Chapter 22
Bowel Elimination
LEARNING OUTCOMES:
· Define the key terms and key abbreviations listed in this chapter
· Describe normal defecation
· List the observations to make about defecation
· Identify the factors that affect bowel defecation
· Describe the common bowel elimination problems
· Explain how to promote comfort and safety during defecation
· Describe bowel training
· Explain why enemas are given
· Describe the common enema solutions
· Describe the rules for giving enemas
· Describe how to care for a person with an ostomy
· Perform the procedures described in this chapter
Ø Bowel elimination is a basic physical need.
Ø Factors affecting bowel elimination include:
• Privacy
• Habits
• Age
• Diet
• Exercise and activity
• Fluids
• Drugs
Ø You assist patients and residents in meeting their elimination needs.
NORMAL BOWEL ELIMINATION
Ø Time and frequency of bowel movements vary.
Ø Stools are normally brown.
Ø Stools are normally soft, formed, moist, and shaped like the rectum.
Ø Stools have a normal odor caused by bacterial action in the intestines.
Ø Your observations are used for the nursing process.
• Carefully observe stools before disposing of them.
• Ask the nurse to observe abnormal stools.
Ø Observe and report the following to the nurse. If allowed to chart, also record the following:
• Color
• Amount
• Consistency
• Presence of blood or mucus
• Odor
• Shape
• Frequency of defecation
• Complaints of pain or discomfort
FACTORS AFFECTING BOWEL ELIMINATION
Ø Normal, regular elimination is the goal.
• Privacy
• Habits
• Diet—high-fiber foods
• Diet—other foods
• Fluids
• Activity
• Drugs
• Disability
• Aging
COMMON PROBLEMS
Ø Constipation is the passage of a hard, dry stool.
• Constipation occurs when feces move slowly through the bowel.
• Constipation is prevented or relieved by:
Dietary changes, fluids, and activity
Drugs and enemas
Ø A fecal impaction is the prolonged retention and buildup of feces in the rectum.
• Fecal impaction results if constipation is not relieved.
• A digital (finger) exam is done to check for an impaction.
• Sometimes the fecal mass is removed with a gloved finger.
This is called digital removal of an impaction.
• Checking for and removing impactions are very dangerous.
The vagus nerve in the rectum can be stimulated.
The heart rate can slow to dangerous levels in some persons.
Ø Diarrhea is the frequent passage of liquid stools.
• Feces move through the intestines rapidly.
• Diet and drugs are ordered to reduce peristalsis.
• You need to:
Assist with elimination needs promptly.
Dispose of stools promptly.
Give good skin care.
• Fluid lost through diarrhea is replaced.
Otherwise dehydration occurs.
• Always follow Standard Precautions and the Bloodborne Pathogen Standard when in contact with stools.
Ø Fecal incontinence is the inability to control the passage of feces and gas through the anus.
• Fecal incontinence affects the person emotionally.
• The person may need:
Bowel training
Help with elimination after meals and every 2 to 3 hours
Incontinence products to keep garments and linens clean
Good skin care
Ø Flatulence
• Gas or air passed through the anus is called flatus.
• Flatulence is the excessive formation of gas or air in the stomach and intestines.
• If flatus is not expelled, the intestines distend.
• The following help produce flatus:
Exercise
Walking
Moving in bed
The left side-lying position
• Doctors may order enemas and drugs to relieve flatulence.
BOWEL TRAINING
Ø Bowel training has two goals:
• To gain control of bowel movements
• To develop a regular pattern of elimination
Ø Factors that promote elimination are part of the care plan and the bowel training program.
ENEMAS
Ø An enema is the introduction of fluid into the rectum and lower colon.
Ø Doctors order enemas:
• To remove feces
• To relieve constipation, fecal impaction, or flatulence
• To clean the bowel of feces before certain surgeries and diagnostic procedures
Ø The doctor orders the enema solution.
• The solution depends on the enema’s purpose:
Tap-water enema is obtained from a faucet.
Saline enema is a solution of salt and water.
Soapsuds enema (SSE) is a solution of castile soap and water.
Small-volume enema is commercially prepared.
Oil-retention enema is mineral, olive, or cottonseed oil.
Other enema solutions may be ordered.
• You do not give enemas that contain drugs.
Ø Cleansing enemas:
• Clean the bowel of feces and flatus
• Relieve constipation and fecal impaction
• Are needed before certain surgeries and diagnostic procedures
Ø The doctor orders a tap water, saline, or soapsuds enema.
Ø Small-volume enemas irritate and distend the rectum.
• They are often ordered for constipation or when the bowel does not need complete cleansing.
Ø Oil-retention enemas relieve constipation and fecal impactions.
• Retaining oil softens feces and lubricates the rectum.
• Most oil-retention enemas are commercially prepared.
THE PERSON WITH AN OSTOMY
Ø An ostomy is a surgically created opening.
• The opening is called a stoma.
The person wears a pouch over the stoma to collect stools and flatus.
Ø Colostomy
• A colostomy is a surgically created opening between the colon and abdominal wall.
• With a permanent colostomy, the diseased part of the colon is removed.
• A temporary colostomy gives the diseased or injured bowel time to heal.
After healing, surgery is done to reconnect the bowel.
• The colostomy site depends on the site of disease or injury.
Ø Ileostomy
• An ileostomy is a surgically created opening between the ileum and the abdominal wall.
• Liquid stools drain constantly from an ileostomy.
Ø Ostomy pouches
• The pouch has an adhesive backing that is applied to the skin.
• Sometimes pouches are secured to ostomy belts.
• Many pouches have a drain at the bottom that closes with a clip, clamp, or wire closure.
The drain is opened to empty the pouch.
• The pouch is emptied when stools are present.
• The pouch is changed every 3 to 7 days and when it leaks.
• Do not flush pouches down the toilet.