Bowel Elimination

Chapter 47 & Chapter 30: Bowel Elimination

Scientific Knowledge Base

• Components involved in bowel elimination: Mouth, Esophagus, Stomach, Small intestine, Large intestine, Rectum, Anus and finally defecation

Nursing Knowledge Base

• Factors that influence bowel elimination: age, diet, fluid intake, physical activity, psychological factors, person habits, position during defection, pain, pregnancy, surgery and anesthesia, medication and diagnostic tests.

Common Bowel Elimination Problems

• Constipation, Diarrhea, Incontinence, Flatulence, Hemorrhoids

• Bowel diversions: Ostomies,

• Other procedures: Ileoanal pouch anastomosis

Critical Thinking in Bowel Elimination

• Integrate knowledge from various disciplines to understand patient responses to bowel elimination issues.

• Use critical thinking attitudes (e.g., fairness, confidence, discipline) and apply relevant standards when choosing nursing measures.

Nursing Process: Assessment

• Through the patient’s perspective: Assess based on history, environmental factors, physical examination of the mouth, abdomen, rectum. As well as laboratory tests, fecal specimens, and diagnostic examinations.

  • Epigastric- Above the umbilicus and between the costal margins.

  • Umbilical-around the naval

  • Suprapubic- above the symphysis pubis

• Order of assessment: Inspect, Auscultate, Percuss, Palpate.

• Abdominal regions: Epigastric, Umbilical, Suprapubic.

• Abdominal assessment steps and details, including abdominal girth measurement and documentation practices.

Inspection:

• Observe for: Symmetry, shape and contour, umbilicus, skin, movements and pulsations.

Auscultation of Bowel Sounds

• Types of bowel sounds: Normal (5-35 sounds/min), Absent (5 min/quadrant), Hypoactive, Hyperactive (these are normally loud, growing sounds borborygmi)

• Immediate reporting of vascular abnormalities, like bruits.

• Bruits are narrowing of major blood vessels and disruption of flow, they should be reported immediately.

• Normal: no vascular sounds over aorta or femoral arteries.

Percussion and Palpation

• Percussion tones: Tympany, Dullness

• Abdominal tenderness, distension, or masses (Light and Deep palpation).

• Light palpation sounds only about ½ inches, should be smooth with consistent softness, non-tender and non masses.

Abnormal Stool Findings

• Characteristics: Color, Odor, Consistency, Shape, Constituents

  • Color: White or clay (biliary issue), black or tarry (melena) Red, pale with fat, translucent mucus or bloody mucus.

  • Odor: Noxious change (absorption issue)

  • Consistency: Liquid hard

  • Shape: Narrow, pencil shaped

  • Constituents: Blood, pus foreign, bodies, mucus, worms, excess fat.

• Significance of variations in stool appearance, e.g., white/clay color indicating biliary issues.

Laboratory Tests

• Fecal specimens, collection techniques, and the importance of aseptic practices.

• Tests like Occult Blood (Guaiac) for hidden blood.

Nursing Process: Analysis and Nursing Diagnosis

• Common diagnoses: Bowel Incontinence, Constipation, Fecal Impaction, Diarrhea.

• Contributing factors: irregular bowel habits, low fiber/fluid intake, anxiety, immobility.

Alteration in Bowel Elimination: Constipation

• Signs/symptoms and risk factors (e.g., laxative misuse, medications, lack of exercise).

• Consideration of co-morbidities like cardiovascular disease and glaucoma.

Alteration in Bowel Elimination: Impaction

• Risk factors (e.g., confusion, immobility).

• Symptoms and interventions, including gentle digital rectal exam if necessary.

Alteration in Bowel Elimination: Diarrhea

• Causes and symptoms, including fluid/electrolyte imbalance and skin integrity concerns.

• Causes like antibiotic use, food intolerances, C. difficile infection.

Alteration in Bowel Elimination: Incontinence

• Issues with fecal and gas control, effects on social interaction and self-image.

Implementation: Promotion of Normal Defecation

• Health promotion tips: sitting position, privacy, medications.

• Digital removal of stool and colorectal cancer screening.

Positioning on Bedpan

• Techniques for patient comfort, including head elevation for patients able to shift.

• Instructions for immobile patients who cannot raise hips.

Implementation: Acute Care

• Enema administration types: tap water, saline, soapsuds, hypertonic solutions.

• Special considerations for patients with fecal incontinence or diarrhea.

Implementation: Continuing and Restorative Care

• Care of patients with ostomies: Irrigating and pouching ostomies.

• Nutritional and psychological considerations, bowel training, skin integrity maintenance.

Evaluation and Patient Outcomes

• Evaluation through the patient’s experience.

Safety Guidelines for Nursing Skills

• Instruct patients on side-lying position for self-administered enemas.

• Check pulse for patients with cardiac concerns due to vagus nerve stimulation risks.