Bowel Elimination PDF

Outcome 7 Bowel Elimination Part 1 Defecation: A bowel movement, or the expulsion of feces from the anus and rectum, occurs with variable frequency and amount, and is facilitated by thigh flexion and a squatting position to increase pressure on the abdomen and rectum....

Outcome 7 Bowel Elimination Part 1 Defecation: A bowel movement, or the expulsion of feces from the anus and rectum, occurs with variable frequency and amount, and is facilitated by thigh flexion and a squatting position to increase pressure on the abdomen and rectum. Assessment of Feces/Stool: Colour: Normal for adult = brown, infant = yellow. Clay or white (obstructive jaundice). Black or tarry (iron ingestion or upper GI bleed). Red (lower GI bleed, hemorrhoids). Pale with fat or frothy (malabsorption of fat). Mucous or pus (spastic constipation, colitis, straining). Bloody mucous (inflammation, infection, hemorrhoids). Green (bile). Consistency: Normal is formed and soft. Abnormal is constipation, hard, dry, diarrhea loose, and watery. Frequency: Normal is daily or 2-3 times weekly. Abnormal is more than 3 times a day or less than once a week. Shape: Normal is like diameter of rectum. Abnormal narrow, pencil- shaped or string-like stool may suggest a bowel narrowing due to a tumor, and liquid. Amount: Normal varies with diet but usually 100-400g per day. Odour: Normal is aromatic affected by foods and bacterial flora. Abnormal is pungent with signs of infection and blood. Constituents (made up of): Normal is undigested roughage, shed dead bacteria, epithelial cells, fat, protein, and dried digestive juices. Abnormal has pus, mucus, parasites (pinworms), blood, large amounts of fat, and foreign objects. Common Problems Constipation: Is a symptom not a disease. Fecal Impaction: Unrelieved constipation. Causes: High intake of fibre without enough fluids and clients that are weak, confused or unconscious are most at risk. Diarrhea: Passage of liquid stools and an increased frequency of defecation.  Bowel Incontinence: AKA fecal incontinence: the inability to control fecal & gaseous discharge through the anal sphincter. 1. Impaired anal sphincter functions 2. Impaired control Flatulence: Accumulation of 100-200 mL of gas in the lumen of the intestines of healthy adults. A healthy individual pass 15-20 times of gas a day. Increased fiber intake and general anesthesia can reduce intestinal motility, leading to farting, burping, and the use of rectal tubes to release air from the rectum. Inability to pass gas/flatus can cause abdominal fullness, pain, and cramping, often due to reduced motility from factors like opiates, general anesthesia, abdominal surgery, and immobility. Change in air pressure such as occurs in flying, ingestion of high carbs, gas producing foods, chewing gum, carbonated beverages. Hemorrhoids: Swollen veins in the rectal lining. External hemorrhoids are clearly visible as protrusions of skin. Internal hemorrhoids can be felt with a rectal examination.  S&S: Pain w/ defecation and rectal pain or burning. Diagnostic Testing/Stool Specimens: When collecting a stool specimen for tests such as routine culture (for Salmonella, Shigella, Campylobacter, and E. coli), C. difficile toxin assay, or ova and parasites, use a clean bedpan, avoid contamination with urine, menstrual discharge, or toilet paper, notify the nurse immediately after defecation, employ medical aseptic techniques with clean gloves, include any visible pus or blood in the sample, and send it to the lab immediately or follow container instructions if immediate transport isn't possible. Stool for FOB: A fecal occult blood test (FOBT) looks at a sample of your stool to check for blood to identify conditions like colon cancer, bleeding GI ulcers, localized gastric or intestinal irritation. With patients instructed on home collection; false positives can occur from red meat or iron supplements, while false negatives may result from vitamin C ingestion, requiring the sample to be free from urine, menstrual blood, or toilet paper. Collected with a wooden stick smeared onto a slide, which is then labeled and placed in an envelope for lab transfer, while the specimen is stored in a larger container in the fridge or on ice. Stool for C&S: Culture and sensitivity test looks for bacteria, viruses, and other germs in your stool. Use a small scoop to gather at least 5 mL of liquid or formed stool, complete the requisition form and label the container, then place it in a biohazard bag for transport to the lab, usually requiring only one specimen. Stool for O&P: An ova and parasites (O&P) test checks poop for parasites and their ova (eggs) or cysts. Collecting stool samples in a container with preservative, usually three samples from different days. Use the small scoop to fill the container to the marked line, label the specimen, complete the requisition, and transport it in a biohazard bag to the lab. Stool for Clostridium Difficile: Use the provided scoop to collect at least 5 ml of liquid stool in the appropriate container, complete and label the requisition form, place the container in a biohazard bag, and transport it to the lab, usually requiring only one specimen. Anoscopy: is a procedure where a scope is placed into the anus that allows the physician to visualize the anal canal. Proctoscopy: is a procedure where a scope is placed into the anus that allows the physician to visualize the anus and rectum. This scope is longer than that of the anoscope and can see into the rectum and bottom part of the colon. Sigmoidoscopy: is a procedure where a scope is placed into the anus that allows the physician to visualize the colon (lower third). Colonoscopy: is a procedure where a scope is placed into the anus that allows the physician to visualize the entire colon. Barium Swallow: Test the upper and middle sections of the gastrointestinal tract. Client is asked to drink a barium solution and then an x-ray is taken. Barium Enema: Special X-ray exam used to detect changes or abnormalities in the large intestine (colon). Part 2 Intervention/Treatments: Medications Laxatives are gentler than cathartics, but overusing either can lead to issues like diarrhea, electrolyte depletion, decreased muscle tone in the large intestine, and altered effectiveness of other medications. Antidiarrheal Agents: Imodium and opiates such as codeine and Lomotil, inhibit bowel movement and increase sodium and water absorption to firm up stools, but they can be habit- forming. Enemas: Primarily used to relieve constipation by stimulating bowel movements and to prepare for certain diagnostic procedures. Cleaning: Promote the complete evacuation of feces from the colon and can be classified as high or low (height), with high enemas delivering at a greater height and pressure to empty the entire colon, while low enemas target only the lower bowel. Can be: 1. Tap Water: Has lower osmotic pressure than interstitial fluid, causing it to move from the colon into the interstitial spaces; can be hypotonic and may lead to circulatory overload if used excessively. 2. Normal Saline: Considered the safest option since it matches the osmotic pressure of the interstitial fluids around the bowel. 3. Hypertonic Solutions: Pull fluid from the interstitial spaces due to higher osmotic pressure. 4. Soapsuds: Uses castile soap added to tap water or normal saline to irritate the bowel and stimulate peristalsis. Oil-Retention: These types of enemas lubricate the rectum and colon. The feces absorb the oil and then stool is easier to pass. Carminative: Instillation of a MGW solution. Consist of a solution of 30 mL magnesium, 60 mL glycerine, and 90 mL water, help relieve gaseous distension. Medicated: Medicated enemas, like Kayexalate, are used to treat conditions such as high potassium levels and may include medications like diazepam (valium). Monitor for low potassium (hypokalemia). Administering an Enema: Procedure (double click): Administering an Enema: Procedure 1. Preparation: - Ensure a bedpan, commode, or access to a bathroom is available. - Position the client on their left side with the left knee bent. 2. Equipment Setup: - Check that the enema solution is at a safe temperature by pouring it on your inner wrist. - Confirm the correct solution is used. - Prime the tube. 3. Insertion: - Insert the tube safely, adjusting for the client's age: - Length of Insertion: - Adult/Adolescent: 7.5-10 cm (3-4 inches) - Child: 5-7.5 cm (2-3 inches) - Infant: 2.5-3.75 cm (1-1.5 inches) - Rectal Tube Size: - Adult: 22- 30 Fr - Child: 12-18 Fr - Instill the appropriate volume based on age: - Adult: 750-1000 mL - Adolescent: 500-700 mL - Children/Infants: 5-10 mL/kg 4. Administration: - Administer the solution slowly. - Encourage the client to retain the enema for as long as possible. 5. Assessment: - Record and report relevant data, including: - Enema Types: - High Enema: 30-45 cm (12-18 inches) - Normal Enema: 30 cm (12 inches) - Low Enema: 7.5 cm (3 inches) - Note that it should take approximately 10 minutes to infuse 1 liter of fluid. Left side lying to facilitate the direction of the bowel 30 sec to infuse bottle Fecal Disimpaction: Using a digital (finger) to remove hardened stool. The procedure is uncomfortable and can lead to bleeding, bowel injury, or a slowed heart rate if the vagus nerve is stimulated. Procedure 1. Wear gloves and use proper hygiene. 2. Position the patient on their left side. 3. Lubricate your index and middle fingers, gently insert them into the rectum. 4. Loosen the stool by moving your fingers in a scissor motion and break it into smaller pieces. 5. Gradually work the stool down and remove it bit by bit, disposing it in a bedpan.  6. Monitor the patient's response, vital signs, and any signs of discomfort. 7. After the procedure, clean the area and document what was done and the results. Suppositories: Suppositories are laxatives or cathartics given rectally to help with bowel movements. Glycerine: Draws water into the intestine to soften stool for easier passage. Bisacodyl: Stimulates the intestines to increase movement for quicker relief. Procedure 1. Position the patient on their left side with the upper leg bent. 2. With a gloved hand, gently insert the lubricated suppository. Insert it past the internal sphincter: 10 cm (4 inches) for adults. 5 cm (2 inches) for children or infants. 3. Advise the patient on preventing early expulsion of the suppository. 4. The suppository typically works within 15-60 minutes. Bowel Diversions: Some diseases prevent normal passage of feces through the rectum, requiring a stoma—an artificial opening in the abdomen. This can be temporary or permanent. Ileostomy: surgical opening in the ileum. Colostomy: surgical opening in the colon. Loop Ostomy: A loop ostomy is usually done in a medical emergency, is often temporary, and has two openings through one stoma. End Colostomy: Involves creating one stoma from one end of the bowel, with the other end either removed or closed off. It is often done to treat colorectal cancer and is usually permanent. Double-Barrel Colostomy: A double-barrel colostomy involves cutting the bowel and bringing both ends to the surface of the abdomen, creating two stomas: Proximal functioning and Distal non-functioning. Ex. Kock Continent Ileostomy Ostomy Care/Management Appliance bag that is fitted into the stoma can be disposable or reusable. Can either be a one piece or two-piece system. Assessment: Color: Red in color and moist looking. Size: it is normal for a stoma to be quite large after surgery, but it will eventually reduce in size. Bleeding: not normal for stoma to bleeding, this is likely due to irritation. Peristomal skin: should be normal/intact with no redness or irritation. Feces: depending on the location of the stoma, stool can be liquid to very formed. Changing Ostomy Appliance: 1. Check if it's time to change the appliance. 2. Clean and dry the skin around the stoma. 3. Check the stoma, skin condition, and stool type. 4. Apply a skin barrier if needed. 5. Measure the stoma (cut opening 3mm larger than stoma), then prepare and apply the new appliance. 6. Report and record any observations, steps taken to prevent skin breakdown, and the client's response.  Emptying Ostomy Bag: Ostomy Care: Regularly empty the ostomy bag to prevent it from getting too full and leaking. Bags may also need to be opened to release air. How often it’s emptied depends on the client's needs, and it can be done in the bathroom or while the client is in bed. Colostomy Irrigation: Like an enema, is used only for clients with a sigmoid or descending colostomy. Its purpose is to expand the bowel to stimulate peristalsis and promote evacuation. Once a regular evacuation pattern is established, wearing a colostomy pouch may not be necessary.