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Pattern
Bowel
Elimination
ELIMINATION
Small intestine (22 feet)
digestion and absorption of nutrients, vitamins,
minerals, fluids and electrolytes
Ileocecal valve
controls emptying of contents from small
intestine into the colon
ELIMINATION
Colon(5-6 feet - 59 inches, 1 - 3
inches diameter)
collect, concentrate,
transport and eliminate
waste
cecum, ascending colon,
transverse colon, sigmoid
colon, and anal canal
ELIMINATION
Chyme - waste products of digestion that moves from small
intestine to large intestine; 1,500 mL/day processed by large
intestine, most absorbed in proximal portion of colon - 100
mL in feces
ELIMINATION
Feces: body waste discharged from the intestine
Peristalsis: the rhythmic smooth muscle
contractions of the intestinal wall that propel the
intestinal contents forward. Q 3-12 times minutes;
mass peristalic sweeps 1-4 times/24 hr.
Flatus: the gas normally found in the GI tract &
passed through the anus
ELIMINATION
Defecation: expulsion of feces from anus and rectum
Moves into sigmoid colon and rectum
Sensory nerves signals need to defecate
Internal sphincter relaxes
Moves into anal canal
External sphincter relaxes voluntarily
Contraction of abdominal muscles and the diaphragm
increases abdominal pressure; contraction of levator
ani muscles pelvic floor
Bowel
Obstruction
Crohns Disease
Appendicitis
HISTORY
Pattern of elimination: What is your normal bowel
elimination pattern, including time of day & frequency?
Appearance: What do your feces look like, including
amount, color, consistency, constituents, frequency,
odor, & shape?
Medications: What medications do you take? How
often do you use laxatives or bowel elimination aids?
Has your use of bowel elimination aids changed
recently?
Recent changes in elimination: Have you noticed any
changes in your bowel elimination pattern?
HISTORY
Dietary & fluid intake: What is your normal dietary
intake for a day? Has it changed recently? What is
your normal fluid intake for a day? Has it changed
recently?
Exercise: What kind of exercise or physical activity
do you get? Has it changed recently?
Past or current problems: Have you had any surgery
pertinent to bowel elimination? eg. presence of
ostomies; any problem now - type, onset, causes, S&S
Emotional state: How is your current emotional state?
Is it different from your normal?
ASSESSMENT
Abdominal assessment
Inspection: contour, masses, distention
Auscultation: bowel sounds - absent, 5 minutes
Percussion: identify masses, fluid, air - resonance
palpation: muscular resistance, masses, enlargement
Stool characteristics
Volume
- Constitutents
Color
- Odor
Consistency
- Shape
NURSING DIAGNOSIS
Bowel incontinence r/t
Gross constipation with impaction & subsequent
overflow
Local causes (inflammation, cancer of rectum,
prolapsed anus, semifluid stool)
Extreme debilitation
Cognitive impairment
NURSING DIAGNOSIS
Constipation r/t
Decreased fiber in diet
Decreased fluid intake
Inactivity
Delaying defecation when urge is present
Abuse of laxatives
Use of constipating medications (antacids, narcotic
analgesics, anticholinergics)
Change in routine
Pain associated with defectation
NURSING DIAGNOSIS
Risk for constipation r/t
Habitually ignores urge to defecate
Inactivity
Decreased fiber in diet
Inadequate fluid intake
Use of pharmacolgic agents that can result in
constipation (iron, opioids, anticholinergics)
Stress, confusion
NURSING DIAGNOSIS
Perceived constipation r/t
Culture
Family health beliefs
Faulty appraisal
Impaired thought processes
NURSING DIAGNOSIS
Diarrhea r/t
Food intolerance (coarse, greasy, or spicy foods)
Food or drug allergies
Abuse of laxatives
Alteration in normal bacterial flora of the intestine
(antibiotic therapy)
Emotional stress
Intestinal infection
Colon disease & other diseases
Dumping Syndrome
NURSING DIAGNOSIS
As etiology
Altered Growth & Development r/t parents
misconceptions about bowel & bladder training
Altered Nutrition: Less Than Body Requirements r/t
loss of appetite from flatulence or impaction
Anxiety related to lack of voluntary control of fecal
elimination & significant others response to ostomy
Body Image Disturbance r/t ostomy, need to wear
disposable adult briefs
Fluid Volume Deficit r/t prolonged diarrhea
NURSING DIAGNOSIS
As etiology
Impaired Skin Integrity r/t
prolonged diarrhea
bowel incontinence
Ineffective Individual Coping r/t inability to accept
permanent ostomy
Knowledge Deficit: Bowel Training r/t no previous
experience
Pain r/t intestinal distention, prolonged constipation or
impaction, fecal incontinence, hemorroids
Self-Care Deficit: Toileting r/t mobility deficit,
weakness, confusion
NURSING DIAGNOSIS
As etiology
Self-Esteem
Disturbance r/t need
for assistance with
toileting, fecal
incontinence
Sexual Dysfunction
r/t perceived change in
body image, lack of
interest, loss of selfesteem
Expected Outcomes
Client with Constipation:
Have a soft, formed bowel movement every 1 to 3
days without discomfort
Listing foods with high-fiber content
Explaining the importance of exercise in relation to
the GI system
Stating the types of laxatives available
Identifying side effects & contraindications of bowel
laxatives
Administering appropriate laxatives to maintain
normal bowel elimination
Expected Outcomes
Client with Diarrhea:
The client will be clean & dry
The client will avoid foods that contribute to
diarrhea
The client will note the frequency & amount of
diarrhea
PLANNING
Goal: Maintain or restore a regular pattern of
elimination
outcomes
increase fluid intake to 2000 ml/day
include fiber in at least 1 meal/day
walk 20 minutes at least 3x/week
verbalizes relief of constipation by 2 weeks
Interventions
Goal: To Promote Healthy
Elimination
Teaching about bowel needs &
care
Toilet habits: availability of
bathroom, time constraints,
response to stimulation;
frequency - normal 3xs/week
to 3xs/day; less than one/week
- a problem; amount & type
varies with type of food
ingested, fluid intake, &
frequency of bowel evacuation;
promote response to urge
Interventions
To Promote Healthy
Elimination
Diet: High fiber diet
increases weight &
water content of
feces; speeds progress
of feces through GI
tract; prevent disease
fruits, vegetables,
whole-grain cereals
& bread
Interventions
To Promote Healthy
Elimination
Interventions
To Promote Healthy Elimination
Exercise: improves
muscle tone, strengthen
muscles used in
defecation - isometric
Abdominal setting:
lying in supine
position, tighten &
hold abdominal
muscles 6 seconds &
relaxes; repeat several
times each waking
hour
Interventions
To Promote Healthy
Elimination
Thigh strengthening:
thigh muscles flexed
& contracted slowly
bringing the knees
up to the chest one at
a time & lowering
them to the bed.
Perform several
times for each knee
each waking hour
Interventions
To Promote Healthy
Elimination
Positioning the client:
facilitates contraction of
abdominal muscles squatting best facilitates,
sitting with leaning
forward; precautions for
surgery - eg. Hip
surgery; bathroom,
bedside commode
preferred
Interventions
To Promote Healthy
Elimination
Promoting relaxation
& privacy: anxious
about odor, sounds;
not interrupt; relief of
pain
Use of laxatives:
short-acting, not to be
used on routine basis
Interventions
To manage constipation
Administering medications:
Cathartics
intestinal lubricant (mineral oil):
use: short term laxative - effective within 8 hours
side effects: impairs nutrition - fat-soluble
vitamins ADEK
irritants (castor oil)
irritates intestinal mucosa
side effects: taste
Interventions
Bulk-forming
psyllium hydrophilic (metamucil)
hemicellulose swells acts as a demulcent and
softens stool; onset - 10-24h, peak 1-3 d
Calcium polycarbophil (FiberCon)
Methylcellose (Citrucel)
side effect: slow acting- n&v, cramps, diarrhea;
interferes with absorption of calcium, iron, & some
drugs
Interventions
Emollient: stool softener
docusate sodium (Colace); with casanthranol (Peri-Colace)
docusate calcium (Surfak); docusate potassium (Dialose)
Interventions
Laxative: Osmotic
Draws water into intestine & stimulates peristalsis; not
use by elderly - produce dehydration
glycerin (suppository)
Lactulose (Chephulac)
Magnesium citrate (milk of magnesia)
Magnesium hydroxide (Mag-Ox)
Magnesium sulfate (Epsom salts)
Sodium Phosphate (Fleet Phospho-soda)
polyethylene glycol-electrolyte solution (GoLYTELY,
Colyte)
Interventions
Enemas - Sodium Phosphate with sodium
biphosphate (Fleet enema), soap suds, oil
retention, tap water (discussion in clinical
conference)
Removing an impaction: oil retention enema
followed by volume cleansing enema; digital
removal - may use topical anesthetic to reduce
discomfort
Interventions
To alleviate diarrhea
Administering medications:
Bismuth subsalicylate (Pepto-Bismol): antisecretory,
antimicrobial, antiinflammatory effects
kaolin & pectin (Kaopectate) - bind & remove
irritants from GI tract & form soothing, protective
coating on the mucosa
Opiate derivative: paregoric, loperamide (Imodium),
diphenoxylate with atropine/difenoxin with atropine
(Lomotil): inhibits gastric motility
intestinal sedative for chronic diarrhea
sedative effects, depression, weakness
Interventions
To alleviate diarrhea
Administering
medications:
Eliminate
antibiotics that may
cause
Reestablish flora:
fermented dairy
products - yogurt,
buttermilk, or
bacillus-containing
medications lactinex
Interventions
To alleviate diarrhea
Limiting food intake:
diet modification to counteract decreased absorption laxative effects of raw fruits, vegetables, highly
spiced foods
Interventions
To alleviate diarrhea
Restoring fluids &
electrolytes:
Oral or parenteral
replacement; Infants
deplete rapidly
Replace lost fluids &
electrolytes with weak
tea, water, bouillon,
clear soup, gelatin
Interventions
To alleviate diarrhea
Preventing skin
breakdown: soft
material to wipe, wash
perianal area with soap
& water
Ensuring privacy:
frequency & urgency
cause fatigue &
embarassment
Do NOT
Disturb
!
Dumping Syndrome
Interventions
To Manage Bowel Incontinence
Note when incontinence is most like to occur - place on
bedpan at this time; if no pattern, offer bedpan at regular
intervals
Keep skin clean & dry by using hygienic measures
Change bed linens & clothing as necessary to avoid
odor, skin irritation, & embarrassment
Confer with physician about using a suppository or daily
cleansing enema - to empty lower colon regularly &
help decrease incontinence; use of bowel training
program
Rectal indwelling catheter for uncontrollable diarrhea
Interventions
To Meet Needs of Patient with Bowel Diversions
Colostomy
Ileostomy
(Discussion in Clinical Conference)
EVALUATION
If outcomes not achieved, explore reasons:
Were the clients fluid intake and diet appropriate?
Was the clients activity level appropriate?
Are prescribed medications or other factors affecting the
gastrointestinal function?
Do the client and family understand the provided
instructions well enough to comply with the required
therapy?
Were sufficient physical and emotional support
provided?
EVALUATION
Able to verbalize the relationships among bowel
elimination & nutrition, fluid intake, exercise, & stress
management.
Develops a plan to modify any factors that contribute to
current bowel problems or that might adversely affect
bowel functioning in the future.