bowel elimination part 2

Mini Case Study

  • Caring for an elderly patient with altered mental status

  • Observation: Continuous oozing of diarrhea stool

Assessments Related to Observation

  • Skin Condition:

    • Assess for irritation or breakdown due to caustic nature of stool.

  • Stool Characteristics:

    • Document using the acronym COCA:

    • C: Color

    • O: Odor

    • C: Consistency

    • A: Amount

    • Note any visible blood in stool.

  • Abdomen:

    • Inspect for abdominal distention.

    • Auscultate bowel sounds.

    • Palpate for abdominal discomfort.

  • Medications:

    • Review chart for relevant medications due to patient's altered mental status (inability to provide medication history).

Assessment Guides

  • Focused Assessment Guides:

    • Table 39-1 (page 1526) - Assessing stool characteristics.

    • Table 39-2 (page 1528) - Normal stool characteristics and special considerations.

Anatomy of the GI System

  • Regular elimination of bowel waste is essential for normal body functioning.

  • Alterations may indicate problems in the GI tract or other body systems.

  • Terminology: Feces or Stool (spelling: f e c e s).

Functions of the GI Tract

  • Absorbs fluids and nutrients.

  • Prepares food for absorption and use.

  • Provides temporary storage of feces.

Large Intestines

  • Primary organ of bowel elimination, extending from:

    • Ileocecal Valve (between small and large intestines)

    • Parts of Large Intestine:

    • Cecum

    • Ascending colon

    • Transverse colon

    • Descending colon

    • Sigmoid colon

    • Rectum

    • Anus

Consistency and Odor of Stool

  • Expected characteristics vary at different points along the GI tract.

  • Importance of knowing where ostomies are diverted for management of stool.

  • Normal Stool: Soft, brown, formed.

    • Composition: Approximately 75% water, 25% solid material.

Peristalsis

  • Definition: Coordinated muscle contractions in the GI tract to expel waste.

  • Controlled by the nervous system.

  • Normal contraction frequency:

    • Contractions: Every 3 to 12 minutes.

    • Mass peristalsis: 1 to 4 times per day (often after meals).

  • Importance of mass peristalsis related to meal intake and waste expulsion.

Physiology of Defecation

  • Definition: Defecation is the act of expelling feces from the rectum and anus.

Critical Physiological Factors

  • Normal GI tract function: If GI tract malfunctions, bowel issues occur.

  • Sensory awareness of rectal distension: Awareness triggers defecation urge.

  • Voluntary sphincter control: Ability to control anal sphincters.

  • Adequate rectal capacity: Space in the rectum to facilitate normal function.

Process of Defecation

  • Internal anal sphincter relaxes.

  • Feces moves into the anal canal.

  • Contraction of abdominal muscles and diaphragm occurs.

  • Defecation is easier in a sitting position with thigh flexion commented on in hospital settings, particularly with bedpans.

Factors Affecting Defecation

Developmental Factors

  • Infants:

    • First fecal material: Meconium (black, tarry, odorless).

    • Unable to control defecation.

    • Immature GI system leads to frequent stooling after feedings, particularly in breastfed infants.

  • Toddlers:

    • Control over defecation develops around 2.5 years.

    • Common constipation causes: Poor diet, fear of pain during defecation.

  • School-age Children:

    • May delay defecation due to distractions, leading to potential constipation.

  • Elderly:

    • Frequently constipated due to reduced activity, inadequate fluid and fiber intake, decreased sensory nerve impulses, muscle weakness.

    • Caution against over-the-counter laxatives, as they can inhibit natural reflexes leading to dependency.