Bowel Elimination Large Intestine

Absorbs
 Elimination of waste products of digestion from the body
 Feces or stool - *excreted waste product  Water
- too little water; diarrhea
Physiology of Bowel Elimination
- Too much water ; constipated
Physiology of defecation is depends on the functioning of the - Cholera ; death by dehydration
following  Inorganic Ions
 Large intestine - Sodium and Potassium
- colon and ileocecal valve
 Rectum  If we loss large intestine the kidney can fulfil this functions
- anal canal and nervous system  Bacteria on colon - assist digestion of nutrients
 5% of stool composed of bacteria that important digesting of
carbs; the biproducts get from that is methane(CH4) and
hydrogen sulfate (H2S)
 CH4 - causes flatulent
 H2S - smell terrible

Rectum
 Storage
 Important part of GI tract

Small intestine - Food absorb  Hold on the stool

large intestine - Food passes

Ileocecal valve - point where large intestine ends Anus

Illeum - last part of small intestine 2 sphincter

Cecum - first part of large intestine Internal Anal sphincter (IAS)

Appendix - large intestine begins  smooth muscle (involuntary)

Right colon (ascending colon)  Stool present in rectum it pushes on IAS, the IAS will

Transverse colon - runs transversely relax and open and allow the stool to move forward

Descending Colon
Sigmoid colon - s shape External Anal Sphincter (EAS)
 skeletal muscle (we control)
 Release food we ate

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 Key points
3 main function
 Absobtion of water and nutrients
 Mucoid protection of the intestinal wall
 Fecal elimination

 Mucous that is secreted by the colon serves to protect the wall

of large intestine from the trauma from the acid
 Serves to hold fecal material

2 products of digestion
 Flatus
- largely air (gas)
- By prodcut of digestion of carb
- Adult 400-700 ml daily

 Feces and Defecation

- Defecation - bowel movement
- Feces is made up of 75% water and 25% solid substances
 Classify feces into 7 groups
- It is normally brown in color due to the presence of
 Types of stool depends on the time its spend in the colon after
Stercobilin and Urobilin (chemicals derived from bilirubin)
the feces past
- Presence of E.coli and staphylococci affects the color of
 Feces result on diets, food we eat and lifestyle
fecal mater

 Contains folds that extends vertically containing a vein and

artery
- this folds helps pertain the feces withing the rectum

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 Factors Affecting Bowel Elimination Physical Activity
Age  With activity it stimulates peristaltic movement of colon
Newborns and Infants
 Meconium - first fecal material pass by the newborn normally Psychological factors
after 24 hrs after birth  Emotional and stability increases of peristaltic movement
 Black, tarry, odorless and sticky and subsequent diarrhea
 It is then followed by transitional stool (witch follows after  People that are depressed may experienced slowed
about a week) generally greenish-yellow color because it intestinal motility, resulting in constipation
contain mucosa Infants - passes stool often after
feeding because their intestine just like kidney is immature so Defecation Habits
water is not well reabsorb  Early bowel training may establish the habit of defecating
 Stool is soft liquid and very frequent for breastfed infants at a regular time.
 Yellow to golden feces - breastfeed
 Dark yellow or tan stool - formula Medication
 Side effects of drug can interfere with normal elimination.
Toddler  medication can cause constipation like painkiller,
 1 year and half to 2 yrs - control defecation diarrhea caused by anti biotics, and medication lead to
 Start parents to potty train their kids defecation like laxative

School Age & Adolescence Surgery and Anesthesia

 similar to adult bowel pattern but varies in frequency and  When a client needs an operation and NPO is advise
quantity this can affect
 When a person doesn’t eat normal defecation is halted
Older Adult
 reduce activity levels and also inadequate of fiber and fluid Pain
intake and muscle weakness are necessary to consider  Especially spinal cord injury may impaired the motility of
 up to half of older adult suffer from constipation GI tract and can cause poor function of sphincter witch
may cause decrease simulation of defecation
Diet
 Sufficient fiber Common bowel elimination problems

 Two types of fiber Constipation

Insoluble - promotes movement of material through the  More of a symptom than a disorder
digestive system and increase the bulk in the stool  Decreased on frequency of BM (fewer 3 BM per week)
Soluble - helps lower cholesterol, glucose level  Straining and pain on defecation is associated symptoms
 Increase fiber on a diet and plenty of water is advise (Valsalva maneuver)
because fiber woks best when absorb with water  Can be significant health hazard (increased ICP, IOP,
reopen surgical wounds, cause trauma, cardiac
Fluid Intake arrhythmias)
 A daily fluid of intake of 2000-3000 ml is advice

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  Medication
 Laxatives
 Colon Disease
 Surgery

Incontinence
 Inability to control passage of feces and gas from the
anus
Flatulence
 Gas accumulation in the lumen of intestines
 The bowel wall stretches and dispense
Impaction  Cause abdominal pain and cramping
 Results from unrelieved constipation
 Associated S/S: Loss of appetite, abdominal distention,
Hemorrhoids
cramping, rectal pain
 dilated, engorged veins in the lining of the rectum
 Commonly cause by frequent constipation, pregnancy,
heart failure and chronic kidney disease
2 Types
 External - clearly visible on anus
 Internal - cause of bright red stool

*feces that cannot pass to defecate

Diarrhea
 Increase in number of stools and the passage of liquid,
unformed stool
Bowel Diversion

 Certain diseases cause conditions that prevent normal

passage of feces through rectum
- Specific disease is crohn’s disease
 Surgical opening (ostomy) are most commonly formed in
Condition that cause Diarrhea ileum (ileostomy) or the colon (colostomy)
 Emotional Stress
 Intestinal Infection (Clostridum difficile)
 Food Allergies
 Food Intolerance
 Tube Feeding (Enteral)

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 Patient who undergo Colostomy Nursing Process Assessment

 Nursing History
 Physical Assessment
 Lab Test
 Fecal characteristics
 Diagnostic evaluation - Endoscopy, Colonoscopy

Implementation Promoting Normal Defecation and Acute

Care Management

 Positioning of patient-squatting
 Positioning on bedpan

Types of Colostomy Bag

 One time use
 Reusable

Ostomy Nursing Consideration

 Patient Education
 Care of skin and stoma, appliance selection and use *if client is on CBR without BP (complete bed rest without
 Body image consideration bathroom privileges
 Enterostomal nursing specialty within profession  Use of cathartics, laxatives
 Anti-diarrheal agents
 Enemas

Irritated stoma
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 Digital removal of stool (use of finger, most in infant)
 Ostomy care
 Fecal Incontinence Devices
 Fiber and Fluid

Nursing Diagnosis

 Bowel Incontinence
 Constipation
 Diarrhea
 Impaired skin integrity
 Body Image Disturbance
 Altered bowel elimination