Fundamentals Of Nursing: Bowel Elimination

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Factors Affecting Bowel Elimination

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Various factors can affect bowel elimination. Interference with the normal functioning of elimination from the intestines can occur in health as well as during illness. Elimination can be affected by a person's developmental stage, daily patterns, the amount and quality of fluid or food intake, the level of activity, lifestyle, emotional states, pathologic processes, medications, and procedures, such as diagnostic tests and surgery.

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Constipation

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defined as bowel movements that are infrequent, hard or dry, and difficult to pass.

Individual bowel patterns may vary. Some people have normal, regular bowel movements every two or three days. This is NOT constipation

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Causes of constipation include:

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Causes of constipation include:
• Frequent use of laxatives
• Advanced age
• Inadequate fluid intake
• Inadequate fiber* intake
• Immobilization due to injury
• A sedentary* lifestyle (sedentary – characterized by inactivity and lack of exercise.)

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Signs and symptoms of constipation:

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Abdominal bloating
Abdominal cramping
Straining to have a bowel movement (defecation).

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Complications of constipation include:

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Fecal impaction –
Development of hemorrhoids or rectal fissure
Bradycardia (slow heart rate), hypotension, and syncope (a brief loss of consciousness associated with a lack of blood circulation in the brain) associated with the Valsalva maneuver that occurs with straining/bearing down.

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Diarrhea

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Defined as an increased number of loose, liquid stools diarrhea is always a symptom of something else going on in the patient.

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Causes of diarrhea include:

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Viral gastroenteritis
Overuse of laxatives
Use of certain antibiotics
Inflammatory bowel disease, such as Crohn’s Disease and Ulcerative Colitis.
• Irritable bowel syndrome – NOT an inflammatory bowel disease!
Food-borne pathogens, such as salmonella.

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Signs and symptoms of diarrhea include:

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Dehydration (dry, sticky mucous membranes, irregular heart rate
Frequent loose, watery stools
Abdominal cramping

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Nursing Interventions for both constipation and diarrhea:

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Monitor client’s normal elimination pattern.
Closely monitor client’s fluid status
Monitor client for signs and symptoms of dehydration
observe and document character of client’s bowel movements
Perform abdominal assessment daily and as needed
Administer laxatives/stool softeners and/or enemas as prescribed
Teaching client about fiber intake, fluid needs, exercise
Monitor client’s skin integrity

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Bowel obstruction

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Intestinal obstruction involves a partial or complete blockage of the bowel that results in the failure of the intestinal contents to pass through.

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Intestinal obstruction is divided into what two basic categories:

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mechanical and non-mechanical.

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Mechanical obstruction

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Results from obstruction within the lumen of the intestine or mural obstruction from pressure on the walls of the intestines. Causes include:

(a) Foreign bodies such as fruit pits, parasitic worms, or gallstones.
(b) Volvulus.
(c) Intussusception.
(d) Hernia.
(e) Cancer.
(f) Adhesions.
(g) Strictures.

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Non-mechanical obstruction

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The result of physiological disturbances. Causes include:
(a) Electrolyte imbalances.
(b) Neurogenic disorders (such as spinal cord lesions).
(c) Paralytic (adynamic) ileus, developing as a result of abdominal surgery, trauma, or infection.

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Signs and symptoms of small bowel obstruction

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1) Small bowel obstruction is characterized by colicky pain, constipation, nausea, and vomiting.
(2) If the small bowel obstruction is complete, the peristaltic waves become quite vigorous, assuming reverse direction and propelling intestinal contents toward the mouth rather than the rectum. The patient vomits stomach contents first, then the bilious contents of the duodenum, and finally the fecal contents of the ileum.
(3) In later stages, dehydration and plasma loss result in hypovolemic shock. (As much as 10 liters of fluid can collect in the small bowel, causing a drastic reduction in plasma volume.)

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Signs and symptoms of large bowel obstruction.

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(1) Symptoms of large bowel obstruction differ from those of small bowel obstruction because the colon is able to absorb its fluid contents and distend well beyond normal size.
(2) Constipation may be the only symptom for several days.
(3) Eventually, the distended colon loops will be visible on the abdomen.
(4) Nausea and cramps, abdominal pain will occur.
(5) Vomiting is absent at first, but when obstruction becomes complete, fecal vomiting will occur.
(6) If the obstruction is only a partial one, any of the above symptoms may occur in a less severe form. Additionally, liquid stool may leak around the obstruction.

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Nursing implication for intestinal obstruction.

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(1) Abdominal girths should be measured daily. For accuracy of comparison, follow these suggested guidelines:

(a) Use the same measuring tape each time.
(b) Place the patient in the same position each time.
(c) Ensure that the tape measure is placed in the same position each time. This can be done by drawing small tic marks on the patient's abdomen to indicate position for the tape.
(d) Measure the patient at the same time each day.
(2) Note the color and character of all vomitus. Test for the presence of occult blood.
(3) Any stool passed should be tested for the presence of occult blood.
(4) Monitor vital signs closely. Elevations of temperature and pulse may indicate infection or necrosis.
(5) Monitor I&O closely. Fluid and electrolyte losses must be replaced.

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Colorectal cancer Signs and symptoms:

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Fatigue due to occult* blood loss
Change in bowel habits (critical sign!)
Visible blood in stool
Mass detected on digital rectal exam
If the cancer has spread (metastasized), there could be partial bowel obstruction (high-pitched tingling bowel sounds), complete bowel obstruction, weight loss.

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Hematemesis

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Vomiting blood

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Melena

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Passage of dark-colored, tarry (looks like tar) stools due to the presence of blood altered by the intestinal juices.

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Appendicitis

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Inflamation of the appendix
Fever, nausea/vomiting, anorexia, pain, rt. lower quadrant pain, increased WBC

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Peritonitis

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Inflamation/infection of peritoneal cavity
Abdominal pain, abdominal rigitity, nausea/vomiting, fever

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Peritonitis Nursing Interventions

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NPO, fluid/electrolyte imbalance, NG tube, antoboitics, surgery, pain control

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Peritonitis Nursing Diagnoses

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Acute pain, deficient fluid volume, imbalanced nutrition: less than

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Diverticulosis/Diverticulitis

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-Diverticulum- Outpouching of bowel mucous membrane
-Diverticulosis- Multiple diverticula
-Diverticulitis- Inflamation/infection of diverticulum

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Diverticulosis/Diverticulitis nursing interventions

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prevent constipation, IV antibiotics, pain control, surgery

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Diverticulosis/Diverticulitis nursing diagnoses

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Acute pain, risk for fluid volume deficit

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Crohn's disease

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Inflamatory bowel disease affecting any part of the intestine. Unknown cause, periods of remission & exacerbations

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Signs and symptoms of Crohn's disease

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Frequent diarrhea, abdominal pain, cramping, weight loss,

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Nursing interventions for Crohn's disease

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Avoidance of offending foods, antiinflammatories, antidiarrheal, antibiotics, immunosuppressants, corticosteroids.

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Ulcerative Colitis

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Inflamatory bowel disease; inflammation and ulcers, or sores, form in the lining of the colon. The disease may involve the entire colon (pancolitis), only the rectum (ulcerative proctitis) or, more commonly, somewhere between the two.

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Signs and symptoms of Ulcerative Colitis

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Abdominal pain, 5-20 loose stools daily, rectal bleeding, fecal urgency, cramping, dehydration, weight loss

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Nursing interventions of Ulcerative Colitis

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Avoidance of offending foods, antiinflammatories, antidiarrheal, antibiotics, immunosuppressants, corticosteroids.

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Irritable bowel syndrome

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Altered intesinal motility/Increased sensitivity to visceral sensations. Doesn't cause inflammation or changes in bowel tissue or increase your risk of colorectal cancer.

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Signs and symptoms of Irritable bowel syndrome

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Abdominal pain, cramps, gas, bloating, diarrhea and constipation are among the symptoms

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Irritable bowel syndrome nursing interventions

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High fiber diet, avoidance of trigger foods, stress management, smaller frequent meals, exercise

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Irritable bowel syndrome diagnoses

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constipation, diarrhea, readiness for enhanced theraputic regimen management

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Anorectal problems

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Hemorrhoids, anal fissures, anorectal absess

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Hemorrhoids

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Abnormally swollen veins in the rectum and anus. When bulging hemorrhoidal veins are irritated, they cause surrounding membranes to swell, burn, itch, become very painful, and bleed. Hemorrhoids are caused by too much pressure in the rectum, forcing blood to stretch and bulge the walls of the veins

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Most frequent causes of hemorrhoids:

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Constant sitting
Straining with bowel movements (from constipation or hard stools)
Diarrhea
Sitting on the toilet for a long time
Severe coughing
Childbirth
Heavy Lifting

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Colon Cancer

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Colorectal cancer is cancer that occurs in the colon or rectum

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Signs and symptoms of colon cancer

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Blood or mucus in stools, fatigue, anemia, Abdominal pain, Change in frequency or character of stool, Small-caliber (narrow) or ribbon-like stools

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Ilieostomy

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An ileostomy connects the small intestine to an opening in the wall of the abdomen to create a stoma. It is required when the large intestine and rectum must be removed due to disease or abnormality. The opening becomes an artificial anus for expelling solid waste. The patient continuously wears a disposable bag that collects the semiliquid waste