Chapter 22 Bowel Elimination All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Bowel Elimination   Bowel elimination is the excretion of wastes from the gastro-intestinal (GI) system.   Factors affecting bowel elimination include:   Privacy   Habits   Age   Diet and fluids   Exercise and activity   Drugs 2 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

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. 3 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Stool   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 4 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

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 5 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

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. 6 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Diarrhea and Dehydration   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 7 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Fecal Incontinence   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 Help with elimination after meals and every 2 to 3 hours Incontinence products to keep garments and linens clean Good skin care 8 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Flatulence   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. 9 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

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.   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. 10 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

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. 11 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Enema Solutions   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. 12 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Cleansing Enemas   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. 13 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

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. 14 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Ileostomy Basics   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. 15 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Ostomy Pouches   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. 16 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

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. 17 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.