Chapter 23

1. Chapter 23 Bowel Elimination

2. Bowel Elimination • 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

3. Normal Bowel Elimination • 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

4. Normal Bowel Elimination (cont’d) • 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

5. Factors AffectingBowel Elimination • 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

6. Common Problems • 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.

7. Common Problems (cont’d) • 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.

8. Common Problems (cont’d) • 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.

9. Common Problems (cont’d) • 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

10. Common Problems (cont’d) • Flatulenceis 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.

11. Bowel Training • 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

12. Suppositories • 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

13. Enemas • 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.

14. Enemas (cont’d) • 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.

15. Enemas (cont’d) • 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.

16. Enemas (cont’d) • 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.

17. The Person with an Ostomy • 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.

18. The Person with an Ostomy (cont’d) • 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.

19. The Person with an Ostomy (cont’d) • 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.

20. Ostomy Changing Supplies