GI Elimination

Bowel Elimination:

Bowel Elimination

Functions of the GI Tract:

Functions of the GI Tract Prepare fluids and nutrients for absorption and use by cells via mechanical and chemical breakdown Absorb fluids and nutrients Receives secretions from organs (eg. gallbladder, pancreas)

Anatomy & Physiology:

Anatomy & Physiology Organs of the GI tract? Function of Large intestine: absorption Extends from Ileocecal valve to anus Chyme Peristalsis & Mass peristalsis

Act of Defecation:

Act of Defecation Defecation reflex Valsalva maneuver Defecation

Alteration in Bowel Elimination:

Alteration in Bowel Elimination Diarrhea Constipation Incontinence Fecal Impaction Flatulence

Characteristics of Stool:

Characteristics of Stool Volume Color Odor Consistency Shape Constituents

Factors That Influence Bowel Elimination:

Factors That Influence Bowel Elimination Age Fluid Intake & Diet Daily Routine Activity Medications Health Status Stress

Diet :

Diet High fiber foods: Legumes (beans) Cereals Whole grains Raw Fruits Vegetables Laxative effect foods: Spicy & greasy Bran/Chocolate Coffee/Alcohol Raw fruits & vegetables

Assessing Elimination Status:

Assessing Elimination Status Usual pattern Changes in bowels Aids to eliminate Current problems

Physical Assessment :

Physical Assessment Inspection - observe contour of abd and note visible peristalsis Auscultation - listen for bowel sounds all quadrants Percussion - resonant or tympany over hollow organs…dullness over intestinal obstruction Palpation - feel for masses, tenderness etc…

Stool Specimen Collection:

Stool Specimen Collection Routine specimen Occult blood Ova & parasite Timed specimens

Outcome Criteria:

Outcome Criteria Pt. will: Develop regular pattern of elimination Have less episodes of incontinence Incorporate fluids/diet that promote bowel elimination

Interventions to Promote Elimination:

Interventions to Promote Elimination Routine Positioning Privacy Comfort Activity Diet/Fluids

Interventions: Promote Bowel Elimination :

Interventions: Promote Bowel Elimination Laxatives and Cathartics Enemas Suppositories Digital Removal

Types of Enemas:

Types of Enemas

Enema Solutions:

Enema Solutions Tap water (Hypotonic) Normal saline (Isotonic) Soap Hypertonic Oil

Tap Water (TWE):

Tap Water (TWE) Amount: 500-1000cc Action: Distends, increases peristalsis Time: 15 min. Indicated: inflamed bowels/irritated colon Contraindicated: Atonic bowels, fluid restrictions

Normal Saline:

Normal Saline Amount: 500-1000cc Action: Distends, increases peristalsis Time: 15 min. Indicated:Inflamed bowels/irritated colon Contraindicated: Na retention problems, fluid restrictions

Soap (SSE):

Soap (SSE) Amount: 500-1000cc (Castile 5ml/1000cc) Action: Distends, Irritates Time: 15 min. Indicated: Constipation Contraindicated: Prior to rectal exams

Hypertonic:

Hypertonic Amount: 70-130 cc solution Action: Distends/Irritates Time: 5-10 min. Indicated: Constipation, convenience Contraindicated: Dehydration, Na problems

Oil Retention:

Oil Retention Amount: 120-200cc Action: Lubricates Time: 30 min. Indicated: Fecal impaction Contraindication: none

Enema Administration:

Enema Administration PPE Position L Sims Linen protector Receptacle (bedpan, commode, toilet) IV pole Lubricant Enema bag with solution Tissue paper

Enema Administration:

Enema Administration Position L Sims Insert lubricated tip 4” Bag raised 18-20” above anal canal Administer slowly - 10 min. Administration is individualized. Pt. holds for 15 min.

Evaluation:

Evaluation Solution given Amount expelled Characteristics of stool Passing of flatus Unusual findings blood, helminthes, pus etc. Client reaction: change in skin color, VS changes, fatigue

Medications Effecting Bowel Elimination:

Medications Effecting Bowel Elimination Laxatives- induce emptying of GI tract Antidiarrheal- slow peristalsis, Pepto Bismol, Kaopectate Codeine/morphine/iron- cause constipation Antibiotics-may cause diarrhea Opiates: paragoric, lomotil- habit forming

Flatulence:

Flatulence Causes : Decreased peristalsis Constipation Medications Surgery Diet Stress Decreased activity

NonInvasive Interventions for Flatulence:

NonInvasive Interventions for Flatulence *Ambulation* Knee chest position

Invasive Interventions for Flatulence:

Invasive Interventions for Flatulence Glycerin Suppository Harris Flush Rectal Tube

Evaluation of Bowel Function:

Evaluation of Bowel Function Achievement of regular defecation habits Patient’s understanding of normal elimination Maintenance of adequate food and fluid intake Regular exercise program Comfort Skin integrity

PowerPoint Presentation:

Gastrointestinal Charting Chuckles The patient had waffles for breakfast and anorexia for lunch. She stated that she had been constipated for most of her life until 1989, when she got a divorce. Bleeding started in the rectal area and continued all the way to Los Angeles. Rectal examination revealed a normal-size thyroid. The patient was to have a bowel resection. However, he took a job as a stockbroker instead. Fleet enema given with stool hard as pine knots. Patient complains of indigestion since last night when he ate a stake. Patient passed flatus . . . two short, one long. Patient was seen in consultation by the physician, who felt we should sit tight on the abdomen, and I agreed.