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39 Cards in this Set

  • Front
  • Back
FECAL ELIMINATION
• Fecal or Bowel Elimination
• Fecal or Bowel Elimination
– Eliminates waste
– Critical to human functioning
– Individual patterns vary
– Alterations effect:
• Fluid & electrolyte balance
• Nutritional status
• Skin integrity
• Comfort and self-concept
Anatomy & Physiology
Main function-
Main function-absorption
Large intestine/Colon
Rectum
Anal Sphincter
Anatomy & Physiology
Waste Products
Waste products
-chyme-enters colon
-feces-exits colon
-stool-after excretion
-Peristalisis every 3-12 min
-Mass peristalisis sweeps are 1-4 times in 24hrs
-1/3 to 1/2 food wastes excreted in stool in 24hr
-rest in next 24-48hrs
-flatus also eliminated
Anatomy & Physiology
Water Absorption
Water Absorption
-800-1500 ml daily
Defecation
• Intrinsic defecation reflex
• Intrinsic defecation reflex
– Feces enters rectum, peristalsis initiated
Defecation
• Parasympathetic defecation reflex
• Parasympathetic defecation reflex
– Rectal nerve fibers stimulated-intensify peristalsis
Defecation
• Expulsion of feces
• Expulsion of feces
– Abdominal muscles & Diaphragm
– Levator ani muscle of pelvic floor
– Thigh flexion increases abdominal pressure
– Sitting position increases downward pressure
Bowel Elimination
Stool/Feces

• Normal Finding
Stool/Feces
• Normal Finding
-Brown color
-Formed consistency
-Normal odor
-25% of feces:
*fat, protein, bile salts, undigested roughage
-75% of feces= water
-cylindrical shape
Stool/Feces

• Abnormal Findings
(table 46-1)
• Abnormal Findings
-occult blood=test
-fats=pale, greasy
-mucus
-abnormal color=diet
*dairy, meds, food color
-bacteria
-viruses
-worms & parasites
Factors affecting bowel elimination
• Appetite, indigestion, food
preferences
• Dysphagia, ulcer, gallbladder
disease
• N/V, colitis, IBS
• Flatulence, change in bowel
routine
• Constipation, diarrhea
• Rectal bleeding, hemorrhoids,
fissure
Fecal Impaction
• Collection of hardened feces in rectum
• Passage of liquid seepage without normal stool
• Symptoms -desire to defecate, rectal pain,
distended abdomen, N/V, anorexic
• Prevention is best
• Enemas-oil retention & cleansing
• May require physician order for manual removal
Enemas: Cleansing
*Cleansing-Remove feces:
-before surgery
-test prep
-constipation/impaction
Enemas: Hypertonic
Hypertonic:
-draws water in
-fleets
Enemas: Hypotonic
Hypotonic
-stimulates peristalsis
-tap water
Enemas: Isotonic
Isotonic
-stimulates peristalsis
-Normal saline
Enemas: Isotonic
Isotonic
-stimulates peristalis
-normal saline
-Soapsuds
* irritate mucosa
* castile soap only
Enemas: Rentention
-soften & lubricate
-Mineral oil
Enemas: Carminative
-Releases gas
-Expel flatus
Enemas:Return flow

(table 46-4)
-Faltus/Abdominal distention
-Repeated 5-6 times
Physical Assessment:
Infants
breast or formula, lack voluntary control
Physical Assessment:
Toddlers
voluntary control, appetite
Physical Assessment:
child, Adolescent, adult
their normal
Physical Assessment:
Older adult
-decreased physical activity
-decreased GI mobility
-change dietary habits
-laxative or enema abuse
Variables
-daily patterns
-food & fluid
-activity
-life style
-psych variables
-pathologic variabls
-medications
-surgery/anesthesia
-pain
-pain of defecation
Nurses as role models
self assessment
• Self Assessment
– Normal pattern without discomfort
– Responds to normal urge
– Increase fiber, fluid in diet
– Identify way to increase fiber & fluid
– Exercise 3-4 times weekly
– Responds to changes in stool-seeks
medical advice as appropriate
Nurses as role models
physical assessment
Physical Assessment:
Abdomen
Inspection
• Look first
Auscultation
• Listen x 4 quads
•5 min. by clock
Palpation
• Touch unless painful
Rectum & Anus
• Assess perineum
Diagnositc Studies
(Endoscopy)
(Radiography)
• Direct Visualization (Endoscopy)
–1 Esophagogastroduodenos-copy
– 2 Colonoscopy
– 3 Sigmoidoscopy
• Indirect Visualization (Radiography)
– 1 Upper G.1.
– 2 Small Bowel Series
– 3 Barium Enema
Diagnostic Studies
-scheduling sequence
-Inspection first
-Auscultation
-Palpation
• Scheduling Sequence
– Fecal Occult Blood Tests
• Noninvasive first
– Barium studies
– Endoscopic Examination
• Possibly before barium
• Inspection first
• Auscultation
• Palpation
Nursing Diagnosis
• Bowel Incontinence
• Bowel Incontinence
– Involuntary passage of
formed stool
Nursing Diagnosis
• Constipation
• Constipation
– Colonic
• Decrease in normal
frequency
– Perceived
• Self diagnosis
Nursing Diagnosis
•Diarrhea
•Diarrhea
– Frequent liquid stool
Nursing Diagnosis
• Self Care Deficit: toileting
• Self Care Deficit: toileting
Nursing Diagnosis
• Skin integrity, impaired
• Skin integrity, impaired
– skin integrity, impaired, risk for
Nursing Diagnosis
• Self-esteem, situational low
• other
• Self-esteem, situational low
• other
Plan and implement nursing
interventions
• Independent
– diet/fluid
–exercise
– privacy/relaxation
– establishing/maintaining routine
• training
• retraining
– positioning
– other
Medications to Promote
Fecal Elimination
•Bulk forming
- Metamucil
• Stool softener
-Colace
• Saline cathartic
-MOM
• Contact cathartic
-Dulcolax
•Lubricant
-Mineral Oil
• CLINICAL INDICATIONS:
• CONTRAINDICATIONS:
Diarrhea
• Assessment
• Diagnosis
• Goal
•Intervention/Implementation





• Evaluation
Constipation: colonic/perceived
• Assessment
• Diagnosis
•Intervention/Implementation
– fecal extraction
– enema
• Evaluation
Bowel Incontinence
• Assessment
• Diagnosis
• Intervention/Implementation
– training/retraining
• Evaluation