Fecal Elimination- Chapter 49 Nursing Fundations Kozier

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Fecal elimination lecture slides

Physiology of Defecation

-Peristaltic waves move the feces into the sigmoid colon and the rectum
-Sensory nerves in rectum are stimulated
Individual becomes aware of need to defecate
-Feces move into the anal canal when the internal and external sphincter relax
-External anal sphincter is relaxed voluntarily if timing is appropriate
-Expulsion of the feces assisted by contraction of the abdominal muscles and the diaphragm
-Moves the feces through the anal canal and expelled through anus
-Facilitated by thigh flexion and a sitting position

Factors that Influence Fecal Elimination

-Developmental stage
-Diet
-Fluid
-Activity
-Psychologic factors
-Defecation habits
-Medications
-Diagnostic procedures
-Anesthesia
-Surgery
-Pathologic conditions
-Pain

Characteristics of Feces

-Color
-Consistency
-Shape
-Amount
-Odor
-Constituents

Selected Fecal Elimination Problems

-Constipation
-Diarrhea
-Bowel incontinence
-Flatulence

Constipation

-Decreased frequency of defecation
-Hard, dry, formed stools
-Straining at stools
-Painful defecation
-Causes include:
-Insufficient fiber and fluid intake
-Insufficient activity
-Irregular habits

Fecal Impaction

-Mass or collection of hardened feces in folds of rectum
-Passage of liquid fecal seepage and no normal stool
-Causes usually:
-Poor defecation habits
-Constipation

Diarrhea

-Passage of liquid feces and increased frequency of defecation
-Spasmodic cramps, increased bowel sounds
-Fatigue, weakness, malaise, emaciation
-Major causes:
-Stress, medications, allergies, intolerance of food or fluids, disease of colon

Bowel Incontinence

-Loss of voluntary ability to control fecal and gaseous discharges
-Generally associated with:
-Impaired functioning of anal sphincter or nerve supply
-Neuromuscular diseases
-Spinal trauma
-Tumor

Flatulence

-Excessive flatus in intestines
-Leads to stretching and inflation of intestines
-Can occur from variety of causes:
-Foods
-Abdominal surgery
-Narcotics

Assessment of Fecal Elimination

-Nursing history
-Physical examination
-Review of data from any diagnostic tests

Nursing History Assesing for Bowel Info

-Ascertains the client's normal pattern
-Description of usual feces
-Recent changes
-Past problems with elimination
-Presence of an ostomy
-Factors influencing elimination pattern

Physical Examination Assesing for Bowel Info

-Examination of the abdomen,
rectum, and anus
-Auscultation precedes palpation because palpation alters peristalsis
-Inspection of feces for color,consistency, shape, amount, odor, abnormal constituents
-Review any data obtained from relevant diagnostic tests

Possible Nursing Diagnoses

-Bowel Incontinence
-Constipation
-Risk for Constipation
-Perceived Constipation
-Diarrhea

Related Nursing Diagnosis

-Anxiety
-Low Self-esteem
-Disturbed Body Image
-Risk for Deficient Fluid Volume
-Risk for Impaired Skin Integrity
-Deficient Knowledge
(Bowel Training, Ostomy Management)

Desired Outcomes

-Maintain or restore normal bowel elimination pattern
-Maintain or regain normal stool consistency
-Prevent associated risks such as fluid and electrolyte imbalance, skin breakdown, abdominal distention and pain

General Nursing Interventions

-Promoting regular defecations
-Teaching about medications
-Decreasing flatulence
-Administering enemas
-Digital removal of a fecal impaction (if agency policy permits)
-Instituting bowel training programs
-Applying a fecal incontinence pouch
-Ostomy management

Measures to Maintain Normal Fecal Elimination

-Patterns
-Privacy
-Timing
-Exercise
-Positioning
-Nutrition and fluids

Common Enema Solutions and Actions

-Hypertonic (Fleet phosphate)
-Draws water into colon
-Hypotonic (tap water)
-Distends the colon
-Stimulates peristalsis
-Softens feces
-Isotonic (physiologic saline)
-Distends the colon
-Stimulates peristalsis
-Softens feces
-Soapsuds (pure soap)
-Irritate mucosa
-Distends the colon
-Oil
-Lubricates feces and colonic mucosa

Types of Enemas

-Cleansing
-Prevents escape of feces during surgery
-Prepare intestines for certain diagnostic tests
-Removes feces in instances of constipation or impaction
-Carminative and return-flow
-Used primarily to expel flatus
-Retention
-Introduces oil or medication into the rectum and sigmoid colon

Stoma Care for Clients with an Ostomy

-Normal stoma should appear red and may bleed slightly when touched
-Assess the peristomal skin for irritation each time the appliance is changed
-Treat any irritation or skin breakdown immediately
-Keep skin clean by washing off any excretion and drying thoroughly
-Protect skin, collect stool, and control odor with an ostomy appliance

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