Fundamentals: Exam 3- Bowel Elmination

Gastrointestinal (GI) System

The system responsible for digestion, absorption of nutrients, and elimination of waste. It extends from the mouth to the anus and includes organs like the esophagus, stomach, intestines, and rectum.

• Digest the food we eat

• Absorb nutrients into the bloodstream

• Process and eliminate waste that the body cannot use

What are the primary roles of the bowel (intestines)?

Esophagus

A muscular tube connecting the pharynx (throat) to the stomach. It uses peristalsis to move food. Contains the Lower Esophageal Sphincter (LES)

Lower Esophageal Sphincter (LES)

which prevents stomach contents from re-entering the esophagus.

Stomach

A muscular organ that temporarily holds food and mixes it with acid and digestive enzymes to break it down into a semi-liquid form (chyme).

Small Intestine (Small Bowel)

A 20-foot-long organ composed of the duodenum, jejunum, and ileum.

Jejunum

the part of the small intestine between the duodenum and ileum.

Jejunum & Ileum

what is responsible for Primarily responsible for nutrient absorption?

Duodenum

the first part of the small intestine immediately beyond the stomach, leading to the jejunum.

continues chemical digestion

Ileum

the final section of the small intestine, is primarily responsible for absorbing vitamin B12, bile acids, and any remaining nutrients that weren't absorbed by the duodenum and jejunum. It also helps move digested food waste towards the large intestine. 

Large Intestine (Colon)

A 2-meter long, 6–7 cm wide muscular tube made of:

• Ascending Colon

• Transverse Colon

• Descending Colon

• Ends in the Rectum and Anus
  Its main role is to absorb water, process waste, and expel feces.

Bacteria in the colon, known as the gut flora, help process waste, produce vitamins (like vitamin K), and support immunity. They include both beneficial and harmful species.

What is the role of bacteria in the colon?

Rectum

The final portion of the large intestine that stores fecal matter until defecation. Typically remains empty unless the person is ready to pass stool.

Anus

The terminal end of the digestive tract through which feces is expelled from the body.

Clostridium difficile (C. diff)

A bacterium that causes diarrhea and colitis (inflammation of the colon). Often linked to antibiotic use that disrupts normal flora. Symptoms include light brown, watery, foul-smelling stool. Handwashing with soap is essential to prevent spread.

Contact precautions. Use gloves and gowns; wash hands with soap and water (NOT alcohol-based sanitizers).

What kind of isolation is used for C. diff?

Valsalva Maneuver

A forceful attempt to exhale with a closed airway, often used during straining to defecate. Can stimulate the vagus nerve and cause fainting or dizziness.

• Inspection

• Auscultation

• Percussion

• Palpation
  (This order prevents alteration of bowel sounds.)

What is the proper order for a focused bowel assessment?

Constipation

Infrequent or difficult passage of stool, usually hard and dry. Can be due to narcotics, dehydration, immobility, or low fiber intake.

Colostomy

A surgical opening where a portion of the large intestine (colon) is brought to the abdominal surface. Used when the bowel needs to rest or a segment is removed.

Ileostomy

A surgically created opening from the small intestine (ileum) to the abdominal wall. Output is liquid and enzyme-rich, requiring skin protection.

• Ileostomy: From small intestine, liquid stool, more enzyme-rich

• Colostomy: From large intestine, stool consistency varies based on location (formed to semi-formed)

What’s the difference between an ileostomy and a colostomy?

Loop Colostomy

A temporary colostomy where a loop of bowel is pulled to the surface and opened. Often used to divert stool from an inflamed or obstructed segment.

Double-Barrel Colostomy

Involves two stomas:

• One for stool (proximal)

• One for mucus (distal)
  Used to rest or bypass a diseased bowel segment.

• Keep skin clean and dry

• Empty pouch when 1/3 to 1/2 full

• Observe stoma color (should be red or pink and moist)

• Consult a Wound Ostomy Continence Nurse (WOCN) for guidance

What are key nursing responsibilities for ostomy care?

Normal Bowel Elimination Frequency

Ranges from 3 times per day to 3 times per week. Normal varies based on the individual.

Fecal Impaction

Hardened stool stuck in the rectum. May present as oozing liquid stool, abdominal discomfort, and distension.

Gas in the GI tract caused by swallowed air, diet (e.g., beans, cabbage), slowed peristalsis, or certain medications.

What is flatulence and what causes it?

Enema

Introduction of fluid into the rectum to stimulate bowel movement. Types include cleansing, retention, oil-based, and medicated.

• Last bowel movement

• Abdominal assessment

• Contraindications (e.g., rectal surgery, severe hemorrhoids)

What should the nurse assess before giving an enema?

Bristol Stool Chart

A medical aid used to classify stool types (Type 1 = hard lumps/constipation; Type 7 = watery/diarrhea).

Stoma

A surgically created opening on the abdomen that allows waste to exit the body. Should be moist, red or pink, and slightly raised.

• High-fiber foods (whole grains, fruits, vegetables)

• Adequate hydration

• Warm liquids in the morning

• Limiting processed foods

What dietary practices help promote normal bowel function?

assess vitals and avoid further straining (it may be a vagal response risk)

• Stop the patient from straining

• Lay them flat and check vital signs

• Monitor for signs of bradycardia or hypotension

• Notify the healthcare provider

what should you do if a patient faints during a bowel movement?

vagal response

a sudden, temporary loss of blood flow to the brain, often causing dizziness, lightheadedness, and sometimes fainting

A drop in heart rate and blood pressure due to stimulation of the vagus nerve, often caused by straining during bowel movements. Can lead to dizziness or fainting.

• Gown

• Gloves

• Soap and water hand hygiene

• Single-patient-use equipment when possible

Which personal protective equipment (PPE) is required for C. diff?

• Paralytic ileus (a condition where the muscles of the intestines stop working properly)

• Recent abdominal surgery

• Constipation

• Late-stage obstruction

What might hypoactive bowel sounds indicate?

Patient Prep for FOBT (Fecal Occult Blood Test)

Patients must avoid red meat, iron, NSAIDs, and vitamin C for 3 days before the test to prevent false results.

• clear liquid diet 24 hours prior

• NPO after midnight

• Bowel prep as ordered

• Consent signed

• IV sedation administered during the procedure

What are pre-procedure instructions for a colonoscopy?

One-Piece Ostomy System

Pouch and barrier are one unit; less bulky

Two-Piece Ostomy System

Pouch attaches to a separate skin barrier; easier to change pouch without removing barrier

• When it’s 1/3 to 1/2 full

• Before meals or going out to reduce odor and leakage

When should an ostomy pouch be emptied?

Diarrhea and Acid-Base Imbalance

Prolonged diarrhea can result in the loss of bicarbonate, leading to metabolic acidosis.

Kussmaul respirations

deep, rapid breathing to blow off CO₂.

• High-fiber foods: bran, whole grains, vegetables, fruits

• Fluids (6–8 glasses/day)

• Warm liquids in the morning (stimulate peristalsis)

What foods should a client with constipation be advised to consume?

• Risk for electrolyte imbalance and fluid loss

• Potential dependency on enemas for bowel function

Why should a nurse avoid repeated enemas in older adults?