BOWEL ELIMINATION

1. BOWEL ELIMINATION

2. BOWEL ELIMINATION • Bowel elimination is a basic physical need. • It is the excretion of wastes from the digestive system. • As a health care worker, you will deal with bowel elimination on a regular basis. • Remember, this can be embarrassing and uncomfortable for the pt. • Some people have BM’s OD, and some have them q2-3 days. It is important to know what is normal for that specific pt.

3. BOWEL ELIMINATION OBSERVATIONS • As a health care worker you must be able to make the following observations regarding bowel elimination and report/record any abnormalities. • Colour – brown, white, black/tarry, coffee grounds red/melena, pale, yellow, green, • Amount - (if diarrhea) • Consistency- soft, formed, liquid, hard • Odour – may be affected by food, infection • Shape – should be shaped like the rectum • Size – Lg, mod, sm • Frequency- varies • C/O Pain – constipation, nausea • Constituents – undigested food, blood, pus, worms, mucous

6. BOWEL ELIMINATION Physical activity Disability Pregnancy Medications Diet Psychological Positioning Anesthesia Dx tests Many factors affect bowel elimination including: • Age • Fluid intake • Personal habits • Pain • Surgery • Infection

7. COMMON BOWEL PROBLEMS

8. BOWEL ELIMINATION COMMON PROBLEMS Common problems include: Constipation: a condition in which BM’s are less frequent and stool is hard and dry as well as difficult to pass. • Defecation many cause pain and the client may only pass a very small amount of stool. • Constipation occurs when peristalsis slows down and more water is absorbed by the large intestine. There are many causes including: • low fiber diet * medications • ignoring the urge to defecate * aging • ↓ fluid intake * certain diseases • inactivity

9. BOWEL ELIMINATION • Fecal impaction: is the prolonged retention and accumulation of feces in the rectum when constipation is not relieved. • The feces becomes extremely hard and cannot be expelled. • If left untreated, a fecal impaction can lead to a complete bowel obstruction requiring surgery. • Most fecal impactions are manually removed. Signs/symptoms may include: • abd. swelling/cramping * fullness/pain in • N & V * fever • ↑ need to urinate • Liquid feces seeping from the anus

11. BOWEL ELIMINATION Diarrhea: the frequent passage of liquid stools. • The feces moves through the intestines at a rapid rate and fluid is not absorbed. • This causes urgency as well as cramping & nausea. • Causes can include anxiety, infection, food and medication intolerances. • Dehydration is a concern c diarrhea d/t the excessive fluid loss. • Dehydration can cause death, be aware of the signs/symptoms including: • pale, dry skin * oliguria • dry, cracked lips * thirst • weakness * dizziness • confusion * ↓ BP , P & R

12. BOWEL ELIMINATION Fecal Incontinence: is the inability to control the passage of feces and gas through the anus. Causes can include: • intestinal & nervous system diseases • injuries • fecal impaction • diarrhea • medications • Those with mental health issues, dementia or other cognitive disorders may not recognize the need to defecate. • They may also play with their stool.

13. BOWEL ELIMINATION • Flatulence: is the excessive formation of gas or air in the stomach and intestines. • The gas and air that is passed is called flatus. There are many causes including: • swallowing air • bacteria • gas forming foods • constipation • surgery • medications

14. BOWEL ELIMINATION SUPPOSITORIES • A bullet shaped solid medication that is inserted into a body opening. • Supps melt at body temperature • Rectal suppositories are usually given to relieve constipation and results take about 30 mins • Supps can also be used to relieve fever, nausea, and pain • Suppositories can be inserted by an RN,RPN, or PSW • Some pt.’s can self medicate.

15. BOWEL ELIMINATION ENEMAS • An enema is the introduction of fluid into the rectum and lower colon. • They are given to remove feces and relieve constipation or fecal impaction. • The most common type of enema is the commercial enema. • They irritate and distend the rectum to promote defecation. • Takes approx. 5-10 mins for results

16. BOWEL ELIMINATION OSTOMY • Surgical removal of part of the intestine is sometimes necessary. • This can be d/t cancer, disease or trauma. • An ostomy is the surgical creation of an artificial opening. This opening is called a stoma. • Stool consistency depends on the location of the ostomy. • The higher the ostomy the more liquid the stools

17. BOWEL ELIMINATION COLOSTOMY • A colostomy is the surgically created opening b/t the colon and the abd. wall. • Part of the colon is brought out onto the abd. wall and a stoma is made. • Feces and flatus pass through the stoma into a pouch. • Colostomies can be temporary ( diseased bowel can heal) or permanent (diseased bowel is removed).

19. BOWEL ELIMINATION ILEOSTOMY • An ileostomy is the surgically created opening b/t the ileum and the abd. wall. • The entire large intestine is removed. • Liquid feces drains constantly from an ileostomy. • Good skin care is essential. Ostomy pouches: • must fit well • must be emptied and cleaned frequently • An ostomy is a serious body image change. • It is imperative that health care professionals be empathetic to the needs of those with ostomies.

20. ILEOSTOMY