General Plan of the Body Bowel Elimination

General Plan of the Body
Bowel Elimination
WEEK 3 DAY 2
T U E S D A Y J A N U A R Y 2 5 TH, 2 0 1 1
LESA MCARDLE, MSN, RN
Objectives
Organization and General Plan of the Body



Define terms specific to anatomical positions and levels of
organization of the body.
Describe the location of body parts with respect to one another.
Name the body cavities, their membranes and organs within each
cavity.
Bowel Care



Identify procedures for promoting bowel elimination.
Assist the patient in evacuation of feces and flatus through the use of
enema, rectal tube or Harris Flush.
Assist or teach the patient with a colostomy or ileostomy to irrigate
the bowel.
General Plan of the Body
ANATOMY AND PHYSIOLOGY
CHAPTER 1
MEDICAL TERMINOLOGY
CHAPTER 2
2
BODY STRUCTURE
Organizational Levels
• Cellular level
• Smallest structural
and functional unit of
the body
• Tissue level
• Organ level
• System level
• Organism level
2
BODY STRUCTURE
Directional Terms
• Anterior/posterior
• Inferior/superior
• Proximal/distal
• Cephalad/caudad
• Ventral/dorsal
• Lateral
• Medial
2
BODY STRUCTURE
Body Cavities
• Dorsal (posterior)
• Cranial
• Spinal
• Ventral (anterior)
• Thoracic
• Abdominal
• Pelvic
2
BODY STRUCTURE
Quadrants
• Four quadrants
1)
2)
3)
4)
RUQ
LUQ
RLQ
LLQ
2
BODY STRUCTURE
Regions
•
Nine regions
1)
2)
3)
4)
Right
hypochondriac
Left
hypochondriac
Right lumbar
Left lumbar
5)
6)
7)
8)
9)
Right inguinal
Left inguinal
Epigastric
Umbilical
Hypogastric
2
BODY STRUCTURE
Signs, Symptoms, and Diseases
• Adhesion
• Chondroma
• Cytotoxic
• Inflammation
• Sepsis
2
BODY STRUCTURE
Diagnostic Procedures
• Endoscopy
• Fluoroscopy
• MRI
• CT scan
• PET
• SPECT
• Ultrasonography (ultrasound)
2
BODY STRUCTURE
Medical and Surgical Procedures
• Anastomosis
• Cauterization
A&P definitions
 Anatomy:
_______________________________________
 Physiology:
_______________________________________
 Pathophysiology:
_______________________________________
 Homeostasis:
_______________________________________
Levels of structural organization
 Chemicals
 Inorganic chemicals
 Organic chemicals
 Cells
 Tissues
 Epithelial tissues
 Connective tissues
 Muscle tissues
 Nerve tissues
 Organs
 Organ systems
Systems
 Circulatory
 Muscular
 Skeletal
 Nervous
 Integumentary
Systems (continued)
 Respiratory
 Urinary
 Endocrine
 Lymphatic
 Digestive
 Reproductive
The organ systems
System
Integumentary
skeletal
muscular
nervous
endocrine
circulatory
lymphatic
respiratory
digestive
urinary
reproductive
Functions
Organs
Feedback mechanisms
Body parts and areas
 All areas are
bilateral
 Some areas are
both anterior
and posterior
 Some areas are
either anterior
or posterior
Body cavities
Planes and sections of the body
Transverse section
Upper abdomen
Transverse section
Upper abdomen
Stomach
Pancreas
Colon
Liver
Gallbladder
Duodenum
Spleen
Ribs
Aorta
Left Kidney
Vertebra
Spinal Cord
Inferior
Vena Cava
Right Kidney
Muscle
Areas of the abdomen
Bowel elimination and care
MEDICAL SURGICAL NURSING
CH 23, PAGES 344-350
FOUNDATIONS OF NURSING
CH 20, PAGES 583-596
NURSING INTERVENTIONS AND CLINICAL
SKILLS
CH 9
Physiology of Defecation
 The muscles of the pelvic floor and the external sphincter
are under voluntary control
 The bowel has its own nerve network that stimulates
peristalsis when it is distended

Disorders of the central nervous system and spinal cord do not
impair bowel control as much as they do bladder control
 The fecal mass enters the rectum by mass movement
 Feces in the rectum creates a desire to defecate
 Defecation occurs when the anal sphincter relaxes and the
rectum contracts
Figure 235
Elimination
 Bowel Elimination
 Elimination of bowel waste (defecation) is a basic human
need and is essential for normal body function.
 Normal bowel elimination depends on several factors: a
balanced diet, including high-fiber foods; a daily fluid intake
of 2000 to 3000 mL; and activity to promote muscle tone
and peristalsis.
 Normal stool (feces) is described for documentation as
moderate in amount, brown, and soft in consistency and is
expelled every 1 to 3 days.
Assessment
 Chief complaint
 Determine usual bowel pattern, changes, stool characteristics,
and related symptoms, such as pain or cramping
 Bowel pattern
 Document usual frequency of bowel movements
 Characteristics of stools
 Assess consistency, color, and constituents of stools
Assessment
 Review of systems
 Problems that may be related to fecal incontinence, such as
motor, sensory, or cognitive impairments
 Functional assessment
 Habits that may be related to bowel function, including diet,
fluid intake, exercise or activity pattern
 Physical examination
 Inspect and palpate the abdomen for distention and auscultate
for bowel sounds
 Inspect the perianal area for irritation or breakdown
Skills for Gastrointestinal Disorders
 Flatulence
 This is the presence of air or gas in the intestinal tract.
 It may occur when a person consumes gas-producing liquids
and foods, such as carbonated beverages, cabbage, or beans;
swallows excessive amounts of air; or has constipation.
 In hospitalized patients, flatulence is often caused by
decreased peristalsis, abdominal surgery, some narcotic
medications, and decreased physical activity.
 May cause distention of the stomach and abdomen and mild
to moderate abdominal cramping and pain
 One of the most effective measures to promote peristalsis
and passage of flatus is walking
 Rectal tube may be used
Skills for Gastrointestinal Disorders
 Constipation
 Condition characterized by infrequent bowel movements with
hard stools that are passed with difficulty
 Can be the result of;
Dehydration
 Improper diet
 Medication

Skills for Gastrointestinal Disorders
 Administering an Enema
 This involves the instillation of a solution into the rectum
and sigmoid colon.
 Primary reason for an enema is promotion of defecation.
 The volume and type of fluid instilled can lubricate or break
up the fecal mass, stretch the rectal wall, and initiate the
defecation reflex.
 Patients should not rely on enemas to maintain bowel
regularity because enemas do not treat the cause.
 Frequent enemas disrupt normal defecation reflexes,
resulting in dependency on enemas for elimination.
Skills for Gastrointestinal Disorders
 Care of the Patient with Hemorrhoids
 The patient with hemorrhoids has pain when hemorrhoidal
tissues are directly irritated from the passage of hard stool.
 The primary goal for the patient with hemorrhoids is soft,
formed stools.
 Proper diet, fluids, and regular exercise improve the
likelihood of soft stools.
 Local heat provides temporary relief to swollen hemorrhoids;
sitz bath is the most effective means of heat application.
Skills for Gastrointestinal Disorders
 Ostomies


Colostomy
Ileostomy
Ostomy pouches and skin barriers
Fecal Incontinence
 Fecal incontinence is less common than urinary




incontinence, but it can be very distressing for patients
Usually related to anal sphincter dysfunction caused by
anal surgery, trauma during childbirth, Crohn’s disease
affecting the anus, or diabetic neuropathy
Some experience temporary incontinence with severe
diarrhea because they do not have time to reach the toilet
Incontinent diarrhea may also be present with fecal
impaction
Diminished muscle strength with aging also a factor
Types of Fecal Incontinence
 Fecal overflow incontinence
 Caused by constipation in which the rectum is constantly
distended
 Medical treatment
 Immediate relief of the constipation and long-term control of
the problem
Cleanse the colon
 Regular evacuation

Types of Fecal Incontinence
 Neurogenic incontinence
 Defecation is not voluntarily delayed
 One or two formed stools occur after meals
 Medical treatment
 Scheduled toileting based on usual time of defecation
 Medications
Types of Fecal Incontinence
 Symptomatic incontinence
 Result of colorectal disease
 Medical treatment
 Identify and treat the cause
 Anorectal incontinence
 Nerve damage that causes the muscles of the pelvic floor to be
weak
 Medical treatment
 Pelvic muscle exercises; sometimes biofeedback
Skills for Gastrointestinal Disorders
 Fecal Incontinence
 The first step in care of the patient with fecal incontinence is to
assess whether fecal impaction is the cause.
 An impaction involves the presence of a fecal mass too large or
hard to be passed voluntarily.
 Either constipation or diarrhea can suggest the presence of an
impaction.
 An oil retention enema lubricates the rectum and colon,
softens the feces, and facilitates defecation.
 It can be used alone or with manual removal of a fecal
impaction.
Diagnostic Tests and Procedures
 Evaluation of fecal incontinence may include
 Assessment of rectal sphincter tone
 Laboratory examination of a stool specimen for blood or
pathogens
 Endoscopic or radiologic procedures to detect underlying
problems
Interventions
 Enemas
 Pouches
 Drug therapy
 Biofeedback
 Dietary changes
Nursing Diagnosis
 Constipation
 Acute pain
 Impaired Skin Integrity
 Situational Low Self-
Esteem
 Anxiety
 Ineffective coping