Chapter_030

Chapter 30: Promoting Bowel Elimination

Lesson 30.1 Overview of Bowel Elimination

• Theory

  • Normal Bowel Elimination: Understand the physiological process that facilitates normal bowel movements.

  • Abnormal Stool Characteristics: Identify signs indicating issues such as blood, unusual color, or consistency which signal potential health problems.

  • Physiologic Effects of Hypoactive Bowel:

    • Result: Decreased peristalsis leading to constipation.

    • Nursing Interventions: Assist patients through measures like encouraging mobility, fluid intake, and dietary changes.

    • Enema Safety Considerations: Analyze the protocols and precautions necessary when administering enemas.

• Clinical Practice

  • Nursing Measures: Promote regular bowel habits using interventions like proper hydration, dietary fiber, and routine toileting.

  • Stool Specimen Collection: Understand the correct methods for collecting and analyzing stool samples.

  • Focused Assessment: Monitor bowel function through diligent assessments.

  • Nursing Care Plan: Develop strategies for patients experiencing bowel issues, including documentation and goal setting.

  • Enema Preparation: Educate on how to prepare and administer enemas effectively.

Structures Involved in Waste Elimination

• Small Intestine:

  • Parts: Duodenum, Jejunum, Ileum.

  • Function: Transports chyme from stomach to large intestine, regulated by the ileocecal valve.

• Large Intestine:

  • Parts: Ascending, Transverse, Descending colon, Sigmoid colon, Rectum, Anus.

• Intestinal Wall Layers:

  • Layers: Mucosa, Submucosa, Muscular layer, Serous layer (serosa).

Functions of the Intestines

• Small Intestine:

  • Transforms chyme into a more liquid form, with bile aiding fat digestion.

  • The villi absorb essential nutrients.

• Large Intestine:

  • Absorbs water and electrolytes, stores waste until elimination occurs.

  • Peristalsis: Moves contents through the intestines, with normal transit time being 18 to 72 hours.

  • Defecation: Controlled voluntarily, often utilizing the Valsalva maneuver.

Effects of Aging on the Intestinal Tract

• Aging Effects:

  • Villi atrophy results in reduced nutrient absorption (fats, vitamin B12).

  • Decreased bowel motility; changes in bowel habits do not regularly occur in healthy elderly individuals.

Normal Stool Characteristics

• Color: Ranges from light to dark brown.

• Consistency: Soft-formed; composed of ¼ solids and ¾ water.

• Appearance Factors: Varies based on diet and metabolism.

• Composition: 70% undigested fibers, 30% dead bacteria.

Abnormal Stool Characteristics

• Blood Present:

  • Most serious form of abnormality.

  • Fresh red blood: Indicates possible bleeding in colon.

  • Occult blood: Upper GI bleed indicated by black stool (melena).

  • Pale or gray stool: Suggests no bile in intestines.

  • Other Indicators: Large levels of mucus, fat, pus, or parasites are concerning.

Hypoactive Bowel and Constipation

• Indicators: Decreased peristalsis often leads to constipation.

• Causes of Constipation:

  • Immobility, bowel injury, medication side effects, surgery.

  • Restricted bed rest increases risk of constipation.

  • Accumulation of flatus due to decreased peristalsis.

Contributing Medications for Constipation

• Classes of Drugs:

  • Narcotics (e.g., Codeine, morphine).

  • General anesthetics, diuretics, sedatives, anticholinergics, calcium channel blockers.

Medications for Treating Constipation

• Types:

  • Stool Softeners: Colace, Surfak.

  • Bulk-forming Laxatives: Fibercon, Metamucil.

  • Stimulant Laxatives: Dulcolax, Ex-Lax.

  • Saline Laxatives: Citrate of magnesia.

Hyperactive Bowel and Diarrhea

• Indication: Increased peristalsis typically leading to diarrhea.

• Common Causes:

  • Gastrointestinal tract inflammation and diseases such as diverticulitis and ulcerative colitis.

  • Antibiotics: Could disrupt normal bowel flora, necessitating probiotics or yogurt for restoration.

Medications to Control Diarrhea

• Examples Include:

  • Camphorated tincture of opium (paregoric), Loperamide (Imodium), Lomotil.

Fecal Incontinence

• Definition: Inability to control fecal release, impacting dignity and self-esteem.

• Causes: Neurological issues, traumatic injury, illness.

Initial Patient Assessment

• Key Considerations:

  • Identify the presence of bowel issues and usual patterns.

  • Assess the patient’s use of enemas, laxatives, and dietary habits.

  • Conduct a physical assessment: observe abdomen shape, auscultate bowel sounds, percuss for air/gas, and palpate for tenderness or masses.

Nursing Diagnosis/Problem Identification

• Common Diagnoses Include:

  • Constipation due to hypoactive bowel.

  • Diarrhea related to food intolerance.

  • Fecal incontinence impacting self-image.

  • Knowledge deficit concerning bowel regularity factors.

Ostomy, Stoma, and Peristoma Care

• Theory:

  • Safety protocols when administering enemas, psychosocial implications for patients with ostomies.

  • Assessment procedures for stoma and peristoma, skin care, and understanding types of intestinal diversions.

• Clinical Practice:

  • Assist patients in retraining bowel habits, evaluating self-catheterization, ostomy maintenance practices including appliance changes.

Rectal Suppositories

• Usage:

  • Glycerin and bisacodyl promote bowel movement through rectal stimulation and lubrication to facilitate stool passage.

Enemas

• Purpose:

  • Introduce fluid into the rectum to stimulate bowel movements or cleanse the bowel.

  • Typical volumes:

    • Infants: 20-150 mL

    • Children (3-5 years): 200-300 mL

    • School-age: 300-500 mL

    • Adults: 500-1000 mL

Types of Enemas

• Retention Enema: Softens stool.

• Cleansing Enema: Provokes peristalsis through colon irritation.

• Distention Reduction Enema: Alleviates gas-related discomfort.

• Medicated Enema: Administers drugs for bacterial control or potassium removal.

• Disposable Enema: Small volume irritants that induce peristalsis.

Fecal Impaction

• Definition: Condition where hardened fecal matter obstructs the rectum/sigmoid colon, indicated by a lack of bowel movement beyond three days in typical patients.

• Risk Factors: Common in hospitalized or bedridden individuals.

Bowel Training for Incontinence

• Principles for Successful Outcomes:

  • Appropriate diet, fluid intake, exercise, and rest schedules.

  • Creating an environment conducive to bowel evacuation, possibly incorporating digital stimulation methods.

  • Utilize medications such as stool softeners and laxatives as needed for regularity.

Types of Ostomies

• Ileostomy: Outflow of small bowel contents; liquid waste.

• Colostomy: Outflow from the colon; consistency varies.

Ostomy Care

• Skin Care Routine: Cleanse the stoma gently, apply barriers as necessary.

• Appliance Application: Correct positioning to ensure compliance with the stoma design.

• Irrigation Procedures: If indicated, facilitate effective elimination through the stoma.

Questions and Quick Reviews**

• Q1: Most critical stool abnormality? (Blood)

• Q2: Who is most at risk for constipation? (Older adults)

• Q3: Which groups dehydrate fastest with diarrhea? (Infants and elderly)

• Q4: Difference between ileostomy and colostomy explained?

• Q5: How long for bowel training to succeed? (Varies, up to months or longer).