Download Bowel Elimination

Bowel Elimination
Health Occupations
February 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
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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
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Collapsible
Muscular
Mucous lined
10 inches long
Stomach
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Expandable sac
Gastric juices
Chyme
2-4 hours
Pyloric Sphincter
Small Intestine
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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.s
wf
Normal Bowel Movements
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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
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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
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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