Ch 47: Bowel Elimination (P&P)

Ch 47: Bowel Elimination (P&P)

1. 1. The role of gastrointestinal organs in digestion and elimination

   • food is chewed in the mouth and broken down/diluted/softens
     • Peristalsis: propels food down the esophagus and reaches the cardiac sphincter (sphincter prevents reflux)
   • Stomach performs three tasks:
     • 1. Storage of swallowing food and liquid
       • 2. mixing of food with digestive juices into chyme
         • 3. regulated emptying of its contents into small intestine
   • Small intestine is divided into 3 parts
     • Duodenum: process fluid from the stomach
       • Jejunum: absorbs carbohydrates and proteins
         • Ileum: absorbs water, fats, and bile salt
     • Duodenum and jejunum absorb most nutrients and electrolytes
   • Large intestine: primary organ f bowel elimination
     • cecum
       • ascending colon
         • transverse colon
           • descending colon
             • sigmoid colon
               • rectum
     • colon has 3 functions: absorption, secretion, elimination
     • it resorbs water, sodium, and chloride
     • rectum is usually empty right before defecation
     • anus expels feces and gas from rectum, it contains a rich supply of sensory nerves that allows people to tell when there is a solid, liquid, or gas and helps maintain continence

2. 2. Physiological aspects of normal defectation

   • normal GI tract function
     • sensory awareness of rectal distention
       • rectal contents
         • voluntary sphincter control
           • adequate rectal capacity and compliance

3. 3. Psychological and physiological factors that influence the elimination process

   • During emotional stress the digestive process is accelerated, causing diarrhea and gaseous distention
     • Stress can cause ulcerative colitis, irritable bowl syndrome, certain gastric and duodenal ulcers, and Crohn's disease

4. 4. Common physiological alterations in elimination

   • Constipation: results form improper diet, reduced fluid intake, lack of exercise, and certain medications
     • Impaction: results from unrelieved constipation
       • Diarrhea: irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate
         • Incontinence: the result of gas accumulation in the lumen of the intestines, making the bowel stretch and distend
           • Hemmorhoids: increased venous pressure from straining at defecation, pregnancy, heart failure, and chronic liver disease causes hemorrhoids

5. 5. Assess a patient's elimination pattern

   • usual elimination pattern
     • description of usual stools characteristics
       • identification of routines followed to promote
         • presence and stasis of bowel diversions
           • changes in appetite
             • diet history
               • daily fluid intake
                 • history of surgery or illnesses affecting GI tract
                   • medication history
                     • emotional state
                       • history of exercise
                         • history of pain and discomfort
                           • social history
                             • mobility and dexterity

6. 6. Nursing diagnosis related to alterations in elimination

   • disturbed body image
     • bowel incontinence
       • constipation
         • perceived constipation
           • risk for constipation
             • diarrhea
               • nausea
                 • deficient knowledge (nutrition)
                   • acute pain
                     • toiling self-care deficit

7. 7. Nursing implications for common diagnostic examination of gastrointestinal tract

   • Colonscopy
     • Bowel Cleansing Programs
       • Education/Support

8. 8. Nursing interventions that promote normal elimination

   • Sitting position
     • positioning on bedpan
       • enemas
         • laxatives

9. 9. Nursing Interventions included in bowel training

   • Assess normal elimination pattern and recording times when patient is incontinent
     • incorporating principles of gerontological nursing when providing bowel retraining programs or an older adult
       • choosing a time based on patient's pattern to initiate defecation control measures
         • offering a hot drink or fruit juice before the defection time
           • helping the patient's to the toilet at the designated time
             • providing privacy
               • instructing patient to lean forward at the hips while sitting on the toilet, apply manual pressure with hands over abdomen, bear down but not strain to stimulate colon emptying
                 • an unhurried environment and nonjudgemental caregiver
                   • maintaining normal exercise within the patient's physical ability

10. 10. Nursing Care measures required for patients with a bowel

    • Provide emotional support before and after surgery
      • refer patient to stony support

11. 11. Critical thinking in providing care to patients with alterations in bowel elimination

    • the nurse needs to select nursing implications to promote normal bowel elimination
      • consult with nutritionists and eriteral stoma therapists if needed
        • involve patient and family in designing nursing interventions
          • individualize therapies to patient's bowel elimination needs
            • select therapies consistent within stony professional practice standards
              • nurse needs to be creative when planning interventions for the patient to achieve normal elimination patterns
                • displace independence when integrated interventions from other disciplines in patient's plan of care
                  • nurse needs to act responsibly by ensuring that interventions are consistent within standards