Bowel Elimination

Basic Human Needs
Bowel Elimination
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
GI Tract Anatomy
• Mouth
• Esophagus
• Stomach
• Small Intestine
• Large Intestine
• Rectum
Colon
• 3 Divisions: Ascending, Transverse, Descending
• Colon Functions: Absorption, Protection, Secretion, &

Elimination (stool and flatus)
Flatus Formation
• Air swallowing
• Diffusion of gas from bloodstream into intestines
• Bacterial action on unabsorbable CHO (Beans)
• Fermentation of CHO (cabbage, onions
• Can stimulate peristalsis
• Adult forms 400-700 ml of flatus daily
Factors Affecting Bowel
Elimination
• Age
• Infection
• Diet
• Fluid Intake
• Physical Activity
• Psychological factors
• Personal Habits
Factors Affecting Bowel
Elimination
• Position during Defecation
• Pain
• Surgery and Anesthesia
• Medications
Common Bowel Elimination
Problems
• Constipation
• Impaction
• Diarrhea
• Incontinence
• Flatulence
• Hemorrhoids
Constipation
• More of a symptom than a disorder
• Decrease in frequency of BM
• Straining & pain on defecation is associated
symptoms(Valsalva maneuver)
• Can be significant heath hazard (increase ICP, IOP, reopen
surgical wounds, cause trauma, cardiac arrhythmias)
Impaction
• Results from unrelieved constipation
• Collection of hardened feces wedged into rectum
• Can extend up to sigmoid colon
• Most at risk: depilated, confused, unconscious (all are at risk
for dehydration)
Impaction
• When a continuous ooze of diarrheal stool develops,
impaction should be suspected
• Associated S/S: Loss of appetite, abdominal distention,
cramping, rectal pain
Diarrhea
• Increase in number of stools & the passage of
liquid, unformed stool
• Symptom of disorders affecting digestion,
absorption, & secretion of GI tract
• Intestinal contents pass through small & large
intestines too quickly to allow for usual
absorption of water & nutrients
Diarrhea
• Irritation can result in increased mucus
secretion, feces become too watery, unable to
control defecation
• Excess loss of colonic fluid can result in acid-base
imbalances or fluid/electrolyte imbalances
• Can also result in skin breakdown
Conditions that cause Diarrhea
• Emotional Stress
• Intestinal Infection (Clostridium difficile)
• Food Allergies
• Food Intolerance
• Tube Feedings (Enteral)
• Medications
• Laxatives
• Colon Disease
• Surgery
Incontinence
Inability to control passage of feces and gas from the anus
• Caused by conditions that create frequent, loose, large
volume, watery stools or conditions that impair sphincter
control or function
Flatulence
• Gas accumulation in the lumen of intestines
• Bowel wall stretches and distends
• Common cause of abdominal fullness, pain, & cramping
• Gas escapes through mouth (belching), or anus (flatus)
Hemorrhoids
• Dilated, engorged veins in the lining of the rectum
• External (Clearly visible) or Internal
• Caused by straining, pregnancy, CHF, chronic liver disease
Clicker Question
• 1. A newly admitted client states that he has recently had a
change in medications and reports that stools are now dry and
hard to pass. This type of bowel pattern is consistent with:
• A. Abnormal defecation
• B. Constipation
• C. Fecal impaction
• D. Fecal incontinence
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Bowel Diversions
• Certain diseases cause conditions that prevent normal passage
of feces through rectum
• Creates need for temporary or permanent artificial opening
(stoma) in the abdominal wall
Bowel Diversions
• Surgical openings (ostomy) are most commonly formed in the
ileum (ileostomy) or the colon (colostomy)
• Incontinent ostomy- need to wear appliance pouch
• Continent ostomy- have control through use of ostomy cap
Incontinent Ostomy
• Location of ostomy determines consistency of
stool
• Ileostomy bypasses the entire large intestine,
stools are frequent & watery
• Ascending colostomy- liquid stool
• Sigmoid colostomy-most like normal stool
Incontinent Ostomies
• Loop colostomy- temporary, usually done on
transverse colon
• 2 openings through stoma, proximal loop for
stool, distal loop for mucus
• End colostomy- one stoma formed from the
proximal end of the bowel with the distal portion
removed or sewn shut (Hartmann’s Pouch)
Incontinent Ostomies
• End colostomy usually done for colorectal cancer
• Ruptured diverticulum- temporary end
colostomy with a Hartmanns Pouch
• Double barrel colostomy- Bowel is surgically
severed, 2 ends are brought out onto abdomen
with 2 distinct stomas (proximal & distal)
Continent Diversions
• Ileoanal reservoir- restorative proctocolectomy,
no outward stoma, no pouch wearing, clients
have internal pouch created from the ileum
• Ileal pouches constructed in various
configurations
• End of the pouch is sewn or anastamosed to the
anus
Ileoanal Reservoir
• Several stages to surgery to create pouch
• May need temporary ostomy to allow time for pouch to heal
• Kegel exercises to increase pelvic floor muscle tone
• Kock Continent Ileostomy-Internal reservoir or
pouch is created using piece of small intestine
• Stoma brought out low on abdomen, end of
internal part in pouch is a one way nipple valve
to promote continence
• Valve only allows fecal contents to drain when an
external catheter is place in stoma, no pouch
required
Ostomy Nursing
Considerations
• Patient Education
• Care of skin & stoma, appliance selection and use
• Body Image considerations
• Support groups (UOA)
• Enterostomal nursing- specialty within profession
Nursing Process
Assessment
• Nursing History
• Physical Assessment
• Lab Tests
• Fecal characteristics
• Diagnostic evaluation- Endoscopy, Colonoscopy
Nursing Diagnosis
• Bowel Incontinence
• Constipation
• Diarrhea
• Impaired Skin Integrity
• Body Image Disturbance
• Altered bowel elimination
• Pain
Implementation
Promoting Normal Defecation and
Acute Care Management
• Positioning of patient-squatting
• Positioning on bedpan
• Use of cathartics, laxatives
• Anti-diarrheal agents
• Enemas
• Digital removal of stool
• Ostomy care
• Fecal Incontinence Devices
• Fiber & Fluids
Common Laxatives &
Cathartics
• Metamucil-bulk forming
• Colace, Surfak-emollient or wetting agent
• Fleets, MOM. Mag Sulfate-saline agent
• Dulcolax, Ex-Lax, Castor oil- stimulant cathartic
• Haley’s MO, mineral oil- Lubricant
Enemas
• Cleansing enema
• Tap water
• Normal saline
• Hypertonic Solutions (Fleet’s enema)
• Soapsuds
• Oil Retention
• Medicated enemas (Kayexalate, Lactulose)
• Administering a Cleansing enema P&P pg. 1200-1201
Nasogastric Tubes
• Decompress GI tract in surgery, infection of GI tract, trauma
to GI tract, conditions where peristalsis is absent
• N/G tube purposes- decompression, feeding, compression, &
lavage
• Pliable tube inserted through nasopharynx into stomach
• Uncomfortable insertion
Nasogastric Tubes
• Types: Levin – single lumen, different sizes used
for feeding or decompression
• Salem Sump – Most preferable for

decompression, dual lumen, one for removal of
gastric contents, one as an air vent, hooked to
suction to achieve decompression
Care of Nasogastric Tubes
• Confirm placement after insertion
• HOB at 30 degrees unless ordered otherwise
• Mark point where tube exits nose (AACN 2005)
• Tape tube securely to nose
• Tube Irrigation
• Nasal skin care
• Frequent oral hygeine
• Assess for abdominal distention
• Suction settings
Restorative Care
• Bowel training
• Maintenance of proper fluid & food intake
• Promotion of regular exercise
• Promotion of comfort
• Maintenance of skin integrity
• Promotion of self concept
Clicker Question
• 2. To maintain normal elimination patterns in the
hospitalized client, you should instruct the client to defecate 1
hour after meals because:
• A. The presence of food stimulates peristalsis.
• B. Mass colonic peristalsis occurs at this time.
• C. Irregularity helps to develop a habitual pattern.
• D. Neglecting the urge to defecate can cause diarrhea.
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Basic Human Needs

• Colon Functions: Absorption, Protection, Secretion, &

• Salem Sump – Most preferable for

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