1. Bowel Elimination Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

2.  Bowel elimination is the excretion of wastes from the gastro-intestinal (GI) system.  Factors affecting bowel elimination include:  Privacy  Habits  Age  Diet  Exercise and activity  Fluids  Drugs Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 2

3.  Time and frequency of bowel movements vary.  Stools normally:  Are brown  Are soft, formed, moist, and shaped like the rectum  Have a normal odor caused by bacterial action in the intestines Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 3

4.  Observe and report the following to the nurse. If allowed to chart, also record the following:  Color  Amount  Consistency  Presence of blood or mucus  Odor  Shape  Frequency of BMs  Complaints of pain or discomfort Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 4

5.  Normal, regular elimination is the goal.  Factors affecting stool frequency, consistency, color, and odor  Privacy  Habits  Diet—high-fiber foods  Diet—other foods  Fluids  Activity  Drugs  Disability  Aging Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 5

6.  Constipation is the passage of a hard, dry stool.  Constipation occurs when feces move slowly through the bowel.  Fecal impaction is the prolonged retention and build-up of feces in the rectum.  Feces are hard or putty-like.  Fecal impaction results in constipation if not relieved.  Symptoms include abdominal discomfort, abdominal distention (swelling), nausea, cramping, and rectal pain. Older persons may have poor appetite, confusion, or even a fever. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 6

7.  The nurse does a digital (finger) exam to check for an impaction. The digital exam often causes the urge to have a BM.  Sometimes the fecal mass is removed with a gloved finger. This is called digital removal of an impaction.  Checking for and removing impactions is very dangerous. The vagus nerve can become stimulated, which slows the heart rate. Heart rate can slow to unsafe levels in some persons. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 7

8.  Diarrhea is the frequent passage of liquid stools.  Feces move through the intestines rapidly.  Diet and drugs are ordered to reduce peristalsis.  You need to: Assist with elimination needs promptly. Dispose of stools promptly. Give good skin care.  Fluid lost through diarrhea must be replaced. Otherwise dehydration occurs.  Always follow Standard Precautions and the Bloodborne Pathogen Standard when in contact with stools. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 8

9.  Fecal incontinence is the inability to control the passage of feces and gas through the anus.  Fecal incontinence affects the person emotionally.  The person 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 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 9

10.  Flatulence is the excessive formation of gas or air in the stomach and intestines.  Gas or air passed through the anus is called flatus.  If flatus is not expelled, the intestines distend.  The following help produce flatus: Exercise Walking Moving in bed The left side-lying position  Doctors may order enemas and drugs to relieve flatulence. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 10

11.  Bowel training has two goals, to:  Gain control of bowel movements.  Develop a regular pattern of elimination.  Factors that promote elimination are part of the care plan and the bowel-training program. These include:  High-fiber diet  Increased fluids  Warm fluids  Activity  Privacy Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 11

12.  A suppository is a cone-shaped, solid drug that is inserted into a body opening. It melts at body temperature.  A rectal suppository is inserted into the rectum.  A BM occurs about 30 minutes later.  The doctor may order a suppository to stimulate a BM for:  Constipation  Fecal impaction  Bowel training Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 12

13.  An enema is the introduction of fluid into the rectum and lower colon.  Doctors order enemas to:  Remove feces  Relieve constipation, fecal impaction, or flatulence  Clean the bowel of feces before certain surgeries and diagnostic procedures  A doctor orders the enema solution. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 13

14.  The solution depends on the enema’s purpose cleansing, constipation, fecal impaction, or flatulence. Tap-water enema is obtained from a faucet. Saline enema is a solution of salt and water. Soapsuds enema (SSE) is a solution of castile soap and water. Small-volume enema is commercially prepared. Oil-retention enema is mineral, olive, or cottonseed oil. Other enema solutions may be ordered.  Nurses give enemas that contain drugs. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 14

15.  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.  Saline enema solution is similar to body fluid.  Soapsuds enemas irritate the bowel’s mucous lining. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 15

16.  Small-volume enemas irritate and distend the rectum.  Often ordered for constipation  Also ordered when the bowel does not need complete cleansing  Oil-retention enemas relieve constipation and fecal impactions.  Retaining oil softens feces and lubricates the rectum.  Most oil-retention enemas are commercially prepared. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 16

17.  An ostomy is a surgically created opening for the elimination of body wastes.  The opening seen through the abdominal wall is called a stoma.  The person wears a pouch over the stoma to collect stools and flatus. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 17

18.  Colostomy  A colostomy is a surgically created opening between the colon and abdominal wall.  With a permanent colostomy, the diseased part of the colon is removed.  A temporary colostomy gives the diseased or injured bowel time to heal. After healing, surgery is done to reconnect the bowel.  The colostomy site depends on the site of disease or injury.  Ileostomy  An ileostomy is a surgically created opening between the ileum (small intestine) and the abdominal wall.  Liquid stools drain constantly from an ileostomy. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 18

19.  Ostomy pouches  The pouch has an adhesive backing applied to the skin.  Sometimes pouches are secured to ostomy belts.  Many pouches have a drain at the bottom that close with a clip, clamp, or wire closure. The drain is opened to empty the pouch. The pouch is emptied when stools are present. It is opened when it balloons or bulges with flatus. Wipe the drain with toilet tissue before it is closed.  The pouch is changed every 3 to 7 days and when it leaks.  Do not flush pouches down the toilet. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 19