1. Professor Hill, RN, MN, MSG an Bernardino Valley College Nursing 102
Bowel Elimination
Professor Hill, RN, MN, MSG
an Bernardino Valley College
Nursing 102

2. At The End of This Lecture, The Learner Will..
Explain the role of the GI system in digestion & elimination
Describe factors that influence elimination
Assess bowel elimination through subjective & objective assessments
Discuss 3 elimination problems and the nursing interventions for each

3. Mouth Esophagus Stomach Small intestine Large intestine Anus
Digestion begins with mastication
Esophagus
Peristalsis moves food into the stomach
Stomach
Stores food; mixes food, liquid and digestive juices; moves food into small intestines
Small intestine
Absorption is primary
Large intestine
Bowel elimination key
Anus
Expels feces & flatus from rectum

5. Factors Affecting Bowel Elimination
Food & fluid
Physical activity
Psychological factors
Bowel habits
Medications
Diagnostic tests
Pathological conditions
Surgery & pain
Knowledge is
a Must!

6. Effects of Aging on GI Tract
Periodontal disease
Decrease in saliva
Decrease in gastric secretions
Smooth muscle changes, decreased esophageal peristalsis
Decreased GI motility

7. Always begin with
Assessment!

8. Subjective Assessment Questions
Usual pattern of bowel elimination?
Aids to elimination?
Recent changes in
bowel elimination?
Problems with bowel
elimination?

9. Physical Assessment Inspect mouth Abdomen Inspection Auscultation
Palpation

10. Stool Characteristics
Color
Odor
Consistency
Shape
Volume
Constituents

11. Laboratory Tests Void first NO toilet paper! Menstruating?
Fecal specimens for lab
Medical asepsis- wear gloves
Obtain specimen, label & seal container
Place container in biohazard bag
Send immediately to lab
Fecal occult blood bedside (POCT)
Medical asepsis
Small amount of stool
Follow instructions per tester

13. Esophagogastroduodenoscopy (EGD)
Diagnostic Studies
Nursing Care
Esophagogastroduodenoscopy (EGD)
Endoscopy
Upper GI series
Barium enema
Sigmoidoscopy
Before:
Consent signed
NPO
Lower GI studies: Bowel cleansing
Aftercare:
Vital signs
Throat soreness
Assess stools
Cathartics to cleanse barium from GI tract

14. Upper GI series
Barium Enema
Flexible Sigmoidoscopy

15. Alterations in
Bowel Elimination

16. Constipation (Symptom!)
Slowed gastric motility
Slowed passage of feces in large intestine
Fecal water content absorbed through walls
Result is dry, hard stool

17. Constipation Signs: infrequent bowel movements
difficulty passing stools
Excessive straining
Hypoactive bowel sounds

18. Constipation Causes: Decreased fiber Reduced fluid intake Immobility
Anxiety, depression
Medications
Abuse of laxatives
Delaying defecation

19. Valsalva Maneuver Individual bears down Thoracic/abdominal pressure
Blood flow to atria/ventricles = low CO
Bearing down stops
Large amount of blood returns to heart = BP

20. Nursing Interventions- Constipation
Provide privacy
Positioning
High fiber intake
Ambulation
Increase fluid intake to 2,000-3,000ml/day

21. Cathartics & Laxatives
Bulk forming
Metamucil
Stool swells
Emollient/stool softeners
Docusate sodium (colace)
Water & fat penetrates BM
Saline
MOM, Fleet enema
Draws water into intestine
Stimulant
Bisacodyl (dulcolax)
Irritate mucosa
Increase motility
Lubricants
Mineral oil
Coats & softens
feces

22. Enemas Instillation of solution into rectum/colon Promotes peristalsis
Fluid breaks up fecal mass
Stretches the rectal wall
Initiates defecation reflex
Indicated for relief of constipation, Impacted feces, diagnostic test/surgery

23. Types of Cleansing Enemas
Hypotonic- Tap water- give once only
Normal Saline -safest
Hypertonic Solutions- Fleets enema
Soapsuds-castile soap
Oil retention -lubricate/hold for hours
**Enemas till clear- do not repeat more than 3 times

24. Enemas Patient positioning Preparation of equipment
High enema- cleanses higher up colon
12-18 inches above anus
Low enema- cleanses rectum & sigmoid
12 inches or lower
Return flow enemas (Harris flush)

26. Impaction Collection of hardened feces wedged in rectum
Can be palpated by digital exam
Signs: oozing of diarrhea stool, frequency, rectal pain
Treatment: oil retention enema, cleansing enemas, suppositories, last resort…
Manual removal of impacted feces

27. Diarrhea Signs: Passage of excessively liquid, unformed stools
Contents pass through GI system too quickly = too much fluid & mucous
Causes:
Altered GI flora
Enteral nutrition
Food allergies
Food intolerances
Clostridium difficile
Food borne pathogens
Nausea & vomiting
Hyperactive
Bowel sounds
Abdominal cramps
Fluid & Electrolyte
Imbalances

28. Diarrhea Treatment Acute diarrhea: oral rehydration therapy,
Chronic diarrhea > 3-4 wks:
Replacement of fluids with electrolytes
Oral if tolerated
If severe, may need IV fluid replacement
Act on GI smooth muscle to slow motility
Paregoric (opiate deriv)
Lomotil
Imodium
Act as an absorbent
Kaopectate

29. In Closing….

30. QUESTIONS