Kozier Ch 48 Fecal Elimination

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  1. Factors that Influence Fecal Elimination
    • •Developmental stage
    • –Toilet training occurs around 2-2 ½ years old
    • –Elders experience changes in patterns (constipation):
    • • Reduced activity levels
    • •Inadequate fluid intake
    • •Lack of fiber
    • •Muscle weakness
    • •Avoid dependence on laxatives

    • •Diet-
    • –Diarrhea- Spicy food, lactose intolerance
    • –Gas-producing- cabbage, cauliflower
    • –Laxative food- bran, chocolate, alcohol
    • –Constipation foods- protein (cheese, eggs, lean
    • meat), lack of fiber

    • •Fluid- adequate fluid intake needed to pass stool
    • •Activity- stimulates peristalsis
    • •Psychologic factors- emotions affect ability
    • •Defecation habits- everyone is different. Ignoring the urge to go can lead to constipation
    • •Medications- side effects can range from diarrhea to
    • constipation (morphine, iron)
    • •Diagnostic procedures- NPO status
    • •Anesthesia- parasympathetic stimulation blocked
    • •Surgery- direct handling of intestines
    • •Pathologic conditions- spinal cord & head injury
    • •Pain- painful defecation or meds for pain

    Black stools could be caused by high iron, Pepto Bismol, and blood in the stool (has a peculuar odor) - of suspect blood - consult MD - could send stools for occult blood test
  2. 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
  3. Characteristics of Feces
    • •Deviation from brown, formed cylindrical, amount, odor or constituents are the concern.
    • •Color: should not be red, black or white
    • - red - blood
    • - black - old blood
    • - while - bile - gall bladder problem
    • •Consistency: not hard, dry or diarrhea
    • •Shape: not narrow
    • •Amount: more or less than usual
    • •Odor: not foul - (really foul test for c. diff)
    • Constituents: pus, blood, parasites, etc
  4. Selected Fecal Elimination Problems
    • •Constipation
    • •Diarrhea
    • •Bowel incontinence
    • •Flatulence - usually based on diet - go from low fiber diet to high fiber diet slowly to avoid gas

    Diverticuli -common after age 50 - small pouches - usually off the large intestine - can become inflamed - if ruptures blood and painful particularly in L lower abdomin. Treatment - soft diet - no fiber until acute inflamation calms down. Long term treatment - lots of Fiber - keep things moving - avoid seeds.
  5. Constipation
    • •Decreased frequency of defecation
    • •Hard, dry, formed stools
    • •Straining at stools; painful defecation
    • •Straining at stool (Valsalva maneuver) not good for client’s with heart, brain or respiratory diseases
    • •Causes include:
    • –Insufficient fiber and fluid intake
    • –Insufficient activity
    • –Irregular habits
    • –Medical conditions, emotional disturbances, medications

    • Home remedies - 1 cup prune juice, 1 cup whole bran,1 cup applesause - mix together and eat 2 tbs every day
    • Flax seeds - ceereal with bran and flax
  6. 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
  7. Diarrhea
    • •Passage of liquid feces and increased frequency of defecation
    • •Spasmodic cramps, increased bowel sounds
    • •Major causes:
    • –Stress, medications, allergies, intolerance of food or fluids, disease of colon

    • •Concerns:
    • –Fatigue, weakness
    • –Malaise
    • –Emaciation - weight loss
    • –Fluid/lyte imbalances
    • –Skin breakdown

    Metformin - Diabetic medication that causes diarrhea
  8. 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

    Dementia - dont know they need to go - establish bowel routine
  9. Flatulence
    • •Excessive flatus in intestines
    • •Leads to stretching and inflation of intestines
    • •Can occur from variety of causes:
    • –Foods- cabbage, broccoli, cauliflower
    • –Abdominal surgery
    • –Narcotics
  10. Assessment of Fecal Elimination
    • •Nursing history
    • •Physical examination - abd sounds, low activity, hyperactive
    • •Review of data from any diagnostic tests - colonoscopy, ct scan, etc.
  11. Nursing History
    • •Asks about the client’s normal pattern
    • •Description of usual feces
    • •Recent changes
    • •Past problems with elimination
    • •Presence of an ostomy
    • •Factors influencing elimination pattern
  12. Physical Examination
    • •Examination of the abdomen, rectum, and anus
    • •Auscultation precedes palpation because palpation alters peristalsis
    • •Inspection of feces; Table 49-1, p. 1325
    • •Review any data obtained from relevant diagnostic tests

    Auscultate before palpate
  13. NANDA Nursing Diagnoses
    • •Bowel Incontinence
    • •Constipation
    • •Risk for Constipation
    • •Perceived Constipation
    • •Diarrhea
  14. Related Nursing Diagnosis
    • Risk for Deficient Fluid Volume
    • •Risk for Impaired Skin Integrity
    • •Low Self-esteem
    • •Disturbed Body Image
    • •Deficient Knowledge (Bowel Training, Ostomy Management)
    • •Anxiety
  15. 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
  16. General Nursing Interventions
    • •Promoting regular defecations
    • –Provide privacy
    • –Timing: establish regular pattern
    • –Diet & Fluids: adequate fiber & liquids
    • –Positioning: commodes, bedpans

    • •Teaching about medications
    • –Cathartics:strong
    • –Laxatives: milder. Types- Table 49-3 , p. 1339

    • •Decreasing flatulence-
    • –exercise/ambulate
    • –rectal tube

    • •Digital removal of a fecal impaction (if agency policy permits)
    • •Instituting bowel training programs
    • •Enemas
    • •Applying a fecal incontinence pouch
    • •Ostomy management
  17. Enemas
    • •A solution introduced into the rectum & large intestine.
    • •Action:
    • –distends intestine
    • –increases peristalsis
    • –softens feces
    • –promotes excretion of feces & flatus
  18. Types of Enemas
    • •Cleansing
    • •Carminative and return-flow
    • –Used primarily to expel flatus
    • •Retention
    • –Introduces oil or medication into the rectum and sigmoid colon
    • –Retained 1-3 hours
  19. Cleansing enemas
    • •Purpose
    • –Prevents escape of feces during surgery
    • –Prepare intestines for certain diagnostic tests
    • –Removes feces from constipation or impaction

    • •Adverse effects:
    • –F & E imbalances
    • –Damage to mucosa

    • •Hypertonic (Fleet)
    • –Draws water into colon
    • •Hypotonic (tap water)
    • •Isotonic (normal saline) Soap suds-
    • –irritates colon
    • •Can be high or low volume
    • •Can be given high (colon) or low (rectum & sigmoid)
  20. Administering an enema
    • •Left side position
    • •Lubricate tubing tip
    • •Expel air from tube
    • •Solution no higher than 12 inches above rectum
    • •Explain procedure
    • •Gloves, privacy
    • •Insert tube 3-4 inches, direct toward umbilicus
    • •Administer slowly
    • •Client should retain fluid
    • •Assist client to defecate
  21. Fecal Incontinence Pouch
    • •Applied to collect & contain large volumes of liquid feces
    • •Prevents perianal skin irritation & frequent linen changes
    • •Apply before skin becomes irritated
    • •Pouches
    • –Drainable
    • –Change often
  22. Ostomies
    • •Feces is diverted to the outside of body by way of a stoma
    • •Temporary to rest the bowel
    • –diverticulosis
    • •Permanent due to removal of the bowel
    • –cancer
    • •Colostomy vs. ileostomy
    • –contents/location
  23. 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
Card Set
Kozier Ch 48 Fecal Elimination
Kozier Ch 48 Fecal Elimination
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