ByPurwaningsih

Objectives Describe the normal physiology of bowel eliminationRecognize causes of constipation Discuss assessment and interventions to achieve nursing outcomes for bowel elimination

GI Tract is a series of hollow mucous membrane lined muscular organsPurpose is to absorb fluids & nutrients, prepare food for absorption & provide storage for feces

MouthEsophagusStomachSmall Intestine Large IntestineRectumGI Tract Anatomy

Small intestine

Made up of three parts: ileum, jejunum, and duodenum.

Main function is absorption

Small intestineSmall intestine

Colon3 Divisions: Ascending, Transverse, DescendingColon Functions: Absorption, Protection, Secretion, & Elimination (stool and flatus)

Sigmoid colonStorage of fecesLength varies with ageWhen fecal mass or flatus moves into rectum, it distends and defecation beginsProcess involves involuntary (Internal sphincter) and voluntary control (external sphincter)Valsalva Maneuver- voluntary contraction of abdominal muscles

Rectum

Physiology Bowel EliminationGI MotilityEnzyme breakdownPeristalsisGastrocolic ReflexMucosal TransportFluids & ElectrolytesWaste(Bisanz, 2007)

Physiology Bowel EliminationDefecation ReflexSphinctersCNS ImpulsesRectal DistentionMechanical AssistanceAnal Sphincter Muscles(Bisanz, 2007)

Frequency

Quantity

Quality

Consistency

Ease of PassageCharacteristics Bowel Elimination

Bristol Stool Scale

Constipation Scoring System http://www.ncbi.nlm.nih.gov/pubmed/864957http:// en.wikpedia.org./wiki/Bristol_stool_Chart Tools for Stools

AgeInfectionDietFluid IntakePhysical ActivityPsychological factorsPersonal HabitsFactors Affecting Bowel Elimination

Position during DefecationPainSurgery and AnesthesiaMedicationsFactors Affecting Bowel Elimination

ConstipationImpactionDiarrheaIncontinenceFlatulenceHemorrhoidsCommon Bowel Elimination Problems

Definition: decreased normal frequency of defecation accompanied by difficult or incomplete passage of excessively dry stool (Wilkinson, J.M., 2005)

CONSTIPATION

Poor IntakeFluidsNPO tests, surgeryChoices juice, waterPositioning

Fiber Menu choices fresh fruit, whole grainsCauses - Constipation

Orthopedic InsultCasts, TractionPain with movementAssistive devices

Other diseases Causes - Constipation

Open Door Policy Privacy visitation policyBathroom vs. Commode

Disruption of Routine Therapy Tests/SurgeryCauses - Constipation

Pain MedicationsOpiates P.O. or PCA

Other medications Antacids with aluminum, anticholinergics, calcium channel blockers, phenothiazines, diuretics, sedatives, etc. (Hinrichs, Huseboe, Tang, & Titler, 2001)Causes - Constipation

Last resort: Bulk-forming Stool softeners Osmotic Laxatives Stimulants Suppository/Enema (Hinrichs, Huseboe, Tang, & Titler, 2001)Laxatives (+/-)

AssessmentAUDITS: DiagnosisPostoperative DayMedications +/-Bowel Movement RecordedINTERVIEWS: NursesLeadershipPatients

Pictorial DiaryFluids 8 servingsWhole grains 3 servingsFruits/vegetables 5 servingsExercise 3-4 x/day

Bowel Movement - recordInterventional Tool

Bowel Elimination Tool (BET)Interventional Tool

Directions:

Mark your selections with an X

Choose: 8 Glasses of Fluid: Best: Water or Juices; Decaffeinated drinks 3 Servings of Whole grain breads or cereal: Best: Whole wheat, oatmeal, bran cereals 5 Servings of Fruits or Vegetables: Best: Fresh fruits, vegetables with skin Exercise 3-4 times per day Best: Walking, physical therapy, or exercises in bed

Record your BM Difficult___ Easy___ Soft___ Hard___ Complete__

Interventional Tool

1) Cooperates for Bowel ManagementPartners for care uses toolOut of bed/ exercises 3-4 x dayOverview of diet>15 gm fiber; >1500 cc fluidsPrivacy and respect toileting regime (Moorhead, 2008)Nursing Outcomes

2) Constipation alleviated as indicated:

Elimination pattern in expected rangeStool soft and formed (soft/hard)Stool easy to pass (easy/difficult)Amount adequate for diet (yes/no)Feeling of evacuation (yes/no) (Moorhead, 2008)

Nursing Outcomes