Concept of Elimination-1 (1).pptx.presentation
- 1. Bowl Elimination By Rubina Yasmin Nursing Instructor College Of Nursing & Midwifery FJMU. Lahore
- 2. Learning outcomes After completing this chapter, students will be able to: 1. Describe the physiology of defecation. 2. Identify factors that influence fecal elimination and patterns of defecation. 3. Identify common causes and effects of selected fecal elimination problems and describe methods used to assess fecal elimination. 4. Identify examples of nursing diagnoses, outcomes, and Interventions for clients with elimination problems. 5. Identify measures that maintain normal fecal elimination patterns.
- 3. Introduction • Elimination of waste products of digestion from the body is essential to health. • The excreted waste products are referred to as feces or stool.
- 4. Points to remember • Large intestine (colon) include the cecum; ascending, transverse, and ascending colon; sigmoid colon; rectum and anus. • Product of digestion flatus ( largely air, by product of digestion of CHO) and feces • Rectum contains folds that extend vertically containing a vain and an artery folds helps retain feces within the rectum
- 5. Elimination pattern • Elimination patterns describe the regulation, control, and removal of by-products and wastes in the body. The term usually refers to the movement of feces or urine from the body.
- 6. Main focus of elimination • Bowel elimination. • Urinary elimination.
- 8. Peristalsis Is wavelike movement produced by the circular and longitudinal muscle fibers of the intestinal walls; it propels the intestinal contents forward.
- 10. Defecation • Defecation is the expulsion of feces from the anus and rectum. It is also called a bowel movement. • Feces Made up of 75% water and 25% solid normally brown in color Escherichia coli or staphylococci
- 11. Physiology of defecation • Peristaltic waves move the feces into the sigmoid colon and the rectum • Sensory nerves in rectum are stimulated • Individual becomes aware of need to defecate • Feces move into the anal canal when the internal and external sphincter relax
- 12. Cont…. • External anal sphincter is relaxed voluntarily if timing is appropriate • Expulsion of the feces assisted by contraction of the abdominal muscles and the diaphragm • Moves the feces through the anal canal and expelled through anus • Facilitated by thigh flexion and a sitting position
- 14. Cont. 2. Diet: Sufficient bulk (cellulose, fiber) Insoluble fiber promotes the movement of material through the digestive system and increases stool bulk Soluble helps lower blood cholesterol and glucose levels. 3. Fluid Intake and Output: • Daily fluid intake of 2,000 to 3,000 ml. 4. Activity: • Activity stimulates peristalsis.
- 15. Cont. 5. Psychological Factors: Emotional instability increases peristaltic activity and subsequent nausea or diarrhea. 6. Defecation Habits: Ignores urge to defecate Weakened conditioned reflexes Habitually ignored
- 16. Cont. 7. Diagnostic Procedures The client is restricted in taking meals Prior thus normal defecation is placed in halt until eating resumes. 8. Medications: Side effects of drugs can interfere with normal elimination. 9. Pathologic Conditions: • Spinal cord injuries and head injuries can decrease the sensory stimulation for defecation.
- 17. Cont. 10. Pain: Clients who experience discomfort when defecating (e.g., following hemorrhoid surgery)
- 18. Problems of elimination • Constipation • Diarrhea • Bowel incontinence • Flatulence
- 19. Constipation It may be defined as fewer than 3 bowel movements per week. This infers the passage of dry, hard stool or the passage of no stool.
- 20. Characteristics of constipation • Decreased frequency of defecation. • Hard , dry stool. • Painful defecation. • Abdominal pain, cramps, or distension. • Anorexia , nausea • Headache • Reports of rectal fullness, or pressure, or incomplete bowel evacuation.
- 21. Causes and factors • Insufficient fiber intake • Insufficient fluid intake • Insufficient activity • Irregular defecation habits • Chronic use of laxative or enemas • Pelvic floor dysfunction or muscle damage • Poor motility
- 22. Causes…. • Neurological conditions e.g. stroke , paralysis • Emotional disturbance • Medications e.g. opioids, iron supplements, etc
- 23. Fecal impaction Mass or collection of hardened feces in folds of rectum that cannot be expelled or Fecal impaction is a severe bowel condition in which a hard, dry mass of stool becomes stuck in the colon or rectum. This immobile mass will block the passage and cause a buildup of waste, which a person will be unable to pass. Causes usually: • Poor defecation habits • Results from unrelieved constipation Treatment • Removed manually • Must have physician order
- 24. Fecal impaction
- 25. DIARRHEA • Passage of liquid feces and increased frequency of defecation Characteristics: •Spasmodic cramps, •increased bowel sounds •Fatigue, •weakness, •Malaise and emaciation • A symptom of disorders affecting digestion, absorption, and secretion of the GI tract
- 26. Causes • Stress, • Medications,( laxatives, cathartics) • Antibiotics • Allergies, • Intolerance of food or fluids, • Disease of colon e.g. malabsorption syndrome
- 27. FECAL INCONTINENCE • Loss of voluntary ability to control fecal and gaseous discharges • Generally associated with: Impaired functioning of anal sphincter or nerve supply • Neuromuscular diseases • Spinal trauma • Tumor of external anal sphincter muscle. •Nursing Considerations • Incontinence can harm a clients body image • Incontinence predisposes the skin to breakdown
- 28. FLATUENCE • It is the presence of excessive flatus in the intestines leads to stretching and inflation of intestines. • Flatulence can occur from variety of causes • Foods • Abdominal surgery • Narcotics
- 29. NANDA Nursing diagnosis for fecal elimination problems •Bowel Incontinence •Constipation •Risk for Constipation •Perceived Constipation •Diarrhea
- 30. Related nursing diagnosis Risk for Deficient Fluid Volume Risk for Impaired Skin Integrity Low Self-esteem Disturbed Body Image Deficient Knowledge Bowel Training Ostomy Management Anxiety
- 31. Outcomes • Maintain or restore normal bowel elimination pattern • Maintain or regain normal stool consistency • Prevent associated risks such as fluid and electrolyte imbalance, skin breakdown, abdominal distention and pain
- 32. Nursing considerations •Promoting regular defecations by the provision of privacy Timing Nutrition and fluid Exercise Positioning •Teaching about medications •Decreasing flatulence •Administering enemas •Applying a fecal incontinence pouch •Ostomy management
- 33. Ostomy • An ostomy is an opening for the gastrointestinal, urinary, or respiratory tract onto the skin. • Gastrostomy: (is an opening through the abdominal wall into the stomach) • Jejunostomy: (opens through the abdominal wall into the jejunum) • Ileostomy: (opens into the ileum (small bowel) • Colostomy: opens into the colon (large bowel).
- 34. Ostomy cont. • Gastrostomies and jejunostomies are generally performed to provide an alternate feeding route. • The purpose of bowel ostomies is to divert and drain fecal material • Stoma: • The opening created in the abdominal wall by the ostomy.
- 35. Ostomies • Ostomies can be temporary or permanent. • Temporary colostomies performed for traumatic injury or inflammatory conditions of the bowel. They allow the diseased portions of the bowel to rest and heal. • Permanent colostomies are performed to provide means of elimination when the rectum or anus is nonfunctional as a result of a birth defect or a disease such as cancer of bowel
- 36. Ostomies
- 38. References • Kozier& Erb‘s. Fundamentals of Nursing: concepts, process and practice, 11th Edition. • Potter & Perry's, Fundamentals of Nursing,2nd Edition