Exam 3- Unit 6-8.
Ch. 34 Diagnostic testing p. 718-748 Carpentino- p. 58, p. 63, p. 80, p. 152-153, 153-156,
Ch. 48 Urinary Elimination p. p. 157-161, p. 161-162, p. 162-164
Ch. 49 Fecal Elimination p.
Ch. 35 Medication p. 750-825
Fecal Elimination
Elimination of the waste products of d...
Exam 3- Unit 6-8.
Ch. 34 Diagnostic testing p. 718-748 Carpentino- p. 58, p. 63, p. 80, p. 152-153, 153-156,
Ch. 48 Urinary Elimination p. 1174-1209 p. 157-161, p. 161-162, p. 162-164
Ch. 49 Fecal Elimination p. 1210-1240
Ch. 35 Medication p. 750-825
Fecal Elimination
Elimination of the waste products of digestion from the body is essential to health.
Feces/stool- excreted waste products.
Hasutra- pouches in large intestine.
Ingestion- the act of taking in food.
Chyme- waste product that leaves the stomach through the small intestine and then
passing through the ileocecal valve.
o As much as 1,500 mL of chyme passes into the large intestine daily.
Flatus- largely air and the by products of the digestion of carbohydrates.
Haustral Churning- involves movement of the chyme back and forth within the haustra.
Peristalsis- wavelike movement produced by the circular and longitudal muscle fibers of
the intestinal walls: it propels the intestinal contents forward.
Mass peristalsis- third type of colonic movement involves a wave of powerful muscular
contraction that moves over large areas of the colon.
Hemorrhoids- when veins become distended.
Defecation- expulsion of feces from the anus and rectum. Also called a bowel movement.
Individuals may use different terms for a bowel movement. The nurse may need to try
several different common words before finding one the client understands.
Feces
o 75% of water
o 25% of solid materials
Factors that affect defecation
o Development
Newborns and infants- meconium is the first fecal material passed by the
newborn within the first 24 hours after birth. Infants pass stool frequently.
Toddlers- some control of defecation at 1 ½ to 2 years of age.
School aged and Adolescents- have similar bowel habits to adults.
Older adults- constipation problems,
o Diet
sufficient bulk in the diet is necessary to provide fecal volume.
Inadequate intake of dietary fiber contributes to the risk od developing
obesity, type 2 diabetes, coronary artery disease, and colon cancer.
o Fluid intake and output
Reduced fluid intake will slow the chyme’s passage along the intestines,
further increasing reabsorption of fluid from the chyme.
o Activity
o Psychological factors
People who are anxious or angry experience increased peristaltic activity.
o Defecation habits
o Medications
, o Diagnostic procedures
o Anesthesia and surgery
o Pathologic conditions
Spinal cord injuries and head injuries can decrease sensory stimulation for
defecation.
o Pain
Fecal elimination problems
o Constipation
Insufficient fiber intake
Insufficient fluid intake
Insufficient activity or immobility
Irregular defecation habits
Change in daily routine
Lack of privacy
Chronic use of laxatives
IBS
Pelvic floor dysfunction
Poor motility or slow transit
Neurologic conditions
Emotional disturbances
Medications
Habitual denial and ignoring urge
o Diarrhea
Passage of liquid feces and an increased frequency of defecation.
o Bowel Incontinence
Loss of voluntary ability to control fecal and gaseous discharges through
the anal sphincter.
o Flatulence
Presence of excessive flatus in the intestines and leads to stretching and
inflation of the intestines.
Bowel Diversion Ostomies
o Ostomy- opening for the GI, Urinary, or respiratory tract onto the skin.
o Gastrostomy- opening through the abdominal wall into the stomach.
o Jejunostomy- opens through the abdominal wall into the jejunum.
o Ileostomy- opens into the colon.
o Stoma- opening created in the abdominal wall by the ostomy.
o Permanence
Permanent colostomies are performed to provide a means of elimination
when the rectum or anus is nonfunctional as a result of a birth defect or a
disease such as cancer of the bowel.
o Surgery to reconnect the ends of the bowel of a temporary ostomy may be called a
take-down.
Surgical construction of a stoma
o End or terminal colostomy- created when one end of the bow is brought out
through an opening on to the anterior abdominals wall. This is permanent.
, o Loop Colostomy- A loop of bowel is brought out onto the abdominal wall and
supported by a plastic bridge or by a piece of rubber tubing.
o Divided colostomy- consists of two edges of valve brought out onto the abdomen
but separated from each other.
o Double barreled colostomy- the proximal and distal loops of bowel are sutured
together for about 10 centimeters (4 in.) and both ends are brought up on to the
abdominal wall.
Assessing
o Vitals
o Examination of abdomen, rectum, and anus
o Inspecting feces
o Diagnostic testing data
o Pain level
o Nursing history- normal pooping pattern, current or past medical problems
Diagnosing
o Bowel incontinence
o Constipation
o Risk for constipation
o Perceived constipation
o Diarrhea
o Dysfunctional GI motility
o Risk for deficient fluid volume and.or risk for electrolyte imbalance
o Risk for impaired skin integrity
o Situational low self-esteem
o Disturbed body image
o Deficient knowledge (bowel training, ostomy management)
o Anxiety
Planning
o Maintain and restore normal bowel elimination
o Maintain or regain normal stool consistency
o Prevent associated risks such as fluid and electrolyte imbalance, skin breakdown,
abdominal distention, and pain.
o Planning for homecare
Implementation
o Provision of privacy
Nurse should provide as much privacy as possible for patient
o Timing
The client and the nurse can discuss when mass peristalsis normally
occurs and provide time for defecation. Nurse should encourage client to
poop multiple times daily.
o Nutrition and fluids
For constipation, increase daily fluid intake and instruct the client to drink
hot liquids, warm water with a squirt of fresh lemon, and fruit juices,
especially prune juice. Include fiber in the diet.
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