1. ELIMINATION FECAL Ma. Tosca Cybil A. Torres, RN, MAN

4. Feces enter rectum distension of rectal walls initiates signal through mesenteric plexus initiate peristaltic waves (descending, sigmoid colon, rectum)anus internal sphincter inhibited from closing relaxed external sphincter defecation

7. FACTORS AFFECTING DEFECATION Age Diet Fluid intake Physical Activity Psychological Factors Personal Habits Position During Defecation Pain Pregnancy Surgery and Anesthesia Medications Diagnostic Tests

9. Normal routines followed to promote normal elimination.

10. Description of any recent change in elimination pattern.

11. Description of usual characteristics of stool.

12. Diet history

13. Daily fluid intake

14. History of surgery or illness affecting the GI tract.

15. Medication history

17. Assessment of the GIT MTCAT '09 3. Normal pattern of bowel elimination frequency and character of stool use of laxatives, enemas 4. Recent changes in normal patterns changes in character of stool (constipation, diarrhea, or alternating constipation and diarrhea) changes in color of stool melena - black tarry stool (upper GI bleeding) hematochezia – fresh blood in the stool (lower GI bleeding) c. drugs /medications being taken d. measures taken to relieve symptoms

19. white patches – due to candidiasis (oral thrush)

21. Assessment of the GIT MTCAT '09

23. assess contour (flat, protuberant, globular)

25. Normoactive – every 5-20 secs.

26. Hypoactive – 1 or 2 sounds in 2 mins.

29. to determine presence of excessive amounts of air or fluid

30. Normal – tympany

32. determine presence and chac. of abdominal masses

34. assess for presence of pruritus, fissures, external hemorrhoids, rectal prolapse

37. GI bleeding

38. No red meat, turnips, horseradish, steroids, NSAIDS, iron

39. Stool for Ova and parasites

41. Client must swallow barium sulfate

42. Sequential films taken as it moves through the system.Barium – is a radiopaque substance that when ingested or given by enema in solution, outlines the passage ways of the GIT for viewing by x-ray or fluoroscopy

44. Pt. swallows a flavored barium solution and the radiologist observes the progress of the barium through the esophagus and take x-ray films

45. NPO for 6-8 hrs

46. Post procedure:

47. Increase fluid intake

48. Laxative

49. Stool – white for 24-72 hrs.

52. Give enemas until clear the morning of the test.

53. Administer laxative or suppository.

58. fiberscope – has a thin, flexible shaft that can pass through and around bends in the GIT, transmit light and the image can be seen in the monitor

62. Ensure consent form has been signed

64. Assess vital signs and for pain, dysphagia, bleeding

66. useful to identify tumors, colonic cancer, colonic polyps

68. dulcolax tabs

69. NPO 8 hrs. prior to procedure

71. assess for sudden abdominal pain (perforation), fever, active

72. bleeding

77. dulcolax tab.

81. MTCAT '09

82. STOOL CHARACTERISTICS

83. STOOL CHARACTERISTICS

85. Bright or dark red

86. Streaking of blood on the surface of the stool

87. Bulky, greasy

88. Clay colored

90. Hematochezia. Passage of stool with bright red blood.

91. Melena. Passage of black tarry stool

93. Spinach - green

94. Carrots & beets - red

95. Cocoa - Dark red or brown

96. Iron, charcoal - Black

98. Client who have a low-fiber diet high in animal fats and refined sugar often have constipation problems. Also low fluid intake slows peristalsis

99. Lengthy bed rest or lack of regular exercise causes constipation.

100. Heavy laxative use causes loss of normal defecation reflex. In addition, the lower colon is completely emptied, requiring a time to refill with bulk.

101. Tranquilizers, opiates, anticholinergics, and iron can cause constipation

102. Older adult experience slowed peristalsis, loss of abdominal muscle elasticity, and reduce intestinal mucous secretion. Older adults often live alone and eat low-fiber foods.

103. Constipation is also caused by GI abnormalities such as bowel obstruction, paralytic ileus, and diverticulitis

106. High-fiber diet.

107. Establish regular pattern of defecation

108. Respond immediately to the urge to defecate.

109. Minimize stress. – Sympathetic response.

110. Promote adequate activity and exercise.

111. Assume sitting or squatting position.

112. Administer laxatives as ordered

113. TYPES:

114. Chemical irritants- provide chemical stimulation to intestinal wall- increase peristalsis . Ex. Dulcolax, castor oil, senokot (senna)

115. Stool lubricants – mineral oil

116. Stool softeners – Colace (Na Docussate)

117. Bulk formers – Metamucil

120. Very large watery to very frequent small stools/ containing blood, mucus or exudate

121. Depends on the course, duration and severity

123. urine- frequency, color, consistency and volume

124. Stools

125. Vomitus

126. Replace fluid and electrolyte losses.

127. Provide good perianal care

128. Promote rest.

129. Diet:

130. Small amounts of bland foods

131. Low fiber diet

132. BRAT

133. Avoid excessive hot or cold fluids.

134. Potassium rich foods and fluid.

136. Oresol

137. Avoid food in the first 24 hours to provide bowel rest, after that time, frequent small feedings

138. Milk are temporary withheld

140. Monitor v/s and record including orthostatic hypotension

142. Status of nothing by mouth

143. Excessive dieting

144. Anorexia

145. Self-induced vomiting

146. Alcoholism

147. Excessive use of enemas or laxatives

148. Food fads

149. Alternative diet forms

150. Altered nutrition more than body requirements

151. Excessive caloric intake

152. Altered nutrition: potential for more body requirements related to:

153. Dysfunctional eating patterns

154. Closely spaced pregnancies

155. Feeding self-care deficit related to:

156. Impaired mobility of both arms

157. Impaired swallowing related to:

158. Surgical trauma

160. Provide good skin care

161. Assist in cleaning the perianal area

163. Anxiety

164. Eating gas-forming foods

165. Rapid food and fluid ingestion

166. Improper use of drinking straw

167. Excessive drinking of carbonated beverages

169. Have the client assume a side-lying position.

170. Lubricate the rectal tube to reduce mucous membrane irritation.

171. Expose the anus and insert the rectal tube into the rectum 10cm (4in). The rectal tube will stimulate peristalsis. If no flatus is expelled, insert the tube another inch or so. Do not force the tube if it does not insert easily.

172. Wrap an abdominal or incontinence pad around the end of the rectal tube to catch any liquid that may be expelled. Or, placing the end of the tube into a receptacle filled with fluid.

173. Leave the tube in no longer than 3 minutes to avoid irritation of the rectal mucosa. If abdominal distention is not relieved, the tube may be inserted every 2 to 3 hours.

175. Cathartics: Castor oil, cascara, phenolphthalein and bisacodyl.

177. Critical Thinking Exercise Adam, 1 year old infant was admitted in the hospital due to fever with temperature of 38 C, vomiting and diarrhea for 2 days duration. The nurse reported that the infant defecated 3 times as many stool as usual with watery consistency. Initially, it is apparent that the child is mildly dehydrated because of stool losses secondary to acute infectious diarrhea. What appropriate nursing care plans could you formulate for Adam. Supplement necessary assessment findings significant to the patient’s case. Eve, 15 year old rider, was admitted in the hospital due to vehicular accident. She reportedly loss her consciousness when she was brought to ER thus upon admission, she was placed initially on NPO. After a few days, on a balance skeletal traction to treat fracture. She does not want to eat because according to her, she lost her appetite every time she sees other patients. She had not defecated also for 5 days already. Formulate appropriate nursing care plan for Eve. Supplement necessary assessment findings significant to the patient’s case.