Fecal Elimination Lecture Week 13 PDF

Fecal Elimination BSN212 Fundamentals of Nursing – Theory Semester 2, 2023 – 2024 Week 14 Chapter 49 Physiology of Defecation Defecation is the elimination of waste products of digestion from the body. The excreted waste products are referred to as feces or st...

Fecal Elimination BSN212 Fundamentals of Nursing – Theory Semester 2, 2023 – 2024 Week 14 Chapter 49 Physiology of Defecation Defecation is the elimination of waste products of digestion from the body. The excreted waste products are referred to as feces or stool. The colon’s main functions are: Absorption of water & nutrients, Protection of the intestinal wall, it secretes mucus Fecal elimination Physiology of Defecation The frequency of defecation is individual, most of waste products are excreted within 48 hours of ingestion (taking food). The rectum in adult is 10-15 cm long, the most distal portion, 2.5-5cm long is anal canal. Peristaltic waves move the feces into sigmoid colon & rectum  Sensory nerves in the rectum are stimulated & person is aware to defecate. Feces  75% water & 25% solid materials. Soft but formed. If propelled very quickly, there will be no time for water to reabsorb, and the feces will be more fluid. Factors Affecting Defecation Developmental Factors Meconium first material passed by the newborn, normally up to 24 hrs. of birth, It is black tarry, odorless & sticky, and will be followed by greenish-yellow feces after a week. At 1 ½ -2 yrs. of age some start to control defecation. School-age children and adolescents have bowel habits similar to those of adults. Elderly: constipation ‫ اإلمساك‬is the most common bowel problem. Factors Affecting Defecation Diet & Fluid intake Cellulose and fiber are necessary for fecal volume. Bland diets and low-fiber diets can cause constipation. Irregular eating can impair regular defecation. Spicy foods can produce diarrhea and flatus. Healthy fecal elimination requires a daily fluid intake of 2,000 to 3,000 mL. Factors Affecting Defecation Activity Stimulates peristalsis. Clients who are confined to bed are at risk for constipation Psychological factors Anxiety or anger stimulates peristalsis. Depression slows intestinal motility. Factors Affecting Defecation Defecation habits Early bowel training establish a regular defecating time. Ignoring urge to defecate can lead to harden stools and the defecation reflexes will be weakened and may ultimately lost. medications Some medications have side effects that interfere the normal elimination. Some medications directly affect elimination. Medications can affect the appearance of the feces. Diagnostic procedures Using of cleansing Enema before colonoscopy. Factors Affecting Defecation Anesthesia and surgery Slow bowel movement by blocking parasympathetic stimulation to the colon. Pathologic conditions Spinal cord injuries and head injuries can decrease the sensory stimulation for defecation; Immobility can cause constipation; Poorly functioning anal sphincters leads to fecal incontinence. pain Post-operative rectal surgeries result in constipation because clients usually suppress the urge to defecate to avoid pain.  Fecal Elimination Problems Constipation Less than 3 bowel movements per week. Passage of dry, hard stool or passage of no stools. Fecal Elimination Problems Fecal Impaction Diarrhea Collection of hardened Passage of liquid feces feces in the rectum. and an increased Recognized by liquid fecal frequency of defecation. seepage (diarrhea), the Common signs and liquid portion of the feces symptoms are spasmodic seeps out around the cramps, increased bowel impacted mass. sounds (movement), Caused by poor defecation fatigue, weakness, habits and constipation. malaise, and emaciation due to prolonged diarrhea. Fecal Elimination Problems Bowel Flatulence Incontinence Presence of excessive Loss of voluntary ability to flatus in the intestines, control fecal and gaseous leads to stretching and discharges through anal inflation of the intestines. sphincter. Cause may be from foods, Associated with impaired abdominal surgery, or functioning of the anal narcotics. sphincter Bowel Diversion Ostomies Ostomy: An Opening of the GI, urinary, or respiratory tract onto the skin. Stoma: opening created in the abdominal wall by the ostomy. Gastrostomy: Opening through the abdominal wall into the stomach. Jejunostomy: Opening through the jejunum. Ileostomy: Opening into the ileum. Colostomy: Opening into the colon to divert and drain the fecal material. May be temporary or permanent. Nursing Management: ASSESSMENT Nursing Management: ASSESSMENT Physical examination: Inspection, auscultation, Percussion, Palpation of abdomen, Examination of rectum & anus Diagnostic studies: visualization procedures & lab tests. Color Brown –adult /Yellow –infant Consistency Formed, soft, semisolid, moist Shape Cylindrical Amount Varies with diet (100-400g/day) Odor Aromatic( odorous) , Affect by ingested food Presence of abnormal A small amount of undigested roughage, dead constituents. bacteria, epithelial cell 16 Nursing Management: DIAGNOSIS Constipation Definition: Infrequent or difficult evacuation of feces Risk for Constipation Definition: Susceptible to infrequent or difficult evacuation of feces, which may compromise health. Impaired Bowel Continence Definition: Inability to hold stool, to sense the presence of stool in the rectum, to relax and store stool when having a bowel movement is not convenient. Nursing Management: DIAGNOSIS Diarrhea Definition: Passage of three or more loose or liquid stools per day. Dysfunctional Gastrointestinal Motility Definition: Increased, decreased, ineffective, or lack of peristaltic activity within the gastrointestinal tract. Perceived Constipation Definition: Self-diagnosis of the infrequent or difficult evacuation of feces combined with abuse of methods to ensure a daily bowel movement. Nursing Management: DIAGNOSIS Risk for Deficient Risk for Impaired Fluid Volume and/or Disturbed Body Skin Integrity Related Risk for Electrolyte Image Related to: to: Imbalance Related to: Prolonged Prolonged diarrhea Ostomy diarrhea Bowel incontinence Abnormal fluid Bowel Bowel loss through diversion incontinence ostomy ostomy Nursing Management: PLANNING Maintain or restore normal bowel elimination Majo pattern. r Maintain or regain normal stool consistency. Goal s: Prevent associated risks such as fluid and electrolyte imbalance, skin breakdown, abdominal distention, and pain. Nursing Management: IMPLEMENTATION Promoting Regular Defecation Provision of privacy extremely important. Timing  encourage to defecate when urge is recognized. Nutrition & fluids: constipation  increased fluids, prune juice, fiber whole grain. Diarrhea  bland, small frequent foods (soft, cooked, e.g., rice, yogurt, egg). Flatulence  straws, chewing gum, carbonated drinks, cabbage, onions, cauliflower, beans should be avoided Exercise  regular exercises Positioning – squatting; Bedside commode, bed pan are needed for some cases 21 Nursing Management: IMPLEMENTATION Client Education Nursing Management: IMPLEMENTATION Administering Enemas Enema: Solution introduced into the rectum & large intestine to distend & stimulate intestine, and increase peristalsis & excretion of feces and flatus Four types:  Cleansing enema: to clear the bowel/remove feces (saline, soapsuds, and oil)  Carminative enema: to expel flatus. ‫لطرد الغازات الزائدة‬  Retention enema: oil or fluid is retained for 1-3 hrs. to soften feces and lubricate the rectum. ‫لتلين الجهاز‬  Return-flow enema: an alternating flow of 100-200 ml of fluid into & out of rectum, repeated 5-6 time ‫تحفيز حركة االخراج‬ 23 Enema 24 Nursing Management: IMPLEMENTATION Digital Removal of Fecal Impaction  Breaking up of the fecal mass digitally & removing it in portions.  Bowel mucosa can be injured. Restricted in some facilities.  Rectal stimulation is contraindicated with cardiac diseases due to vagal stimulation & cardiac arrhythmia.  Oil retention enema can be given for 30 minutes to retain in colon before disimpaction.  After disimpaction, suppositories or enema can be given to remove remaining stool. 25 Nursing Management: IMPLEMENTATION Bowel Training Programs  Indication: Helping clients to establish normal defecation for:  Chronic constipation,  Frequent fecal impaction  Fecal incontinence  Design a plan with the client that includes the following:  Fluid intake of about 2500 to 3000 ml per day.  Increase in fiber in the diet.  Intake of hot drinks, especially before the usual defecation.  Increase in exercise. 26 Nursing Management: IMPLEMENTATION Bowel Training Programs  Maintain the following daily routine for 2 to 3 weeks:  Administer suppository (e.g. Dulcolax) 30 minutes before defecation to stimulate peristalsis.  When client experiences the urge to defecate, assist him to the toilet or commode or bedpan.  Provide client with privacy.  Teach client to lean forward at the hips, to apply pressure on the abdomen, and to bear down for defecation.  Provide positive feedback and offer encouragement to client. 27 Nursing Management: IMPLEMENTATION Fecal Incontinence Pouch Fecal collector: is bag secured around the anal opening to collect feces. Nursing responsibilities: 1. Assessment & documentation of the perianal skin. 2. Changing bag every 72 hours or when there is leakage 3. Maintaining the drainage system. 4. Providing explanation and support. Nursing Management: IMPLEMENTATION Artificial Bowel Sphincter It consists of cuff around the anal canal, it is inflated close to sphincter, then can be deflated to have bowel movement. It is used for cases such as:  Post trauma  Paraplegic or quadriplegic  Post stroke patients Critical Thinking Question: Which statement provides evidence that an older adult who is prone to constipation is in need of further teaching? A. “I need to drink one and a half to two quarts of liquid each day.” B. “I need to take a laxative such as Milk of Magnesia if I don’t have a BM every day.” C. “If my bowel pattern changes on its own, I should call you.” D. “Eating my meals at regular times is likely to result in regular bowel movements.” Critical Thinking Question: Which of the following is most likely to validate that a client is experiencing intestinal bleeding? A. Large quantities of fat mixed with pale yellow liquid stool B. Brown, formed stools C. Semisoft black-colored stools D. Narrow, pencil-shaped stool Critical Thinking Question: Which nursing diagnoses is/are most applicable to a client with fecal incontinence? Select all that apply: Bowel Incontinence Risk for Deficient Fluid Volume Disturbed Body Image Social Isolation Risk for Impaired Skin Integrity