Bowel Elimination Lecture Notes

Part 1: Bowel Elimination

Objectives

1. Understand normal physiology of urination and defecation.
2. Recognize risk factors for elimination alterations.
3. Use nursing processes to prevent elimination issues.
4. Link elimination with nutrition, fluid balance, cognition, and mobility.
5. Analyze medications for constipation and diarrhea.
6. Assess and compare constipation, diarrhea, urinary retention, and incontinence.
7. Apply nursing care for elimination needs.

Anatomy & Physiology of the Gastrointestinal System

• Mouth: Starts mechanical and chemical breakdown.
• Esophagus: Moves food to the stomach via peristalsis.
• Stomach: Stores and mixes food, liquids, and digestive juices.
• Small Intestine: Responsible for digestion and absorption.
  • Duodenum: Processes chyme.
  • Jejunum: Absorbs carbohydrates and proteins.
  • Ileum: Absorbs water, fats, and bile salts.
• Large Intestine: Main organ for elimination, includes the cecum, colon (ascending, transverse, descending, sigmoid), and rectum. Also aids in electrolyte balance and defecation.

Factors Influencing Bowel Elimination

• Nutrition & Fluids:
  • Daily fiber: 25g – 38g.
  • Daily fluid: 2,000 to 3,000 mL.
  • Foods causing gas, odor, thickening, or loosening of stool.
• Physical Activity: Affects muscle tone and peristalsis.
• Psychological Factors: Stress increases peristalsis; depression decreases it.
• Personal Habits: Regular schedules promote regular elimination.
• Posture: Optimal posture is squatting.
• Pain: Affects defecation if related to hemorrhoids or surgery.
• Surgery and Anesthesia: Can stop peristalsis; direct handling affects patterns.
• Medications: Various drugs can alter bowel habits.

Developmental Considerations

• Infants: Rapid peristalsis, lack control.
• Adolescents: Growth affects patterns.
• Older Adults: Increased GI disturbances.

Problems of Bowel Elimination

• Constipation: Less than 3 BM/week.
• Fecal Impaction: Result of prolonged constipation.
• Diarrhea: Rapid movement and frequent watery stools.
• Incontinence: Inability to control stool passage.
• Flatulence: Gas causes discomfort.
• Hemorrhoids: Strain-induced vein dilation.

Part 2: Bowel Elimination

Bowel Assessment

• History: Patterns, dietary habits, and medication use.
• Physical Exam: Inspection, auscultation, and palpation.
• Laboratory Tests: Stool analysis, fecal occult blood test.

Diagnostic Testing

• Endoscopy: Direct visualization.
• Patient Preparation: Diet and medication adjustments for procedures.

Nursing Diagnoses

• Issues like incontinence, constipation, diarrhea, and others.

Planning: Client Outcomes

• Goals related to incontinence and bowel regularity.

Implementation

• Health Promotion: Diet, fluids, exercise.
• Acute Care: Medication use, enemas, digital removal.

Medications

• Constipation: Bulking agents, stool softeners, laxatives.
• Antidiarrheal: Thicken stool, slow intestines.

Continuing Care

• Bowel training and skin integrity maintenance.

Urinary Elimination

Learning Objectives

• Similar objectives to bowel elimination, focusing on urination.

Anatomy & Physiology

• Kidneys, Ureters, Bladder, Urethra: Fundamental structures.
• Urination Process: Involves brain and pelvic floor muscle coordination.

Factors Affecting Urinary Elimination

• Developmental Considerations: Children, aging effects.
• Disease Conditions: Diabetes, neurological diseases.
• Medications: Affect urine production and color.

Alterations in Urination

• Production Changes: Polyuria, anuria, oliguria.
• Elimination Changes: Frequency, urgency, retention.
• Incontinence Types: Urge, stress, overflow, functional, reflex.

Nursing Process

• Assessment: Patterns, symptoms, physical examination.
• Urine Testing: Analysis of characteristics and tests.

Implementation

• Health Promotion: Education, fluid intake, infection prevention.
• Restorative Care: Bladder training, self-catheterization.

Evaluation

• Assess if patient outcomes are met and adjust care accordingly.