10/13/2014

Mohon perhatiannya bahwa slide ini dikembangkan khusus

untuk kepentingan pengajaran di Jurusan Keperawatan
Unsoed.
Dilarang mempublikasikan di blog/ website/ file sharing
website tanpa seijin penulis.
Rahmi Setiyani, MN
Oktober 2014

Learning objectives

2 x 50
Menjelaskan perubahan kebutuhan
eliminasi bowel pada lanjut usia & faktorfaktor yang mempengaruhinya

Faktor yang mempengaruhi kebutuhan

eliminasi bowel pada lanjut usia

1. Perubahan fisiologis saluran cerna bagian

bawah (faktor penuaan) bukan resiko utama
2. Penurunan level aktivitas
3. Perubahan intake
4. Efek samping obat-obatan
5. Faktor penyakit

Kebutuhan Eliminasi Bowel

Mengeluarkan sisa produk digestive

(saluran cerna) dari dalam tubuh
Lanjut usia sering mengeluhkan adanya
gangguan kenyamanan saluran cerna
dan mencoba berbagai cara untuk
mengatasinya

Perubahan Fisiologis saluran cerna

Intestinal wall atrophy

Reduced blood supply
Neuronal changes (Enteric nervous system)
Pelvic floor muscle strength
Sphincter function
Rectal sensitivity
Disturbed colonic motility
Inability to evacuate stool completely
Slow transit constipation
Overflow fecal incontinence

10/13/2014

Bowel Transit Time

How long does it take for the food to move from the
mouth to the anus?
Normal < 3 days
Slow transit 4-9 days

Level of Activity

Activity stimulates peristaltic

Lack of exercise & immobility weak abdominal &
pelvic muscle ineffective in increasing abdominal
pressure during defecation & controlling defecation
Bed rest patient often constipated

10/13/2014

Intake

Bland diet & low-fiber diet

insufficient residue to stimulate
defecation reflex
Irregular eating impaired regular
defecation
Inadequate fluid intake

Medication

Elderly might take medications to treat their disease

Side effect of medication
Drugs that affect CNS (Antidepressants, anxiolytic,
antipsychotic)
Antacids (aluminum hydroxide, calcium antacids)
Iron tablet affect mucosa
Laxative abuse

Interventions

Dietary fiber intake (20-35 grams/day)

Drink plenty of fluid > 1500 ml/day
Established regular eating habit
Dont use laxative regularly

Faktor Penyakit (di luar sistem GI bawah)

Endocrine and metabolic

disease (Diabetes mellitus
& Hypothyroidism)
Neurologic disease
(Cerebrovascular disease ;
spinal cord injury;
Parkinsons disease;
Alzheimers disease)
Musculoskeletal problem
Psychological conditions
(anxiety & depression)

Sensory stimulation
for defecation
or
Parasympathetic
stimulation
Impaired mobility
(limit the ability to
respond to the urge to
defecate
Prevent the person
understand the need to
defecate & the action
needed to perform the
activity

10/13/2014

Interventions

Adequate level of activity (30 minutes exercise/ day

or doing household chores)
Established the habit of defecating at a regular time
(ex. after breakfast; adanya reflex gastrocolic)
Do not ignoring defecation signal
Provide opportunity (time and position) for full
emptying and for repeated attempt

Whats your position?

Which one is better??? Squat or Sit

Daftar Pustaka

Berman, Synder, Kozier & Erb. Kozier & Erbs Fundamental of

Nursing: Concepts, Process, and Practice (8th edition), pp.1284-1321.
New Jersey: Pearson Education.
Carpenito, L.J. (2013).Nursing Diagnosis: Application to Clinical
Practice (14th edition), pp.699-752. Philadelphia: Lippincott
Williams & Wilkins.
Eliopoulous, C. (2010). Gerontological Nursing. 7th edition, pp.282290. Philadelphia: Lippincott Wiliams & Wilkins.
McCrea, GL., Miaskowski, C., Stotts, NA., Macera, L. & Varma,
MG. (2008). Pathophysiology of constipation in the older adult.
World Journal of Gastroenterology, 14(17), 2631-2638.
Sherwood, L. (2009). Fisiologi Manusia: Dari Sel ke Sistem, pp.553597. Jakarta: EGC.
The Joanna Briggs Institute. (2008). Management of constipation
in older adults. Best Practice, 12(7), 1-4.