Alternations in bowel elimination

MEETING PATIENT NEEDS: BOWEL ELIMINATION

1. Alternations in bowel elimination

2. Constipation Impaction Diarrhea Incontinence Flatulence Hemorrhoids Intrduction

3. It is the term is used to describe an infrequent bowel movements or irregularity of defecation , abnormal hardening of stool that makes their passage difficult and painful. Constipation

4. Causes Irregular bowel habits and ignoring the urge to defecate Chronic diseases Low fiber diet and high in animal fat less fluid intake Anxiety, depression, cognitive impairment Immobilization or lack of exercise Laxative misuse Illnesses (neurological illnesses & organic illnesses) Medications Constipation

5. Signs and symptoms Decreased frequency of defecation Hard, dry, formed stools Straining at stool; painful defecation Feeling of fullness, discomfort in rectum, abdomen Anorexia or nausea Headache Constipation

6. Medical management Treat the under lying cause Increase fiber and fluid intake Routine exercises Biofeedback Use of laxatives Nursing management Maintain a regular pattern of elimination Dietary pattern Exercises Privacy Psychological support Posture Laxative administration Administration of suppositories or enema Management

7. It is the accumulation of hardened feces in the rectum, as a result of which the person is unable to voluntarily evacuate the stool. Mass or collection of hardened feces in folds of rectum Passage of liquid fecal seepage and no normal stool Usual causes Poor defecation habits Untreated or un relieved Constipation Impaction

8. Signs and symptoms Feeling of fullness in rectum and abdomen An urge for defecation and inability to pass stool Generalized malaise Loss of appetite Nausea/vomiting Abdominal distension Management Laxatives , enema or manual removal of the stool(digital evacuation) Impaction

9. Defined as frequent passage of loose, fluid unformed stools due to increased gastro intestinal motility Manifested by frequent evacuation of watery stool Besides the intense urge to defecate, there may be abdominal cramps, nausea & painful burning sensations at the anus Diarrhea

10. Causes Intestinal infections (enteritis) Nervous tension (emotional or psychogenic diarrhea ……excessive stimulation of parasympathetic nervous system Medications ( antibiotics &iron supplements) Abuse of cathartics Mechanical causes : incomplete obstruction ….stenosis,adhesions and tumors Other causes :Malabsorption syndrome, irritable colon, narcotic withdrawal. Etc. Diarrhea

11. Management Replace the fluid and electrolytes Treat the cause Drug therapy Antibiotics/antimicrobials Antimotility agents (loperamide) Nursing care Replacements of fluid and electrolytes ( potassium) Small frequent diet.. Avoid spicy foods Use of bedpan and commodes Skin care Adequate rest Psychological support Medications Healthy eating habits Diarrhea

12. The loss of voluntary ability to control fecal and gaseous discharges through the anal sphincter Types : Partial :inability to control flatus or to prevent minor soiling Major : inability to control feces of normal consistency Causes Neuromuscular disease Spinal cord trauma Tumors Treated with surgery Repair of sphincter Fecal incontinence pouch Bowel diversion or colostomy Fecal Incontinence

13. Flatulence is the presence of excessive flatus in the intestines and leads to stretching and inflation of the intestines (intestinal distensions) Causes Action of bacteria on the Chyme in L.intestine Swallowed air Gas that diffuses between the blood stream and the intestine Foods (cabbage, onions) Signs Gastric distension Management :insertion of rectal tube Flatulence

14. Hemorrhoids are dilated, engorged vein in the lining of the rectum External or internal Hemorrhoids

15. External Clearly visible as protrusions of skin If underlying vein is hardened or purple colored Pain Need to be excised Internal An outer mucus membrane Causes : Increased venous pressure due to straining Pregnancy Heart failure Chronic liver diseases Treatment Hemorrhoidectomy Hemorrhoids

16. Nursing management of patients with bowel elimination problems Nursing process

17. History Physical examination Food and fluid intake Chewing ability Medications Recent illnesses or stressors Assessment

18. Fecal characteristics & Review of relevant results Examination of fecal specimen for Occult blood Stool culture Fecal fat Laboratory tests Total bilirubin Alkaline phosphate Amylase Direct visualization (Endoscopy & colonoscopy) Indirect visualization (x ray film with contrast medium) Assessment

19. Constipation Risk for constipation Perceived constipation Chronic functional constipation Risk for chronic functional constipation Diarrhoea Dysfunctional gastrointestinal motility Bowel incontinence Nursing diagnosis

20. As etiology Risk for electrolyte imbalance Risk for imbalanced fluid volume Deficient fluid volume Risk for deficient fluid volume Impaired skin integrity Risk for Impaired skin integrity Impaired comfort Nursing diagnosis

21. Goals / objectives Maintain or restore normal bowel elimination pattern Maintain or regain normal stool consistency Prevent associated risks Planning

22. Promoting regular defecation Privacy Timing Nutrition and fluids For constipation, diarrhea, flatulence Exercise Positioning Commode Bedpan Implimenting

23. Decreasing flatulence Avoid gas-producing foods Exercise Movement in bed ( position) Ambulation Probiotics Administering enemas Rectal suppositories Bowel wash Digital removal of a fecal impaction Bowel training programs Based on factors within client's control Goal of establishing normal defecation pattern Implimenting

24. Bowel training programs Major phases Determine client's usual habits and factors that help or hinder defecation Design plan with client Determine fluid, fiber, hot drinks, exercise Maintain routine for 2–3 weeks Cathartic suppositories Prompt response to urges Privacy Effective physical positioning Provide positive feedback for successful defecation Offer support; encourage client to have patience with the process Implimenting

25. Fecal incontinence pouch Collect and contain large amounts of liquid feces Artificial sphincter Ostomy Is a term for a surgically formed opening from the inside of an organ to the out side ( eg : ileostomy or colostomy) Stoma ( the part of the ostomy that is attached to the skin, is formed by suturing the mucosa to the skin) skin care Implimenting

26. A B A, A closed pouch; B, a drainable pouch.

27. Inflatable artificial sphincter.

28. Loop colostomy

29. Thank you