1. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 22 Bowel Elimination

2. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 2  Bowel elimination is a basic physical need.  Factors affecting bowel elimination include: Privacy Privacy Habits Habits Age Age Diet Diet Exercise and activity Exercise and activity Fluids Fluids Drugs Drugs  You assist patients and residents in meeting their elimination needs.

3. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 3  NORMAL BOWEL ELIMINATION  Time and frequency of bowel movements vary.  Stools are normally brown.  Stools are normally soft, formed, moist, and shaped like the rectum.  Stools have a normal odor caused by bacterial action in the intestines.  Your observations are used for the nursing process. Carefully observe stools before disposing of them. Carefully observe stools before disposing of them. Ask the nurse to observe abnormal stools. Ask the nurse to observe abnormal stools.

4. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 4  Observe and report the following to the nurse. If allowed to chart, also record the following: Color Color Amount Amount Consistency Consistency Presence of blood or mucus Presence of blood or mucus Odor Odor Shape Shape Frequency of defecation Frequency of defecation Complaints of pain or discomfort Complaints of pain or discomfort

5. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 5  FACTORS AFFECTING BOWEL ELIMINATION  Normal, regular elimination is the goal. Privacy Privacy Habits Habits Diet—high-fiber foods Diet—high-fiber foods Diet—other foods Diet—other foods Fluids Fluids Activity Activity Drugs Drugs Disability Disability Aging Aging

6. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 6  COMMON PROBLEMS  Constipation is the passage of a hard, dry stool. Constipation occurs when feces move slowly through the bowel. Constipation occurs when feces move slowly through the bowel. Constipation is prevented or relieved by: Constipation is prevented or relieved by:  Dietary changes, fluids, and activity  Drugs and enemas

7. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 7  A fecal impaction is the prolonged retention and buildup of feces in the rectum. Fecal impaction results if constipation is not relieved. Fecal impaction results if constipation is not relieved. A digital (finger) exam is done to check for an impaction. A digital (finger) exam is done to check for an impaction. Sometimes the fecal mass is removed with a gloved finger. Sometimes the fecal mass is removed with a gloved finger.  This is called digital removal of an impaction. Checking for and removing impactions are very dangerous. Checking for and removing impactions are very dangerous.  The vagus nerve in the rectum can be stimulated.  The heart rate can slow to dangerous levels in some persons.

8. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 8  Diarrhea is the frequent passage of liquid stools. Feces move through the intestines rapidly. Feces move through the intestines rapidly. Diet and drugs are ordered to reduce peristalsis. Diet and drugs are ordered to reduce peristalsis. You need to: You need to:  Assist with elimination needs promptly.  Dispose of stools promptly.  Give good skin care. Fluid lost through diarrhea is replaced. Fluid lost through diarrhea is replaced.  Otherwise dehydration occurs. Always follow Standard Precautions and the Bloodborne Pathogen Standard when in contact with stools. Always follow Standard Precautions and the Bloodborne Pathogen Standard when in contact with stools.

9. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 9  Fecal incontinence is the inability to control the passage of feces and gas through the anus. Fecal incontinence affects the person emotionally. Fecal incontinence affects the person emotionally. The person may need: 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

10. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 10  Flatulence Gas or air passed through the anus is called flatus. Gas or air passed through the anus is called flatus. Flatulence is the excessive formation of gas or air in the stomach and intestines. Flatulence is the excessive formation of gas or air in the stomach and intestines. If flatus is not expelled, the intestines distend. If flatus is not expelled, the intestines distend. The following help produce flatus: The following help produce flatus:  Exercise  Walking  Moving in bed  The left side-lying position Doctors may order enemas and drugs to relieve flatulence. Doctors may order enemas and drugs to relieve flatulence.

11. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 11  BOWEL TRAINING  Bowel training has two goals: To gain control of bowel movements To gain control of bowel movements To develop a regular pattern of elimination To develop a regular pattern of elimination  Factors that promote elimination are part of the care plan and the bowel training program.

12. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 12  ENEMAS  An enema is the introduction of fluid into the rectum and lower colon.  Doctors order enemas: To remove feces To remove feces To relieve constipation, fecal impaction, or flatulence To relieve constipation, fecal impaction, or flatulence To clean the bowel of feces before certain surgeries and diagnostic procedures To clean the bowel of feces before certain surgeries and diagnostic procedures

13. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 13  The doctor orders the enema solution. The solution depends on the enema’s purpose: The solution depends on the enema’s purpose:  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. You do not give enemas that contain drugs. You do not give enemas that contain drugs.

14. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 14  Cleansing enemas: Clean the bowel of feces and flatus Clean the bowel of feces and flatus Relieve constipation and fecal impaction Relieve constipation and fecal impaction Are needed before certain surgeries and diagnostic procedures Are needed before certain surgeries and diagnostic procedures  The doctor orders a tap water, saline, or soapsuds enema.

15. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 15  Small-volume enemas irritate and distend the rectum. They are often ordered for constipation or when the bowel does not need complete cleansing. They are often ordered for constipation or when the bowel does not need complete cleansing.  Oil-retention enemas relieve constipation and fecal impactions. Retaining oil softens feces and lubricates the rectum. Retaining oil softens feces and lubricates the rectum. Most oil-retention enemas are commercially prepared. Most oil-retention enemas are commercially prepared.

16. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 16  THE PERSON WITH AN OSTOMY  An ostomy is a surgically created opening. The opening is called a stoma. The opening is called a stoma.  The person wears a pouch over the stoma to collect stools and flatus.

17. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 17  Colostomy A colostomy is a surgically created opening between the colon and abdominal wall. 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. With a permanent colostomy, the diseased part of the colon is removed. A temporary colostomy gives the diseased or injured bowel time to heal. 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. The colostomy site depends on the site of disease or injury.  Ileostomy An ileostomy is a surgically created opening between the ileum and the abdominal wall. An ileostomy is a surgically created opening between the ileum and the abdominal wall. Liquid stools drain constantly from an ileostomy. Liquid stools drain constantly from an ileostomy.

18. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 18  Ostomy pouches The pouch has an adhesive backing that is applied to the skin. The pouch has an adhesive backing that is applied to the skin. Sometimes pouches are secured to ostomy belts. Sometimes pouches are secured to ostomy belts. Many pouches have a drain at the bottom that closes with a clip, clamp, or wire closure. Many pouches have a drain at the bottom that closes with a clip, clamp, or wire closure.  The drain is opened to empty the pouch. The pouch is emptied when stools are present. The pouch is emptied when stools are present. The pouch is changed every 3 to 7 days and when it leaks. The pouch is changed every 3 to 7 days and when it leaks. Do not flush pouches down the toilet. Do not flush pouches down the toilet.