1. By
Purwaningsih

2. Objectives Recognize causes of constipation
Describe the normal physiology of bowel elimination
Recognize causes of constipation
Discuss assessment and interventions to achieve nursing outcomes for bowel elimination

3. Bowel Elimination
GI Tract is a series of hollow mucous membrane lined muscular organs Purpose is to absorb fluids & nutrients, prepare food for absorption & provide storage for feces

4. GI Tract Anatomy Mouth Esophagus Stomach Small Intestine
Large Intestine
Rectum

7. Main function is absorption
Small intestine
Made up of three parts: ileum, jejunum, and duodenum.
Main function is absorption

8. Small intestine
Small intestine

12. Colon 3 Divisions: Ascending, Transverse, Descending
Colon Functions: Absorption, Protection, Secretion, & Elimination (stool and flatus)

14. Rectum Sigmoid colon Storage of feces Length varies with age
When fecal mass or flatus moves into rectum, it distends and defecation begins
Process involves involuntary (Internal sphincter) and voluntary control (external sphincter)
Valsalva Maneuver- voluntary contraction of abdominal muscles

15. Physiology – Bowel Elimination
GI Motility
Enzyme breakdown
Peristalsis
Gastrocolic Reflex
Mucosal Transport
Fluids & Electrolytes
Waste
(Bisanz, 2007)

16. Physiology – Bowel Elimination
Defecation Reflex
Sphincters
CNS Impulses
Rectal Distention
Mechanical Assistance
Anal Sphincter Muscles
(Bisanz, 2007)

17. Characteristics – Bowel Elimination
Frequency
Quantity
Quality
Consistency
Ease of Passage

18. Constipation Scoring System
Tools for Stools
Bristol Stool Scale
en.wikpedia.org./wiki/Bristol_stool_Chart
Constipation Scoring System

19. Factors Affecting Bowel Elimination
Age
Infection
Diet
Fluid Intake
Physical Activity
Psychological factors
Personal Habits

20. Factors Affecting Bowel Elimination
Position during Defecation
Pain
Surgery and Anesthesia
Medications

21. Common Bowel Elimination Problems
Constipation
Impaction
Diarrhea
Incontinence
Flatulence
Hemorrhoids

22. CONSTIPATION
Definition: decreased normal frequency of defecation accompanied by difficult or incomplete passage of excessively dry stool
(Wilkinson, J.M., 2005)

23. Menu choices – fresh fruit, whole grains
Causes - Constipation
Poor Intake
Fluids
NPO – tests, surgery
Choices – juice, water
Positioning
Fiber
Menu choices – fresh fruit, whole grains

24. Orthopedic Insult Casts, Traction Other diseases Causes - Constipation
Pain with movement
Assistive devices
Other diseases

25. Open Door Policy ↓ Privacy – visitation policy Disruption of Routine
Causes - Constipation
Open Door Policy
↓ Privacy – visitation policy
Bathroom vs. Commode
Disruption of Routine
Therapy
Tests/Surgery

26. Pain Medications Other medications
Causes - Constipation
Pain Medications
Opiates – P.O. or PCA
Other medications
Antacids with aluminum, anticholinergics,
calcium channel blockers, phenothiazines,
diuretics, sedatives, etc.
(Hinrichs, Huseboe, Tang, & Titler, 2001)

27. Last resort: Suppository/Enema Laxatives (+/-) Bulk-forming →
Stool softeners →
Osmotic Laxatives →
Stimulants →
Suppository/Enema
(Hinrichs, Huseboe, Tang, & Titler, 2001)

28. Assessment AUDITS: INTERVIEWS: Nurses Leadership Patients Diagnosis
Postoperative Day
Medications +/-
Bowel Movement Recorded
INTERVIEWS:
Nurses
Leadership
Patients

29. Pictorial Diary Fluids – 8 servings Interventional Tool
Whole grains – 3 servings
Fruits/vegetables – 5 servings
Exercise – 3-4 x/day
Bowel Movement - record

30. Interventional Tool
Bowel Elimination Tool (BET)

31. Interventional Tool Directions: Mark your selections with an X Choose:
8 Glasses of Fluid:
Best: Water or Juices; Decaffeinated drinks
3 Servings of Whole grain breads or cereal:
Best: Whole wheat, oatmeal, bran cereals
5 Servings of Fruits or Vegetables:
Best: Fresh fruits, vegetables with skin
Exercise – 3-4 times per day
Best: Walking, physical therapy,
or exercises in bed
Record your BM
Difficult___ Easy___
Soft___ Hard___
Complete__
Interventional Tool
Directions:

32. 1) Cooperates for Bowel Management
Nursing Outcomes
1) Cooperates for Bowel Management
Partners for care – uses tool
Out of bed/ exercises – 3-4 x day
Overview of diet
>15 gm fiber; >1500 cc fluids
Privacy and respect – toileting regime
(Moorhead, 2008)

33. 2) Constipation alleviated as indicated:
Nursing Outcomes
2) Constipation alleviated as indicated:
Elimination pattern in expected range
Stool soft and formed (soft/hard)
Stool easy to pass (easy/difficult)
Amount adequate for diet (yes/no)
Feeling of evacuation (yes/no)
(Moorhead, 2008)