bowel elimination nursing preparation.pptx

bowel elimination nursing preparation

1. BOWEL ELIMINATION Physiology of defecation Factors affecting bowel elimination Alteration in bowel elimination

2. Characteristics of feces Normal colour: Adult: brown Infant: yellow

3. Abnormal colour: ( b i l e C l a y o r w h i t e : A b se n c e o f bil e pig m e n t obstruction) or diagnostic study using barium Black or tarry: Drug (e.g., iron), bleeding from upper gastrointestinal tract (e.g., stomach, small intestine), diet high in red meat and dark green vegetables (e.g.,spinach) (e . g . , m i l k R e d : B l ee d in g fr o m l o w e r g a s t r oint e stin a l tract rectum), some foods (e.g. beets) P a le : M al a b s o r p ti o n o f f a t s , d i e t hig h i n m i l k an d products and low in meat

4. Consistency consistency : Formed, soft, semisolid , Normal moist Abnormal consistency Hard, dry , constipated stool Deh y d r a t ion , dec r e a s e d i n t e sti n a l m o tili t y re s u lt i n g from lack of fiber in diet, lack of exercise, emotional upset, laxative abuse Diarrhoea : Increased intestinal motility

5. Sh a p e Normal shape : Cylindrical , about 2.5 cm (1 inch) in diameter in adults Abn o r m a l sh a p e : N a r r o w , p e n c i l - s h a p e d , or string likestool Obstructiveconditional of the rectum

6. Normal amount : Varies with diet ( About 100 to 400 g perday) Normal odour : Aromatic, affected by ingested food and person’s own bacterial flora Abnormal odour : Pungent (sharply strong ) Infection, blood

7. Factor s affecting B o w e l elimination

8. ALTERATION IN BOWEL ELIMINATION

9. CONSTIPATION Constipation is an elimination problem characterized by dry, hard stool that is difficult to pass. It occurs when stool moves through the large intestine too slowly or remains in the large intestine for too long Involves a change in stool consistency ( harder & drier than usual ) Change in defecation frequency (less than usual )

10. Cau s es

11. Constipation is classified into one of four distinct types Primary Secondary Iatrogenic and Pseudoconstipation

12. 1. PRIMARY OR SIMPLE CONSTIPATION Primary or simple constipation is well within the treatment domain of nurses. It results from lifestyle factors such as inactivity, inadequate intake of fiber, insufficient fluid intake, or ignoring the urge to defecate

13. 2. SECONDARY CONSTIPATION S econdary constipation is a consequence of a pathologic disorder such as a partial bowel obstruction. It usually resolves when the primary cause is treated.

14. 3. IATROGENIC CONSTIPATION Iatrogenic constipation occurs as a consequence of other medical treatment. For example, prolonged use of narcotic analgesia tends to cause constipation. These and other drugs slow peristalsis, delaying transit time. The longer the stool remains in the colon, the drier it becomes, making it more difficult to pass.

15. 4. PSEUDOCONSTIPATION Pseudoconstipation, also referred to as perceived constipation, is a term used when clients believe themselves to be constipated even though they are not.

16. Complaints of abdominal fullness or bloating Abdominal distention Complaints of rectal fullness or pressure Pain on defecation Decreased frequency of bowel movements Inability to pass stool Changes in stool characteristics such as hard small stool Signs and Symptoms

17. Prevention & management Health teaching Adequate intake of diet & fluid Adequate intake of fibre in diet Establishing a habit pattern Relaxation Privacy Posture Exercise Use of laxatives , suppositories & enemas

18. Diarrhoea Diarrhoea is manifested by frequent evacuation of watery stool due to increased intestinal motility R a p i d pa s sa g e o f f aecal c o n t e n t s t hr o u g h the lo w er GI tract R e d uce s the t i m e ava i l a ble f or r e a b s orb w a ter & electrolytes Water, Mucus (major content) Light brown to yellow to green (Colour)

19. Cau s es Food poisoning Intestinal infection Allergies to certain foods & fluids Medications like antibiotics Inflammatory bowel disease (crohn’s disease )

20. Symptoms Intense urge to defecate Abdominal cramps Nausea Painful burning sensation at the anus Anal soreness Inflamed skin around anus

21. Management Replacement of fluid & electrolyte Avoid spicy & allergic food Make arrangement of use of bed pan or commode Care of skin Adequate rest Psychological support Medication like ant diarrhoeal

22. Faecal impaction It is the accumulation of the hardened faeces in the rectum , as a result of which the person is unable to voluntarily evacuate the stool Develops usually R/T untreated or unrelieved constipation As the faeces remains in the rectum & sigmoid colon , the water is reabsorbed making the faeces harder , drier & more difficult to pass More faeces continued to produced, which get accumulated in the colon proximal to the impacted stool

23. Signs & symptoms Feeling of fullness of rectum & abdomen Swelling or tightness/Bloating of abdomen Urge of defecation but an inability to pass stool Feeling of malaise-general discomfort Loss of appetite Nausea & vomiting

24. Management Laxatives Enema Manual removal of stool (digital evacuation )

25. Faecal incontinence It i s th e i nvo l un t a r y el i m i na t i on o f b o wel con t en t s , of t en assoc i at e d w i t h n e u r ol o gic , mental or emotional impairments

26. Cau s es Anal sphincters muscle damage Vaginal childbirth Diarrhoea IBD Alzheimer's disease

27. Management Eat 20 to 30 grams of fiber per day Avoid caffeine Medications - Imodium, Lomotil Exercise Bowel training

28. Flatulence F l at u le n ce i s t h e a c c u m u la t i on of exce s s i ve a m o u nts o f ga s ( f l a t us) i n t he GI tract , leading to distension of the abdomen

29. Causes Excessive swallowing of air with anxiety or rapid food or fluid ingestion, (usually eliminated by burping) Ga s e s pr o du ce d b y ba c ter ia l a ct i v i ty i n la r ge i n t e s ti ne (eliminated through anus) Certain gases from foods such as cabbage , onions etc Po s t o p e ra t i ve p a ti e n t s bec a use o f e f f e c t of anaesthesia Gas that diffuses from blood stream into the intestine

30. Abdominal distension It is accumulation of excessive amounts of flatus, liquid or solid intestinal content

31. Causes Long period of bed rest can slow the peristalsis An obstruction that blocks the passage of flatus & faeces Surgery causes decreased peristalsis Constipation

32. Treatment Depending on the underlying cause