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- 2. Constipation Impaction Diarrhea Incontinence Flatulence Hemorrhoids
- 3. It isthe term is used to describe an infrequent bowel movements or irregularity of defecation ,abnormal hardening of stool that makes their passage difficult and painful.
- 4. Causes ◦ Irregularbowel habits and ignoring the urge to defecate ◦ Chronic diseases ◦ Low fiber diet and high in animal fat ◦ less fluid intake ◦ Anxiety, depression, cognitive impairment ◦ Immobilization or lack of exercise ◦ Laxative misuse ◦ Illnesses (neurological illnesses & organic illnesses) ◦ Medications
- 5. Signs andsymptoms ◦ Decreased frequency of defecation ◦ Hard, dry, formed stools ◦ Straining at stool; painful defecation ◦ Feeling of fullness, discomfort in rectum, abdomen ◦ Anorexia or nausea ◦ Headache
- 6. Medical management ◦Treat the under lying cause ◦ Increase fiber and fluid intake ◦ Routine exercises ◦ Biofeedback ◦ Use of laxatives Nursing management ◦ Maintain a regular pattern of elimination ◦ Dietary pattern ◦ Exercises ◦ Privacy ◦ Psychological support ◦ Posture ◦ Laxative administration ◦ Administration of suppositories or enema
- 7. It isthe accumulation of hardened feces in the rectum, as a result of which the person is unable to voluntarily evacuate the stool. ◦ Mass or collection of hardened feces in folds of rectum ◦ Passage of liquid fecal seepage and no normal stool Usual causes ◦ Poor defecation habits ◦ Untreated or un relieved Constipation
- 8. Signs andsymptoms ◦ Feeling of fullness in rectum and abdomen ◦ An urge for defecation and inability to pass stool ◦ Generalized malaise ◦ Loss of appetite ◦ Nausea/vomiting ◦ Abdominal distension Management ◦ Laxatives , enema or manual removal of the stool(digital evacuation)
- 9. Defined as frequentpassage of loose, fluid unformed stools due to increased gastro intestinal motility ◦ Manifested by frequent evacuation of watery stool ◦ Besides the intense urge to defecate, there may be abdominal cramps, nausea & painful burning sensations at the anus
- 10. Causes ◦ Intestinalinfections (enteritis) ◦ Nervous tension (emotional or psychogenic diarrhea ……excessive stimulation of parasympathetic nervous system ◦ Medications ( antibiotics &iron supplements) ◦ Abuse of cathartics ◦ Mechanical causes : incomplete obstruction ….stenosis,adhesions and tumors ◦ Other causes :Malabsorption syndrome, irritable colon, narcotic withdrawal. Etc.
- 11. Management ◦ Replacethe fluid and electrolytes ◦ Treat the cause ◦ Drug therapy Antibiotics/antimicrobials Antimotility agents (loperamide) Nursing care ◦ Replacements of fluid and electrolytes ( potassium) ◦ Small frequent diet.. Avoid spicy foods ◦ Use of bedpan and commodes ◦ Skin care ◦ Adequate rest ◦ Psychological support ◦ Medications ◦ Healthy eating habits
- 13. The lossof voluntary ability to control fecal and gaseous discharges through the anal sphincter Types : ◦ Partial :inability to control flatus or to prevent minor soiling ◦ Major : inability to control feces of normal consistency Causes ◦ Neuromuscular disease ◦ Spinal cord trauma ◦ Tumors Treated with surgery ◦ Repair of sphincter ◦ Fecal incontinence pouch ◦ Bowel diversion or colostomy
- 14. Flatulence isthe presence of excessive flatus in the intestines and leads to stretching and inflation of the intestines (intestinal distensions) Causes ◦ Action of bacteria on the Chyme in L.intestine ◦ Swallowed air ◦ Gas that diffuses between the blood stream and the intestine ◦ Foods (cabbage, onions) Signs ◦ Gastric distension Management :insertion of rectal tube
- 15. Hemorrhoids aredilated, engorged vein in the lining of the rectum ◦ External or internal
- 16. External Clearlyvisible as protrusions of skin If underlying vein is hardened or purple colored Pain Need to be excised Internal An outer mucus membrane Causes : Increased venous pressure due to straining Pregnancy Heart failure Chronic liver diseases Treatment Hemorrhoidectomy
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- 18. History Physicalexamination Food and fluid intake Chewing ability Medications Recent illnesses or stressors
- 19. Fecal characteristics& Review of relevant results ◦ Examination of fecal specimen for Occult blood Stool culture Fecal fat ◦ Laboratory tests Total bilirubin Alkaline phosphate Amylase ◦ Direct visualization (Endoscopy & colonoscopy) ◦ Indirect visualization (x ray film with contrast medium)
- 20. Constipation Riskfor constipation Perceived constipation Chronic functional constipation Risk for chronic functional constipation Diarrhoea Dysfunctional gastrointestinal motility Bowel incontinence
- 21. As etiology ◦Risk for electrolyte imbalance ◦ Risk for imbalanced fluid volume ◦ Deficient fluid volume ◦ Risk for deficient fluid volume ◦ Impaired skin integrity ◦ Risk for Impaired skin integrity ◦ Impaired comfort
- 22. Goals /objectives ◦ Maintain or restore normal bowel elimination pattern ◦ Maintain or regain normal stool consistency ◦ Prevent associated risks
- 23. Promoting regular defecation Privacy Timing Nutritionand fluids For constipation, diarrhea, flatulence Exercise Positioning Commode Bedpan
- 24. Decreasing flatulence ◦Avoid gas-producing foods ◦ Exercise ◦ Movement in bed ( position) ◦ Ambulation ◦ Probiotics Administering enemas Rectal suppositories Bowel wash Digital removal of a fecal impaction Bowel training programs ◦ Based on factors within client's control ◦ Goal of establishing normal defecation pattern
- 25. Bowel trainingprograms ◦ Major phases Determine client's usual habits and factors that help or hinder defecation Design plan with client Determine fluid, fiber, hot drinks, exercise Maintain routine for 2–3 weeks Cathartic suppositories Prompt response to urges Privacy Effective physical positioning Provide positive feedback for successful defecation Offer support; encourage client to have patience with the process
- 26. Fecal incontinencepouch ◦ Collect and contain large amounts of liquid feces Artificial sphincter Ostomy ◦ Is a term for a surgically formed opening from the inside of an organ to the out side ( eg: ileostomy or colostomy) ◦ Stoma ( the part of the ostomy that is attached to the skin, is formed by suturing the mucosa to the skin) ◦ skin care
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