This document discusses defecation and common bowel problems. It defines defecation as the expulsion of feces from the anus and rectum, and describes the intrinsic and parasympathetic defecation reflexes. Common bowel problems mentioned include constipation, impaction, diarrhea, and incontinence. Factors that can affect defecation are also listed such as age, diet, fluid intake, medications, and psychological factors. The document provides details on assessing the gastrointestinal system through nursing history and physical examination. It concludes by describing various gastrointestinal tests and procedures.

1. ELIMINATION FECALMa. Tosca Cybil A. Torres, RN, MAN

2. DEFECATIONDefecation is the expulsion of feces from the anus and rectum.

3. Also known as bowel movementDefecation reflexIntrinsic defecation reflex

4. Feces enter rectum distension of rectal walls initiates signal through mesenteric plexus initiate peristaltic waves (descending, sigmoid colon, rectum)anus internal sphincter inhibited from closing relaxed external sphincter defecation

5. Parasympathetic defecation reflexCommon Bowel Elimination ProblemsConstipation. Decreased frequency of bowel movements accompanied by prolonged or difficult passage of dry hard stoolImpaction. Collection of hardened feces wedged in the rectumDiarrhea. Increase in number of stools and the passage of liquid, unformed feces.Incontinence Flatulence Hemorrhoids

7. FACTORS AFFECTING DEFECATIONAgeDietFluid intakePhysical ActivityPsychological FactorsPersonal HabitsPosition During DefecationPain PregnancySurgery and AnesthesiaMedicationsDiagnostic Tests

8. AssessmentNursing HistoryUsual pattern of elimination, frequency and time of the day.

9. Normal routines followed to promote normal elimination.

10. Description of any recent change in elimination pattern.

11. Description of usual characteristics of stool.

12. Diet history

13. Daily fluid intake

14. History of surgery or illness affecting the GI tract.

15. Medication history

16. Emotional state.Assessment of the GITMTCAT '09Nursing History : Subjective Data1. General Datapresence of dental prosthesis, comfort of usagedifficulty eating or digesting foodnausea or vomitingweight losspain – may be caused by distention or sudden contraction of any part of the GIT - specify the area, describe the pain2. Specific data if symptoms are presentsituations or events that effect symptomsonset, possible cause, location, duration, character of symptomsrelationship of specific foods, smoking or alcohol to severity of symptomshow the symptoms was managed before seeking medical help

17. Assessment of the GITMTCAT '093. Normal pattern of bowel eliminationfrequency and character of stooluse of laxatives, enemas4. Recent changes in normal patternschanges in character of stool (constipation, diarrhea, or alternating constipation and diarrhea)changes in color of stool melena - black tarry stool (upper GI bleeding)hematochezia – fresh blood in the stool (lower GI bleeding)c. drugs /medications being takend. measures taken to relieve symptoms

18. Assessment of the GITMTCAT '09B. Physical Examination : Objective Dataa.) Mouth and Pharynxlips – color, moisture, swelling, cracks or lesionsteeth – completeness (20 in children, 32 in adults), caries, loose teeth, absence of teeth  impair adequate chewinggums – color, redness, swelling, bleeding, pain (gingivitis)mucosa – color (light pink)examine for moisture, white spots or patches, areas of bleeding, or ulcers

19. white patches – due to candidiasis (oral thrush)

20. white plaques w/in red patches may be malignant lesionstongue – color, mobility, symmetry, ulcerations / lesions or nodulespharynx – observe the uvula, soft palate, tonsils, posterior pharynx signs of inflammation (redness, edema, ulceration, thick yellowish secretions), assess also for symmetry of uvula and palateAssessment of the GITMTCAT '09b.) Abdomen - assess for the presence or absence of tenderness, organ enlargement, masses, spasm or rigidity of the abdominal muscles, fluid or air in the abdominal cavityAnatomic Location of OrgansRUQ – liver, gallbladder, duodenum, right kidney, hepatic flexure of colonRLQ - cecum, appendix, right ovary and fallopian tubeLUQ – stomach, spleen, left kidney, pancreas, splenic flexure of colonLLQ – sigmoid colon, left ovary and tube

21. Assessment of the GITMTCAT '09

22. Assessment of the GITMTCAT '091. Inspectionassess the skin for color, texture, scars, striae, engorged veins, visible peristalsis (intestinal obstruction), visible pulsations (abdominal aorta), visible masses (hernia)

23. assess contour (flat, protuberant, globular)

24. abdominal distension, measure abdominal girth or circumference at the level of umbilicus or 2-5 cm. belowAssessment of the GITMTCAT '092. Auscultationpresence or absence of peristalsis or bowel sounds

25. Normoactive – every 5-20 secs.

26. Hypoactive – 1 or 2 sounds in 2 mins.

27. Absent – no sounds in 3-5 mins.  peritonitis, paralytic ileus, Hyperactive – 5-6 sounds in less than 30 sec. diarrhea, gastroenteritis, early intestinal obstruction

28. Assessment of the GITMTCAT '093. Percussiondone to confirm the size of various organs

29. to determine presence of excessive amounts of air or fluid

30. Normal – tympany

31. dullness or flatness – area of liver and spleen, solid structure – tumor4. Palpationto determine size of liver, spleen, uterus, kidneys – if enlarged

32. determine presence and chac. of abdominal masses

33. determine degree of tenderness and muscle rigidity (rebound or direct)c.) Rectumperineal skin and perianal skin

34. assess for presence of pruritus, fissures, external hemorrhoids, rectal prolapse

35. FECAL STUDIESFor blood, fat, infectious organismsA freshly passed, warm stool is the best specimen.

36. From fat or infections organisms, collect three separate specimens and label day # 1, day #2, day # 3.Stool examination (fecalysis)Stool for occult blood(Guaiac Test)

37. GI bleeding

38. No red meat, turnips, horseradish, steroids, NSAIDS, iron

39. Stool for Ova and parasites

40. proper collection of specimen  should not be mixed with water or urine, should be sent immediately to the laboratoryUPPER GI SERIES (BARIUM SWALLOW)Fluoroscopic examination of upper GI tract to determine structural problems and gastric emptying time.

41. Client must swallow barium sulfate

42. Sequential films taken as it moves through the system.Barium – is a radiopaque substance that when ingested or given by enema in solution, outlines the passage ways of the GIT for viewing by x-ray or fluoroscopy

43. UPPER GI SERIES (BARIUM SWALLOW)for identification disorders of esophagus, stomach, duodenum – esophageal lesions, hiatal hernia, esophageal reflux, tumors, ulcers, inflammation

44. Pt. swallows a flavored barium solution and the radiologist observes the progress of the barium through the esophagus and take x-ray films

45. NPO for 6-8 hrs

46. Post procedure:

47. Increase fluid intake

48. Laxative

49. Stool – white for 24-72 hrs.

50. Observe for: impaction, distended abdomen, constipationLOWER GI SERIES (BARIUM ENEMA)Barium is instilled into the colon by enema

51. Client retains the contrast medium while x-rays are taken to identify structural abnormalities of the large intestine or the colon.Nursing care: pretestNPO for 8 hours pretest

52. Give enemas until clear the morning of the test.

53. Administer laxative or suppository.

54. Explain that cramping may be experienced during procedure.Nursing care: posttestAdminister laxatives and fluids to assist in expelling the barium

56. ESOPHAGOGASTRODUODENOSCOPY (EGD)Direct visualization of the esophagus, stomach, and duodenum by insertion of a lighted fiberscope.

57. Used to observe structures, ulcerations, inflammation, tumors; may include biopsy. directly visualize the GIT by the use of a fiberscape