Bowel Elimination and Fecal Impaction

• The goal of bowel elimination is normal, regular function.
• Healthcare providers (HCP) can help clients meet this goal by being knowledgeable about the client's condition, bowel habits, and personal habbits.
• Clients should sit on the toilet or commode at consistent times, usually before or after meals.
• HCP should assist the person as soon as requested.
• HCA responsibilities in preventing or minimizing constipation include:
  • Hydration
  • Activity
  • Diet

Positioning

• Positioning aids in bowel elimination
• Position the person in a sitting position
• Feet should be elevated on a foot rest if possible
• If the person is in bed, position them on the bedpan as close to a sitting position as possible.

Fecal Impaction

• Occurs when there is prolonged retention and buildup of feces in the rectum.
• It results if constipation is not relieved.
• More water is then absorbed from already hard feces.
• Liquid feces may pass around the hardened fecal mass in the rectum.
• Signs of a resident being impacted include:
  • Abdominal pain and cramping
  • Rectal pain
  • Nausea and vomiting
  • Fever
  • Seepage of liquid feces

Bowel Care Intevention

• If constipation or impaction occurs, interventions may be necessary
• These interventions include the administration of:
  • Laxatives (given by RN's or LPN's)
  • Suppositories
  • Enemas
  • Digital Removal (Done by Nurses)

Suppositories

• Cone-shaped, solid mold that is inserted into the rectum to promote defecation.
• Suppositories melt at body temperature.
• A bowel movement usually occurs, on average, 30 minutes later.
• Glycerine Suppository is usually clear or transparent in color.
  • It contains glycerol, a colorless emollient used to loosen and lubricate stool.
• Dulcolax or Bisacoydl Suppository is usually white in color.
  • It contains a medication that works on the muscle of the bowel, causing it to contract and help the client expel feces.

Enemas

• Definition: Fluid is introduced into the lower bowel.
• Purpose: To induce a bowel movement by stretching the rectal wall initiating a defecation reflex or breaking up the stool with enzymes.
• Enemas are given:
  • To relieve constipation, fecal impaction, and flatulence.
  • To cleanse the bowel before surgery or certain diagnostic procedure.
  • Sodium Phosphate Enema (Fleet)
  • Ready to give
  • Works by irritating and distending the rectum with fluid.
  • Enemas act faster than suppositories, so be prepared.
  • Works on average in 5 minutes.
  • Microlax Enema
  • It contains enzymes which cause, by a chemical action, a breakdown of the feces.
  • Bowel evacuation usually follows within 4-20 mins

Ostomies

• Ostomy: A surgical opening made on the surface of the skin.
• The protruding bowel is called the stoma.
• Ileostomy: ostomy is in the small intestine
• Liquid feces drain constantly from an ileostomy.
• Water is not absorbed because the colon is removed.
• Good skin care is essential.
• Colostomy: ostomy is in the large intestine
• The person wears a pouch over the stoma to collect formed feces and flatus.
• Ostomy Pouches
  • 2 Piece System
    • A flange with an adhesive backing applied to the skin around the stoma.
    • The bag is then removable and secured to the flange with a seal similar to tupperware.
    • Emptied and cleansed when full.
  • One piece system
    • Cut to stoma size and remove when full and reapply a new bag.

HCA Responsibilities for Ostomies

• Follow agency policy.
• Try to dress resident in loose fitting clothing around the stoma site.
• Check seal regularly
• Remove gas/flatus ASAP.
• Emptying, cleaning and/or changing the bag, flange and stoma site when stool is present.
• Observations:
  • Examine carefully for skin breakdown
  • Record amount, consistency of feces
  • Note complaints of pain or discomfort to the RN

Stool Specimen

• Stools are analyzed to identify microbes, blood, altered absorption, fat, worms and other abnormal contents.
• Three common types:
  • Culture & Sensitivity (C&S)
  • Ova and parasites (O&P)
  • Occult blood or (Fecal Immunochemical Test) (FIT Test)