1. Bowel Elimination Health Occupations February 2012

2. Objectives/Duty Tasks Task1201- Assist the resident/patient in bowel training Task 1506 -Report nausea, vomiting, pain, inability to swallow, bowel movement changes such as color, diarrhea, or constipation. (gastrointestinal conditions) 1603 Demonstrate intervention strategies to prevent abuse and neglect. Label structures of the digestive system Describe the functions of the digestive system Describe normal defecation List observations to be made about defecation Explain how to promote safety and comfort during defecation

3. More Objectives Identify the factors that affect bowel elimination Explain why enemas are given Demonstrate competence in assisting resident/patient in toileting

4. Vocabulary Bowel movement/Defecation Constipation Dehydration Diarrhea Enema Fecal impaction Fecal incontinence Feces/stool Flatus/flatulence Ostomy Illeostomy Colostomy Stoma Peristalsis suppository

5. Functions of the Digestive System Ingestion- eating Digestion- food broken down into small particles Absorption- vitamins and nutrients are absorbed Elimination- body expels waste products of metabolism

6. The Mouth Around the teeth and through the gums - look out stomach, here it comes ! Digestion begins here The teeth – The Salivary Glands -

7. Esophagus Collapsible Muscular Mucous lined 10 inches long

8. Stomach Expandable sac Gastric juices Chyme 2-4 hours Pyloric Sphincter

9. Small Intestine Nutrient absorption 20 feet long Large surface area Villi Ducts for pancreatic juices/bile

10. Liver Produces bile Aids in fat digestion

11. Gallbladder Muscular sac - under the liver Stores/ concentrates bile Bile released from the GB into the Small Intestine

12. Pancreas Secretes digestive enzymes Proteases - proteins Lipase - fats Amylase –starches

13. Large Intestine AKA Colon 5 feet long Absorbs water from food that can not be digested

14. The End of the Line Rectum 2 inch long canal Serves as a holding area for stool Anus 2 sphincters ( ring muscles) control defecation

15. KITSES Animation of Digestive system http://kitses.com/animation/swfs/digestion.s wf http://kitses.com/animation/swfs/digestion.s wf

16. Normal Bowel Movements Defecation Feces Stool Frequency Timing color- – Diet- affects color – Diseases- affects color Shape Consistency Odor

17. NA Observations Notice – Color – Amount – consistency – Frequency – Odor – Shape – Complaints of pain/discomfort

18. Factors Affecting Bowel Elimination Privacy Habits Diet Fluids Activity Drugs Disability Age

19. Comfort and Safety in packet- complete this slide using Box 20-1 page 377

20. Effects of Aging on Bowel Elimination Complete this slide on the back of your PowerPoint packet using Page 377 in text packet as a reference

21. Constipation Passage of a hard dry stool Caused by feces moving slowly through the bowel Stools large or marble sized Caused by low fiber diet, inactivity, medications, resisting the urge to defecate. Aging, certain diseases

22. Fecal Impaction Prolonged retention of feces in rectum The longer the feces sits in the rectum the harder the feces gets Feces becomes hard or putty like – Abdominal discomfort, nausea, cramping, rectal pain Digital exam( not an NA function) Digital removal of impaction ( not an NA function)

23. Diarrhea Frequent passage of liquid stools Feces move through bowel rapidly reduces time for fluid absorption Sometimes causes fecal incontinence causes – infection, drugs, irritating foods, pathogens in food

24. Care for residents/patients with diarrhea Respond to elimination needs promptly Dispse of stools promptly, using infection control measures Good skin care liquid stools can be irritating to the skin Risk of dehydration – flushed, dry sskin, headache, dizziness, oliguria, concentrated urine, coated skin

25. Fecal Incontinence Inability to control the passage of feces or flatus through the anus – Intestinal diseases – Nervous system diseases – Fecal impaction – Diarrhea – Some medications – dementia/ mental health disorders

26. Care for people with Fecal Incontinence Bowel Training Help with toileting after meals and every 2-3 hrs. Incontinence products to keep linens and garments clean Good skin care

27. Flatulence Gas and air are normal in stomach and intestines Expelled through mouth and anus Gas and air through anus is called flatus Flatulence is excessive flatus Causes Swallowing air Bacterial action of the intestines Gas forming foods Constipation Medicines that decrease peristalsis Bowel surgeries

28. Bowel Training Goals Gain control of bowel movements Develop a regular pattern of elimination – Note resident’s normal time for elimination – Usually after a meal – Toilet resident at the same time each day after a meal – Also-high fiber diet, warm liquids, activity and privacy

29. Enemas Introduction of fluid into rectum and lower colon Ordered by the physician, NP, PA

30. Ostomies Surgically created opening In digestive system the opening is on the abdomen Named by where in the intestine the opening is created – Colostomy- large intestine – Illeostomy – small intestine Care Prevent skin irritation Change ostomy pouch