1. BOWEL ELIMINATION
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2. Promoting normal bowel elimination
Elimination pattern and habits varies among individuals
Support patients’ privacy and emotional needs
Minimize discomfort

3. GI System A and P review

4. 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)

5. 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

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

7. Factors influencing bowel elimination
Pregnancy
Surgery and anesthesia
Medications
Diagnostic tests

8. Some common elimination problems
Constipation
Impaction
Diarrhea
Incontinence
Flatulence
Hemorrhoids

9. 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

10. Bowel diversions
Ileostomy

11. Bowel diversions
colostomy

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

13. 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

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

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