Part 46: Bowel Elimination

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Section 46: Bowel Elimination Bonnie M. Wivell, MS, RN, CNS

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Scientific Knowledge Base

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Factors Affecting Bowel Elimination Age Infants: little stomach limit; less discharge of digestive catalysts; fast peristalsis; need neuromuscular improvement so can't control guts Older grown-ups: arteriosclerosis which causes diminished mesenteric blood stream, diminishing ingestion in small digestive tract; diminish in peristalsis; free muscle tone in perineal floor and butt-centric sphincter in this manner are at hazard for incontinence; moderating nerve driving forces in the butt-centric locale make more established grown-ups less mindful of need to crap prompting to sporadic BMs and danger of blockage

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Factors Affecting Bowel Elimination Diet: fiber, for example, entire grains, new leafy foods flush the fats and waste items from the body with more productivity; diminished fiber → expanded danger of polyps; know about nourishment bigotries Fluid admission: 6-8 glasses of noncaffeinated liquid every day; liquifies intestinal substance facilitating entry through colon Physical movement: advances peristalsis Psychological components: stretch builds peristalsis bringing about loose bowels and vaporous extension; ulcerative colitis; IBS; gastric and duodenal ulcers; crohn's infection Personal propensities: dread of pooing far from home Position amid poo: hunching down is the typical position

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Factors Affecting Bowel Elimination Pain: hemorrhoids, rectal surgery, rectal fistulas and abd. surgery Pregnancy: expanded weight; abating peristalsis in third trimester Surgery and Anesthesia: lows or stops peristalsis; disabled ileus = coordinate control of the entrail and keeps going 24-48 hours Medications: purgatives and cathartics; diuretic abuse can diminish muscle tone and can bring about the runs which can bring about parchedness and electrolyte irregularity; see Table 46-2 Diagnostic tests: inside prep; barium

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Common Bowel Elimination Problems Constipation Causes: despicable eating regimen, decreased liquid admission, absence of work out, and certain meds A noteworthy wellbeing peril Impaction Causes: unrelieved stoppage Debilitated, confounded, and oblivious more at hazard Continuous overflow of loose bowels is a presume sign Diarrhea Causes: anti-toxins by means of any course; enteral sustenance; nourishment sensitivities or bigotry; surgeries or indicative testing of the lower GI tract; C. difficile; transferable sustenance borne pathogens

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Common Bowel Elimination Problems Incontinence Causes: physical conditions that disable butt-centric sphincter capacity or control Flatulence Causes: certain nourishments; diminished intestinal motility Can get to be sufficiently serious to bring about abd widening and extreme sharp torment Hemorrhoids = expanded, engorged veins; inner or outside Causes: straining with poop; pregnancy; heart disappointment; ceaseless liver illness

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Bowel Diversions Ostomies: Certain ailment/conditions avoid typical entry of stool; transitory or perpetual counterfeit opening in the abd divider; area decides consistency of stool Loop colostomy: Usually done emanantly; impermanent; ordinarily includes transverse colon; two openings through one stoma – stool and bodily fluid; outer supporting gadget generally evacuated in 7-10 days End colostomy: one stoma framed from the proximal end of the inside and distal bit of the GI tract expelled or sewn shut (Hartman's pocket); normal in colorectal tumor and rectum is normally expelled; brief in surgery for diverticulitis Double-barrel colostomy: gut is surgically disjoined and two closures brought out onto the abd; proximal stoma capacities and distal stoma is nonfunctioning

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Loop Colostomy

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Double-Barrel Colostomy

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Double-Barrel Colostomy

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End Colostomy

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Bowel Diversions Cont'd. Elective methods Ileoanal pocket: colon expelled for tx of ulcerative colits or familial polyps; pocket is shaped from distal end of small digestion systems and joined to rear-end; pocket goes about as rectum so pt. is mainland; has transitory ileostomy while mending Kock landmass ileostomy: comprises of a repository built from little entrail and areola valve which keeps substance of store inside body; licenses section of outer catheter to deplete pocket Macedo-Malone Antegrade Continence Enema (MACE); for enhancing self control in pts with neuropathic or auxiliary variations from the norm of the butt-centric sphincter

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Ileoanal Pouch Anastomosis

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Kock Continent Ileostomy

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Care of the Patient With a Bowel Diversion "Sacking" the ostomy Assessing stoma and skin Assessing stool yield New stoma versus Old stoma Patient instruction and advising

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Psychological Considerations Body picture changes Face an assortment of nerves and concerns Must figure out how to oversee stoma Cope with clashes of self-regard and self-perception Can be hidden with garments yet pt. mindful of its nearness Difficulty with closeness/sexual relations Foul smells, spillage, spills and powerlessness to control or direct entry of gas and stool is humiliating Ostomy bolster: United Ostomy Association National Foundation for Ileitis and Colitis

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Nursing Process and Bowel Elimination Assessment Nursing history (see Box 46-2) Usual disposal design Usual stool qualities Routines to advance typical end Use of fake guides Presence/status of gut preoccupations Changes in craving Diet history Daily liquid admission History of surgery or diseases of GI tract Medication history Emotional state History of practice Pain or inconvenience Social history Mobility and expertise

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Nursing Process and Bowel Elimination Physical evaluation of the stomach area Mouth: poor dentition, dentures, mouth wounds Abdomen: investigate, auscultate, palpate, percuss Rectum: examine Inspection of fecal attributes Review of applicable test outcomes Fecal examples: can't blend excrement with pee or water Stool for mysterious blood (FOBT or guiac) see Box 46-3 Fecal fat requires 3-5 days of accumulation Ova & Parasites (O&P) Labs: bilirubin, ALK, Amylase, CEA Diagnostic Exams: KUB, endoscopy, colonoscopy, barium purification, barium swallow, US, MRI, CT sweep (may require pre-system arrangement)

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Nursing Diagnosis Bowel incontinence Constipation Risk for stoppage Perceived clogging Diarrhea Toileting self-mind shortfall Body picture, exasperates

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Planning Goals and results Client sets standard poop propensities Client can list legitimate liquid and nourishment consumption expected to accomplish gut end Client actualizes a general practice program Client reports day by day section of delicate, shaped chestnut stool Client doesn't report any distress connected with poo Setting Priorities Collaborative Care - WOCN

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Implementation Health Promotion: build up routine Promotion of ordinary crap Sitting Position on bedpan – see pg. 1196 Privacy Acute Care Meds Cathartics and purgatives Antidiarrheal operators Enemas

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Types of Enemas Cleansing douches Tap water Normal saline Hypertonic arrangements Soapsuds Oil Retention Carminative – Mag, gylcerin and water; assuages vaporous extension Medicated purifications – Kayexalate

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Implementation Cont'd. Bowel purge organization "Purifications till clear" See pages 1200-1202 Digital expulsion of stool – final resort Can make aggravation the mucosa, draining and incitement of vagus nerve Inserting and keeping up a nasogastric tube

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NG Tubes Levine or salem sump tubes are most normal for stomach decompression or lavage See pages 1204-1209 for inclusion method Connected to discontinuous suction (LIS) Air vent ought to NEVER be clasped, associated with suction or utilized for water system Not a clean strategy Care of pt. with NG Comfort Frequent mouth mind/rinsing Maintain patency of tube Turn customer every now and again to take into account sufficient exhausting

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Continuing and Restorative Care of ostomies Irriating a colostomy Pouching ostomies (see pages 1211-1215) Nutritional contemplations with ostomies Bowel preparing Proper liquid and nourishment consumption Regular practice Hemorrhoids Skin uprightness

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Evaluation The viability of care relies on upon how effective the customer is in accomplishing objectives and results Optimally the customer will have the capacity to have general, torment free poop of delicate framed stools It is important to make inquiries so setting up a helpful relationship is VERY vital Nursing intercessions might be adjusted if vital