Bowel Elimination

Health OccupationsFebruary 2012

Objectives/Duty Tasks• Task1201- Assist the resident/patient in bowel training• Task 1506 -Report nausea, vomiting, pain, inability to swallow, bowel

movement changes such as color, diarrhea, or constipation. (gastrointestinal conditions)

• 1603 Demonstrate intervention strategies to prevent abuse and neglect.• Label structures of the digestive system• Describe the functions of the digestive system• Describe normal defecation• List observations to be made about defecation• Explain how to promote safety and comfort during defecation

More Objectives

• Identify the factors that affect bowel elimination

• Explain why enemas are given• Demonstrate competence in assisting

resident/patient in toileting

Vocabulary

• Bowel movement/Defecation

• Constipation• Dehydration• Diarrhea• Enema• Fecal impaction• Fecal incontinence

• Feces/stool• Flatus/flatulence• Ostomy• Illeostomy• Colostomy• Stoma• Peristalsis• suppository

Functions of the Digestive System

• Ingestion- eating• Digestion- food broken down into small

particles• Absorption- vitamins and nutrients are

absorbed• Elimination- body expels waste products of

metabolism

The Mouth

• Around the teeth and through the gums - look out stomach, here it comes !

• Digestion begins here• The teeth –• The Salivary Glands -

Esophagus

• Collapsible• Muscular• Mucous lined• 10 inches long

Stomach

• Expandable sac• Gastric juices• Chyme• 2-4 hours• Pyloric Sphincter

Small Intestine

• Nutrient absorption• 20 feet long • Large surface area • Villi • Ducts for pancreatic

juices/bile

Liver

• Produces bile • Aids in fat digestion

Gallbladder

• Muscular sac - under the liver

• Stores/ concentrates bile

• Bile released from the GB into the Small Intestine

Pancreas

• Secretes digestive enzymes

• Proteases - proteins• Lipase - fats• Amylase –starches

Large Intestine

• AKA Colon

• 5 feet long

• Absorbs water from food that can not be digested

The End of the Line

• Rectum• 2 inch long canal• Serves as a holding area

for stool

• Anus• 2 sphincters ( ring muscles) control defecation

KITSES

• Animation of Digestive system• http://

kitses.com/animation/swfs/digestion.swf

Normal Bowel Movements

• Defecation• Feces• Stool• Frequency• Timing

• color-– Diet- affects color– Diseases- affects color

• Shape• Consistency• Odor

NA Observations

• Notice– Color– Amount – consistency – Frequency– Odor– Shape– Complaints of pain/discomfort

Factors Affecting Bowel Elimination

• Privacy• Habits• Diet• Fluids• Activity• Drugs• Disability• Age

Comfort and Safety

• in packet- complete this slide using Box 20-1 page 377

Effects of Aging on Bowel Elimination

• Complete this slide on the back of your PowerPoint packet using Page 377 in text packet as a reference

Constipation

• Passage of a hard dry stool

• Caused by feces moving slowly through the bowel

• Stools large or marble sized• Caused by low fiber

diet, inactivity, medications, resisting the urge to defecate. Aging, certain diseases

Fecal Impaction• Prolonged retention of feces in

rectum• The longer the feces sits in the

rectum the harder the feces gets

• Feces becomes hard or putty like– Abdominal discomfort, nausea,

cramping, rectal pain

• Digital exam( not an NA function)

• Digital removal of impaction ( not an NA function)

Diarrhea

• Frequent passage of liquid stools• Feces move through bowel rapidly reduces

time for fluid absorption• Sometimes causes fecal incontinence• causes – infection, drugs, irritating foods,

pathogens in food

Care for residents/patients with diarrhea

• Respond to elimination needs promptly• Dispse of stools promptly, using infection

control measures• Good skin care liquid stools can be irritating to

the skin• Risk of dehydration – flushed, dry sskin,

headache , dizziness, oliguria , concentrated urine, coated skin

Fecal Incontinence

• Inability to control the passage of feces or flatus through the anus– Intestinal diseases– Nervous system diseases– Fecal impaction– Diarrhea– Some medications– dementia/ mental health disorders

Care for people with Fecal Incontinence

• Bowel Training• Help with toileting after meals and every 2-3

hrs.• Incontinence products to keep linens and

garments clean• Good skin care

Flatulence

• Gas and air are normal in stomach and intestines

• Expelled through mouth and anus

• Gas and air through anus is called flatus

• Flatulence is excessive flatus

Causes• Swallowing air• Bacterial action of the

intestines• Gas forming foods• Constipation• Medicines that

decrease peristalsis• Bowel surgeries

Bowel Training Goals

• Gain control of bowel movements• Develop a regular pattern of elimination– Note resident’s normal time for elimination– Usually after a meal– Toilet resident at the same time each day after a

meal– Also-high fiber diet, warm liquids, activity and

privacy

Enemas

• Introduction of fluid into rectum and lower colon

• Ordered by the physician, NP, PA

Ostomies

• Surgically created opening• In digestive system the

opening is on the abdomen

• Named by where in the intestine the opening is created– Colostomy- large intestine– Illeostomy – small

intestine

Care• Prevent skin irritation• Change ostomy pouch