funds 31 promoting bowel elimination

structures involved in waste elimination

overview of intestinal system

normal transit time in intestine

18h - 72h

aging of intestinal tract

atrophy of villi

decreased absorption of fats, b12

decrease in motility

bowel habits should not change in normal healthy individual

normal stool

color: light - dark brown

consistency: soft in children & adults. ¼ solids, ¾ water

appearance: affected by diet, metabolism and meds eg iron

composition: solid materials 70% undigested carbs, fats, protein, inorganic matter. 30% dead bacteria

abnormal stool

most serious: blood

• fresh red blood: colon blood. recent

• occult (hidden): upper GI bleed. black stool: melena

pale white / light gray: absence of bile in intestines

steatorrhea: stool w abnormally high fat content

• frothy, foul smelling, floats

hypoactive bowel sounds → constipation

indicates decrease in peristalsis → flatus (gas) accumulates

• causes: bed rest & immobility, injury to bowel, drugs, surgery

drugs that constipate

• general anesthetics

• narcotics

• diuretics

• sedatives

• anticholinergics (slow down rest & digest, drying effects)

• calcium channel blockers (effect smooth muscles)

• barium (contrast). drink 3 ½ liters after, maybe lax

drugs used to treat constipation

72h w/o bm before contacting hcp

stool softeners

• colace, surfax, dialose

bulk-forming laxatives

• fibercon, metamucil, citrucel - increase fluids!

irritant/ stimulant laxatives

• dulcolax, neolid, ex-lax, correctol, senokat

saline laxatives

• citrate/ milk of magnesia, phosphoosoda

hyperactive bowel sounds → diarrhea

increase in peristalsis

causes: inflammation of GI tract, infectious diseases, meds eg antibiotics

• diverticulitis, ulcerative colitis, crohn’s disease

meds used to treat diarrhea

use for 48h before contacting hcp

• camphorated tincture of opium (paregoric)

• lomotil

• motofen

fecal incontinence

causes: illness, cerebrovascular accident, neurogenic dysfunction, traumatic injury

not a normal part of aging, there is a cause

assessment of pt

• does pt have bowel problem?

• usual bowel pattern , any changes?

• anything used to promote defecation?

• enemas or laxative?

• eating and exercise habits

• foods and disorders that promote diarrhea or constipation

when assessing,

pt supine

is abdomen flat or distended? soft or hard?

auscultate in all quads - order: RL, RU, LU, LL

percuss for presence of excess gas, palpate for masses/ tenderness

nursing dx

rectal suppositories

used to promote bowel movements

• Glycerin & Bisacodyl (Dulcolax)

left sims. lubricant. must touch mucosa of rectum

• forms gas that expands the rectum

enemas

fluid into rectum via tube. enemas until clear (no fecal matter)

stimulate peristalsis / wash out waste products

• often before colonoscopy / xray

• school age: 300-500mL. adults: 500-1000mL

• 4in inside, toward umbilicus

no more than 3 large-volume enemas. check w pcp

may result in fluid / electrolyte imbalance

types of enemas

for cleansing enema, do not administer too rapdily (distention of rectum and colon, will stimulate defecation)

• should be 12-18 inches above anus.

if pt undergoing edema has discomfort,

clamp. wait until passes then continue until can no longer retain, then reclamp.

bowel training for incontinence

establishing regular elimination: adequate diet, sufficient fluids, adequate exercise, sufficient rest

• regular time should be established

• may require digital sphincter to relax anal sphincter

• may require drug therapy

bowel ostomy

a diversion of intestinal contents from their normal path

result is an external opening: stoma

types of ostomies

ileostomy: small bowel contents to pouch / stoma. effluent (fecal matter) is liquid

colostomy: diversion of colon. effluent may be liquid / solid, depending on site. may require irrigation

kock pouch: internal pouch near ileum

• can be from the sigmoid, descending, ascending, transverse aka double - barrel (mucus & stool)

ostomy care

changed q3-5 days

stoma should appear pink-red

liquid is measured

skin care

• stoma & skin washed w mild soap and water. patted dry

• skin barrier paste is applied

applying an ostomy appliance / wafer

• skin prep applied to peristoma before applying faceplate

• measured so the opening is appropriate for stoma/ ab ¼ in around stoma

irrigating

solution instillied into colon via stoma

applying ostomy appliance

faceplate / disk: attaches to abdomen. must be measured right size

pouch: collects effluent and gas. empty when 1/3 - ½ full

belt: can support pouch

clamp: at bottom of pouch to secure