ChapLer 46 Summary

8owel MovemenL
8owel movemenL ls a normal process Whenever Lhere ls an lnLerrupLlon ln Lhe process LhaL can mean Lhere ls a
problem wlLh Lhe gasLrolnLesLlnal sysLem or anoLher sysLem
Cl conslsLs of mucusmembranellned muscular organs
urpose of Cl Crgans absorb flulds nuLrlenLs prepare food Lo be absorbed by cells sLore feces
MouLh where ulgesLlon sLarLs ends ln SlnLesLlne 1eeLh masLlcaLe food and sallva
dlluLes and sofLens food
Lsophagus food passes Lhru esophageal sphlncLer whlch ls a clrcular muscle LhaL prevenLs
food from golng back and alr from enLerlng 8olus ls Lhe food LhaL goes down Cl
lL ls pushed by perlsLalsls (muscle conLracLlons LhaL push food down Cl)
SLomach performs 3 Lhlngs 1) sLored swallowed food/llquld 2) mlxlng
food/enzymes/dlgesLlve flulds 3) empLylng conLenLs lnLo slnLesLlne lL produces
hydrochlorlc acld (PCl) enzyme pesln Lo faclllLaLe dlgesLlon of proLeln Musus Lo
proLecL sLomach from acld lnLrlnslc facLor essenLlal for absorpLlon of vlL b12
Small lnLesLlne segmenLaLlon perlsLalLlc movemenL help dlgesLlon and absorpLlon Chyme
mlxes wlLh dlgesLlve [ulces lL absorbs mosL of nuLrlenLs qulckly and by Llme
whaLever ls lefL ln slnLesLlne and chyme mlxLure reaches Lhe end of slnLesLlne lL
ls a pasLe llke conslsLency lL has 3 secLlons duodenum (811 lnches longconLlnues
process wlLh chyme) [e[unum (8 fLabsorbs carbs and proLelns) and lleum (12 fL
longabsorbs waLer faLs blle salLs vlLamlns lron) WhaLever canL be dlgesLed
goes lnLo Lhe cecumwhlch ls Lhe beglnnlng of Lhe llnLesLlne

Large lnLesLlnes lleocecal valve connecLs slnLesLlne large lnLesLlne and prevenLs backflow
LlnLesLlne ls 36 fL Wlder Lhen slnLesLlne ulvlded lnLo cecum colon (ascendlng
Lransverse decendlng slgmold) recLum lL ls Lhe prlmary organ ln 8M
ellmlnaLlon 1he colons muscular Llssue allows for ellmlnaLlon of wasLe and gas #
funcLlons 1) absorpLlon secreLlon and ellmlnaLlon Lvery 4 hrs an adulLs absorbs
abouL 1 gallon of waLer a 1 ounce of salL lf perlsLalsls ls fasL Lhere ls less Llme for
waLer Lo be absorbed and wasLe ls waLery lf ls slows down wasLe wlll be hard
mass SecreLory funcLlon helps ln elecLrolyLe balance 8lcarbonaLe ls secreLed ln
exchange for chlorlde MovemenL of food by perlsLalsls occurs 34 Llmes a day ln
Lhe recLum bacLerla convers wasLe Lo flnal form 8ecLum ls usually free of fecal
maLLer 1ransvers and verLlcal folds ln colon hold fecal maLLer ln place unLll
defecaLlon
Anus where feces exlLs lL ls rlchly supplled wlLh sensory nerves LhaL help conLrol
conLlnence
uefecaLlon physlologlcal facLors LhaL affecL bowel funcLlonnormal gl funcLlon sensory
awareness of recLal conLenLs volunLary spchlncLer conLrol and adequaLe recLal
capaclLywhen feces reaches recLum lL sends sensory slgnals LhaL lL ls Llme Lo go Lo
Lhe baLhroom eople aL rlck Lo have problems lnclude cardlovascular dlsease
lnLracranlal pressure surglcal wound cardlac lrregularlLles elevaLed pressure
acLors affecLlng bowel ellmlnaLlon ageex lnfacnLs have a fasLer perlsLalsls and are unable Lo conLrol Lhelr bowel
movemenL As you geL older perlsLalsls decreases esophageal empLylng slows
down Looslng of muscle Lone
uleLflber ls nondlgesLlble resldue helps flush Lhe faLs and wasLe producLs from
Lhe body Along wlLh whole gralns rulLs and vegeLables When Lhere ls no flber lL
lncreases Lhe rlsk of polyps
luld lnLakefluld lnLake or fulld loss affecLs characLer of feces uecrease ln fluld
lnLake slows down passage of food and causes consLlpaLlon
hyslcal acLlvlLypromoLes perlsLalsls MalnLalnlng Lone of skeleLal muscles
sychologlcal facLorssLresswhlch lncreases perlsLalsls causlng dlarrhea and
gaseous dlsLenLlon
ersonal hablLsuslng own LolleLs busy work schedules belng ln hosplLal seLLlngs
oslLlonlng durlng defecaLlonsquaLLlng ls normal poslLlon lmmoblllzed people
have dlfflculLy
aln due Lo hemorrholds recLal surgery recLal flsLulas abdomlnal surgery
regnancyfeLus puLs pressure on recLum prevenLlng passage of feces Slowlng of
perlsLalsls ln 3
rd
LrlmesLer
Surgery and anesLheslaslows or sLops perlsLalsls
MedlcaLlonslaxaLlves sLool sofLner
ulagnosLlc LesLs requlre prescrlbes bowel preparaLlon such as no eaLlng/drlnklng
for a cerLaln lengLh of Llme
Common bm problems consLlpaLlon lL ls a sympLom noL a dlsease Caused by lmproper dleL decrease ln
fluld lnLake lack of exerclse Slgns lnclude bm lrregularlLles dlfflculLy passlng
sLool hard feces (causlng paln when exlLlng recLum)
valva maneuver pressure exerLed Lo expel feces Lhrough volunLary conLracLlons fo Lhe abdomlnal
muscles whlle malnLalnlng forced explraLlon agalnsL a closed alrway
lmpacLlon collecLlon of hardened feces wedged ln Lhe recLum LhaL a person cannoL expel lL
can exLend up lnLo slgmold colon Cbvlous slgn ls lnablllLy Lo pass sLool for days
desplLe Lhe urge Lo go SympLoms lnclude nausea loss of appeLlLe abdomlnal
dlsLenLlon cramplng recLal paln
ularrhea ls Lhe lncrease ls number of sLools and passlng of llquld (unformed mass)
lnLesLlnal conLenL passes Lo fasL Lhru Lhe s llnLesLlne Lo allow absorpLlon of
flulds and nuLrlenLs lrrlLaLlon ln colon resulLs ln lncreased mucus secreLlon Lxcess
loss of colonlc flulds resulLs ln serlous elecLrolyLe lmbalances or acldbase
lmbalances Many condlLlons cause Lhls
lnLervenLlons lnclude admlnlsLer canned formula aL room LemperaLure ollow
sanlLaLlon lncrease raLe slowly lf uslng hyperLonlc soluLlonglve lnlLlal aL half
sLrengLh and Lhen lncrease so paLlenLs geLs used Lo lL
ClosLrldlum slfflclle Commonly assoclaLed wlLh dlarrhea sympLoms are mlld dlarrhea Lo severe collLls
Can be acqulred ln healLh care seLLlng envlronmenL eLc need LLlSA LesL
lnconslsLence Lhe lnablllLy Lo conLrol passage of feces and gas from anus LmbarrassmenL can
lead Lo lsolaLlon
laLulence as gas accumulaLes ln Lhe lumen of Lhe lnLesLlnes Lhe bowel wall sLreLches and
dlsLends (flaLulence) Causes abdomlnal fullness paln cramplng Cas escapes Lhru
Lhe mouLh (belchlng) or anus (passlng of gas aka farLlng)
Pemorrholds are dllaLed engorged velns ln Lhe llnlng of Lhe recLum Can be lnLernal or exLernal
LxLernal are vlsual purpllsh dlscoloraLlon (Lhrombosls) Causes paln and needs Lo
be removed lnLernal ones have a mucus membrane lL can be caused by sLralnlng
aL defecaLlon pregnancy hearL fallure chronlc lever dlsease
8owel dlverslons when feces cannoL exlL properly a Lemporary or permanenL openlng ln Lhe
abdomlnal wall ls creaLed (sLoma) Surglcal openlngs are creaLed ln Lhe lleum
(lleosLomy) or colon (colosLomy) wlLh Lhe ends of Lhe lnLesLlne broughL Lhrough
Lhe abdomlnal wall Lo creaLe Lhe sLoma
CsLomles locaLlon of osLomy (surgery) deLermlnes Lhe conslsLency of sLool lf lLs closer Lo
Lhe slnLesLlne lLs more lllquld as opposed lf lLs by Lhe slgmold colon CllenLs
medlcal problem deLermlnes Lhe locaLlon of colosLomy
Loop colosLomy done ln emergency slLuaLlons 1emporary large sLomas ln Lhe Lransverse colon
Lnd colosLomy ls one sLoma done aL end of Lhe proxlmal end of bowel wlLh Lhe dlsLal porLlon
elLher removed or sown LogeLher and kepL lnslde Lhe abdomlnal cavlLy Lx would
be a removal of recLum due Lo cancer
uoublebarrel colosLomy conslsLs of 2 dlsLlncL sLomas 1) Lhe proxlmal funcLlonlng sLoma 2) dlsLal non
funcLlonlng sLoma
AlLernaLlve procedures lleoanal pouch anasLomosls used when cllenLs need a colosLomy and colon ls
removed Lnd of slnLesLlne ls aLLached Lo pouch and Lhen connecLed Lo anus Lo
allow ellmlnaLlon of feces
kock conLlnenL lleosLomy uslng Lhe slnLesLlne lL deLubularlzes lLs shape Lo creaLe
a spherlcal reservolr 1reaLmenL of ulceraLlve collLls pouch has a conLlnenL sLoma
and a exLernal caLheLer ls used Lo expel wasLe
Macedomalone anLegrade conLlnence enema (MACL) made for paLlenLs who
cannoL conLrol bm and soll Lhelr cloLhes A caLheLer ls placed ln Lhe flap fo lefL
colon creaLlng aLubular passage Lnd of Lupe ls made lnLo a v shape
sychologlcal conslderaLlons sLoma causes serlous body changes SLress of how Lo malnLaln sLoma Appearance
and body lmage SLomas do noL usually lnLerfere wlLh normal llfe acLlvlLy Covered
by cloLhes Some people have lssues wlLh Lhelr sexual llves Cdors leakage causes
loss of selfesLeem
nurslng process and 8owel ellmlnaLlon nurslng hlsLory physlcal assessmenL of abdomen lnspecLlon of fecal
characLerlsLlcs resL resulLs hlsLory paLLern for food/llquld lnLake chewlng
medlcaLlon recenL lllness sLressors
nurslng hlsLory glves you an ldea of normal bowel movemenL paLLerns and hablLs ueLermln
usual bm ellmlnaLlon CllenLs descrlpLlon of sLool characLerlsLlcs rouLlnes done Lo
help ellmlnaLlon process use of arLlflclal alds changes ln appeLlLe emoLlonal
sLaLe paln moblllLy soclal hlsLory eLc
hyslcal assesemenL mouLh (LeeLh Longue denLures ablllLy Lo chew sores ln
mouLh LhaL cause paln)
Abdomencheck all 4 abdomlnal quadranLs for shape symmeLry skln color scars
Abdomlnal dlsLenLlon alpaLe sLomach for masses or Lenderness
8ecLumcheck for leslons dlscoloraLlon lnflammaLlon hemorrholds
Lab LesLwlll deLecL paLhologlcal condlLlons ex 1umor bleedlng lnfecLlon
ecal speclmenshave Lo be collecLed and labeled properly and Laken Lo lab Wear
clean gloves because 23 of sLool ls bacLerla SLool culLures requlre small sample
lf measurlng fecal faL several days collecLlon ls necessary
C81 fecal occulL blood LesLcommonly used aL home or by nurse lL measure
amounL of mlcroscoplc blood ln feces lL ls a used colorecLal cancer screenlng
lnspecL fecal characLerlsLlcs because lL wlll reveal any lnformaLlon abouL Lhe
naLure of ellmlnaLlon alLeraLlons
CllenL expecLaLlons cllenLs expecL you Lo know all Lhe answers and Leach Lhe
cllenL meLhods of promoLlng and malnLalnlng a normal bowel ellmlnaLlon process
nurslng dlagnosls assessmenL wlll help ln deLermlnlng dlagnosls Lxample of dlagnosls lnclude
bowel lnconLlnence consLlpaLlon rlsk for consLlpaLlon percelved consLlpaLlon
dlarrhea LolleLlng selfcare deflclLs ueLermlne rlsk and lmplemenL plan Lo
malnLaln normal bowel funcLlon
8ead procedure for gualac fecal occulL blood LesL on page 1189
8ead Lables and boxes on page 1190 Lo end of chapLer
lannlng use crlLlcal Lhlnklng Lo creaLe a proper care plan LhaL lnLegraLes all you know
abouL cllenL and cllnlcal problem
Coals and ouLcomeslncorporaLe cllenLs rouLlnes and hablLs and relnforce
rouLlnes LhaL promoLe healLh Lx Lxerclse programs eLc
SeLLlng prlorlLles seL a reallsLlc Llme frame rlorlLles all dlagnosls accordlngly
CollaboraLlve carelnclude fam ln care of paLlenL lf dlsabled eLc asslsLlng ls uslng
bedpan eLc
lmplemenLaLlon lmprove cllenLs and famlly's undersLand of bowel ellmlnaLlon 1each abouL proper
dleL adequaLe fluld lnLake sLress regular rouLlnes and exerclse
PealLh promoLlon lnform cllenLs when lLs usually Llme Lo defecaLe LsLabllsh a
Llme where defecaLlon usually occurs (mornlng before bedLlme eLc) offer
bedpan or help cllenL reach baLhroom ln Llmely manner Make sure Lo provlde
prlvacy
romoLlon of normal defecaLlon slLLlng poslLlon regular baLhrooms may be Loo low for paLlenLs who are weak or
have moblllLy problems An elevaLed LolleL seaL mlghL be necessary for home
oslLlonlng on bedpanwomen use bedpan boLh for urlne and feces males only
for feces 1here are 2 Lypes 1) regular bedpab 2) a fracLure pan Lo be used when
lower exLremlLy fracLures revenL muscle sLraln and dlscomforL See page 1196
for plc never leave bed flaL when uslng a bedpan
CaLharLlcs and laxaLlves have a shroLLerm acLlon of empLylng Lhe bowel used when paLlenL ls golng Lhru
Cl LesLlng or abdomlnal surgery Avallable ln varlous forms
AnLldlarrheal agenLs lmodlumover Lhe counLer med Lo rellve dlarrhea MosL effecLlve anLldlarrhea are
prescrlpLlve oplaLes
Lnemas ln Lhe lnsLlllaLlon of a soluLlon lnLo Lhe recLum and slgmold colon used Lo
promoLe defecaLlon by sLlmulaLlng perlsLalsls
Cleanslng enemas promoLe compleLe evacuaLlon of feces from Lhe colon SLlmulaLe perlsLalsls by
lnfuslon of large volume of soluLlon such as waLer normal sallne low volume
hyperLonlc sallne
Lnema admlnlsLraLlon avallable ln commerlclly packaged dlsposable unlLs or reusable equlpmenL SLerlle
Lechnlque ls unnecessary because Lhe colon conLalns bacLerla buL do wear gloves
Lxplaln procedure
ulglLal removal of sLool lf sLool ls Loo large Lo pass and enemas don'L work use your flnger Lo break Lhe
sLool and remove lL ln secLlons 1hls ls used as a lasL resorL
nasogasLrlc Lube used when perlsLalsls doesn'L exlsL surgery Cl lnfecLlons Lrauma
SLoma and pouchlng osLomles osLomles have a pouch Lo collecL fecal maLerlal are odorless and comforLable
1hey are used for sLomas and Lhey come ln dlfferenL shapes and slzes A wond
osLomy conLlnence nurse (WCCn) ls speclally Lralned Lo care of osLomy cllenLs
Skln barrlers lnclude powders llquld fllms LhaL are applled Lo Lhe skln around Lhe
sLoma and some are aLLached Lo Lhe osLomy pouch Make sure skln ln free from
lrrlLaLlon lLs clean eLc
LvaluaLlon deLermlne lf cllenLs ls uslng Lechnlques demonsLraLed and pracLlclng healLh hablLs
Lo faclllLaLe bowel movemenL CreaLe a relaLlonshlp Lo wear cllenL feels
comforLable Lo Lalk abouL ellmlnaLlon needs