Bowel Elimination Lecture Notes

Bowel Elimination

Course Information

  • Course Code: NURS 175

  • Focus: Understanding and managing bowel elimination processes in nursing care.

Competencies

  • Discuss self-care aspects of elimination.

  • Evaluate the impact physiology has on bowel function.

  • Identify nursing measures for elimination alterations including:

    • Illness

    • Medications

    • Testing

    • Education

  • Appreciate the impact of culture on elimination needs.

Vocabulary

Definitions of Key Terms

  • Peristalsis: The wave-like muscle contractions that move food through the digestive tract.

  • Defecation: The process of excreting waste from the body through the rectum.

  • Achalasia: A condition where the lower esophageal sphincter fails to relax properly, hindering food passage to the stomach.

  • Digestion: The biochemical breakdown of food into smaller components for absorption.

  • Dyspepsia: Discomfort or pain in the upper abdomen, often related to eating.

  • Enema: A procedure to introduce liquid into the rectum to stimulate bowel movements or to cleanse the bowel.

Physiologic Aspects of Bowel Function

Physiology of the Lower GI System

  • Focuses on the complex processes involved in bowel elimination, including anatomy and function of the intestines.

Factors Impacting Bowel Elimination

Various Influences

  1. Developmental Considerations: Age-related anatomical and physiological changes affecting gut function.

  2. Daily Patterns: Routine eating and bowel habits.

  3. Food & Fluid Intake: Nutritional factors that influence bowel regularity and consistency.

  4. Activity & Muscle Tone: The role of physical activity in stimulating bowel movements and maintaining muscle tone.

  5. Lifestyle & Culture: How cultural practices, dietary preferences, and lifestyle choices affect elimination needs.

  6. Psychological Variables: Stress, anxiety, or depression that may disrupt normal elimination patterns.

  7. Pathologic Conditions: Diseases and conditions (e.g., IBS, inflammatory bowel diseases) affecting bowel function.

  8. Medications: The side effects of drugs that may alter bowel movements.

  9. Diagnostic Studies, Surgery, and Anesthesia: How medical interventions can impact bowel function.

Special Considerations for Patients

  • Obese or Emaciated Patients: Unique challenges in bowel care, including dietary needs and mobility issues.

  • Bedridden Patients: Strategies to promote bowel health despite limited mobility.

  • Sedentary Patients: Risks associated with inactivity and recommendations for increasing movement.

  • Depressed Patients: Psychological factors affecting bowel health and the need for supportive care.

Changes in Older Patients

Areas of Impact

  • Oral Cavity/Esophagus: Altered function and issues such as reduced salivary flow or esophageal motility.

  • Stomach: Changes in gastric emptying and acid secretion affecting digestion.

  • Intestines: Alterations in bowel motility and absorption, leading to constipation or other issues.

Referred Pain Locations

  • General Pain References:

    • Liver, Heart (indicative pathway to systemic diseases).

    • Biliary colic, Cholecystitis, Pancreatitis (gastrointestinal issues).

    • Appendicitis and various forms of colonic pain.

    • Renal colic indicating kidney stone issues.

Assessment of Bowel Movements

Key Assessment Aspects

  • How to assess bowel movements effectively, including questions to ask patients about their regularity, consistency, and issues they're experiencing.

  • Stool Sampling: Collection methods for assessing conditions such as C. diff or parasites.

Diagnostic Testing

Types of Diagnostic Tests

  1. Abdominal CT Scan: Imaging to view gastrointestinal structures.

  2. Endoscopic Studies:

    • Esophagogastroduodenoscopy (EGD): Visualization of the upper digestive tract.

    • Colonoscopy: Examination of the colon to detect abnormalities.

    • Sigmoidoscopy: Evaluation of the sigmoid colon.

    • Wireless Capsule Endoscopy: Non-invasive method for visualizing the intestines.

  3. Upper Gastrointestinal Series (UGI): Radiographic examination of the upper GI tract.

  4. Small Bowel Series (SBS): Imaging of the small intestine.

  5. Barium Enema: Radiologic examination of the large bowel using barium contrast.

  6. Abdominal Ultrasound: Imaging technique to assess abdominal organs.

  7. Magnetic Resonance Imaging (MRI): Advanced imaging to view soft tissues.

Medications Influencing Bowel Function

Categories of Medications

  1. H-2 Receptor Antagonists:

    • Cimetidine

    • Famotidine

    • Ranitidine

  2. Proton-Pump Inhibitors:

    • Lansoprazole

    • Omeprazole

    • Pantoprazole

    • Esomeprazole

  3. Antacids:

    • Maalox, Mylanta, Tums, Milk of Magnesia

  4. Anti-diarrheal medications: Used to treat diarrhea.

  5. Laxatives:

    • Chemical Stimulants

    • Bulk Stimulants

    • Osmotic Laxatives

    • Stool Softeners

Alterations in Bowel Function

Conditions and Care

  1. Diarrhea:

    • Define causes, treatment options, and patient education.

  2. Constipation:

    • Identify causative factors, treatment modalities, and education for patients.

  3. Fecal Impaction:

    • Definition, treatment options, and patient care strategies.

  4. Flatulence & Hemorrhoids:

    • Identification of causes, treatment options, and patient education for prevention.

Individuals at High Risk for Constipation

  • Patients on Bedrest: Particularly those on constipating medications.

  • Patients with Reduced Fluid or Bulk Intake: Importance of dietary fiber and hydration.

  • Depressed Patients: Addressing psychological factors impacting bowel health.

  • Patients with CNS Disease: Conditions causing pain during defecation due to lesions.

Delegation to Unlicensed Assistive Personnel (UAP)

  • **Tasks to Consider: **

    • Enemas

    • Specimen Collection

    • Bowel Sound Assessment

    • Assessment of Abdominal Distention

Assessment Techniques

Key Considerations

  • Conducting a comprehensive health history focusing on gastrointestinal health.

  • Performing thorough physical assessments to identify bowel health issues.

Methods of Emptying the Colon of Feces

Procedures Used

  1. Enemas: Introducing fluid into the rectum to induce a bowel movement.

  2. Rectal Suppositories: Medications administered rectally to stimulate bowel evacuation.

  3. Oral Intestinal Lavage: A method to cleanse the bowel through ingestion of a saline solution.

  4. Digital Removal of Stool: Manual disimpaction when necessary for fecal impaction cases.

Types of Enemas

Classifications

  1. Cleansing Enemas: Intended to cleanse the bowel before procedures or alleviate constipation.

  2. Retention Enemas: Designed to be held in the bowel for a period to treat conditions or deliver medications.

Bowel Training Program

Strategies for Promoting Regular Bowel Habits

  • Timing: Establishing a regular schedule for bowel movements.

  • Positioning: Ensuring proper posture during defecation.

  • Privacy: Allowing patients privacy to encourage bowel habits.

  • Nutrition: Promoting a high-fiber diet and adequate hydration.

  • Exercise: Encouraging physical activity to support bowel function.