ED

Lab 5

Bowel Elimination

 

Learning Outcomes

After studying this topic, you will be able to accomplish the following:

  • Administer a large-volume cleansing enema.

  • Administer a small-volume cleansing enema.

  • Administer a retention enema.

  • Remove stool digitally.

  • Apply a fecal incontinence collection device.

  • Empty and change an ostomy appliance.

  • Irrigate a colostomy.

  • Insert a nasogastric tube.

  • Irrigate a nasogastric tube connected to suction.

  • Remove a nasogastric tube.

Nursing Concepts

  • Assessment

  • Clinical Decision Making/Clinical Judgment

  • Elimination

  • Functional Ability

  • Safety

Introduction to Bowel Elimination

Elimination of the waste products of digestion is a natural process critical for human functioning. Patients differ widely in their expectations about bowel elimination, their usual pattern of defecation, and the ease with which they speak about bowel elimination or bowel problems. Although most people have experienced minor acute bouts of diarrhea or constipation, some patients experience severe or chronic bowel elimination problems affecting their fluid and electrolyte balance, hydration, nutritional status, skin integrity, comfort, and self-concept. Moreover, many illnesses, diagnostic tests, medications, and surgical treatments can affect bowel elimination. Nurses play an integral role in preventing and managing bowel elimination problems.

This topic covers skills the nurse may use to promote bowel elimination. Understanding the anatomy of the gastrointestinal (GI) system is integral to performing the skills in this topic (Fundamentals Review 13-1). An abdominal assessment is required as part of providing the interventions outlined in many of these skills. Refer to Skill 3-7: Assessing the Abdomen in Topic Overview: Health Assessment. Fundamentals Review 13-2 summarizes factors that may affect bowel elimination. Fundamentals Review 18-2 in Topic Overview: Laboratory Specimen Collection reviews the characteristics of stool.

Fundamentals Review 13-1: Anatomy of the Gastrointestinal Tract

  • The GI tract begins with the mouth and continues to the esophagus, the stomach, the small intestine, and the large intestine. It ends at the anus.

  • From the mouth to the anus, the GI tract is approximately 9 m (30 ft) long.

  • The small intestine consists of the duodenum, jejunum, and ileum.

  • The large intestine consists of the cecum, colon (ascending, transverse, descending, and sigmoid), and rectum.

  • Accessory organs of the GI tract include the teeth, salivary glands, gallbladder, liver, and pancreas.

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Anatomy of the gastrointestinal tract.

Fundamentals Review 13-1: Factors That Affect Bowel Elimination

  • Mobility: Regular exercise improves GI motility and muscle tone, whereas inactivity decreases both. Adequate tone in the abdominal muscles, the diaphragm, and the perineal muscles is essential for ease of defecation.

  • Food and Fluids: Foods high in fiber help keep stool moving through the intestines. Adequate fluid intake keeps stools from becoming dry and hard. Adequate fluid also helps fiber to keep stool soft and bulky and prevents dehydration from being a contributing factor to constipation.

  • Medications: Some antibiotics and laxatives may cause stool to become loose and more frequent. Diuretics may lead to dry, hard, and less frequent stools. Opioids decrease GI motility, leading to constipation.

  • Intestinal diversions: Ileostomies normally have liquid, foul-smelling stool. Sigmoid colostomies normally have pasty, formed stool.