Bowel elimination ppt

topic which is coming under foundation

1. Good morning

2. BOWEL ELIMINATION Mr. Melvin Jacob MSc (N)

3. Physiology of bowel elimination Bowel elimination or defecation Defecation, also called bowel movement, the act of eliminating solid or semisolid waste materials/ faces from the digestive tract. In human beings, wastes are usually removed once or twice daily, but the frequency can vary from several times daily to three times weekly and remain within normal limits.

4. Muscular contractions - move fecal material to the rectum. The rectum - temporary reservoir for the waste . As the rectal walls expand with filling, stretch receptors from the nervous system, located in the rectal walls, stimulate the desire to defecate. Cont….

5. The urge passes within one to two minutes if not relieved , and the material in the rectum is then often returned to the colon where more water is absorbed If defecation is continuously delayed, constipation and hardened feces result. Cont….

6. When the rectum is filled, pressure within it is increased. This increased intra rectal pressure initially forces the walls of the anal canal apart and allows the fecal material to enter the canal In the anus there are two muscular constrictors, the internal and external sphincters, that allow the feces to be passed or retained Cont….

7. While defecation is occurring, the excretion of urine is usually stimulated. The chest muscles, diaphragm, abdominal-wall muscles, and pelvic diaphragm all exert pressure on the digestive tract. Cont….

8. Respiration temporarily ceases as the filled lungs push the diaphragm down to exert pressure. Blood pressure rises in the body, and the amount of blood pumped by the heart decreases .

9. Composition of feces 1. Water 65-85 % of stools are water. All the water drank by an individual is completely absorbed in the small and large intestine. In case of diarrhoea, the water content of stools is more than 85%.

10. 2. Protein Protein from food is digested completely in the small intestine and is converted into amino acids before being absorbed in blood.

11. 3. Fat 95% of all fat consumed is absorbed in the small intestine. Traces of fat can definitely be found in stools. F ats in excess of 6% in stool are abnormal. ( Steatorrhea .)

12. 4. Carbohydrate Simple and complex carbohydrates - sugar and starches in diet. They are completely absorbed in the small intestine and assimilated in blood as glucose, fructose or galactose . Undigested carbohydrates in normal stools should be below 0.5%.

13. 5. Fiber Fiber is completely indigestible and gives volume and bulk to stools. The more fiber one eats the more of undigested food wastes can be discharged from the body. F iber diet- undigested food would account for 5-7% of the total stool volume. High fiber diet, 10-15% of the undigested wastes could be discharged from the body.

14. Besides the five major components : M ineral salts which are insoluble. They too cannot be digested by the body. This indigestible component of feces is known as Ash. 0.2 to 1.2% of normal stools is ash . The stools also contain mucous shed from the inner lining of digestive tract. The mucus helps to bind together undigested food, intestinal bacteria and metabolic debris like dead cells or bile secreted by the liver etc.

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

16. Abnormal colour: Clay or white : Absence of bile pigment (bile 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) Red : Bleeding from lower gastrointestinal tract (e.g., rectum), some foods (e.g. beets) Pale : Malabsorption of fats, diet high in milk and milk products and low in meat

17. C onsistency Normal consistency: Formed, soft, semisolid , moist Abnormal consistency Hard, dry, constipated stool Dehydration, decreased intestinal motility resulting from lack of fiber in diet, lack of exercise, emotional upset, laxative abuse Diarrhoea :Increased intestinal motility

18. S hape Normal shape : Cylindrical , about 2.5 cm (1 inch) in diameter in adults Abnormal shape : Narrow, pencil-shaped, or string like stool Obstructive conditional of the rectum

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

20. Factors affecting bowel elimination

21. Age Diet fluid intake medications, physical activity psychological activity personal habits Position Pain Pregnancy surgery & anaesthesia diagnostic tests

22. Age Must be of a certain age or physical maturity to be able to control your bowels Humans also can lose control of their bowels after a certain age

23. Diet There many different ways that diet can affect bowel elimination ex: high fiber diets & fruits promote regularity, while cheeses cause constipation

24. Fluid intake The more fluid you take in the less likely you are to become constipated The less fluid you take in the more likely you are to become constipated . Physical activity Higher activity rate lessens the chances of constipation

25. Psychological factor Usually the source of ulcerative colitis or crohn's disease D epression causes peristalsis to decrease Personal habits A person not wanting to go for an extended period of time can cause harm to their body and can make it harder to go later They may not want to use those facilities

26. P o s i ti o n s Normal positioning for Bowel elimination is sitting or squatting Pain Person may be hesitant about going if they think it will cause them pain usually due to haemorrhoids, rectal surgery, or Abdominal surgery

27. Pregnancy The way the baby is lying on the mothers GI tract affects peristalsis by slowing it Force the mother to go in between Surgery & anaesthesia A ffects defecation by the slowing of peristalsis or complete stoppage of it

28. Medications Different meds affect Bowel elimination differently some medications increase the process others may inhibit it or stop it completely Diagnostic tests These affect the patient because they usually require them to be NPO prior to it which in turn will limit their food intake which limits Bowel elimination or stops them completely

29. ALTERATION IN BOWEL ELIMINATION

30. CONSTIPATION Constipation 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 )

31. Causes Inadequate, irregular & restricted diet Insufficient fluid intake Habit pattern regarding timing Lack of exercise Emotional upset Unnatural position Overuse of laxatives , suppositories & enemas Surgery of intestine & rectum Malformation & obstruction of colon Systemic disorders Haemorrhoids & other lesions of anal canal Use of certain drugs Excessive use of tea & coffee

32. 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

33. Diarrhoea Diarrhoea is manifested by frequent evacuation of watery stool due to increased intestinal motility Rapid passage of faecal contents through the lower GI tract R educes the time available for reabsorb water & electrolytes W ater, Mucus (major content) Light brown to yellow to green (Colour)

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

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

36. 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

37. 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 D evelops 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

38. 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

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

40. Faecal incontinence It is the involuntary elimination of bowel contents , often associated with neurologic , mental or emotional impairments

41. Causes Anal sphincters muscle damage Vaginal childbirth Diarrhoea IBD Alzheimer's disease

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

43. Flatulence Flatulence is the accumulation of excessive amounts of gas ( flatus ) in the GI tract , leading to distension of the abdomen

44. Causes Excessive swallowing of air with anxiety or rapid food or fluid ingestion, (usually eliminated by burping) Gases produced by bacterial activity in large intestine (eliminated through anus) Certain gases from foods such as cabbage , onions etc Post operative patients because of effect of anaesthesia Gas that diffuses from blood stream into the intestine

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

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

47. Types and collection of specimen

48. A specimen of freshly passed faces of 0.5 to 1 ounce (15 g to 30 g) is collected, without contamination of urine or toilet tissue, into a small container that may have a small spoon or spatula attached inside the lid of the cup for easier collection of the sample.

49. Equipment Clean bed pan or disposable receiver – ensure the bedpan is not contaminated with detergent or disinfectant as this may affect the results Sterile specimen pot with an integral spoon; Non-sterile gloves Apron

50. Procedure Ensure privacy and dignity Wash hands with soap and water Assemble the equipments Put on non-sterile gloves and apron Ask the patient to pass urine before taking the stool sample

51. Ask the patient to defecate into the bedpan or receiver If the patient is incontinent, a sample can be taken from the bed linen Use the integral spoon in the sample pot to collect enough faeces to fill around a quarter of the specimen pot

52. Secure the top of the container – this will prevent leakage Remove gloves and apron and dispose of them Wash hands with soap and water Examine the specimen and record the colour, consistency and odour of the stool as part of the nursing assessment.

53. Label the sample and complete the microbiology form including any factors such as recent antibiotic treatment and suspected food poisoning (accurate laboratory result) Put the sample in a specimen bag. Send the sample to the laboratory as soon as possible Document the procedure in the patient’s notes

54. Ova and parasites Supplies: Clean plastic stool cup 1. The stool should be passed into a clean, dry container. Urine will contaminate the spicemen cannot be collected directly out of the toilet. 2. Transfer stool specimen to stool cup and send to the Laboratory within 2 hours of collection, refrigerate if > than 2 hours.

55.  Occult Blood Transfer stool specimen to stool cup. Transport to lab. NOTE: If using wooden applicator stick to transfer stool, do not leave stick in stool container; specimen will dry out.

56. Thank you