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Bowel Elimination

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... Outcome Criteria Interventions to Promote Elimination Interventions: Promote Bowel Elimination Types of Enemas Enema Solutions Tap Water (TWE ... – PowerPoint PPT presentation

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Title: Bowel Elimination


1
Bowel Elimination
  • NUR101 Fall 2009 Lecture 23
  • K. Burger, MSEd, MSN, RN, CNE
  • PPP By Sharon Niggemeier RN MSN

2
Anatomy Physiology
  • Function of Large intestine absorption
  • Extends from Ileocecal valve to
  • anus
  • Chyme
  • Peristalsis Mass peristalsis

3
Act of Defecation
  • Defecation reflex
  • Valsalva maneuver
  • Defecation

4
Alteration in Bowel Elimination
  • Diarrhea
  • Constipation
  • Incontinence
  • Fecal Impaction
  • Flatulence

5
Characteristics of Stool
  • Volume
  • Color
  • Odor
  • Consistency
  • Shape
  • Constituents

6
Factors That Influence Bowel Elimination
  • Age
  • Fluid Intake Diet
  • Daily Routine
  • Activity
  • Medications
  • Health Status
  • Stress

7
Diet
  • Laxative effect foods
  • Spicy greasy
  • Bran/Chocolate
  • Coffee/Alcohol
  • Raw fruits vegetables
  • High fiber foods
  • Legumes (beans)
  • Cereals
  • Whole grains
  • Raw Fruits
  • Vegetables

8
Assessing Elimination Status
  • Usual pattern
  • Changes in bowels
  • Aids to eliminate
  • Current problems

9
Physical Assessment
  • Inspection- observe contour of abd and note
    visible peristalsis
  • Auscultation- listen for bowel sounds all
    quadrants
  • Percussion- resonant or tympany over hollow
    organsdullness over intestinal obstruction
  • Palpation- feel for masses, tenderness etc

10
Stool Specimen Collection
  • Routine specimen
  • Occult blood
  • Ova parasite
  • Timed specimens

11
Nursing Dx R/T Bowel Elimination
  • ?

12
Outcome Criteria
  • Pt. will
  • Develop regular pattern of elimination
  • Have less episodes of incontinence
  • Incorporate fluids/diet that promote bowel
    elimination

13
Interventions to Promote Elimination
  • Routine
  • Positioning
  • Privacy
  • Comfort
  • Activity
  • Diet/Fluids

14
Interventions Promote Bowel Elimination
  • Laxatives
  • Enemas
  • Suppositories
  • Digital Removal

15
Types of Enemas
16
Enema Solutions
  • Tap water (Hypotonic)
  • Normal saline (Isotonic)
  • Soap
  • Hypertonic
  • Oil

17
Tap Water (TWE)
  • Amount 500-1000cc
  • Action Distends, increases peristalsis
  • Time 15 min.
  • Indicated inflamed bowels/irritated colon
  • Contraindicated Atonic bowels, fluid
    restrictions

18
Normal Saline
  • Amount 500-1000cc
  • Action Distends, increases peristalsis
  • Time 15 min.
  • IndicatedInflamed bowels/irritated colon
  • Contraindicated Na retention problems, fluid
    restrictions

19
Soap (SSE)
  • Amount 500-1000cc (Castile 5ml/1000cc)
  • Action Distends, Irritates
  • Time 15 min.
  • Indicated Constipation
  • Contraindicated Prior to rectal exams

20
Hypertonic
  • Amount 70-130 cc solution
  • Action Distends/Irritates
  • Time 5-10 min.
  • Indicated Constipation, convenience
  • Contraindicated Dehydration, Na problems

21
Oil Retention
  • Amount 120-200cc
  • Action Lubricates
  • Time 30 min.
  • Indicated Fecal impaction
  • Contraindication none

22
Enema Administration
  • PPE
  • Position L Sims
  • Linen protector
  • Receptacle (bedpan, commode, toilet)
  • IV pole
  • Lubricant
  • Enema bag with solution
  • Tissue paper

23
Enema Administration
  • Position L Sims
  • Insert lubricated tip 4
  • Bag raised 18-20 above anal canal
  • Administer slowly - 10 min.
  • Administration is individualized.
  • Pt. holds for 15 min.

24
Evaluation
  • Solution given
  • Amount expelled
  • Characteristics of stool
  • Passing of flatus
  • Unusual findings blood, helminthes, pus etc.
  • Client reaction change in skin color, VS
    changes, fatigue

25
Medications Effecting Bowel Elimination
  • Laxatives- induce emptying of GI tract
  • Antidiarrheal- slow peristalsis
  • Codeine/morphine/iron- cause constipation
  • Antibiotics-may cause diarrhea

26
Flatulence
  • Causes
  • Decreased peristalsis
  • Constipation
  • Medications
  • Surgery
  • Diet
  • Stress
  • Decreased activity

27
NonInvasive Interventions for Flatulence
  • Ambulation
  • Knee chest position

28
Invasive Interventions for Flatulence
  • Glycerin Suppository
  • Harris Flush
  • Rectal Tube
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