Bowel Elimination
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The document discusses bowel elimination and defecation, outlining various factors that can affect regularity such as diet, fluid intake, medications, and medical conditions. It also covers common fecal elimination problems like constipation, diarrhea, flatulence, and hemorrhoids, and provides measures to help relieve each issue including lifestyle changes, medications, and surgical options when needed.
Bowel Elimination
- 1. Bowel Elimination By Richard Araneta
- 2. Bowel Elimination Defecation – is the expulsion of feces from anus and rectum
- 3. Principles Quality varies with the amount of food consumed and absorbed Consistency of stool depends on the length of time the contents are in the GIT and the type of food eaten
- 4. Factors Affecting Defecation Age and development Diet – some foods are impossible for some people to digest Fluid intake – in adequate, chyme becomes more dry Activity – it stimulates peristalsis (movement of food in the small intestine)
- 5. Factors Affecting Defecation Psychologic Factors Anxious and angry – diarrhea Depressed – constipation Lifestyle – Ex: availability of toilet facilities Medications Laxatives – stimulate bowel movement Bentyl – suppresses peristaltic activity
- 6. Factors Affecting Defecation Pathologic Conditions – Ex: spinal cord and injuries Anesthesia and surgery – Ex: Paralytic ileus (no movement in the small intestines) Irritants – Ex: spicy foods, bacterial toxins Pain
- 7. Normal Characteristics of Stool Color Yellow or golden brown (due to bile pigment derivative known as stercobilin) Amount Depends on the bulk of food intake
- 8. Alterations in the Characteristics of Stool Acholic Stools Grey, pale, or clay colored, due to biliary obstruction Hematochezia Passage of stool with bright red blood due to lower GI bleeding Melena Passage of black tarry stools due to upper GI bleeding Steatorrlea Greasy, bulky, foul smelling stool due to hepatobilary pancreatic obstruction of disorders
- 9. Common Fecal Elimination Problems Constipation Fecal impaction Diarrhea Fecal incontinence Flatulence Hemorrhoids
- 10. I. Constipation Passage of small, dry, hard stools of the non- passage of stool for a period of time
- 11. Measures to Relieve Constipation Adequate fluid intake High fiber diet Establish regular pattern of defecation Respond immediately to the urge to defecate Minimize stress
- 12. Measures to Relieve Constipation Adequate activity and exercise Laxatives as ordered Avoid overuse, may lead to rebound effect Enzymes Cleansing or non-retention Retention Return flow Suppositions
- 13. Types of Laxatives Stool lubricants Lubricates feces and facilitates its expulsion Ex: Mineral oil Stool/enrollment softeners Soften and delays the drying of the feces; permits fat and water to penetrate feces Ex: Colace Bulk formers Ex: Metamucil
- 14. Types of Laxatives Osmotic agents Attracts fluids from intestinal capillaries to stool Ex: Milk of Magnesia – lactose, magnesium citrate Chemical irritants Increase peristalsis Ex: dulcolax, castor oil, cascera sagrado
- 15. II. Fecal Impaction Is a mass or collection of hardened putty-like feces in the folds of the rectum
- 16. Measures to Relieve Impaction Increase fluid intake Sufficient bulk in diet Adequate activity and exercise Manual extraction Water out for vagal stimulation -> decrease cardiac activity
- 17. III. Diarrhea Passage of liquid feces and increased frequency of defecating
- 18. Measures to Relieve Diarrhea Replace fluid-electrolyte loss Good peri-anal care Promote rest Diet bland foods: decrease fiber diet BAR (banana, apple, rice am) Avoid excessively hot and cold fluids Give potassium rich foods
- 19. Measures to Relieve Diarrhea Anti-diarrheal drugs Demulcents – coat the irritated bowel, acts as protective Absorbents – absorb gas and toxic substances from the blood Astringents – shrink swollen or inflamed tissues
- 20. IV. Flatulence Presence of excessive gas in the intestines (tympanism)
- 21. Measures to Relieve Flatulence Avoid gas forming foods Limit carbonated drinks, drinking straws, chewing gum Provide warm fluids to drink Early ambulation: prone or knee chest positions Adequate activity and exercise Rectal tube – 3-4 inches; for 22-30 Cholinergic as ordered Carminative enemas as ordered (60-180cc fluid or herbal oils)
- 22. V. Fecal Incontinence Inability of anal sphincter to control the discharge of fecal and gaseous material Ex: in neuromuscular disease, spinal cord injuries, aging process, etc.
- 23. Nursing Care for Fecal Incontinence Good peri-anal care Use of fecal collector (pouch/ diapers) Provide emotional support
- 24. VI. Hemorrhoids Also called “piles”, distended veins in the anal area
- 25. Nursing Care and Management Astringents to shrink tissues Local anesthetics Stool softeners Surgery – hemorrhoidectomy