Chapter 22 Bowel Elimination All items and derived

Bowel Elimination Bowel elimination is the excretion of wastes from the gastro-intestinal (GI) system. � Factors affecting bowel elimination include: � ◦ ◦ ◦ Privacy Habits Age Diet and fluids Exercise and activity Drugs All items and derived items © 2015, 2011 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 2

Normal Bowel Elimination � � � Feces move through the intestines by peristalsis. Feces move through the large intestine to the rectum. Feces are stored in the rectum until excreted from the body. Defecation (bowel movement [BM]) is the process of excreting feces from the rectum through the anus. Frequency and time of bowel movements vary from person to person. All items and derived items © 2015, 2011 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 3

Stool � Stools are normally brown, soft, formed, moist, and shaped like the rectum. ◦ They have a normal odor. � Observe ◦ ◦ ◦ ◦ and report the following: Color Amount Consistency Presence of blood or mucus Odor Shape Frequency of defecation Complaints of pain or discomfort All items and derived items © 2015, 2011 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 4

Factors Affecting Bowel Elimination � The nurse considers the following factors when using the nursing process to meet the person’s elimination needs: ◦ ◦ ◦ ◦ Privacy Habits Diet Fluids Activity Drugs Aging Disability All items and derived items © 2015, 2011 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 5

Common Problems � Constipation is the passage of a hard, dry stool. ◦ Constipation occurs when feces move slowly through the bowel. � A fecal impaction is the prolonged retention and buildup of feces in the rectum. ◦ Feces are hard or putty-like. ◦ Symptoms include abdominal discomfort, abdominal distention (swelling), nausea, cramping, and rectal pain; older persons may have poor appetite, confusion, or even a fever. ◦ Fecal impaction results if constipation is not relieved. All items and derived items © 2015, 2011 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 6

Diarrhea and Dehydration � Diarrhea is the frequent passage of liquid stools. ◦ ◦ � Signs of dehydration ◦ ◦ � Feces move through the intestines rapidly, causing fluid loss. If fluid is not replaced, dehydration occurs. Dehydration can lead to death. Clostridium difficile is a microbe that causes diarrhea. Pale or flushed skin, dry skin, coated tongue Urine is dark and scant in amount. Thirst, weakness, dizziness, confusion Falling blood pressure and increased pulse Preventing the spread of infection is important! ◦ Good hand hygiene ◦ Standard Precautions and Bloodborne Pathogen Standard All items and derived items © 2015, 2011 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 7

Fecal Incontinence � Fecal incontinence is the inability to control the passage of feces and gas through the anus. ◦ Fecal incontinence affects the person emotionally. ◦ The person with fecal incontinence 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 All items and derived items © 2015, 2011 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 8

Flatulence � Flatulence is the excessive formation of gas or air in the stomach and intestines. ◦ Gas and air passed through the anus is called flatus. ◦ If flatus is not expelled, the intestines distend. �Abdominal cramping or pain, shortness of breath, and a swollen abdomen occur. All items and derived items © 2015, 2011 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 9

Bowel Training � Bowel training is used to ◦ Gain control of bowel movements. ◦ Develop a regular pattern of elimination. � Fecal impaction, constipation, and fecal incontinence are prevented. The person’s usual time of day for a BM is noted on the care plan. The nurse tells you about a person’s bowel training program. All items and derived items © 2015, 2011 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 10

Enemas The introduction of fluid into the rectum and lower colon is called an enema. � Doctors order enemas: � ◦ To remove feces ◦ To relieve constipation, fecal impaction, or flatulence ◦ To clean the bowel of feces before certain surgeries and diagnostic procedures � The doctor orders the enema solution. All items and derived items © 2015, 2011 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 11

Enema Solutions � The solution depends on the enema’s purpose. ◦ ◦ ◦ � Tap water enema (obtained from a faucet) Saline enema (a solution of salt and water) Soapsuds enema (SSE) Small-volume enema Oil-retention enema Do not give enemas that contain drugs. All items and derived items © 2015, 2011 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 12

Cleansing Enemas � 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. ◦ The saline enema solution is similar to body fluid. ◦ Soapsuds enemas irritate the bowel’s mucous lining. � Small-volume enemas irritate and distend the rectum. ◦ They are often ordered for constipation. ◦ They are ordered when the bowel does not need complete cleansing. � Oil-retention enemas relieve constipation and fecal impactions. All items and derived items © 2015, 2011 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 13

The Person with an Ostomy � An ostomy is a surgically created opening for the elimination of body wastes. ◦ The opening is called a stoma. ◦ The person wears a pouch over the stoma to collect stools and flatus. � Colostomy ◦ With a permanent colostomy, the diseased part of the colon is removed. ◦ A temporary colostomy gives the diseased or injured bowel time to heal. ◦ The colostomy site depends on the site of disease or injury. ◦ Stool consistency depends on the colostomy site. ◦ Skin care prevents skin breakdown around the stoma. All items and derived items © 2015, 2011 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 14

Ileostomy Basics � Ileostomy ◦ ◦ ◦ The entire colon is removed. Liquid stools drain constantly from an ileostomy. The ileostomy pouch must fit well. Stools must not touch the skin. Good skin care is required. All items and derived items © 2015, 2011 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 15

Ostomy Pouches � Ostomy pouches are emptied when stools are present. ◦ The pouch is opened when it balloons or bulges with flatus. ◦ The drain is wiped with toilet tissue before it is closed. ◦ The pouch is changed every 3 to 7 days and when it leaks. Frequent pouch changes can damage the skin. ◦ The person can wear normal clothes. ◦ Showers and baths are delayed for 1 to 2 hours after applying a new pouch to allow the adhesive to seal to the skin. ◦ Do not flush pouches down the toilet. All items and derived items © 2015, 2011 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 16

Quality of Life Protect the person’s rights. � Assist with bowel elimination as directed by the nurse and the care plan. � Do all you can to protect the person’s right to privacy. � Residents have the right to personal choice. � All items and derived items © 2015, 2011 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 17