Bowel Elimination
Bowel Elimination
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GI Tract is a series of hollow mucous
membrane lined muscular organs
Purpose is to absorb fluids & nutrients, prepare
food for absorption & provide storage for feces
GI Tract Anatomy
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Mouth
Esophagus
Stomach
Small Intestine
Large Intestine
Rectum
Mouth
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Digestion begins here
Mechanical, chemical breakdown of nutrients
Teeth-Mastication
Salivary secretions-enzymes
Food Bolus ‫مضغة‬
Esophagus
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Hollow, muscular tube for passage of food to
stomach
Peristaltic waves, contraction and relaxation of
smooth muscle moves food down to stomach
Sphincter control to prevent reflux
Stomach
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Food is temporarily stored and mechanically and
chemically broken down
Secretes HCL, mucus, pepsin, & intrinsic
factor(Needed for Vitamin B12 absorption)
Food is converted into chyme
Small Intestine
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1 inch in diameter
20 feet long
Three divisions: Duodenum, Jejunum, Ileum
Enzymes in small intestine (amylase, lipase, & bile)
break down fats, proteins & carbs into basic elements
Nutrients absorbed in duodenum & jejunum, ileum
absorbs vitamins, iron, & bile salts
Large Intestine
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Lower GI tract
Larger diameter, 5-6 feet in length
3 divisions: cecum, colon, rectum
Responsible for absorption of water
Primary organ of bowel elimination
Cecum-chyme enters cecum via the ileocecal valve,
valve prevents regurg back to small intestine, cecum
ends with appendix
Colon
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3 Divisions: Ascending, Transverse, Descending
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Colon Functions: Absorption, Protection,
Secretion, & Elimination (stool and flatus)
Rectum
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Sigmoid colon
Storage of feces
Length varies with age
When fecal mass or flatus moves into rectum, it
distends and defecation begins
Process involves involuntary (Internal sphincter) and
voluntary control (external sphincter)
Valsalva Maneuver - voluntary contraction of
abdominal muscles
Factors Affecting Bowel
Elimination
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Age
Infection
Diet
Fluid Intake
Physical Activity
Psychological factors
Personal Habits
Factors Affecting Bowel
Elimination
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Position during Defecation
Pain
Surgery and Anesthesia
Medications
Common Bowel Elimination
Problems
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Constipation
Impaction
Diarrhea
Incontinence
Flatulence
Hemorrhoids
Constipation
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More of a symptom than a disorder
Decrease in frequency of BM
Straining & pain on defecation is associated
symptoms(Valsalva manuever)
Can be significant heath hazard (increase ICP,
IOP, reopen surgical wounds, cause trauma,
cardiac arrhythmias)
Impaction
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Results from unrelieved constipation
Collection of hardened feces wedged ‫ عالق‬into
rectum
Can extend up to sigmoid colon
Most at risk: confused, unconscious (all are at
risk for dehydration)
Impaction
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When a continuous ooze of diarrheal stool
develops, impaction should be suspected
Associated S/S: Loss of appetite, abdominal
distention, cramping, rectal pain
Diarrhea
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Increase in number of stools & the passage of liquid,
unformed stool
Symptom of disorders affecting digestion, absorption,
& secretion of GI tract
Intestinal contents pass through small & large intestines
too quickly to allow for usual absorption of water &
nutrients
Diarrhea
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Irritation can result in increased mucus secretion, feces
become too watery, unable to control defecation
Excess loss of colonic fluid can result in acid-base
imbalances or fluid/electrolyte imbalances
Can also result in skin breakdown
Conditions that cause Diarrhea
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Emotional Stress
Intestinal Infection (Clostridium difficile)
Food Allergies
Food Intolerance
Tube Feedings (Enteral)
Medications
Laxatives
Colon Disease
Surgery
Incontinence
Inability to control passage of feces and gas
from the anus
 Caused by conditions that create frequent, loose,
large volume, watery stools or conditions that
impair sphincter control or function
Flatulence
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Gas accumulation in the lumen of intestines
Bowel wall stretches and distends
Common cause of abdominal fullness, pain, &
cramping
Gas escapes through mouth (belching), or anus
(flatus)
Flatus Formation
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Air swallowing
Diffusion of gas from bloodstream into intestines
Bacterial action on unabsorbable CHO (Beans)
Fermentation of CHO (cabbage, onions
Can stimulate peristalsis
Adult forms 400-700 ml of flatus daily
Flatulence
Causes:
Decreased
peristalsis
 Constipation
 Medications
 Surgery
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Diet
 Stress
 Decreased activity
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NonInvasive Interventions for
Flatulence
*Ambulation*
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Knee chest
position
Invasive Interventions for
Flatulence
 Glycerin
Suppository
 Harris
Flush
 Rectal
Tube
Hemorrhoids
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Dilated, engorged veins in the lining of the
rectum
External (Clearly visible) or Internal
Caused by straining, pregnancy, CHF, chronic
liver disease
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…
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Bowel Diversions
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Certain diseases cause conditions that prevent
normal passage of feces through rectum
Creates need for temporary or permanent
artificial opening (stoma) in the abdominal wall
Bowel Diversions
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Surgical openings (ostomy) are most commonly
formed in the ileum (ileostomy) or the colon
(colostomy)
Incontinent ostomy- need to wear appliance
pouch
Continent ostomy- have control through use of
ostomy cap
Ostomy Nursing Considerations
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Patient Education
Care of stoma, appliance selection and use
Body Image considerations
Support groups
Enterostomal nursing- specialty within
profession
Nursing Process
Assessment
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Nursing History
Physical Assessment
Lab Tests
Fecal characteristics
Diagnostic evaluation- Endoscopy,
Colonoscopy
Nursing Diagnosis
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Bowel Incontinence
Constipation
Diarrhea
Impaired Skin Integrity
Body Image Disturbance
Altered bowel elimination
Pain
Implementation
Promoting Normal Defecation
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Positioning of patient-squatting
Positioning on bedpan
Use of cathartics, laxatives
Anti-diarrheal agents
Enemas
Digital removal of stool
Ostomy care
Interventions: Promote Bowel
Elimination
 Laxatives
and Cathartics
 Enemas
 Suppositories
 Digital
Removal
Types of Enemas
Types of Enemas
Cleansing
Retention
Return Flow
Enemas
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Cleansing enema
Tap water
Normal saline
Hypertonic Solutions (Fleet’s enema)
Soapsuds
Oil Retention
Medicated enemas (Kayexalate, Lactulose)
Administering a Cleansing enema P&P pg. 12001201
Tap Water (TWE)
Amount: 500-1000cc
 Action: Distends, increases peristalsis
 Time: 15 min.
 Indicated: inflamed bowels/irritated colon
 Contraindicated: Atonic bowels, fluid
restrictions
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Normal Saline
Amount: 500-1000cc
 Action: Distends, increases peristalsis
 Time: 15 min.
 Indicated:Inflamed bowels/irritated
colon
 Contraindicated: Na retention problems,
fluid restrictions
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Soap
Amount: 500-1000cc (Castile 5ml/1000cc)
 Action: Distends, Irritates
 Time: 15 min.
 Indicated: Constipation
 Contraindicated: Prior to rectal exams
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Hypertonic
Amount: 70-130 cc solution
 Action: Distends/Irritates
 Time: 5-10 min.
 Indicated: Constipation, convenience
 Contraindicated: Dehydration, Na
problems
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Oil Retention
 Amount:
120-200cc
 Action: Lubricates
 Time: 30 min.
 Indicated: Fecal impaction
 Contraindication: none
Colostomy nursing care
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1. Wash hands.
2. Apply clean gloves.
3. Assemble irrigation kit: Attach cone or
catheter to irrigation bag tubing.
4. Fill irrigation bag with 1000 cc tepid tap water
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5. Open clamp and let water from the irrigation
bag fill the tubing.
6. Hang bottom of irrigation bag at height of
client’s shoulder, or 18 inches above the stoma if
the client is supine.
7. Check direction of intestine by inserting a
gloved finger into orifice of stoma.
8. Place irrigation sleeve over stoma and hold in
place with belt‫يطوق بحزام‬
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9. Spray inside of irrigation sleeve and bathroom
with odor eliminator (usual dose is two sprays).
10. Cuff end of irrigation sleeve and place into
toilet bowl (if client is in bathroom) or bedpan
(if client is in bed or chair) (see Figure 6-22-5).
11. Lubricate the cone end of the irrigation
tubing and insert into orifice of stoma through
the top opening of irrigation sleeve
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12. Close top of irrigation sleeve over the tubing.
13. Slowly run water through tubing into colon
14. Remove cone after all water has emptied out
of irrigation bag.
15. Close end of irrigation sleeve by attaching it
to the top of the sleeve.
16. Encourage client to ambulate to facilitate
emptying of remaining stool from colon.
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17. Remove irrigation sleeve after 20–30 minutes
or when stool is no longer emptying from colon.
18. Cleanse stoma and skin with warm tap water.
Pat dry.
19. Place gauze pad over stoma to absorb mucus
from stoma.
20. Secure gauze with hypoallergenic tape.
21. Remove gloves and wash hands.