1. King Saud University College of Nursing Fundamentals of Nursing Bowel Elimination

2. The Gastrointestinal System

3. The Large Intestine  Primary organ of bowel elimination  Extends from the ileocecal valve to the anus  Functions 1.Absorption of water & Nutrients. 2. Mucoid protection of the intestinal wall. 3.Formation of feces. 4.Fecal elimination.

4. Process of Defecation  When the Peristaltic waves move the feces into the sigmoid colon and rectum, the sensory nerves in the rectum are stimulated and the individual becomes aware of the need to defecate.  When the internal anal sphincter relaxes, feces move into the anal canal,the external anal sphincter is relaxed voluntary.  Expulsion of feces is assisted by contraction of the abdominal muscle, and the downward pressure on the rectum.

5. Factors Influencing Bowel Elimination 1.Developmental considerations 2.Daily patterns 3.Food and fluid 4.Activity and muscle tone 5.Lifestyle, psychological variables 6.Pathologic conditions 7.Medications 8.Diagnostic studies 9.Surgery and anesthesia

6. Effect of Medications on Stool  Aspirin, anticoagulants — pink to red to black stool  Iron salts — black stool  Antacids — white discoloration or speckling in stool  Antibiotics — green-gray color

7. Promoting Regular Bowel Habits  Timing  Positioning  Privacy  Nutrition  Exercise –Abdominal muscles strengthening. –Thigh muscles strengthening.

8. Copyright 2008 by Pearson Education, Inc. Assessment of Fecal Elimination  Nursing history  Physical examination  Review of data from any diagnostic tests Nursing Diagnosis  Bowel Incontinence  Constipation  Risk for Constipation  Perceived Constipation  Diarrhea

9. Individuals at High Risk for Constipation 1.Patients on bed rest taking constipating medicines such as opioids, iron, antacids. 2.Patients with reduced fluids or bulk in their diet. 3.Patients who are depressed. 4.Patients with central nervous system disease or local lesions that cause pain.

10. Nursing Measures for the Patient With Diarrhea 1.Increase the fluid intake ( 8 glasses of water/day) 2.Remove the cause of diarrhea whenever possible (e.g., medication). 3.Limit fatty foods and beverages with caffeine. 4.Limit food containing high fibers such as cereals and whole grain breads, raw fruits & vegetables. 5.Give special care to the region around the anus. 6.After diarrhea stops, suggest the intake of fermented dairy products such as yogurt.

11. Methods of Emptying the Colon of Feces 1.Enemas a. Cleansing Enema, given to : – Prevents escape of feces during surgery –Prepare intestines for certain diagnostic tests e.g Colonoscopy. –Removes feces in instances of constipation or impaction b. Retention Enema: - Introduces oil or medication into the rectum and sigmoid colon - Introduces oil or medication into the rectum and sigmoid colon c. Return-flow Enema c. Return-flow Enema - Used primarily to expel flatus in cases of abdominal distension - Used primarily to expel flatus in cases of abdominal distension 2. Rectal suppositories 3. Rectal catheters

12. Common Enema Solutions and Actions 1.Hypertonic (Fleet phosphate) 1.Draws water from the intestinal space into the colon 2.Hypotonic (tap water) 1.Distends the colon 2.Stimulates peristalsis 3.Softens feces 3.Isotonic (physiologic normal saline) 1.Distends the colon 2.Stimulates peristalsis 3.Softens feces 4.Soapsuds (pure soap) 1.Irritate the mucosa 2.Distends the colon 5.Oil (mineral, olive) 1.Lubricates feces and colonic mucosa