BOWEL ELIMINATION N116

Promoting normal bowel elimination Elimination pattern and habits varies among individuals Support patients’ privacy and emotional needs Minimize discomfort

GI System A and P review

defecation Contraction and relaxation of the internal and external sphincters Anal canal is innervated by sympathetic and parasympathetic systems that allow control of continence Abdominal muscles contract, increasing intrarectal pressure Valsalva maneuver (next slide)

Valsalva maneuver Contraction of abdominal muscles while maintaining a forced expiration against a closed airway Do not encourage in people with CV disease, glaucoma, IICP, or new surgical wound

Factors influencing bowel elimination Age Diet Fluid intake Physical activity Psychological factors Personal habits Position Pain

Factors influencing bowel elimination Pregnancy Surgery and anesthesia Medications Diagnostic tests

Some common elimination problems Constipation Impaction Diarrhea Incontinence Flatulence Hemorrhoids

Causes of constipation Irregular bowel habits, ignoring urge Chronic illness Low fiber, high fat diet Low fluid intake Anxiety, depression Laxative misuse Slowed peristalsis Medication side effects Neurological conditions

Bowel diversions Ileostomy

Bowel diversions colostomy

Think!!! What nursing diagnoses are associated with a person with constipation? What nursing diagnoses are associated with a person who has a colostomy appliance?

assessment Physical assessment: bowel tones, ability to chew, abdominal masses or tenderness, rectal inflammation, hemorrhoids Laboratory : fecal specimens for c&s, c. diff, guaiac Diagnositic: endoscopy, KUB (abd xray), upper GI (barium swallow) lower GI (barium enema), US

Promoting bowel function Assist to sitting upright Bedpan : head 30 degrees, bend legs to “squatting” postion ( fig 46-170 Provide privacy Provide perineal cleansing

Promoting bowel function Cathartics, laxatives, stool softeners Suppositories, enemas Digital disimpaction (requires provider order) Routine/training Proper food and fluid intake