1. Bowel Elimination
Chapter 49

2. Physiology of Defecation
Elimination of waste products of digestion from the body is essential to health
Excreted waste products are referred to as feces or stool

4. Defecation Defecation is the process of elimination of waste. Feces
Causes distention of rectum
Stimulates stretch receptors

5. Characteristics of Feces Tab 49-1 pg. 1213
Color
Consistency
Shape
Amount
Odor
Constituents

6. Factors Affecting Bowel Elimination
Developmental
Diet
Activity
Psychological
Defecation habits

7. Factors Affecting Bowel Elimination
Medications
Diagnostic procedures
Anesthesia and Surgery
Pathological conditions
Pain

8. Constipation Decreased frequency of defecation
Hard, dry, formed stools
Causes

9. Fecal Impaction
Mass or collection of hardened feces in folds of rectum
Passage of liquid fecal seepage and no normal stool
Causes
Treatments

10. Diarrhea Passage of liquid feces and increased frequency of defecation
Causes
Concerns???
Client teaching (pg. 1222)

11. Bowel (Fecal) Incontinence
Loss of voluntary ability to control fecal and gaseous discharges
Causes

12. Flatulence
AKA “gas”
May lead to gastric distension

13. Assessment (pg. 1220) Normal bowel patterns Changes in bowel habits
History of elimination problems
Bowel elimination aids, including diet, exercise, medications, etc
Focused physical assessment
Stool appearance
Diagnostic studies
Stool specimens in lab

14. Nursing Process
Nursing Diagnoses

15. Nursing Process
Goals
Interventions

16. Interventions to Promote Regular Defecation
Privacy
Timing
Nutrition/fluids
Constipation
Diarrhea (client teaching pg. 1223)
Flatulence
Exercise
Positioning

17. Implementing: Teaching about Medications
Laxatives
Suppositories
Antidiarrheal medications
Antiflatulence medications

18. Enemas
Cleansing
Retention
Return-flow

19. Cleansing Enema Hypotonic Isotonic Hypertonic
Water moves out of colon after it stimulates peristalsis
Isotonic
No fluid movement in or out of the colon
Hypertonic
Attracts water into colon causing distention
Small volume

20. Retention Enema Retained for prolonged period (1–3 hrs.) Softens feces
Lubricates

21. Return-Flow Enema Expel gas Relieve abd. Distention
ml water or saline
Allow solution to flow back into container

22. Administering Enemas Guidelines (pg. 1227-1230)
Per clinical learning lab

23. Bowel Training Programs
Indications
Phases

24. Mrs. Phillip case study
In a small group, discuss the Mrs. Phillip’s case study.