Basic Human Needs Bowel Elimination

1. Basic Human NeedsBowel Elimination

2. Bowel Elimination • GI Tract is a series of hollow mucous membrane lined muscular organs • Purpose is to absorb fluids & nutrients, prepare food for absorption & provide storage for feces

3. GI Tract Anatomy • Mouth • Esophagus • Stomach • Small Intestine • Large Intestine • Rectum

6. Colon • 3 Divisions: Ascending, Transverse, Descending • Colon Functions: Absorption, Protection, Secretion, & Elimination (stool and flatus)

8. Flatus Formation • Air swallowing • Diffusion of gas from bloodstream into intestines • Bacterial action on unabsorbable CHO (Beans) • Fermentation of CHO (cabbage, onions • Can stimulate peristalsis • Adult forms 400-700 ml of flatus daily

9. Factors Affecting Bowel Elimination • Age • Infection • Diet • Fluid Intake • Physical Activity • Psychological factors • Personal Habits

10. Factors Affecting Bowel Elimination • Position during Defecation • Pain • Surgery and Anesthesia • Medications

11. Common Bowel Elimination Problems • Constipation • Impaction • Diarrhea • Incontinence • Flatulence • Hemorrhoids

12. Constipation • More of a symptom than a disorder • Decrease in frequency of BM • Straining & pain on defecation is associated symptoms(Valsalva maneuver) • Can be significant heath hazard (increase ICP, IOP, reopen surgical wounds, cause trauma, cardiac arrhythmias)

14. Impaction • Results from unrelieved constipation • Collection of hardened feces wedged into rectum • Can extend up to sigmoid colon • Most at risk: depilated, confused, unconscious (all are at risk for dehydration)

15. Impaction • When a continuous ooze of diarrheal stool develops, impaction should be suspected • Associated S/S: Loss of appetite, abdominal distention, cramping, rectal pain

17. Diarrhea • Increase in number of stools & the passage of liquid, unformed stool • Symptom of disorders affecting digestion, absorption, & secretion of GI tract • Intestinal contents pass through small & large intestines too quickly to allow for usual absorption of water & nutrients

18. Diarrhea • Irritation can result in increased mucus secretion, feces become too watery, unable to control defecation • Excess loss of colonic fluid can result in acid-base imbalances or fluid/electrolyte imbalances • Can also result in skin breakdown

19. Conditions that cause Diarrhea • Emotional Stress • Intestinal Infection (Clostridium difficile) • Food Allergies • Food Intolerance • Tube Feedings (Enteral) • Medications • Laxatives • Colon Disease • Surgery

21. Incontinence Inability to control passage of feces and gas from the anus • Caused by conditions that create frequent, loose, large volume, watery stools or conditions that impair sphincter control or function

22. Flatulence • Gas accumulation in the lumen of intestines • Bowel wall stretches and distends • Common cause of abdominal fullness, pain, & cramping • Gas escapes through mouth (belching), or anus (flatus)

23. Hemorrhoids • Dilated, engorged veins in the lining of the rectum • External (Clearly visible) or Internal • Caused by straining, pregnancy, CHF, chronic liver disease

24. Clicker Question 1. A newly admitted client states that he has recently had a change in medications and reports that stools are now dry and hard to pass. This type of bowel pattern is consistent with: A. Abnormal defecation B. Constipation C. Fecal impaction D. Fecal incontinence 46 - 24

25. Bowel Diversions • Certain diseases cause conditions that prevent normal passage of feces through rectum • Creates need for temporary or permanent artificial opening (stoma) in the abdominal wall

26. Bowel Diversions • Surgical openings (ostomy) are most commonly formed in the ileum (ileostomy) or the colon (colostomy) • Incontinent ostomy- need to wear appliance pouch • Continent ostomy- have control through use of ostomy cap

31. Incontinent Ostomy • Location of ostomy determines consistency of stool • Ileostomy bypasses the entire large intestine, stools are frequent & watery • Ascending colostomy- liquid stool • Sigmoid colostomy-most like normal stool

33. Incontinent Ostomies • Loop colostomy- temporary, usually done on transverse colon • 2 openings through stoma, proximal loop for stool, distal loop for mucus • End colostomy- one stoma formed from the proximal end of the bowel with the distal portion removed or sewn shut (Hartmann’s Pouch)

34. Incontinent Ostomies • End colostomy usually done for colorectal cancer • Ruptured diverticulum- temporary end colostomy with a Hartmanns Pouch • Double barrel colostomy- Bowel is surgically severed, 2 ends are brought out onto abdomen with 2 distinct stomas (proximal & distal)

39. Continent Diversions • Ileoanal reservoir- restorative proctocolectomy, no outward stoma, no pouch wearing, clients have internal pouch created from the ileum • Ileal pouches constructed in various configurations (S,J,W) • End of the pouch is sewn or anastamosed to the anus

40. Continent DiversionsIleoanal Reservoir • Several stages to surgery to create pouch • May need temporary ostomy to allow time for pouch to heal • Kegel exercises to increase pelvic floor muscle tone

42. Continent Diversions • Kock Continent Ileostomy-Internal reservoir or pouch is created using piece of small intestine • Stoma brought out low on abdomen, end of internal part in pouch is a one way nipple valve to promote continence • Valve only allows fecal contents to drain when an external catheter is place in stoma, no pouch required

44. Ostomy Nursing Considerations • Patient Education • Care of skin & stoma, appliance selection and use • Body Image considerations • Support groups (UOA) • Enterostomal nursing- specialty within profession

46. Nursing ProcessAssessment • Nursing History • Physical Assessment • Lab Tests • Fecal characteristics • Diagnostic evaluation- Endoscopy, Colonoscopy

50. Nursing Diagnosis • Bowel Incontinence • Constipation • Diarrhea • Impaired Skin Integrity • Body Image Disturbance • Altered bowel elimination • Pain