Bowel Elimination
NUR101 Fall 2008
Lecture # 23
K. Burger, MSEd, MSN, RN, CNE
PPP By: Sharon Niggemeier RN MSN
J Borrero 12/08
Functions of the GI Tract
• Prepare fluids and nutrients for absorption
and use by cells via mechanical and
chemical breakdown
• Absorb fluids and nutrients
• Receives secretions from organs (eg.
gallbladder, pancreas)
Anatomy & Physiology
• Organs of the GI tract?
• Function of Large intestine: absorption
Extends from Ileocecal valve to
anus
• Chyme
• Peristalsis & Mass peristalsis
Act of Defecation
• Defecation reflex
• Valsalva maneuver
• Defecation
Alteration in Bowel
Elimination
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Diarrhea
Constipation
Incontinence
Fecal Impaction
Flatulence
Characteristics of Stool
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Volume
Color
Odor
Consistency
Shape
Constituents
Factors That Influence Bowel
Elimination
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Age
Fluid Intake & Diet
Daily Routine
Activity
Medications
Health Status
Stress
Diet
High fiber foods:
• Legumes (beans)
• Cereals
• Whole grains
• Raw Fruits
• Vegetables
Laxative effect
foods:
• Spicy & greasy
• Bran/Chocolate
• Coffee/Alcohol
• Raw fruits &
vegetables
Assessing Elimination Status
• Usual pattern
• Changes in bowels
• Aids to eliminate
• Current problems
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…
Stool Specimen Collection
• Routine specimen
• Occult blood
• Ova & parasite
• Timed specimens
Nursing Dx R/T Bowel
Elimination
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Outcome Criteria
• Pt. will:
• Develop regular pattern of elimination
• Have less episodes of incontinence
• Incorporate fluids/diet that promote
bowel elimination
Interventions to Promote
Elimination
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Routine
Positioning
Privacy
Comfort
Activity
Diet/Fluids
Interventions: Promote Bowel
Elimination
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Laxatives and Cathartics
Enemas
Suppositories
Digital Removal
Types of Enemas
Types of Enemas
Cleansing
Retention
Return Flow
Enema Solutions
• Tap water (Hypotonic)
• Normal saline (Isotonic)
• Soap
• Hypertonic
• Oil
Tap Water (TWE)
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Amount: 500-1000cc
Action: Distends, increases peristalsis
Time: 15 min.
Indicated: inflamed bowels/irritated
colon
• Contraindicated: Atonic bowels, fluid
restrictions
Normal Saline
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Amount: 500-1000cc
Action: Distends, increases peristalsis
Time: 15 min.
Indicated:Inflamed bowels/irritated
colon
• Contraindicated: Na retention
problems, fluid restrictions
Soap (SSE)
• Amount: 500-1000cc (Castile
5ml/1000cc)
• Action: Distends, Irritates
• Time: 15 min.
• Indicated: Constipation
• Contraindicated: Prior to rectal exams
Hypertonic
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Amount: 70-130 cc solution
Action: Distends/Irritates
Time: 5-10 min.
Indicated: Constipation, convenience
Contraindicated: Dehydration, Na
problems
Oil Retention
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Amount: 120-200cc
Action: Lubricates
Time: 30 min.
Indicated: Fecal impaction
Contraindication: none
Enema Administration
• PPE
• IV pole
• Position L Sims
• Lubricant
• Linen protector
• Enema bag with
solution
• Receptacle (bedpan,
commode, toilet)
• Tissue paper
Enema Administration
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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.
Evaluation
• Unusual findings
• Solution given
blood,
• Amount expelled
helminthes, pus
• Characteristics of
etc.
stool
• Client reaction:
• Passing of flatus
change in skin
color, VS
changes, fatigue
Medications Effecting Bowel
Elimination
• Laxatives- induce emptying of GI tract
• Antidiarrheal- slow peristalsis, Pepto Bismol,
Kaopectate
• Codeine/morphine/iron- cause constipation
• Antibiotics-may cause diarrhea
• Opiates: paragoric, lomotil- habit forming
Flatulence
Causes:
• Decreased
peristalsis
• Constipation
• Medications
• Surgery
• Diet
• Stress
• Decreased
activity
NonInvasive Interventions for
Flatulence
*Ambulation*
• Knee chest
position
Invasive Interventions for
Flatulence
• Glycerin Suppository
• Harris Flush
• Rectal Tube
Evaluation of Bowel Function
• Achievement of regular defecation habits
• Patient’s understanding of normal
elimination
• Maintenance of adequate food and fluid
intake
• Regular exercise program
• Comfort
• Skin integrity
Gastrointestinal Charting Chuckles
The patient had waffles for breakfast and anorexia for lunch.
She stated that she had been constipated for most of her life until
1989, when she got a divorce.
Bleeding started in the rectal area and continued all the way to Los
Angeles.
Rectal examination revealed a normal-size thyroid.
The patient was to have a bowel resection. However, he took a job as
a stockbroker instead.
Fleet enema given with stool hard as pine knots.
Patient complains of indigestion since last night when he ate a stake.
Patient passed flatus . . . two short, one long.
Patient was seen in consultation by the physician, who felt we
should sit tight on the abdomen, and I agreed.