bowel elimination and irrigation nursing.pdf

Nursing College

1. Bowel elimination
Dr . Hoda alkamali

2. Learning objectives :
On completion of this chapter the student should
be able to :
1- Describe the process of defecation
2- Name two components of a bowel elimination ,
assessment
3- List five common alterations in bowel elimination
4- Name four types of constipation
5- Identify nursing measure for treating
constipation

3. of Defecation (bowl Definition
elimination )
Is the act of expelling faces (stool ) from the
body .

* A remarkable volume of water is reabsorbed in
the large intestine , causing the bowel’s content
of a residue consolidated mass to become a
before being eliminated

4. peristalsis
It is the rhythmic contractions of intestinal smooth muscle that
facilitate defecation .

__ It moves fiber , water and nutritional wastes a long the ascending ,
transverse , descending
And sigmoid colon toward the rectum .

__ peristalsis becomes even more active during eating , it is called the
gastro colic reflex

precedes defecation it is accelerated wave like Gasrocolic reflex __
movement , sometimes perceived as slight abdominal cramping ,
propel stool …

5. peristalsis
As the rectum distends ,the person feels the
urge to defecate
Stool is eventually released when the anal
sphincter relax .

6. Assessment bowel elimination
assessment of bowel elimination involves collecting data
about the clients elimination pattern ( bowel habits ) and the
actual characterized of faces
Elimination pattern : -A
1- frequency of elimination
2- effort required to expel stool
3- elimination aids , if any used ?
Stool characteristics -B
_ inspecting the stool or asking the client to describe its
appearance
_ information that is particularly diagnostic include stool color ,
odor , consistency ,shape , and unusual components
_ the incidence of colorectal cancer increase with age .
Therefor advice older adults to have regular endoscopic bowel
examination after 50 years of age .

7. Health education regarding
bowel elimination
- Adults should identify their own patterns of
bowel regularity which can range from 3times a
day to 3 times a week .
- Daily exercise .
- Eat high fiber foods on regular basis .
- Drink 8—10 glasses of liquid a day

8. Common alterations in bowel
elimination
Constipation -1
It’s an elimination problem characterized by dry , hard
stool that is difficult to pass easily
Sings and symptoms :
- Inability to pass stool easily
- Complains of abdominal fullness or bloating
- Abdominal distention
- Complains of rectal fullness or pressure
- Pain on defecation
- decreased frequency of bowel movement
- Stool Ch- by hard or small stool

9. Common alterations in bowel
elimination
Constipation -
It is classified into four distinct types :
A- primary constipation
Primary or simple constipation can be treated by nurse . It results from
lifestyle factors such as inactivity , inadequate intake of fibers ,
insufficient fluid intake , or ignoring the urge to defecate .
B- secondary constipation (R/T disease )
It is a consequence of a pathologic order such as a partial bowel
obstruction .
It usually resolves when the primary cause is treated .
C- Iatrogenic constipation
It occurs as a consequence of prolonged use of narcotic analgesia
These drugs slow peristalsis delaying transit time

10. Common alterations in bowel
elimination
Constipation -
D- Pseudo constipation
Is a term use when clients believe themselves to be
constipated even through they are not diagnosed as
perceived constipation
- It may occur in people who are extremely
concerned about having a daily bowel movement
- They often overuse or abuse laxatives ,
suppositories and enemas

11. Common alterations in bowel
elimination
Fecal impaction -2
It occurs when a large , hardened mass of stool
interferes with defecation , making it impossible for
the client to pass faces voluntarily .
Causes of fecal impaction :
- Un relieved constipation
- Retained barium from an intestinal X ray
- Dehydration
- Weakness of abdominal muscles

12. Fecal impaction
Manifestations :
- Usually report a frequent devise to defecate but
unable to do so .
- Rectal pain may result from unsuccessful efforts to
evacuate the lower bowel .
- Some clients may pass liquid stool , which may be
misinterpreted as diarrhea .
To determine whether or not a fecal impaction is
present it may be necessary to insert a lubricated
,gloved finger into the rectum . If the rectum is
filled with a mass of stool .

13. Common alterations in bowel
elimination
Fecal impaction
Nursing measure for removal of impaction :
_ Some times nurses administer enemas , another intervention is to remove
the stool digitally or irrigation by rectal tube .

_ Flatulence 3
Flatulence or flatus ( an excessive accumulation of intestinal gas ) result from
a – swallowing air while eating
b – sluggish peristalsis
c_ bacterial fermentation in the bowel

When the clients are extremely uncomfortable and ambulating does not
eliminate flatus , the nurse may insert a rectal tube to help the gas escape

14. Common alterations in bowel
elimination
Diarrhea -4
_ diarrhea is the urgent passage of watery stool
and commonly is accompanied by abdominal
cramping .
- Usually diarrhea is a means of eliminating an
irritating substance such as tainted
,contaminated food or intestinal pathogens
- Simple diarrhea usually begins suddenly and
lasts for a short period

15. Common alterations in bowel
elimination
Diarrhea -
Causes of diarrhea :
- Emotional stress
- Dietary food
- Laxative abuse
- Bowel disorder
Nursing management :
- Resting the bowel temporarily may relieve simple diarrhea
- Encourage the client to drink clear liquids but
avoids solid food for 12-24 hrs.
- Resumed eating begins with bland food and these low in residue such as
bananas and apple sauce
- If the diarrhea not relieved within 24hrs ,it is best to consult the physician

16. Common alterations in bowel
elimination
Fecal incontinence -5
It is the inability to control the elimination of stool .
Causes of incontinence :
- Neurologic changes or when a person can not
reach a toilet in time to eliminate .
Chronic fecal incontinence can be disturbing socially
and emotionally .
Client with chronic fecal incontinence and their
families require much support and understanding

17. Bowel wash ( rectal
irrigation )

18. Definition
It is washing out of colon with large quantities of
solution to clear colon of feces .

Bowel irrigation is defined as the procedure when
water is introduced into the bowel via the rectum
using a rectal catheter .

Rectal irrigations are the best method to clean
(wash out ) the colon of stool and to prevent “stasis
“ of stool in the colon .

19. Purposes
_ To prepare colon for specific surgical or
diagnostic procedure
_ To dilute and remove toxic agents that may be
present in the large intestine
_ To reduce temperature in the hyperpyrexia
and heat stroke
_ To stimulate peristalsis
_ To keep person clean in case of fecal
incontinence or constipation

20. Colon cleanse side effect
__ Nausea
__ Abdominal pain
__ Vomiting
__ Diarrhea
__ Loss of electrolytes

21. Contraindications
_ Bleeding hemorrhoids
_ Chronic diarrhea
_Intestinal obstruction
Anal fistula_
_ Rectal surgeries ,infection
_ Massive colon carcinoma
_ painful skin lesion a round anus

22. Equipment
1-One silicon Foley
catheter .
2-60 ml catheter tip
syringe .
3-Lubricant jelly .
4-Two kidney basin .
5-Saline solution .
6- Mackintosh .

23. procedure
- Wash hands
- Prepare equipment
- Introduce your self and explain the procedure to the patient
-provide privacy
Sims’ position))-Put patient in appropriate position _ lateral position
- Pour normal saline solution into a non sterile basin
- Using a 60 ml syringe , draw up 20ml of normal saline solution.
- Lubricate 2 inches (5cm ) the distal parte of the Foley .
- Gently insert the Foley into the rectum ,approximately 4-6 inches (10-15cm) ,depending on the size of
the child
- Allow the gas and stool to pass freely
- Place the syringe into the end of the silicone catheter and inject 20 ml of warm normal saline solution
into the rectum
--Disconnect syringe from the end of the catheter , allow the normal saline solution to drip into an
empty basin

-Repeat this process until the discarded fluid is clear
-Return equipment
-Remove gloves and wash hands
-Record

24. Insert flatus tube
* A rectal tube is inserted into the rectum relives the
flatulence and gaseous distention of the abdomen .
_ Prepare client as for enema .
_ Lubricate flatus tube and insert about 4-6 inches into
the anal canal while the free end is kept under the water
in the kidney tray
_ Watch the expulsion of the gas which is seen bubbling
through the water .
_ The tube is left in lace for not more than 20minutes
,longer periods leads to permanent sphincter damage .
_ Tube can be reinserted every 3-4 hrs. .