Bowel Elimination Chapter 49 1 Physiology of Defecation

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Bowel Elimination Chapter 49 1

Bowel Elimination Chapter 49 1

Physiology of Defecation �Elimination of waste products of digestion from the body is essential

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

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Defecation �Defecation is the process of elimination of waste. �Feces ◦ Causes distention of

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

Characteristics of Feces Tab 49 -1 pg. 1357 �Color �Consistency �Shape �Amount �Odor �Constituents

Characteristics of Feces Tab 49 -1 pg. 1357 �Color �Consistency �Shape �Amount �Odor �Constituents

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

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

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

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

Constipation �Decreased frequency of defecation �Hard, dry, formed stools �Causes

Constipation �Decreased frequency of defecation �Hard, dry, formed stools �Causes

Fecal Impaction �Mass or collection of hardened feces in folds of rectum �Passage of

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

Diarrhea �Passage of liquid feces and increased frequency of defecation �Causes �Concerns? ? ?

Diarrhea �Passage of liquid feces and increased frequency of defecation �Causes �Concerns? ? ? �Client teaching (pg. 1358)

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

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

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

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

Assessment (pg. 1355) � � � � ◦ Normal bowel patterns Changes in bowel

Assessment (pg. 1355) � � � � ◦ 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 (pg. 818 -820) in lab 13

Nursing Process �Nursing Diagnoses 14

Nursing Process �Nursing Diagnoses 14

Nursing Process �Goals �Interventions 15

Nursing Process �Goals �Interventions 15

Interventions to Promote Regular Defecation �Privacy �Timing �Nutrition/fluids ◦ Constipation ◦ Diarrhea (client teaching

Interventions to Promote Regular Defecation �Privacy �Timing �Nutrition/fluids ◦ Constipation ◦ Diarrhea (client teaching pg. 1358) ◦ Flatulence �Exercise �Positioning 16

Implementing: Teaching about Medications �Laxatives �Suppositories �Antidiarrheal medications �Antiflatulence medications

Implementing: Teaching about Medications �Laxatives �Suppositories �Antidiarrheal medications �Antiflatulence medications

Enemas �Cleansing �Retention �Return-flow 18

Enemas �Cleansing �Retention �Return-flow 18

Cleansing Enema � Hypotonic ◦ Water moves out of colon after it stimulates peristalsis

Cleansing Enema � Hypotonic ◦ 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 19

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

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

Return-Flow Enema �Expel gas �Relieve abd. Distention � 100 -200 ml water or saline

Return-Flow Enema �Expel gas �Relieve abd. Distention � 100 -200 ml water or saline �Allow solution to flow back into container 21

Administering Enemas �Guidelines (pg. 1362 -1365) ◦ Per clinical learning lab 22

Administering Enemas �Guidelines (pg. 1362 -1365) ◦ Per clinical learning lab 22

Bowel Training Programs �Indications �Phases 23

Bowel Training Programs �Indications �Phases 23

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

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