 5-10 min. Indicated: Constipation, convenience Contraindicated: Dehydration, Na problems

21. Oil Retention Amount: 120-200cc Action: Lubricates Time: 30 min. Indicated: Fecal impaction Contraindication: none

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

23. 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.

24. 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

25. Medications Effecting Bowel Elimination Laxatives- induce emptying of GI tract Antidiarrheal- slow peristalsis Codeine/morphine/iron- cause constipation Antibiotics-may cause diarrhea

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

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

28. Invasive Interventions for Flatulence Glycerin Suppository Harris Flush Rectal Tube