Chapter 37

Bowel Elimination

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Gastrointestinal Tract

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The Large Intestine

Primary organ of bowel elimination

Extends from the ileocecal valve to the anus
Functions
Absorption of water
Formation of feces
Expulsion of feces from the body

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Process of Peristalsis

Peristalsis is under control of the nervous system.

Contractions occur every 3 to 12 minutes.
Mass peristalsis sweeps occur one to four times each 24hour period.
One-third to one-half of food waste is excreted in stool
within 24 hours.

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Variables Influencing Bowel Elimination

Developmental considerations
Daily patterns
Food and fluid
Activity and muscle tone
Lifestyle
Psychological variables
Pathologic conditions
Medications
Diagnostic studies
Surgery and anesthesia

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Developmental Considerations

Infants: Characteristics of stool and frequency depend on

formula or breast feedings.
Toddler: Physiologic maturity is the first priority for bowel
training.
Child, adolescent, adult: Defecation patterns vary in
quantity, frequency, and rhythmicity.
Older adult: Constipation is often a chronic problem;
diarrhea and fecal incontinence may result from
physiologic or lifestyle changes.

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Foods Affecting Bowel Elimination

Constipating foods: cheese, lean meat, eggs, pasta
Foods with laxative effect: fruits and vegetables, bran,
chocolate, alcohol, coffee
Gas-producing foods: onions, cabbage, beans, cauliflower

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Effect of Medications on Stool

Aspirin, anticoagulants: pink to red to black stool

Iron salts: black stool
Antacids: white discoloration or speckling in stool
Antibiotics: green-gray color

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Nursing Process: Physical Assessment of

the Abdomen
Inspection: observe contour, any masses, scars, or
distention
Auscultation: listen for bowel sounds in all quadrants
Note frequency and character, audible clicks, and
flatus.
Describe bowel sounds as hypoactive, hyperactive,
absent or infrequent.
Percussion and palpations: performed by advanced
practice professionals

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Nursing Process: Physical Assessment of

the Anus and Rectum
Inspection and palpation
Lesions, ulcers, fissures (linear break on the margin
of the anus), inflammation, and external
hemorrhoids
Ask the patient to bear down as though having a
bowel movement. Assess for the appearance of
internal hemorrhoids or fissures and fecal masses.
Inspect perineal area for skin irritation secondary to
diarrhea or fecal incontinence.

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Diagnostic Studies: Stool Collection

Medical aseptic technique is imperative.

Hand hygiene, before and after glove use, is essential.
Wear disposable gloves.
Do not contaminate outside of container with stool.
Obtain stool and package, label, and transport according
to agency policy.

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Diagnostic Studies: Patient Guidelines for

Stool Collection
Void first so that urine is not in stool sample.
Defecate into the container rather than toilet bowl.
Do not place toilet tissue in the bedpan or specimen
container.
Notify nurse when specimen is available.

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Diagnostic Studies: Types of Direct

Visualization Studies (Endoscopy)
Esophagogastroduodenoscopy
Colonoscopy
Sigmoidoscopy
Wireless capsule endoscopy

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Diagnostic Studies: Indirect Visualization

Studies
Upper gastrointestinal (UGI)
Small bowel series
Barium enema
Abdominal ultrasound
Magnetic resonance imaging (MRI)
Abdominal CT scan

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Diagnostic Studies: Scheduling Diagnostic

Tests
1: fecal occult blood test
2: barium studies (should precede UGI)
3: endoscopic examinations
Noninvasive procedures take precedence over invasive
procedures

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Planning: Patient Outcomes for Normal

Bowel Elimination
Patient has a soft, formed bowel movement every 1 to 3
days without discomfort.
The relationship between bowel elimination and diet,
fluid, and exercise is explained.
Patient should seek medical evaluation if changes in stool
color or consistency persist.

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Intervention: Promoting Regular Bowel

Habits
Timing
Positioning
Privacy
Nutrition
Exercise
Abdominal settings
Thigh strengthening

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Intervention: Comfort Measures

Encourage recommended diet and exercise.

Use medications only as needed.
Apply ointments or astringent (witch hazel).
Use suppositories that contain anesthetics.

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Intervention: Individuals at High Risk for

Constipation
Patients on bedrest taking constipating medicines
Patients with reduced fluids or bulk in their diet
Patients who are depressed
Patients with central nervous system disease or local
lesions that cause pain while defecating

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Intervention: Nursing Measures for the

Patient With Diarrhea
Answer call bells immediately.
Remove the cause of diarrhea whenever possible (e.g.,
medication).
If there is impaction, obtain physician order for rectal
examination.
Give special care to the region around the anus.

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Intervention: Preventing Food Poisoning

Never buy food with damaged packaging.

Take items requiring refrigeration home immediately.
Wash hands and surfaces often.
Use separate cutting boards for foods.
Thoroughly wash all fruits and vegetables before eating.
Do not wash meat, poultry, or eggs to prevent spreading
microorganisms to sink and other kitchen surfaces.
Never use raw eggs in any form.
Do not eat seafood raw or if it has an unpleasant odor.
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Intervention: Preventing Food Poisoning

(cont.)
Use a food thermometer to ensure cooking food to safe
internal temperature.
Keep food hot after cooking; maintain safe temperature
of 140F or above.
Give only pasteurized fruit juices to small children.

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Intervention: Methods of Emptying the

Colon of Feces
Enemas
Rectal suppositories
Oral intestinal lavage
Digital removal of stool

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Intervention: Types of Enemas

Cleansing
Retention
Oil
Carminative
Medicated
Anthelmintic
Large volume
Small volume

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Intervention: Retention Enemas

Oil-retention: lubricate the stool and intestinal mucosa,

easing defecation
Carminative: help expel flatus from the rectum
Medicated: provide medications absorbed through the
rectal mucosa
Anthelmintic: destroy intestinal parasites

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Intervention: Bowel-Training Programs

Manipulate factors within the patients control.

Food and fluid intake, exercise, and time for
defecation
Eliminate a soft, formed stool at regular intervals
without laxatives.
When achieved, continue to offer assistance with toileting
at the successful time.

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Intervention: Nasogastric Tubes

Inserted to decompress or drain the stomach of fluid or

unwanted stomach contents
Used to allow the gastrointestinal tract to rest before or
after abdominal surgery to promote healing
Inserted to monitor gastrointestinal bleeding

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Intervention: Types of Ostomies

Sigmoid colostomy
Descending colostomy
Transverse colostomy
Ascending colostomy
Ileostomy

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Location of Ostomies

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Intervention: Colostomy Care

Keep the patient as free of odors as possible; empty the

appliance frequently.
Inspect the patients stoma regularly.
Note the size, which should stabilize within 6 to 8
weeks.
Keep the skin around the stoma site clean and dry.
Measure the patients fluid intake and output.
Explain each aspect of care to the patient and self-care
role.
Encourage patient to care for and look at ostomy.

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Intervention: Patient Teaching for

Colostomies
Explain the reason for bowel diversion and the rationale
for treatment.
Demonstrate self-care behaviors that effectively manage
the ostomy.
Describe follow-up care and existing support resources.
Report where supplies may be obtained in the
community.
Verbalize related fears and concerns.
Demonstrate a positive body image.

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