Bowel Elimination
Objectives
1.
Discuss aids used for bowel elimination
2.
Review incontinent care supplies and assessments
3.
Identify different types of stool patterns using the Bristol Stool
Chart
4.
Review assessment and care of stomas
5.
Review ostomy care, pouching and best practices
Factors
Affecting
Bowel
Elimination
Diet
Fluid Intake
Personal bowel and
elimination habits
Physical Activity
Privacy
 Positioning
•
Clients should be taught to refrain from
straining and what an optimal position
for defecation is.
•
Immobilized patients have difficulty
defecating in the supine position, try to
raise the head of the bed if possible.
•
Ensure client has privacy while using the
toilet, commode or bedpan.
(Potter & Perry, 2019)
Image of positioning to open up bowels. From Potter and Perry, 2019
The Bedpan
Aids for bowel
elimination
Image of regular bedpan and fracture pan. Retrieved from Potter &
Perry (2019)
Incorrect positioning
Positioning on
the bed pan
Correct positioning
Image of position on a bedpan. Retrieved from Potter & Perry, 2019)
Placing a
patient on a
bedpan
1.
Lower the head of the bed
to a supine position
2.
Assist client to roll on to
their side (their backside is
facing you)
3.
Plan the bedpan firmly
against their buttocks,
down into the mattress
with the open rim towards
the client’s feet
Image of bedpan placement. Image retrieved from Potter &
Perry, 2019)
(Potter and Perry, 2019)
Practice!
Causes
1.
Chronic constipation
2.
Fecal impaction
3.
Long-term laxative use
4.
Colectomy or bowel surgery
5.
Lack of sensation
6.
Gynecological, prostate or rectal surgery
7.
Injury due to childbirth
8.
Emotional or mental health issues
Bowel
incontinence
(Potter and Perry, 2019)
Supplies
Adult briefs
(Depends,
Attends)
 Refrain from calling incontinence briefs diapers
 Change frequently and assess skin integrity
Nursing
Assessments &
Interventions
 Assess stool as per the Bristol stool chart
 Ensure privacy
 Dispose of as per agency protocol
 Document as per agency policy
 Age
 Infectious disease
 Irritable bowel syndrome
Factors
affecting
elimination
 Inflammatory Bowel Disease
 Diabetes
 Pain
 Pelvic floor trauma
 Acute illness/ surgery or anesthesia
 Enteral feeding
 Medications that effect elimination
(Potter and Perry, 2019)
Assessments
• What are the client’s normal bowel patterns?
• Description of stool characteristics (see Bristol
Stool Chart)
• Diet
• Fluid intake
• Assessment of use of laxatives
• Cognitive abilities
• Changes in appetite
• Medications
• Physical exercise
• Skin integrity
(Potter and Perry, 2019)
Bristol Stool
Chart
Bristol Stool Chart. Retreived from https://aboutconstipation.org/what-is-constipation/common-questions-mistaken-beliefs/
Alterations in bowel
elimination
Stoma
 Certain diseases
conditions prevent the
normal passage of feces
through the rectum.
 Treatment can result in
the need for a stoma
 Stoma is a temporary or
permanent artificial
opening in the abdominal
wall
Image of stoma and pouch. Retrieved from Potter & Perry, 2019)
(Potter & Perry, 2019)
Bowel
Diversions Ostomies
Image of ostomies. Retrieved from Potter & Perry, 2019.
References
Potter P., Perry, A., (2019). Canadian Fundamentals of Nursing. Toronto: Elsevier