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Bowel EliminationNUR101 Fall 2008
Lecture # 23
K. Burger, MSEd, MSN, RN, CNE
PPP By: Sharon Niggemeier RN MSN
J Borrero 12/08
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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)
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Anatomy & Physiology
Organs of the GI tract?
Function of Large intestine: absorption
Extends from Ileocecal valve to
anus
Chyme Peristalsis & Mass peristalsis
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Act of Defecation
Defecation reflex
Valsalva maneuver
Defecation
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Alteration in Bowel
Elimination Diarrhea
Constipation Incontinence
Fecal Impaction
Flatulence
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Characteristics of Stool
Volume
Color Odor
Consistency
Shape
Constituents
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Factors That Influence Bowel
Elimination Age
Fluid Intake & Diet Daily Routine
Activity
Medications
Health Status
Stress
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Diet
High fiber foods:
Legumes (beans) Cereals
Whole grains
Raw Fruits
Vegetables
Laxative effect
foods:
Spicy & greasy
Bran/Chocolate
Coffee/Alcohol Raw fruits &
vegetables
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Assessing Elimination Status
Usual pattern
Changes in bowels
Aids to eliminate
Current problems
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Physical Assessment
Inspection- observe contour of abd andnote visible peristalsis
Auscultation- listen for bowel sounds allquadrants
Percussion- resonant or tympany over
hollow organsdullness over intestinalobstruction
Palpation- feel for masses, tenderness
etc
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Stool Specimen Collection
Routine specimen
Occult blood
Ova & parasite
Timed specimens
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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 promotebowel elimination
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Interventions to Promote
Elimination Routine
Positioning Privacy
Comfort
Activity
Diet/Fluids
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Interventions: Promote Bowel
Elimination Laxatives and Cathartics
Enemas Suppositories
Digital Removal
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Types of Enemas
Cleansing Retention Return Flow
Types of Enemas
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Enema Solutions
Tap water (Hypotonic)
Normal saline (Isotonic) Soap
Hypertonic Oil
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Tap Water (TWE)
Amount: 500-1000cc
Action: Distends, increases peristalsis
Time: 15 min.
Indicated: inflamed bowels/irritatedcolon
Contraindicated: Atonic bowels, fluidrestrictions
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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 (SSE)
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, Naproblems
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Oil Retention
Amount: 120-200cc
Action: Lubricates Time: 30 min.
Indicated: Fecal impaction
Contraindication: none
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Enema Administration
PPE
Position L Sims
Linen protector
Receptacle (bedpan,
commode, toilet)
IV pole
Lubricant
Enema bag with
solution
Tissue paper
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Enema Administration
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.
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Evaluation
Solution given
Amount expelled
Characteristics of
stool
Passing of flatus
Unusual findingsblood,
helminthes, pusetc.
Client reaction:
change in skincolor, VSchanges, fatigue
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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
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Flatulence
Causes:
Decreasedperistalsis
Constipation
Medications
Surgery
Diet
Stress
Decreasedactivity
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NonInvasive Interventions for
Flatulence
*Ambulation*
Knee chest
position
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Invasive Interventions for
Flatulence Glycerin Suppository
Harris Flush
Rectal Tube
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Evaluation of Bowel Function
Achievement of regular defecation habits
Patients understanding of normal
elimination Maintenance of adequate food and fluid
intake
Regular exercise program Comfort
Skin integrity
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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 until1989, 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.
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