1. Chapter 31:
Bowel Elimination

2. Defecation Defecation: the act of expelling feces from the body
Peristalsis: rhythmic contractions of intestinal smooth muscle to facilitate defecation
Gastrocolic reflex: increased peristaltic activity occurring during food consumption
Valsalva maneuver: increasing abdominal muscle pressure to facilitate defecation

3. Assessment of Bowel Elimination
Elimination patterns- frequency of elimination, effort to expel stool. and any elimination aids used
Stool characteristics – color, odor, consistency shape and unusual components (table 31-2)

4. Common Alterations in Bowel Elimination
Constipation- dry hard stool that is hard to pass
Primary- inactivity, low fiber intake, insufficient fluid intake, ignoring the urge
Secondary-pathological- partial bowel obstruction
Iatrogenic-medical tx- prolonged use of narcotics
Pseudoconstipation-”think they are constipated”- Chronic purging weakens bowel tone

5. Common Alterations in Bowel Elimination (cont’d)
Fecal impaction-large mass interferes with defecation, cause unrelieved constipation
See N G 31-2 page 734
Flatulence- excessive accumulation of intestinal gas
Diarrhea-urgent passage of watery stool
Fecal incontinence-inability to control elimination

6. Nursing Measures Treat Constipation
Primary constipation- encourage dietary fiber, fruits and vegetables, increase fluid intake
Education
Laxative abuse due to very bowel- conscious older adults
Effects of prolonged use of mineral oil

7. Measures to Promote Bowel Elimination
Two physician-ordered interventions to promote elimination when not naturally occurring
Insert a rectal suppository
Administer an enema
Cleansing enemas
Tap water, normal saline
Soapsuds, hypertonic saline

8. Measures to Promote Bowel Elimination (cont’d)
Administer an enema (cont’d)
Retention enemas
Oil retention enema
Mineral, cottonseed, or olive oil
Retained at least 30 minutes
Lubricate and soften stool to ease stool expulsion

9. Ostomy Care Ileostomy: surgically created opening to the ileum
Colostomy: surgically created opening to the colon
Providing peristomal care
Applying an ostomy appliance(page 751)
Draining a continent ileostomy
Irrigating a colostomy( page 753)