Lect23 GI Elimination

7/28/2019 Lect23 GI Elimination

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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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Lect23 GI Elimination