Chapter 47 Bowel Elimination

Chapter 47 Bowel Elimination

1. Mechanical breakdown of food elements, GI motility, and selective absorption and secretion of substances by the large intestine influence the character of feces.

   • Food high in fiber content and an increased fluid intake normalize stool consistency.
     • Use of cathartics, laxative, and enemas are short-term solutions to constipation; long-term management includes lifestyle changes in diet, activity, and defecation schedule.
       • Fecal incontinence is a source of physical and psychological distress and frequently leads to the need for agency-based care in the elderly.
         • Proper selection and use of an ostomy-pouching system are necessary to prevent damage to the skin around the stoma.
           • Skin breakdown occurs after repeated exposure to liquid stool.

2. The greatest risk from diarrhea is development of fluid and electrolyte imbalance.

   • The location of an ostomy influences consistency of the stool. Focus assessment of elimination patterns on bowel habits, factors that normally influence defecation, recent changes in elimination, and a physical examination.
     • Endoscopic procedures for diagnostic testing of the GI tract may require cleansing of the bowel before the procedure.
       • Consider frequency of defecation and fecal characteristics when instructing a patient on establishing a bowel-elimination routine.
         • NG intubation decompresses the stomach by removing gastric contents until GI motility returns and decreases the risk of vomiting and aspiration.
           • Digital removal of stool relieves the obstruction and discomfort of a fecal impaction but causes trauma to the rectal mucosa and vagal nerve stimulation.