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Bowel Elimination

Bowel Elimination. Chapter 46. Why do we care?. Alterations in elimination reflect problems in the GI tract or elsewhere Create problems for our patients

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Bowel Elimination

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  1. Bowel Elimination Chapter 46 C.Collings NRS320/105_ 2011

  2. Why do we care? • Alterations in elimination reflect problems in the GI tract or elsewhere • Create problems for our patients • If we understand ‘normal’ elimination and what factors cause alterations we can help patients manage alterations, promote normal elimination C.Collings NRS320/105_ 2011

  3. The GI Tract • Functions: • Prepare food for absorption & use • Absorb nutrients and fluid • Temporary storage of waste • Electrolyte balancing • Remove secretions [gallbladder, pancreas] C.Collings NRS320/105_ 2011

  4. GI Tract • Parts, Functions, and Essential Elements • Mouth: mechanical and chemical breakdown • Saliva, teeth, tongue, swallowing • Esophagus: to stomach, airway protection • 2 sphincters – upper and lower prevent reflux • Stomach: storage, mixing, emptying • HCL, pepsin [protein breakdown], mucous [protection], intrinsic factor [B12] C.Collings NRS320/105_ 2011

  5. GI Tract • Small intestine: Digestion and Absorption of most nutrients • Duodenum, jejunum, ileum • Duodenum [10”] processes chyme • Jejunum [8’] absorbs carbs, protein • Ileum [12’] absorbs H2O, fat, salts, vitamins, iron • Alterations in small intestine → malabsorption, nutrient deficiency, electrolyte imbalance C.Collings NRS320/105_ 2011

  6. GI Tract • Large Intestine: organ of elimination • ileocecal valve, 3 sections by location • Absorption of H2O, Na, Cl depends on speed • Bicarb exchanged for chloride, K+ excreted • Essential bacteria • Anus: sphincters [CNS control] Elimination relies on GI function, CNS control and sensation, moderate peristalsis C.Collings NRS320/105_ 2011

  7. Factors Affecting Elimination • Age & Development • Infant: small capacity, ↑speed, no control • Older Adult: ↓efficiency/motility/sensation → ↓absorption, protein synthesis, constipation • Diet: • fiber, gas-producing foods ↑motility • Lack of enzyme → food intolerance • lactose, gluten C.Collings NRS320/105_ 2011

  8. Factors Affecting Elimination • Fluid [1500-2000ml/day for normal stool] • Activity: promotes peristalsis, tone • Psychosocial: stress, depression, access • Privacy, cleanliness and impaired ability may →ignoring urge, constipation; embarrassment may cause delay in seeking help • Position [bedbound], Pain, Pregnancy • Surgery, Anesthesia ↓ peristalsis, ileus C.Collings NRS320/105_ 2011

  9. Factors Affecting Elimination • Medications affecting Elimination • Analgesics: opiods slow peristalsis • NSAIDS, ASA: irritation, bleeding, ↓protective mucous • Antibiotics: disrupt flora → diarrhea Elimination also Affects Medications • motility may affect absorption, excretion; which affects timing & effectiveness, side effects C.Collings NRS320/105_ 2011

  10. Alterations in Elimination • Constipation • Impaction • Diarrhea • Incontinence • Flatulence • Hemorrhoids • Neurogenic Bowel – lack of innervation C.Collings NRS320/105_ 2011

  11. Surgical Alterations • G- tubes and J- tubes for feeding • Ostomies for elimination • Name refers to site; ileostomy, colostomy • Site determines consistency of effluent, nutritional deficiencies likely • May be reversed or permanent • ACE procedure [antegrade continent enema] • (Malone) – creates opening for long term continent enemas using appendix • Neurogenic bowel R/T neural defect, tethered cord C.Collings NRS320/105_ 2011

  12. Nursing Dx for Elimination • Altered Elimination: constipation/diarrhea • Self- Care deficit • Knowledge deficit • [Risk for] Fluid/ Electrolyte imbalance • Pain • Nutrition: less than body requirements r/t altered digestion, elimination, absorption C.Collings NRS320/105_ 2011

  13. Assessment • Diet and intake • Elimination pattern ‘usual’ and new • bowel sounds, palpation & observation • Medications • Activity • Age • Appearance of stool – • Tarry/bright red smear – blood • Pale, clay mucous fatty C.Collings NRS320/105_ 2011

  14. Goals for Elimination • Overall: return to normal elimination pattern • Pt reports passing soft, formed stool daily w/o pain • Short term goals support modifiable factors: • Pt will increase fluid intake to 1500ml/ day • Pt will walk to end of hall and back 3X today C.Collings NRS320/105_ 2011

  15. Goals for Altered Patterns • Pt will correctly demonstrate ostomy care by end of week • Pt will independently perform ACE after breakfast today • Pt will demonstrate improved self-esteem R/T ostomy by next visit • Pt will choose a nutritionally balanced diet incorporating gluten-free foods from a list C.Collings NRS320/105_ 2011

  16. Nursing Interventions • Promote normal Elimination when possible • Position, privacy, pain management, safety • Advancing diets: clear, soft, regular, • Special diets: lactose free, gluten free, high fiber, fluid restriction • Activity • Medications: laxatives, softeners, fiber, cathartics, antidiarrheals, C.Collings NRS320/105_ 2011

  17. More Interventions • Enemas • Ostomy Care • Assessment, irrigation, change bag, skin care • NG tubes: for decompression, removal of gas/secretions • Bowel training • Education: Pt and family • vagal response [cardiac], Fluid restriction, meds, diet, new Dx, post-op, when to call M.D C.Collings NRS320/105_ 2011

  18. Evaluation • Goal met? • E.g., goal met: pt passed soft formed brown stool w/o pain today. Continue with plan of care • Advance education as pt progresses in ability and comfort, general health C.Collings NRS320/105_ 2011

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