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Bowel Elimination

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  • 1. Bowel Elimination By Richard Araneta
  • 2. Bowel Elimination Defecation – is the expulsion of feces from anus and rectum
  • 3. Principles Quality varies with the amount of food consumed and absorbed Consistency of stool depends on the length of time the contents are in the GIT and the type of food eaten
  • 4. Factors Affecting Defecation Age and development Diet – some foods are impossible for some people to digest Fluid intake – in adequate, chyme becomes more dry Activity – it stimulates peristalsis (movement of food in the small intestine)
  • 5. Factors Affecting Defecation Psychologic Factors  Anxious and angry – diarrhea  Depressed – constipation Lifestyle – Ex: availability of toilet facilities Medications  Laxatives – stimulate bowel movement  Bentyl – suppresses peristaltic activity
  • 6. Factors Affecting Defecation Pathologic Conditions – Ex: spinal cord and injuries Anesthesia and surgery – Ex: Paralytic ileus (no movement in the small intestines) Irritants – Ex: spicy foods, bacterial toxins Pain
  • 7. Normal Characteristics of Stool Color  Yellow or golden brown (due to bile pigment derivative known as stercobilin) Amount  Depends on the bulk of food intake
  • 8. Alterations in the Characteristics of Stool Acholic Stools  Grey, pale, or clay colored, due to biliary obstruction Hematochezia  Passage of stool with bright red blood due to lower GI bleeding Melena  Passage of black tarry stools due to upper GI bleeding Steatorrlea  Greasy, bulky, foul smelling stool due to hepatobilary pancreatic obstruction of disorders
  • 9. Common Fecal Elimination Problems Constipation Fecal impaction Diarrhea Fecal incontinence Flatulence Hemorrhoids
  • 10. I. Constipation Passage of small, dry, hard stools of the non- passage of stool for a period of time
  • 11. Measures to Relieve Constipation Adequate fluid intake High fiber diet Establish regular pattern of defecation Respond immediately to the urge to defecate Minimize stress
  • 12. Measures to Relieve Constipation Adequate activity and exercise Laxatives as ordered  Avoid overuse, may lead to rebound effect Enzymes  Cleansing or non-retention  Retention  Return flow Suppositions
  • 13. Types of Laxatives Stool lubricants  Lubricates feces and facilitates its expulsion  Ex: Mineral oil Stool/enrollment softeners  Soften and delays the drying of the feces; permits fat and water to penetrate feces  Ex: Colace Bulk formers  Ex: Metamucil
  • 14. Types of Laxatives Osmotic agents  Attracts fluids from intestinal capillaries to stool  Ex: Milk of Magnesia – lactose, magnesium citrate Chemical irritants  Increase peristalsis  Ex: dulcolax, castor oil, cascera sagrado
  • 15. II. Fecal Impaction Is a mass or collection of hardened putty-like feces in the folds of the rectum
  • 16. Measures to Relieve Impaction Increase fluid intake Sufficient bulk in diet Adequate activity and exercise Manual extraction  Water out for vagal stimulation -> decrease cardiac activity
  • 17. III. Diarrhea Passage of liquid feces and increased frequency of defecating
  • 18. Measures to Relieve Diarrhea Replace fluid-electrolyte loss Good peri-anal care Promote rest Diet bland foods: decrease fiber diet  BAR (banana, apple, rice am)  Avoid excessively hot and cold fluids  Give potassium rich foods
  • 19. Measures to Relieve Diarrhea Anti-diarrheal drugs  Demulcents – coat the irritated bowel, acts as protective  Absorbents – absorb gas and toxic substances from the blood  Astringents – shrink swollen or inflamed tissues
  • 20. IV. Flatulence Presence of excessive gas in the intestines (tympanism)
  • 21. Measures to Relieve Flatulence Avoid gas forming foods Limit carbonated drinks, drinking straws, chewing gum Provide warm fluids to drink Early ambulation: prone or knee chest positions Adequate activity and exercise Rectal tube – 3-4 inches; for 22-30 Cholinergic as ordered Carminative enemas as ordered (60-180cc fluid or herbal oils)
  • 22. V. Fecal Incontinence Inability of anal sphincter to control the discharge of fecal and gaseous material  Ex: in neuromuscular disease, spinal cord injuries, aging process, etc.
  • 23. Nursing Care for Fecal Incontinence Good peri-anal care Use of fecal collector (pouch/ diapers) Provide emotional support
  • 24. VI. Hemorrhoids Also called “piles”, distended veins in the anal area
  • 25. Nursing Care and Management Astringents to shrink tissues Local anesthetics Stool softeners Surgery – hemorrhoidectomy