1. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 23 Bowel Elimination

2. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  Bowel elimination is the excretion of wastes from the gastrointestinal (GI) system.  Factors affecting bowel elimination include:  Privacy  Habits  Age  Diet and fluids  Exercise and activity  Drugs Slide 2

3. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Normal Bowel Elimination  Feces move through the intestines by peristalsis.  Feces move through the large intestine to the rectum.  Feces are stored in the rectum until excreted from the body.  Defecation (bowel movement [BM]) is the process of excreting feces from the rectum through the anus.  Frequency and time of bowel movements vary from person to person. Slide 3

4. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  Stools are normally brown, soft, formed, moist, and shaped like the rectum.  They have a normal odor.  Observe and report the following:  Color  Amount  Consistency  Presence of blood or mucus  Odor  Shape  Frequency of defecation  Complaints of pain or discomfort Slide 4

5. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Factors Affecting Bowel Elimination  The nurse considers the following factors when using the nursing process to meet the person’s elimination needs:  Privacy  Habits  Diet  Fluids  Activity  Drugs  Aging  Disability Slide 5

6. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Common Problems  Constipation is the passage of a hard, dry stool.  Constipation occurs when feces move slowly through the bowel.  A fecal impaction is the prolonged retention and buildup of feces in the rectum.  Feces are hard or putty-like.  Symptoms include abdominal discomfort, abdominal distention (swelling), nausea, cramping, and rectal pain; older persons may have poor appetite, confusion, or even a fever.  Fecal impaction results if constipation is not relieved. Slide 6

7. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  Diarrhea is the frequent passage of liquid stools.  Feces move through the intestines rapidly, causing fluid loss.  If fluid is not replaced, dehydration occurs.  Dehydration can lead to death.  Clostridium difficile is a microbe that causes diarrhea.  Signs of dehydration  Pale or flushed skin, dry skin, coated tongue  Urine is dark and scant in amount.  Thirst, weakness, dizziness, confusion  Falling blood pressure and increased pulse  Preventing the spread of infection is important!  Good hand hygiene  Standard Precautions and Bloodborne Pathogen Standard Slide 7

8. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  Fecal incontinence is the inability to control the passage of feces and gas through the anus.  Fecal incontinence affects the person emotionally.  The person with fecal incontinence may need: Bowel training Bowel training Help with elimination after meals and every 2 to 3 hours Help with elimination after meals and every 2 to 3 hours Incontinence products to keep garments and linens clean Incontinence products to keep garments and linens clean Good skin care Good skin care Slide 8

9. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  Flatulence is the excessive formation of gas or air in the stomach and intestines.  Gas and air passed through the anus is called flatus.  If flatus is not expelled, the intestines distend. Abdominal cramping or pain, shortness of breath, and a swollen abdomen occur. Abdominal cramping or pain, shortness of breath, and a swollen abdomen occur. Slide 9

10. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Bowel Training  Bowel training is used to  Gain control of bowel movements.  Develop a regular pattern of elimination. Fecal impaction, constipation, and fecal incontinence are prevented. Fecal impaction, constipation, and fecal incontinence are prevented.  The person’s usual time of day for a BM is noted on the care plan.  The nurse tells you about a person’s bowel training program. Slide 10

11. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Enemas  The introduction of fluid into the rectum and lower colon is called an enema.  Doctors order enemas:  To remove feces  To relieve constipation, fecal impaction, or flatulence  To clean the bowel of feces before certain surgeries and diagnostic procedures  The doctor orders the enema solution. Slide 11

12. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  The solution depends on the enema’s purpose.  Tap-water enema (obtained from a faucet)  Saline enema (a solution of salt and water)  Soapsuds enema (SSE)  Small-volume enema  Oil-retention enema  Do not give enemas that contain drugs. Slide 12

13. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  Cleansing enemas:  Clean the bowel of feces and flatus  Relieve constipation and fecal impaction  Are needed before certain surgeries and diagnostic procedures  Tap-water enemas can be dangerous.  The saline enema solution is similar to body fluid.  Soapsuds enemas irritate the bowel’s mucous lining.  Small-volume enemas irritate and distend the rectum.  They are often ordered for constipation.  They are ordered when the bowel does not need complete cleansing.  Oil-retention enemas relieve constipation and fecal impactions. Slide 13

14. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. The Person with an Ostomy  An ostomy is a surgically created opening for the elimination of body wastes.  The opening is called a stoma.  The person wears a pouch over the stoma to collect stools and flatus.  Colostomy  With a permanent colostomy, the diseased part of the colon is removed.  A temporary colostomy gives the diseased or injured bowel time to heal.  The colostomy site depends on the site of disease or injury.  Stool consistency depends on the colostomy site.  Skin care prevents skin breakdown around the stoma. Slide 14

15. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  Ileostomy  The entire colon is removed.  Liquid stools drain constantly from an ileostomy.  The ileostomy pouch must fit well.  Stools must not touch the skin.  Good skin care is required. Slide 15

16. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  Ostomy pouches are emptied when stools are present.  The pouch is opened when it balloons or bulges with flatus.  The drain is wiped with toilet tissue before it is closed.  The pouch is changed every 3 to 7 days and when it leaks. Frequent pouch changes can damage the skin.  The person can wear normal clothes.  Showers and baths are delayed for 1 to 2 hours after applying a new pouch to allow the adhesive to seal to the skin.  Do not flush pouches down the toilet. Slide 16

17. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Quality of Life  Protect the person’s rights.  Assist with bowel elimination as directed by the nurse and the care plan.  Do all you can to protect the person’s right to privacy.  Residents have the right to personal choice. Slide 17