Class 13: Urinary concept of bowel elimination

Definition of bowel elimination

passage and dispelling of stool through the intestinal tract by means of intestinal smooth muscle contraction

What is chyme?

a mixture of partially digested food, water, and gastric juices

what is the digestive process

food travels from mouth to stomach

formation of chyme in the stomach

chyme transports to small bowel and colon

nutrients and water absorbed into blood stream and sent to liver for processing

unabsorbed chyme gets expelled from the anus

normal feces is

75% water

25% solid material

stool should be

soft but formed

where does feces get its brown color from

from the bile and bilirubin

what is the normal bacterial flora in feces and digestive tract

e coli

staphylococcus

flatus

gas expelled through the anus

a "toot"

how much gas (flatus) is formed in the large intestine daily?

7-10 L

in older adults ______ is a choleric problem

constipation

daily patterns of bowel elimination are

different for every person

daily patterns of bowel elimination

frequency

timing considerations

position

place

changes in these patterns may upset a person's routine and lead to constipation

changes in a persons routine can lead to

constipation

what is the best position for bowel movements

squatting or slightly leaning forward

what is a low residue food

rice

eggs

lean meat

low residues can lead to

constipation

examples of food that you should bulk in your diet to help BM

foods high in cellulose and fiber

whole grains, bran, peas, beans, fruits, veggies, etc

what foods can give you diarrhea

spicy foods

foods high in sugar

fluid intake should be around

2000-3000ml a day

(2L)

what is the number one education piece you could teach your patient about bowel elimination

go to the bathroom when you feel the first urge

Peristalsis

Involuntary waves of muscle contraction that keep food moving along in one direction through the digestive system.

if you hold the urge to go make a BM, then the

muscles that help with BM will get weaker and the stool will get harder and not be able to come out as fast

pathologic conditions for BM

spinal cord and head injuries

impaired mobility

poorly functioning sphincter

pain for BM

discomfort while defecating

analgesic for pain

narcotic medicine...

slows down the GI tracy

psychological factors for BM

anxiety, anger, depression

anger or anxiety can cause

increased peristaltic activity which can lead to nausea or diarrhea

depression can cause

decreased intestinal mobility

constipation

strong pain meds are often prescribed with

stool softeners

Narcotic Analgesics (Opioids) will

decrease GI activity and cause constipation

iron tablets will cause

constipation

black coloration of stool

antacids will

neutralize stomach acid

this may decrease peristalsis and cause whitish discoloration

anti motility drugs (loperamide aka Imodium)

will decrease diarrhea

Laxatives

medications or foods given to stimulate bowel movements

promotes elimination

Stool Softeners

Draw water into the stool

softens the stool

antibiotics can

decrease normal bacteria flora which can cause diarrhea

may cause greenish gray discoloration

NSAIDS (ibuprofens, etc) can cause

ulcerations in stomach or duodenum which can lead to an upper GI bleed and cause black stool

blood thinners (aspirin, etc) can cause

bleeding in the GI tract.

if its an upper GI tract bleed, stool will be black

if a lower GI tracy, stool will be red (fresh blood)

stomach and up is the

upper gi tract

intestines and below is the

lower GI tract

what is the best way to stimulate bowel movements

ambulating and exercise

GoLYTELY

polyethylene glycol (bowel evacuant)

given to a patient the day before (24 hours) their colonoscopy to irrigate the whole bowel so its empty for the colonoscopy

colonoscopy

visual examination of the colon

anesthesia does what to bowels

slows down colonic movement

paralytic ileus

complete absence of peristaltic movement that may follow abdominal surgery or complete bowel obstruction

what do you do if you hear no bowel movements or sounds during auscultation

listen for five minutes in each quadrant to confirm

diarrhea

when chyme passes through go tract too quickly

decreased absorption of nutrients

difficulty to hold in urge

flatulence

excessive gas in intestine

can be from swallowed air, food ingested, or bacteria

gas producing foods

onions, cabbage, beans, cauliflower, broccoli, milk, raw veggies

risks that can happen from bowel incontinence

risk of skin integrity- stool sits on skin for too long

risk of infection- utis

embarrassment- can affect personal life

Bowel Incontinence (Fecal Incontinence)

loss of voluntary ability to control fecal and gaseous discharges through the anal sphincter

bowel incontinence is usually a

s/s of another condition

neurologic disorder, traumatic injury, and hemorrhoids

constipation is the

passage of fewer then 3 BM a week

bowel incontinence interventions

Good skin care

Change linens often

Toilet regularly

Bowel training

surgery for a sphincter

Bristol Stool Chart

Medical tool to classify stool.

3-5 is normal

7 is diarrhea

1 is constipation

black or red stool can indicate

GI bleeding

White/grey feces indicates

possible hepatitis, antacids, or pancreatic illness

Black feces indicates

upper gi tract bleeding, black jelly beans or black licorice, or antidiarrheal meds

right feces indicates

bleeding ulcer from intestinal tract

hemorrhoids

stool testing

stool culture- to test for bacteria, parasites, etc

fecal occult blood- for ulcers, IBS, and colon cancer

blood test- is it systemic

sigmoidoscopy

visual examination of the sigmoid colon

polyp

growth extending from the surface of mucous membrane

Flat polyp

lies flat on the surface

adhesions

tissues grown together that are normally separate

ulcerative colitis (UC)

inflammation of the colon with the formation of ulcers, which can cause bloody diarrhea

appendicitis

inflammation of the appendix

Chron's disease

chronic inflammation of the intestinal tract

Diveriticultis

small, bulging pouches that can form in the lining of your digestive system

digital rectum exams are used for

visual examination of rectum to see abnormalities and evaluate sphincter strength muscles

where does the body absorb the most water

the large intestine

ileostomy

the surgical creation of an artificial excretory opening between the ileum, at the end of the small intestine, and the outside of the abdominal wall

stoma

opening of the intestine from the skin

stomas should be

bright red

-ostomy

an opening of the intestine on the skin

Colostomy Types

ascending, transverse, descending, sigmoid

why should someone avoid straining

it can stimulate the vagal nerve and cause a drop in HR

antiflatulent

relieves gas and bloating in GI tract

enema

the placement of a solution into the rectum and colon to empty the lower intestine through bowel activity

diarrhea is defined as

more then 3 loose stools a day

what foods should you avoid if you have diarrhea

cold food

foods high in sugar

spicy food

Indwelling Rectal Tube

Used in patient's with uncontrollable diarrhea.

Disadvantages include, leakage and perirectal

skin damage, injury to the rectal mucosa and injury of anal sphincter.

its like a catheter for ur booty