2. BOWEL ELIMINATION Bowel elimination is a basic physical need. It is the excretion of wastes from the digestive system. As a health care worker, you will deal with bowel elimination on a regular basis. Remember, this can be embarrassing and uncomfortable for the pt. BM’s OD q2-3Some people have BM’s OD, and some have them q2-3 days. It is important to know what is normal for that specific pt.

3. BOWEL ELIMINATION OBSERVATIONS As a health care worker you must be able to make the following observations regarding bowel elimination and report/record any abnormalities. Colour – brown, white, black/tarry, coffee grounds red/melena, pale, yellow, green, Amount - (if diarrhea) Consistency- soft, formed, liquid, hard Odour – may be affected by food, infection Shape – should be shaped like the rectum Size – Lg, mod, sm Frequency- varies C/O Pain – constipation, nausea Constituents – undigested food, blood, pus, worms, mucous

6. BOWEL ELIMINATION Many factors affect bowel elimination including: Age Fluid intake Personal habits Pain Surgery Infection Physical activity Disability Pregnancy Medications Diet Psychological Positioning Anesthesia Dx tests

7. COMMON BOWEL PROBLEMS

8. BOWEL ELIMINATION COMMON PROBLEMS Common problems include: Constipation Constipation : a condition in which BM’s are less frequent and stool is hard and dry as well as difficult to pass. Defecation many cause pain and the client may only pass a very small amount of stool. Constipation occurs when peristalsis slows down and more water is absorbed by the large intestine. There are many causes including: low fiber diet* medications ignoring the urge to defecate* aging ↓ fluid intake* certain diseases inactivity

9. BOWEL ELIMINATION Fecal impaction :Fecal impaction : is the prolonged retention and accumulation of feces in the rectum when constipation is not relieved. The feces becomes extremely hard and cannot be expelled. If left untreated, a fecal impaction can lead to a complete bowel obstruction requiring surgery. Most fecal impactions are manually removed. Signs/symptoms may include: abd. swelling/cramping * fullness/pain in N & V* fever ↑ need to urinate Liquid feces seeping from the anus

11. BOWEL ELIMINATION Diarrhea Diarrhea: the frequent passage of liquid stools. The feces moves through the intestines at a rapid rate and fluid is not absorbed. This causes urgency as well as cramping & nausea. Causes can include anxiety, infection, food and medication intolerances. Dehydration is a concern c diarrhea d/t the excessive fluid loss. Dehydration can cause death, be aware of the signs/symptoms including: oliguriapale, dry skin* oliguria dry, cracked lips* thirst weakness* dizziness confusion* ↓ BP, P & R

12. BOWEL ELIMINATION Fecal Incontinence: Fecal Incontinence: is the inability to control the passage of feces and gas through the anus. Causes can include: intestinal & nervous system diseases injuries fecal impaction diarrhea medications Those with mental health issues, dementia or other cognitive disorders may not recognize the need to defecate. They may also play with their stool.

13. BOWEL ELIMINATION Flatulence:Flatulence: is the excessive formation of gas or air in the stomach and intestines. The gas and air that is passed is called flatus. There are many causes including: swallowing air bacteria gas forming foods constipation surgery medications

14. BOWEL ELIMINATION SUPPOSITORIES A bullet shaped solid medication that is inserted into a body opening. Supps melt at body temperature Rectal suppositories are usually given to relieve constipation and results take about 30 mins Supps can also be used to relieve fever, nausea, and pain Suppositories can be inserted by an RN,RPN, or PSW Some pt.’s can self medicate.

15. BOWEL ELIMINATION ENEMAS An enema is the introduction of fluid into the rectum and lower colon. They are given to remove feces and relieve constipation or fecal impaction. The most common type of enema is the commercial enema. They irritate and distend the rectum to promote defecation. Takes approx. 5-10 mins for results

16. BOWEL ELIMINATION OSTOMY Surgical removal of part of the intestine is sometimes necessary. This can be d/t cancer, disease or trauma. An ostomy is the surgical creation of an artificial opening. This opening is called a stoma. Stool consistency depends on the location of the ostomy. The higher the ostomy the more liquid the stools

17. BOWEL ELIMINATION COLOSTOMY A colostomy is the surgically created opening b/t the colon and the abd. wall. Part of the colon is brought out onto the abd. wall and a stoma is made. Feces and flatus pass through the stoma into a pouch. Colostomies can be temporary ( diseased bowel can heal) or permanent (diseased bowel is removed).

19. BOWEL ELIMINATION ILEOSTOMY An ileostomy is the surgically created opening b/t the ileum and the abd. wall. The entire large intestine is removed. Liquid feces drains constantly from an ileostomy. Good skin care is essential. Ostomy pouches: must fit well must be emptied and cleaned frequently An ostomy is a serious body image change. It is imperative that health care professionals be empathetic to the needs of those with ostomies.

20. ILEOSTOMY