1. Bowel Elimination Parts of the GI system Functions
mouth
pharynx
esophagus
stomach
small intestine (20-21’)
duodenum
jejunum
ileum
large intestine (4-5’)
cecum
ascending colon
transverse colon
descending colon
sigmoid colon
rectum
Functions
digestion of food
elimination of waste

2. Bowel Elimination Peristalsis
in small intestine the peristaltic waves are frequent
in large intestine there is mass peristalsis
this muscular contraction goes the length of the colon (toward the anus)
occurs 2 to 4 times a day
strongest during the hour after mealtime

3. Bowel Elimination Feces Rectum
name for the waste products when they reach the sigmoid colon
Rectum
in the adult is 4 to 6 inches long
contains folds of tissue which contain a vein and an artery
when the veins become distended (as with repeated pressure) a condition known as hemorrhoids can occur

4. Bowel Elimination Anal canal most distal portion of the rectum
bounded by internal and external sphincter muscles
internal sphincter cannot be controlled voluntarily
external sphincter under voluntary control

5. Common Problems Constipation Fecal impaction
passage of small, dry, hard stool OR the passage of no stool for a period of time
Fecal impaction
mass or collection of hard, puttylike feces in the folds of the rectum that cannot be expelled
passage of liquid fecal seepage (diarrhea) and no normal stool
digital exam by nurse

6. Common Problems Diarrhea Fecal incontinence
passage of liquid feces and an increased frequency of defecation
difficult or impossible to control for very long the urge to defecate
Fecal incontinence
loss of voluntary ability to control fecal and gaseous discharges thru the anal sphincter
digestive enzymes are highly irritating to skin

7. Common Problems Flatulence Hemorrhoids
the presence of excessive flatus in the intestines
flatus is air or gas in the intestinal tract
Hemorrhoids
common name: piles
symptoms
pain
itching
bleeding

8. Characteristics of Feces
Color
brown
black, tarry
clay-colored
green or orange
Consistency
soft
75% water
25% solid material

9. Characteristics of Feces
Shape
normally stool has shape of rectum
stringlike or ribbon- like
Odor
results from action of bacteria in the intestine
rotten odor
Blood
abnormal
frank vs occult

10. Enemas Types Cleansing cleansing retention other large volume enema
tap water (TWE)
saline (NS)
soap solution (SSE)

11. Enemas Cleansing large volume enema small volume enema 500 to 1500 cc
stimulate peristalsis by distention of rectum & colon
SSE causes chemical irritation
small volume enema
Fleet Brand
amount of solution 4and 1/2 ounces (135 cc)
stimulate peristalsis by a mild chemical irritation and by pulling water into colon (causes distention)

12. Enemas Retention enema Preparation of patient
solution is instilled into rectum and allowed to remain there
example: oil retention
Preparation of patient
hospital gown only
fanfold covers then put blanket over patient
pad the bed!!
left Sim’s position

13. Enemas Administration of enema hang enema bag
lubricate tip with lubricant
insert tip into rectum
locate anus--have patient take deep breath
aim in direction of navel
insert 3 to 4 inches
hold onto tube
control flow with clamp

14. Enemas Administration of enema if patient c/o cramps or abdominal pain
slow, deep breaths thru mouth
slow down rate of fluid
hold solution as long as possible (5 to 10 min)
expel enema into bedpan, BSC, toilet
“don’t flush”
check for results

15. Bowel Care Incontinence care Fecal Containment Device (FCD)
Prevacare No-Rinse Cleanse
Prevacare Extra Protective Ointment
if no breakdown
Convatec SensiCare
for example if pt. has diarrhea 6 or more times a day
charged item
Fecal Containment Device (FCD)

16. Bowel Care Fecal disimpaction Flatulence Bowel diversion ostomies
not a PCA function
Flatulence
walking
rectal tube
Bowel diversion ostomies
colostomy
ileostomy