Bowel elimination ppt
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The document provides information on the physiology of bowel elimination or defecation. It discusses the normal process of defecation including the role of muscles in moving fecal material through the digestive tract. It describes factors that influence defecation frequency and the signals that stimulate the urge to defecate. The document also covers the composition of feces, normal and abnormal characteristics of feces, and factors that can affect bowel elimination such as diet, medications and medical conditions.
Bowel elimination ppt
- 1. Good morning
- 3. Physiologyof bowelelimination Bowelelimination ordefecation Defecation, also called bowel movement, the act of eliminating solid or semisolid waste materials/ faces from thedigestivetract. • In human beings, wastes are usually removed once or twice daily, but the frequency canvary from severaltimes daily to three times weekly and remain within normal limits.
- 4. • Muscular contractions- move fecal material to the rectum. • Therectum -temporary reservoir for the waste. • As the rectal walls expand with filling, stretch receptors from the nervous system, located in the rectalwalls,stimulatethe desireto defecate. Cont….
- 5. • The urge passes within one to two minutes if not relieved , and the material in the rectum is then often returned to the colon where more water is absorbed • If defecation is continuously delayed, constipation and hardened feces result. Cont….
- 6. • When the rectum is filled, pressure within it is increased. • This increased intra rectal pressure initially forces the walls of the anal canal apart and allows the fecal material to enterthe canal • In the anus there are two muscular constrictors, the internal and external sphincters, that allow the feces to bepassedorretained Cont….
- 7. • While defecation is occurring, the excretion of urine is usuallystimulated. • The chest muscles, diaphragm, abdominal-wall muscles,andpelvic diaphragm all exert pressure on the digestivetract. Cont….
- 8. • Respiration temporarily ceases as the filled lungs pushthe diaphragm down to exert pressure. • Blood pressure rises in the body, and the amount of blood pumped by the heart decreases.
- 10. Composition offeces 1.Water • 65-85%of stools arewater. • All the water drank by an individual is completely absorbed in the small and largeintestine. • In case of diarrhoea, the water content of stools is morethan 85%.
- 11. 2.Protein Protein from food is digested completely in the small intestine and is converted into amino acids before being absorbed inblood.
- 12. 3.Fat • 95% of all fat consumed is absorbed in the small intestine. • Tracesof fat candefinitelybefoundin stools. • Fats in excess of 6% in stool are abnormal. (Steatorrhea.)
- 13. 4.Carbohydrate • Simple and complex carbohydrates - sugar and starches in diet. • They are completely absorbed in the small intestine and assimilated in blood as glucose, fructose or galactose. • Undigested carbohydrates in normal stools should be below0.5%.
- 14. 5.Fiber • Fiber is completely indigestible and gives volume and bulk to stools. • The more fiber one eats the more of undigested food wastes can be dischargedfrom the body. • Fiber diet- undigested food would account for 5-7% of the total stool volume. • High fiber diet, 10-15% of the undigested wastes could be dischargedfrom thebody.
- 15. Besides thefive majorcomponents: • Mineral salts which are insoluble. • They too cannotbedigestedbythe body. • This indigestible component of feces is known asAsh. 0.2 to 1.2% of normal stools isash. • The stools also contain mucous shed from the inner lining of digestive tract. • The mucus helps to bind together undigested food, intestinal bacteria and metabolicdebrislikedeadcellsorbilesecretedbythe liveretc.
- 16. Characteristicsof feces Normal colour: • Adult: brown • Infant: yellow
- 17. Abnormal colour: • Clay or white: Absence of bile pigment (bile obstruction)ordiagnosticstudyusingbarium • Blackor tarry: Drug (e.g., iron), bleeding from upper gastrointestinal tract (e.g., stomach, small intestine), diet high in red meat anddark green vegetables (e.g.,spinach) • Red: Bleeding from lower gastrointestinal tract (e.g., rectum),somefoods(e.g.beets) • Pale: Malabsorption of fats, diet high in milk and milk productsandlowinmeat
- 18. Consistency Normal consistency:Formed,soft,semisolid, moist Abnormalconsistency • Hard, dry, constipatedstool • Dehydration, decreased intestinal motility resulting from lack of fiber in diet, lack of exercise, emotional upset,laxativeabuse • Diarrhoea:Increasedintestinal motility
- 19. Shape Normal shape: Cylindrical , about 2.5 cm (1 inch)indiameter in adults Abnormal shape: Narrow, pencil-shaped, or string likestool • Obstructiveconditionalof the rectum
- 22. Normal amount : • Varieswithdiet (About 100to 400 g perday) Normal odour: Aromatic, affected by ingested foodandperson’sownbacterialflora Abnormal odour: Pungent (sharply strong) • Infection, blood
- 24. • Age • Diet • fluid intake • medications, • physical activity • psychological activity • personal habits • Position • Pain • Pregnancy • surgery & anaesthesia • diagnostic tests
- 25. Age • Must be of a certain age or physical maturity to be able to control your bowels • Humans also can lose control of their bowels after a certain age
- 26. Diet • There many different ways that diet can affect bowel elimination • ex: high fiber diets & fruits promote regularity, while cheeses cause constipation
- 27. Fluid intake • The more fluid you take in the less likely you are to become constipated • The less fluid you take in the more likely you are to become constipated. Physical activity • Higher activity rate lessens the chances of constipation
- 28. Psychological factor • Usually the source of ulcerative colitis or crohn's disease • Depression causes peristalsis to decrease Personal habits • A person not wanting to go for an extended period of time can cause harm to their body and can make it harder to go later • They may not want to use those facilities
- 29. Positions • Normal positioning for Bowel elimination is sitting or squatting Pain • Person may be hesitant about going if they think it will cause them pain • usually due to haemorrhoids, rectal surgery, or Abdominal surgery
- 30. Pregnancy • The way the baby is lying on the mothers GI tract affects peristalsis by slowing it • Force the mother to go in between Surgery & anaesthesia • Affects defecation by the slowing of peristalsis or complete stoppage of it
- 31. Medications • Different meds affect Bowel elimination differently • some medications increase the process others may inhibit it or stop it completely Diagnostic tests • These affect the patient because they usually require them to be NPO prior to it which in turn will limit their food intake which limits Bowel elimination or stops them completely
- 33. CONSTIPATION • Constipation occurs when stool moves through the large intestine too slowly or remains in the large intestine for too long • Involves a change in stool consistency ( harder & drier than usual ) • Change in defecation frequency (less than usual )
- 34. Causes • Inadequate, irregular & restricted diet • Insufficient fluid intake • Habit pattern regarding timing • Lack of exercise • Emotional upset • Unnatural position • Overuse of laxatives , suppositories & enemas • Surgery of intestine & rectum • Malformation & obstruction of colon • Systemic disorders • Haemorrhoids & other lesions of anal canal • Use of certain drugs • Excessive use of tea & coffee
- 35. Prevention & management • Health teaching • Adequate intake of diet & fluid • Adequate intake of fibre in diet • Establishing a habit pattern • Relaxation • Privacy • Posture • Exercise • Use of laxatives , suppositories & enemas
- 36. Diarrhoea • Diarrhoea is manifested by frequent evacuation of watery stool due to increased intestinal motility • Rapid passage of faecal contents through the lower GI tract • Reduces the time available for reabsorb water & electrolytes • Water, Mucus (major content) • Light brown to yellow to green (Colour)
- 37. Causes • Food poisoning • Intestinal infection • Allergies to certain foods & fluids • Medications like antibiotics • Inflammatory bowel disease (crohn’s disease )
- 38. Symptoms • Intense urge to defecate • Abdominal cramps • Nausea • Painful burning sensation at the anus • Anal soreness • Inflamed skin around anus
- 39. Management • Replacement of fluid & electrolyte • Avoid spicy & allergic food • Make arrangement of use of bed pan or commode • Care of skin • Adequate rest • Psychological support • Medication like ant diarrhoeal
- 40. Faecal impaction • It is the accumulation of the hardened faeces in the rectum , as a result of which the person is unable to voluntarily evacuate the stool • Develops usually R/T untreated or unrelieved constipation • As the faeces remains in the rectum & sigmoid colon , the water is reabsorbed making the faeces harder , drier & more difficult to pass • More faeces continued to produced, which get accumulated in the colon proximal to the impacted stool
- 41. Signs & symptoms • Feeling of fullness of rectum & abdomen • Swelling or tightness/Bloating of abdomen • Urge of defecation but an inability to pass stool • Feeling of malaise-general discomfort • Loss of appetite • Nausea & vomiting
- 42. Management • Laxatives • Enema • Manual removal of stool (digital evacuation )
- 43. Faecal incontinence It is the involuntary elimination of bowel contents , often associated with neurologic , mental or emotional impairments
- 44. Causes • Anal sphincters muscle damage • Vaginal childbirth • Diarrhoea • IBD • Alzheimer's disease
- 45. Management • Eat 20 to 30 grams of fiber per day • Avoid caffeine • Medications - Imodium, Lomotil • Exercise • Bowel training
- 46. Flatulence Flatulence is the accumulation of excessive amounts of gas ( flatus ) in the GI tract , leading to distension of the abdomen
- 47. Causes • Excessive swallowing of air with anxiety or rapid food or fluid ingestion, (usually eliminated by burping) • Gases produced by bacterial activity in large intestine (eliminated through anus) • Certain gases from foods such as cabbage , onions etc • Post operative patients because of effect of anaesthesia • Gas that diffuses from blood stream into the intestine
- 48. Abdominal distension It is accumulation of excessive amounts of flatus, liquid or solid intestinal content
- 49. Causes • Long period of bed rest can slow the peristalsis • An obstruction that blocks the passage of flatus & faeces • Surgery causes decreased peristalsis • Constipation
- 50. Types andcollection of specimen
- 51. A specimen of freshly passed faces of 0.5 to 1 ounce (15 g to 30 g) is collected, without contamination of urine or toilet tissue, into a small container that may have a small spoon or spatula attached inside the lid of the cup for easier collection of the sample.
- 52. Equipment • Clean bed pan or disposable receiver – ensure the bedpan is not contaminated with detergent or disinfectant as this may affect the results • Sterile specimen pot with an integral spoon; • Non-sterile gloves • Apron
- 53. Procedure • Ensure privacy and dignity • Wash hands with soap and water • Assemble the equipments • Put on non-sterile gloves and apron • Ask the patient to pass urine before taking the stool sample
- 54. • Ask the patient to defecate into the bedpan or receiver • If the patient is incontinent, a sample can be taken from the bed linen • Use the integral spoon in the sample pot to collect enough faeces to fill around a quarter of the specimen pot
- 55. • Secure the top of the container – this will prevent leakage • Remove gloves and apron and dispose of them • Wash hands with soap and water • Examine the specimen and record the colour, consistency and odour of the stool as part of the nursing assessment.
- 56. • Label the sample and complete the microbiology form including any factors such as recent antibiotic treatment and suspected food poisoning (accurate laboratory result) • Put the sample in a specimen bag. • Send the sample to the laboratory as soon as possible • Document the procedure in the patient’s notes
- 58. Ova and parasites Supplies: Clean plastic stool cup 1. The stool should be passed into a clean, dry container. Urine will contaminate the spicemen cannot be collected directly out of the toilet. 2. Transfer stool specimen to stool cup and send to the Laboratory within 2 hours of collection, refrigerate if > than 2 hours.
- 59. Occult Blood • Transfer stool specimen to stool cup. Transport to lab. NOTE: If using wooden applicator stick to transfer stool, do not leave stick in stool container; specimen will dry out.
- 60. Thank you