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Bowel Elimination

Bowel Elimination. NUR101 Fall 2009 Lecture # 23 K. Burger, MSEd, MSN, RN, CNE PPP By: Sharon Niggemeier RN MSN. Anatomy & Physiology. Function of Large intestine: absorption Extends from Ileocecal valve to anus Chyme Peristalsis & Mass peristalsis. Act of Defecation.

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Bowel Elimination

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  1. Bowel Elimination NUR101 Fall 2009Lecture # 23 K. Burger, MSEd, MSN, RN, CNE PPP By: Sharon Niggemeier RN MSN

  2. Anatomy & Physiology • Function of Large intestine: absorption • Extends from Ileocecal valve to anus • Chyme • Peristalsis & Mass peristalsis

  3. Act of Defecation • Defecation reflex • Valsalva maneuver • Defecation

  4. Alteration in Bowel Elimination • Diarrhea • Constipation • Incontinence • Fecal Impaction • Flatulence

  5. Characteristics of Stool • Volume • Color • Odor • Consistency • Shape • Constituents

  6. Factors That Influence Bowel Elimination • Age • Fluid Intake & Diet • Daily Routine • Activity • Medications • Health Status • Stress

  7. High fiber foods Legumes (beans) Cereals Whole grains Raw Fruits Vegetables Laxative effect foods Spicy & greasy Bran/Chocolate Coffee/Alcohol Raw fruits & vegetables Diet

  8. Assessing Elimination Status • Usual pattern • Changes in bowels • Aids to eliminate • Current problems

  9. Physical Assessment • Inspection- observe contour of abd and note visible peristalsis • Auscultation- listen for bowel sounds all quadrants • Percussion- resonant or tympany over hollow organs…dullness over intestinal obstruction • Palpation- feel for masses, tenderness etc…

  10. Stool Specimen Collection • Routine specimen • Occult blood • Ova & parasite • Timed specimens

  11. Nursing Dx R/T Bowel Elimination ?

  12. Outcome Criteria • Pt. will: • Develop regular pattern of elimination • Have less episodes of incontinence • Incorporate fluids/diet that promote bowel elimination

  13. Interventions to Promote Elimination • Routine • Positioning • Privacy • Comfort • Activity • Diet/Fluids

  14. Interventions: Promote Bowel Elimination • Laxatives • Enemas • Suppositories • Digital Removal

  15. Types of Enemas

  16. Enema Solutions • Tap water (Hypotonic) • Normal saline (Isotonic) • Soap • Hypertonic • Oil

  17. Tap Water (TWE) • Amount: 500-1000cc • Action: Distends, increases peristalsis • Time: 15 min. • Indicated: inflamed bowels/irritated colon • Contraindicated: Atonic bowels, fluid restrictions

  18. Normal Saline • Amount: 500-1000cc • Action: Distends, increases peristalsis • Time: 15 min. • Indicated:Inflamed bowels/irritated colon • Contraindicated: Na retention problems, fluid restrictions

  19. Soap (SSE) • Amount: 500-1000cc (Castile 5ml/1000cc) • Action: Distends, Irritates • Time: 15 min. • Indicated: Constipation • Contraindicated: Prior to rectal exams

  20. Hypertonic • Amount: 70-130 cc solution • Action: Distends/Irritates • Time: 5-10 min. • Indicated: Constipation, convenience • Contraindicated: Dehydration, Na problems

  21. Oil Retention • Amount: 120-200cc • Action: Lubricates • Time: 30 min. • Indicated: Fecal impaction • Contraindication: none

  22. PPE Position L Sims Linen protector Receptacle (bedpan, commode, toilet) IV pole Lubricant Enema bag with solution Tissue paper Enema Administration

  23. Enema Administration • Position L Sims • Insert lubricated tip 4” • Bag raised 18-20” above anal canal • Administer slowly - 10 min. • Administration is individualized. • Pt. holds for 15 min.

  24. Solution given Amount expelled Characteristics of stool Passing of flatus Unusual findings blood, helminthes, pus etc. Client reaction: change in skin color, VS changes, fatigue Evaluation

  25. Medications Effecting Bowel Elimination • Laxatives- induce emptying of GI tract • Antidiarrheal- slow peristalsis • Codeine/morphine/iron- cause constipation • Antibiotics-may cause diarrhea

  26. Causes: Decreased peristalsis Constipation Medications Surgery Diet Stress Decreased activity Flatulence

  27. NonInvasive Interventions for Flatulence *Ambulation* • Knee chest position

  28. Invasive Interventions for Flatulence • Glycerin Suppository • Harris Flush • Rectal Tube

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