CH30

Chapter 30: Bowel Elimination and Care

Normal Bowel Elimination

  • Definition: Bowel elimination begins in the mouth and ends as waste (feces/stool) is expelled from the anus (defecation).

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

  • Frequency: Variations exist in elimination frequency across the lifespan. Typically, bowel movements occur 30 minutes to an hour post meal consumption.

Fecal Characteristics

  • Normal Characteristics:

    • Soft, formed, light yellowish-brown to dark brown.

    • Mild odor; typically conforms to a slightly curved shape.

  • Abnormal Characteristics (Table 30.1):

    • Consistency: Liquid, semiliquid or excessively dry, hard stools.

    • Shape: Should be cylindrical; beware of balls, clumps, flat, or ribbon-like shapes.

    • Color: Normal: light brown; Abnormal: bright red, black (like coffee grounds), pale, or clay-colored.

Abnormal Stool Indicators (Table 30.2)

  • Presence of Infection:

    • Normal: Absence of pus, mucus, fat.

    • Abnormal: Presence of pus, excessive mucus, foamy stools.

  • Presence of Parasites:

    • Normal: Absence of parasites.

    • Abnormal: Presence of worms or eggs.

  • Odor: Normal has slight odor; abnormal is foul, with possible bloody or metallic odors.

Assessment of Bowel Elimination

  • Key areas to assess:

    • Color, amount, consistency, shape, and odor of feces.

Focused Assessment

  • Abdominal shape: Should be rounded or flat, not distended.

  • Bowel Sounds: Auscultate in all four quadrants at least once per shift, observing for impacts:

    • Hyperactive sounds indicate potential diarrhea or blockage, while hypoactive sounds suggest constipation.

Bowel Sounds and Their Significance (Table 30.2)

  • Normal: Soft gurgles, irregular clicks (5-30/min).

  • Hypoactive: <5/min, may indicate constipation.

  • Hyperactive: >30/min or continuous; may indicate diarrhea.

  • Borborygmi: Excessively loud gurgling; may indicate hunger or bowel obstruction.

Alterations in Bowel Elimination - Constipation

  • Definition: Infrequent, hard, and difficult-to-expel stools.

  • Contributing Factors: Decreased activity, fluid intake changes, medication side effects, pregnancy, depression, aging, laxative overuse, nerve damage.

Nursing Interventions for Constipation

  • Encourage increased activity and fluid intake.

  • Ensure privacy and assist with proper positioning.

  • Administer medications and enemas as needed.

Types of Enemas (Table 30.3)

  • Tap Water Enema: 500-1000 mL; cleansing, hypotonic (not for infants or heart failure patients).

  • Normal Saline: 500-1000 mL; safe for use in children and heart failure patients.

  • Soapsuds Enema: Added castile soap to water; stimulates peristalsis.

  • Hypertonic Sodium Phosphate: 120 mL; used in adults only.

  • Oil Retention: 120 mL; lubricates and softens impacted stool.

  • Return Flow: Used to remove flatus by siphoning gas back.

Contraindications for Enemas

  • Certain medical conditions like rectal surgeries, severe hemorrhoids, ulcerative colitis, fissures, or heart conditions can prevent enema use.

Complications of Enemas

  • Potential risks include vagal response and intestinal perforation.

Nursing Interventions for Fecal Impaction

  • Often necessitates digital removal before a cleansing enema. Follow facility protocols for personnel permitted to conduct procedures.

Factors Contributing to Diarrhea

  • Consider lactose intolerance, medication effects, anxiety, diverticulosis, inflammatory processes, and allergies.

Lab Tests for Diarrhea

  • Guaiac Test: Checks for blood in stool.

  • Culture and Sensitivity: Identifies microorganisms.

  • Ova and Parasite Test: Screens for parasitic infections.

Nursing Interventions for Diarrhea

  • Modify diet, increase fluids, administer medications, and provide perineal care to prevent skin irritation.

Nursing Interventions for Fecal Incontinence

  • Establish regular bowel training to help maintain elimination schedules. Utilize topical barriers and emotional support.

Bowel Elimination and Aging

  • Aging can reduce activity, dental health, and peristalsis leading to constipation. Diarrhea poses serious risks for dehydration.

Alternative Bowel Elimination

  • Can include surgical interventions (ostomy) for diseases/injuries requiring bowel diversion (e.g., colostomy, ileostomy).

  • Nursing Interventions: Measuring stoma, selecting/appliance care, skin care, and emotional support.