1. Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 21 Bowel Elimination

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

3. Slide 3 Copyright © 2007, 2003 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) is the process of excreting feces from the rectum through the anus.  Frequency and time of bowel movements vary from person to person.

4. Slide 4 Copyright © 2007, 2003 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. They have a normal odor.  Observe and report the following: Color Color Amount Amount Consistency Consistency Presence of blood or mucus Presence of blood or mucus Odor Odor Shape Shape Frequency of defecation Frequency of defecation Complaints of pain or discomfort Complaints of pain or discomfort

5. Slide 5 Copyright © 2007, 2003 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 Privacy Habits Habits Diet Diet Fluids Fluids Activity Activity Drugs Drugs Aging Aging Disability Disability

6. Slide 6 Copyright © 2007, 2003 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. 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. Feces are hard or putty-like. Fecal impaction results if constipation is not relieved. Fecal impaction results if constipation is not relieved.

7. Slide 7 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Diarrhea is the frequent passage of liquid stools. Feces move through the intestines rapidly. Feces move through the intestines rapidly. Fluid lost through diarrhea is replaced. Fluid lost through diarrhea is replaced. If fluid is not replaced, dehydration occurs. If fluid is not replaced, dehydration occurs. Dehydration can lead to death. Dehydration can lead to death.  Fecal incontinence is the inability to control the passage of feces and gas through the anus. Fecal incontinence affects the person emotionally. Fecal incontinence affects the person emotionally.

10. Slide 10 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. The person with fecal incontinence may need: The person with fecal incontinence may need:  Bowel training  Help with elimination after meals and every 2 to 3 hours  Incontinence products to keep garments and linens clean  Good skin care  Flatulence is the excessive formation of gas or air in the stomach and intestines. Gas and air passed through the anus is called flatus. Gas and air passed through the anus is called flatus. If flatus is not expelled, the intestines distend. If flatus is not expelled, the intestines distend.  Abdominal cramping or pain, shortness of breath, and a swollen abdomen occur.

11. Slide 11 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  BOWEL TRAINING HAS TWO GOALS:  To gain control of bowel movements  To develop a regular pattern of elimination Fecal impaction, constipation, and fecal incontinence are prevented. Fecal impaction, constipation, and fecal incontinence are prevented.

12. Slide 12 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  ENEMAS  Doctors order enemas: To remove feces To remove feces To relieve constipation, fecal impaction, or flatulence To relieve constipation, fecal impaction, or flatulence To clean the bowel of feces before certain surgeries and diagnostic procedures To clean the bowel of feces before certain surgeries and diagnostic procedures  The doctor orders the enema solution.

13. Slide 13 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  The solution depends on the enema’s purpose. Tap-water enema (obtained from a faucet) Tap-water enema (obtained from a faucet) Saline enema (a solution of salt and water) Saline enema (a solution of salt and water) Soapsuds enema (SSE) Soapsuds enema (SSE) Small-volume enema Small-volume enema Oil-retention enema Oil-retention enema  Do not give enemas that contain drugs.

14. Slide 14 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Cleansing enemas: Clean the bowel of feces and flatus Clean the bowel of feces and flatus Relieve constipation and fecal impaction Relieve constipation and fecal impaction Are needed before certain surgeries and diagnostic procedures Are needed before certain surgeries and diagnostic procedures Tap-water enemas can be dangerous. Tap-water enemas can be dangerous. The saline enema solution is similar to body fluid. The saline enema solution is similar to body fluid. Soapsuds enemas irritate the bowel’s mucous lining. Soapsuds enemas irritate the bowel’s mucous lining.  Small-volume enemas irritate and distend the rectum. They are often ordered for constipation. They are often ordered for constipation. They are ordered when the bowel does not need complete cleansing. They are ordered when the bowel does not need complete cleansing.  Oil-retention enemas relieve constipation and fecal impactions.

18. Slide 18 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  THE PERSON WITH AN OSTOMY  An ostomy is a surgically created opening. The opening is called a stoma. The opening is called a stoma. The person wears a pouch over the stoma to collect stools and flatus. 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. With a permanent colostomy, the diseased part of the colon is removed. A temporary colostomy gives the diseased or injured bowel time to heal. A temporary colostomy gives the diseased or injured bowel time to heal. The colostomy site depends on the site of disease or injury. The colostomy site depends on the site of disease or injury. Stool consistency depends on the colostomy site. Stool consistency depends on the colostomy site. Skin care prevents skin breakdown around the stoma. Skin care prevents skin breakdown around the stoma.

20. Slide 20 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Ileostomy The entire colon is removed. The entire colon is removed. Liquid stools drain constantly from an ileostomy. Liquid stools drain constantly from an ileostomy. The ileostomy pouch must fit well. The ileostomy pouch must fit well. Stools must not touch the skin. Stools must not touch the skin. Good skin care is required. Good skin care is required.

22. Slide 22 Copyright © 2007, 2003 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 pouch is opened when it balloons or bulges with flatus. The drain is wiped with toilet tissue before it is closed. The drain is wiped with toilet tissue before it is closed. The pouch is changed every 3 to 7 days and when it leaks. The pouch is changed every 3 to 7 days and when it leaks. Odors are prevented. Odors are prevented. The person can wear normal clothes. The person can wear normal clothes. Showers and baths are delayed for 1 to 2 hours after applying a new pouch. Showers and baths are delayed for 1 to 2 hours after applying a new pouch. Do not flush pouches down the toilet. Do not flush pouches down the toilet.

24. Slide 24 Copyright © 2007, 2003 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.