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