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N 336 Bowel Elimination student 2011

N 336 Bowel Elimination student 2011 -...

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Jacqueline Tulley, RN, MSN, ACNP
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Defecation: process of eliminating waste from  bowels Feces:  stool – semisolid mass of fiber,  undigested food, inorganic (Ca# etc) material,  bacteria and water Flatus:  gas produced during digestion 
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Fecal material reaches the rectum Distention stimulates stretch receptors to initiate  contraction of the sigmoid colon and rectal  muscles Internal anal sphincter relaxes Sensory impulses cause voluntary “bearing  down” External anal sphincter relaxes
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Range from several times daily to once weekly No excessive urgency No blood Minimal effort and no straining Without laxatives
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History Bowel patterns Previous surgeries Laxatives Other meds Travel Interpersonal contacts Family hx
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Observe Amount Stool color Clay or white Black or tarry Red Pale Stool consistency Hard, dry Diarrhea Observe (cont.) Stool shape Stool odor Stool constituents Auscultate Percuss
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Provide privacy Correct position Seated upright Timing Often occurs after meals Some clients may need assistance
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Encourage fluids Proper diet Fresh fruits, vegetables, whole grains, fiber Exercise 3-5 times a week Range of motion for clients on bedrest
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Diarrhea Constipation Fecal impaction Fecal incontinence Flatulence  Bowel diversions
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A symptom, not a disease Etiology Decreased fluid absorption Increased fluid secretion Motility disturbances Clinical manifestations Chronic Acute
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Infectious diarrhea Bacterial E. Coli Salmonella Clostridum difficile Viral Rotovirus, Norwalk virus Parasitic Giardia lamblia
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Monitor stools to  quantify diarrhea Assess and monitor  for fluid imbalance Monitor for alterations  in perineal skin  integrity Frequency, amount, color,  consistency Monitor I & O, body weight, VS Skin turgor, mucous  membranes Check electrolytes Assess perineal area for  irritation and excoriation Provide assistance with  hygiene
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Proper dietary teaching
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