By Purwaningsih. OBJECTIVES Describe the normal physiology of bowel elimination Recognize causes of...
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Transcript of By Purwaningsih. OBJECTIVES Describe the normal physiology of bowel elimination Recognize causes of...
ByPurwaningsih
Objectives
Describe the normal physiology of bowel
elimination
Recognize causes of constipation
Discuss assessment and interventions to achieve
nursing outcomes for bowel elimination
GI Tract is a series of hollow mucous membrane lined muscular organs
Purpose is to absorb fluids & nutrients, prepare food for absorption & provide
storage for feces
Mouth
Esophagus
Stomach
Small Intestine
Large Intestine
Rectum
GI Tract Anatomy
Small intestine
• Made up of three parts: ileum, jejunum, and duodenum.
• Main function is absorption
Small intestineSmall
intestine
Colon
3 Divisions: Ascending, Transverse, Descending
Colon Functions: Absorption, Protection, Secretion, & Elimination (stool and flatus)
Sigmoid colon Storage of feces Length varies with age When fecal mass or flatus moves into
rectum, it distends and defecation begins
Process involves involuntary (Internal sphincter) and voluntary control (external sphincter)
Valsalva Maneuver- voluntary contraction of abdominal muscles
Rectum
Physiology – Bowel Elimination
GI MotilityEnzyme breakdownPeristalsisGastrocolic Reflex
Mucosal TransportFluids & ElectrolytesWaste(Bisanz, 2007)
Physiology – Bowel Elimination
Defecation Reflex
• Sphincters
• CNS Impulses
• Rectal Distention
• Mechanical Assistance
Anal Sphincter Muscles(Bisanz, 2007)
Frequency
Quantity
Quality
Consistency
Ease of Passage
Characteristics – Bowel Elimination
Bristol Stool Scale
Constipation Scoring System http://www.ncbi.nlm.nih.gov/pubmed/864957
http:// en.wikpedia.org./wiki/Bristol_stool_Chart
Tools for Stools
o Ageo Infectiono Dieto Fluid Intakeo Physical Activityo Psychological factorso Personal Habits
Factors Affecting Bowel Elimination
Position during Defecation Pain Surgery and Anesthesia Medications
Factors Affecting Bowel Elimination
ConstipationImpactionDiarrheaIncontinenceFlatulenceHemorrhoids
Common Bowel Elimination Problems
Definition: decreased normal frequency of defecation
accompanied by difficult or incomplete passage of excessively
dry stool (Wilkinson, J.M., 2005)
CONSTIPATION
Poor IntakeFluidsNPO – tests, surgeryChoices – juice, waterPositioning
Fiber Menu choices – fresh fruit,
whole grains
Causes - Constipation
Orthopedic Insult Casts, Traction Pain with movement Assistive devices
Other diseases
Causes - Constipation
Open Door Policy ↓ Privacy – visitation policy
Bathroom vs. Commode
Disruption of Routine Therapy
Tests/Surgery
Causes - Constipation
Pain MedicationsOpiates – P.O. or PCA
Other medications Antacids with aluminum, anticholinergics,
calcium channel blockers, phenothiazines, diuretics, sedatives, etc. (Hinrichs, Huseboe, Tang, & Titler, 2001)
Causes - Constipation
Last resort: Bulk-forming → Stool softeners → Osmotic Laxatives → Stimulants →
Suppository/Enema (Hinrichs, Huseboe, Tang, & Titler, 2001)
Laxatives (+/-)
Assessment
AUDITS: • Diagnosis• Postoperative
Day• Medications +/-• Bowel
Movement Recorded
INTERVIEWS: • Nurses•
Leadership• Patients
Pictorial Diary Fluids – 8 servings Whole grains – 3 servings Fruits/vegetables – 5 servings Exercise – 3-4 x/day
Bowel Movement - record
Interventional Tool
Bowel Elimination Tool (BET)
Interventional Tool
Directions:
Mark your selections with an X
Choose: 8 Glasses of Fluid: Best: Water or Juices; Decaffeinated drinks 3 Servings of Whole grain breads or cereal: Best: Whole wheat, oatmeal, bran cereals 5 Servings of Fruits or Vegetables: Best: Fresh fruits, vegetables with skin Exercise – 3-4 times per day Best: Walking, physical therapy,
or exercises in bed
Record your BM Difficult___ Easy___
Soft___ Hard___ Complete__
Interventional Tool
1) Cooperates for Bowel Management
• Partners for care – uses tool
• Out of bed/ exercises – 3-4 x day
• Overview of diet
>15 gm fiber; >1500 cc fluids
• Privacy and respect – toileting regime
(Moorhead, 2008)
Nursing Outcomes
2) Constipation alleviated as indicated:
Elimination pattern in expected range
Stool soft and formed (soft/hard) Stool easy to pass (easy/difficult) Amount adequate for diet (yes/no) Feeling of evacuation (yes/no) (Moorhead, 2008)
Nursing Outcomes