Which part of the gastrointestinal tract plays a major role in bowel elimination

Chapter 26

The GI tract extends from the mouth to the anus major functions of the GI system are to digest and absorb the nutrients in food and to eliminate food waste product as feces.  Paralytic Ileus: a cessation of bowel peristalsis o Abdominal or pelvic surgery in which the bowel is manipulated may result in paralytic Normal Defecation Patternsileus Normal stool will be soft, formed (semi-solid)about 75% water 25% solid*make sure you have a conversation with your patient to determine what a normal stool is for them

Factors that affect Bowel Elimination *Developmental: varies in regards to age  Infants typically pass the muconium (dark/blackish) feces and over a few days the stools turn

 greenColor/odor of stool is determined whether infant is breastfed or formula fed  Increased risk for constipation in older adults *Personal/Sociocultural  Privacy is extremely important  Stress affects people differently and usually leads to diarrhea *Nutrition/Hydration/Activity Level  What you eat plays a huge role in bowel movement   fiber promotes peristalsis and defecationlow fiber foods slow down peristalsis   calcium supplements can cause constipationfluids (1500-2000 mL per day) help promote a normal bowel movement and helps to keep it soft   bed bound patients are more at risk for constipationbeing active helps promote normal bowel movements

*Medications Box 26-1: Types of Laxatives  laxatives promote bowel movements   antibiotics decrease normal flora which can cause diarrheaIron causes constipation; suggest increased fiber diet

  pain meds can cause major constipation; educate patient on how they can help prevent thisantimotility meds help treat diarrhea

*Surgery and Procedures  anesthesia can cause decreased peristalsis, therefore causing constipation *Pregnancy  prenatal vitamins have a lot of extra iron which can led to constipation

Bowel Diversion: surgically created opening for elimination and can be temporary or permanent Stoma/Ostomy –Stoma: the surgically created opening in the abdominal wall

A. Ileostomy – brings a portion of the ileum through a surgical opening in the abdomen; continuous B. liquid drainageColostomy – surgical procedure that brings a portion of the colon through the abdomen; stool is more formed Assessments –  Assess the actual stoma   Color: deep pink to brick red; you want it shiny and moistcan clean with warm water, you have to keep it clean   stoma will be swollen after surgery and usually stabilizes within 6-8 weeks after surgerypay very close attention to the skin around the stoma  body image: start talking to the patient before the surgery about what to expect & how to carefor it   Pouches hold the feceswhole system is usually changed out every 3-5 days, or prn

-Dietary Teaching –   may initially need to follow a more bland or low residue (low fiber) dietinfluence fluids to stay well hydrated   void gasses foodsavoid foods that can cause a potential blockage (corn, seeds, etc.)

Procedure 26-6, pg. 1108

Physical Assessment Bowel Sounds – make sure to pay close attention to patients bowel sounds Normal bowel sounds: every 3 seconds, if not heard, listen for up to 5 minutesHyperactive bowel sounds: more like to have diarrhea

Constipation:  increase fluids decrease in the frequency of bowel movements   increase fiberincrease physical activity; get them moving   incorporate a stool softenerif still constipated after all of the above, provide an enema

*Enemas (Procedure 26-3, pg. 1100) Enema: introduction of a solution into the rectum to soften feces and stimulate peristalsis making iteasier for them to pass   Soap suds enema administers solution into the rectum to break up the fecesmay need enema for vaginal birth   enema process may be uncomfortable but they will feel better when its all overplace in left side position with right knee flexed   insert tip 3-4 inches, is pre lubricated but you should lubricate morelet the solution flow in and then stop   if they feel pain or you meet resistance, stop administrationwe want all the hardened fecal mass to be broken up so that the pt can have a BM

*Digital Removal of Stool (Procedure 26-4, pg. 1104)   Digital removal of stool: manually removing stool with your fingersinvolves breaking up the hard mass  must have an order for digital removal of stool because it can stimulate the vagus nerve whichcan slow the heart rate (bradycardia)

Bowel Incontinence   More common in women and older adultsinability to control discharge of feces   patient typically will be wearing a briefbe very mindful of their skin, using barrier creams and changing brief frequently  indwelling fecal drainage device: collects stool from bedside that is typically used in ICU thatprevents the stool from coming in contact with skin Bowel Diversions Assessments – Dietary ConsiderationsGuidelines for Ostomy Care

Book Highlights:   Mastication: chewingStress plays a big role in the development of irritable bowel syndrome (IBS)  Epiglottis: a flap of connective tissue closes over the trachea when food is swallowed to preventchoking

  Food leaves the stomach as a liquid called chymeDuodenum: first section of the small intestine; is a C shaped tube that branches off from the

 stomach about 30 to 60 cm longJejunum: the coiled midsection of the small intestine; is about 6 to 8 feet long and forms the  connection between the duodenum and the ileumIleum: joins the small and large intestines; is responsible for the absorption of fats, bile salts, and  some vitaminsAntacids are often used for heartburn, and to neutralize stomach acid but may slow peristalsis   Nutrients are mainly absorbed in the duodenum and jejunumYogurt stimulates peristalsis and promotes intestinal healing   General anesthesia and analgesics slow bowel motilityHypoactive bowel sounds are low-pitched, infrequent, and quiet   After surgery, patients often experience immobility which increases the risk for constipationTo irrigate an immobile patient’s colostomy, put patient in a left side-lying position  Patients who have surgery that disrupts the anal sphincter may experience uncontrolleddrainage after the surgery  Antibiotic therapy is a key treatment to diverticulitis

Which part of the gastrointestinal tract plays a major role in bowel elimination stomach esophagus small intestine large intestine?

What causes bowel elimination?

What is the process of bowel elimination known as?

Which bowel elimination problem is associated with abdominal fullness?