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Bowel Elimination

Bowel Elimination. NUR101 Fall 2008 Lecture # 23 K. Burger, MSEd, MSN, RN, CNE PPP By: Sharon Niggemeier RN MSN J Borrero 12/08. Functions of the GI Tract. Prepare fluids and nutrients for absorption and use by cells via mechanical and chemical breakdown Absorb fluids and nutrients

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Bowel Elimination

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  1. Bowel Elimination NUR101 Fall 2008Lecture # 23 K. Burger, MSEd, MSN, RN, CNE PPP By: Sharon Niggemeier RN MSN J Borrero 12/08

  2. Functions of the GI Tract • Prepare fluids and nutrients for absorption and use by cells via mechanical and chemical breakdown • Absorb fluids and nutrients • Receives secretions from organs (eg. gallbladder, pancreas)

  3. Anatomy & Physiology • Organs of the GI tract? • Function of Large intestine: absorption Extends from Ileocecal valve to anus • Chyme • Peristalsis & Mass peristalsis

  4. Act of Defecation • Defecation reflex • Valsalva maneuver • Defecation

  5. Alteration in Bowel Elimination • Diarrhea • Constipation • Incontinence • Fecal Impaction • Flatulence

  6. Characteristics of Stool • Volume • Color • Odor • Consistency • Shape • Constituents

  7. Factors That Influence Bowel Elimination • Age • Fluid Intake & Diet • Daily Routine • Activity • Medications • Health Status • Stress

  8. High fiber foods: Legumes (beans) Cereals Whole grains Raw Fruits Vegetables Laxative effect foods: Spicy & greasy Bran/Chocolate Coffee/Alcohol Raw fruits & vegetables Diet

  9. Assessing Elimination Status • Usual pattern • Changes in bowels • Aids to eliminate • Current problems

  10. Physical Assessment • Inspection- observe contour of abd and note visible peristalsis • Auscultation- listen for bowel sounds all quadrants • Percussion- resonant or tympany over hollow organs…dullness over intestinal obstruction • Palpation- feel for masses, tenderness etc…

  11. Stool Specimen Collection • Routine specimen • Occult blood • Ova & parasite • Timed specimens

  12. Nursing Dx R/T Bowel Elimination ?

  13. Outcome Criteria • Pt. will: • Develop regular pattern of elimination • Have less episodes of incontinence • Incorporate fluids/diet that promote bowel elimination

  14. Interventions to Promote Elimination • Routine • Positioning • Privacy • Comfort • Activity • Diet/Fluids

  15. Interventions: Promote Bowel Elimination • Laxatives and Cathartics • Enemas • Suppositories • Digital Removal

  16. Types of Enemas

  17. Enema Solutions • Tap water (Hypotonic) • Normal saline (Isotonic) • Soap • Hypertonic • Oil

  18. Tap Water (TWE) • Amount: 500-1000cc • Action: Distends, increases peristalsis • Time: 15 min. • Indicated: inflamed bowels/irritated colon • Contraindicated: Atonic bowels, fluid restrictions

  19. Normal Saline • Amount: 500-1000cc • Action: Distends, increases peristalsis • Time: 15 min. • Indicated:Inflamed bowels/irritated colon • Contraindicated: Na retention problems, fluid restrictions

  20. Soap (SSE) • Amount: 500-1000cc (Castile 5ml/1000cc) • Action: Distends, Irritates • Time: 15 min. • Indicated: Constipation • Contraindicated: Prior to rectal exams

  21. Hypertonic • Amount: 70-130 cc solution • Action: Distends/Irritates • Time: 5-10 min. • Indicated: Constipation, convenience • Contraindicated: Dehydration, Na problems

  22. Oil Retention • Amount: 120-200cc • Action: Lubricates • Time: 30 min. • Indicated: Fecal impaction • Contraindication: none

  23. PPE Position L Sims Linen protector Receptacle (bedpan, commode, toilet) IV pole Lubricant Enema bag with solution Tissue paper Enema Administration

  24. Enema Administration • Position L Sims • Insert lubricated tip 4” • Bag raised 18-20” above anal canal • Administer slowly - 10 min. • Administration is individualized. • Pt. holds for 15 min.

  25. Solution given Amount expelled Characteristics of stool Passing of flatus Unusual findings blood, helminthes, pus etc. Client reaction: change in skin color, VS changes, fatigue Evaluation

  26. Medications Effecting Bowel Elimination • Laxatives- induce emptying of GI tract • Antidiarrheal- slow peristalsis, Pepto Bismol, Kaopectate • Codeine/morphine/iron- cause constipation • Antibiotics-may cause diarrhea • Opiates: paragoric, lomotil- habit forming

  27. Causes: Decreased peristalsis Constipation Medications Surgery Diet Stress Decreased activity Flatulence

  28. NonInvasive Interventions for Flatulence *Ambulation* • Knee chest position

  29. Invasive Interventions for Flatulence • Glycerin Suppository • Harris Flush • Rectal Tube

  30. Evaluation of Bowel Function • Achievement of regular defecation habits • Patient’s understanding of normal elimination • Maintenance of adequate food and fluid intake • Regular exercise program • Comfort • Skin integrity

  31. Gastrointestinal Charting Chuckles The patient had waffles for breakfast and anorexia for lunch. She stated that she had been constipated for most of her life until 1989, when she got a divorce. Bleeding started in the rectal area and continued all the way to Los Angeles. Rectal examination revealed a normal-size thyroid. The patient was to have a bowel resection. However, he took a job as a stockbroker instead. Fleet enema given with stool hard as pine knots. Patient complains of indigestion since last night when he ate a stake. Patient passed flatus . . . two short, one long. Patient was seen in consultation by the physician, who felt we should sit tight on the abdomen, and I agreed.

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