NURSING CARE CLIENT WITH
Motility & Bowel
Elimination Disorders
By
Ni Ketut Alit A
Faculty Of Nursing Airlangga University
REFERENCES
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Black, J.M. & Matassarin E, (1997). Medical Surgical Nursing: Clinical
Management for continuity of care. J.B. Lippincott.co.
Barbara C.L & Wilma J.P. (2006). Essentials of Medical Surgical Nursing.
Philadelphia: Lippincott Williams & Wilkins.
Smeltzer, S.C., & Bare, B. (2003). Brunner and Suddarth's Textbook of
Medical-Surgical Nursing (10th ed.). Philadelphia: Lippincott Williams &
Wilkins.
Ignativicius & Bayne. (2001). Medical and Surgical Nursing. Philadelphia:
W.B. Saunders Company.
Luckman & Sorensen. (2000). Medical Surgical Nursing. Philadelphia: W.B.
Saunders Company.
Journals and article related to..
Review Intestine
(Small – Large Intestine)
Longest segment of GI tract, 7000 cm surface area for absorption
of nutrients into bloodstream through intestinal walls.
3 anatomic parts: duodenum, jejunum, ileum)
Digestive enzymes and bile in the duodenum come from
pancreas, liver, gallbladder and glands within the intestines
Intestinal glands secrete mucus, hormones, electrolytes and
enzymes

2 types of contractions: Small Intestine
– Segmentation contractions: mixing waves of contents,
churning motion
– Intestinal peristalsis: propels the contents of the small intestine
towards colon

Colonic Function:
(Ascending, Transverse, Descending, Sigmoid, and Rectum)
– Within 4 hrs of eating residual waste material passes through
ileocecal valve into colon.
–
Each peristaltic wave of sm. Intestine opens the valve briefly to
allow some contents to pass into colon
–
Bacteria make up a major part of the contents of large
intestine, assist in breakdown of waste material
–
2 types of secretions: bicarbonate (neutralize) and mucus
(protects colonic mucosa)
Small intestine
Large Intestine
Assessment of Bowel Function

Subjective
–
–
–
–
–
–
–
onset
characteristics
course
severity
precipitating factor
relieving factors
associated symptoms
Sample Interview Questions
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Can you describe the type of cramping and
abdominal pain you are having?
Have you every had bleeding from your
rectum?
Have you noticed any changes in your bowel
habits?
Blood and Stool
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Melena - black tarry stool
Blood on Stool - bleeding sigmoid colon, rectum
Blood in Stool - colon, ulcerative colitis,
– diverticulitis, tumor, ulcer
Stool black, hard = oral iron
Strong odor = blood of high fat content
Disorders of Intestinal Motility

Diarrhea
–
–
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serious in the young and elderly
increase in the frequency, volume and fluid
content of the stool
Causes
–
bacteria, or parasitic infections, malaborption,
medications, diseases, allergies or pyschological
Diarrhea

Clinical Manifestations
–
–
vary widely from several large watery stool to very
frequent small stools
result in severe electrolyte imbalances

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–
hypokalemia - Low K+
hypomagnesemia - low Mg+
hypovolemia - fluid volume deficit - hypovolemic
shock with vascular collapse
Diarrhea

Collaborative Care
–
–
–
treat underlying cause
Labs
 stool specimen - for WBC’s, parasitic
infections culture
 electrolytes - imbalance
Diagnostic tests

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Dietary management
–
–
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sigmoidoscopy - direct exam of bowel
fluid replacement, pedialyte
bowel rest for 24 hours
Pharmacology
–
absorbents, anticholinergics, antibiotics
CRITICAL CARE : DEHYDRATION
SYOK HIPOVELIEMIK


Children are more susceptible to dehydration due to
greater % or portion of their body weight being water
Signs and Symptoms
– poor skin turgor
– sunken fontanel
– decreased urine out-put
(1-2ml/uo/kg/hr)
– decreased body weight
– dry mucous membranes, lips
– no tears
The Client with Constipation

The infrequent or difficult passage of stool
–
–
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two or less BM’s per week
affects elders - impaired health, medications,
decrease physical activity
Diagnostics
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Barium enema

–
- tumors, diverticular disease
colonoscopy

- tumor, obstruction
Constipation

Dietary Management
–
–
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high fiber - vegetable fiber
adequate fluids
Pharmacology
–
–
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laxatives for short term use
bulk form agents for long term use
enemas - acute short term or as prep
Irritable Bowel Syndrome
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Disorder characterized by
alternating periods of
constipation and diarrhea
Cause - no organic cause
found
–
–
related to food ingestion,
meds., stress, hormones
looking at motor activity of the
G.I. tract
IBS….

Clinical Manifestations
–
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Colic-like abdominal pain
Altered bowel elimination

–
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Tenderness
Labs and Diagnostics
–

mucous in stool, change in frequency, straining, urgency,
incomplete emptying
stool specimen, colonoscopy, UGI with SBFT
Dietary management
–
add fiber and water content
The Client with Fecal Incontinence


Loss of voluntary control of defecation
Causes
–
interfere with sensory or motor control of rectum
and anal sphincters
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neuro -spinal cord injury, head injury
local trauma - anal-rectal injury, surgery
Other - radiation, impaction, tumors, confusion
Fecal Incontinence

Collaborative Care
–
–
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dx made by history
digital exam - poor sphincter tone
treatment

bowel training program - establish regular pattern
–
dietary changes
– stimulant - coffee, suppository.

surgery - colostomy
Malabsorption Syndrome

Clinical manifestations
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anorexia, abd bloating, diarrhea, weight loss,
weakness, malaise, muscle cramps, anemia

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signs of malnutrition
Celiac Disease
–
–
hypersensitivity to gluten, protein found in cereal
Tx - gluten free diet
Malabsorption Syndrome

Lactose Intolerance
–
–
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deficiency of lactase the enzymes needed for
digestion and absorbtion of lactose the primary
carbohydrate in milk
affects 90% of Asians, 75% of African Americans,
high incidence among Hispanic populations
usually hereditary, symptoms occur in
adolescence or early adulthood
Malabsorption Syndrome

Short Bowel Syndrome
–
from resection of significant portions of the small
intestine

–
CA, mesenteric thrombosis with bowel infarction,
Crohn’s disease or trauma
Treatment


frequent small, high caloric and high protein meals
multivitamin and mineral supplements
QUIZ
Please writedown nursing alert & nursing
education for client with :
1.Diarhea
2. Constipation
3. Malabsorption syndrom
4. Fecal Incontinence