Bowel Elimination

Bowel Elimination

1. Factors

   • Age
   • Fluid Intake
   • Exercise
   • Medication
   • Diet
   • Surgery
   • Pregnancy

2. Problems

   • impaction
     • Sever constipation -unable to expel hardened feces -oozing of liquid stool -must be digitally stimulated
   • incontinence
     • -No control
   • flatulence
     • WHO FARTED?! -Can cause sever pain and discomfort if not released -You want your patient to "pass gas" 
   • Constipation
   • hemorrhoids
     • -Painful -swollen blood vessels -can be both inside and outside of rectum  -can be cause from strain and pressure when defecating 

3. Medications

   • Cathartics/Laxatives
   • Antidiarrheals
     • Decrease intestinal muscle tone=slows passage of feces
   • Edemas
     • Different types: -Tap water -normal saline -hypotonic -hypertonic -oil retention -soupsud

4. Bowel Division

   • Ileoanal pouch Anastomosis
     • When Pt needs colostomy  -removes colon, creates of pouch from part of small intestine and  attaches it to the anus 
   • Ostomy
     • -the surgically created opening in the body for the discharge of body wastes
   • Stoma
     • -A stoma is the actual end of the intestine that can be seen protruding through the abdominal wall

5. Assessment

   • Nursing History
     • -Usual patters -Routines followed to promote BM -surgery -meds -exercise -emotional state -Characteristic of usual stool
   • Type of stool
     • Refers to: -shape -color -odor -consistency (for form scale, Pg 1155) 
   • Physical Assessment
     • Abdomen
       • -Listen to all 4 quadrants  -Look for distention
     • Rectum
       • -Check for lesions, or hemorrhoids -Discoloration  -Bleeding 
   • Lab tests

6. Diagnosis

   • Very important to establish "related to" factors. This insures correct implementation 
   • Bowel Incontinence
   • Diarrhea
   • acute pain
   • Risk for constipation
   • Nausea

7. Planning

   • Goals
     • Enforce routines that promote health! Ex: Pt implements regular exercise program -Pt reports no strain or discomfort -Pt has a regular "poop" schedule
   • Teamwork
     • -Include family when needed -Involve dietitians  -Delegate:bedpan or bedside commode 
   • Priorities

8. Implementation

   • Promote normal Digestion
     • Helping them sit properly -Position bedpan properly
   • Digital Removal of stools
   • NG tube for nutrition
   • Continuing care
     • -irrigating colostomy -Pouching Ostomies With these devices consider psychological consideration for the Pt 
     • SKin care
     • Promote Exercise
     • Proper Intake
     • Bowel Training
       • -Involves setting up a daily routine -Attempting to defecate at the same time every day -Takes a lot of time an effort (FUN!)

9. Evaluation

   • Observe stool Characteristics
   • Ask if expectations are met
   • Level of Knowledge
     • -Regarding routine, caring for ostomy, and promoting skin integrity