Duhok Polytechnic University

1st stage/ 2nd Semester

Fundamental Of Nursing

Bowel Elimination

Prepared By
Nursing Team
ANATOMY OF THE GASTROINTESTINAL TRACT(GIT)
Elimination:-is the complete removal or destruction of
something.
Factors affecting bowel elimination include:-
• Age
• Diet and fluids:- Foods high in fiber help keep
stool moving through the intestines
• Exercise and activity:-Movement and
exercise help to move stool through the
bowel.
• Drugs:- laxatives
• Disability
1.Administer a large-volume cleansing enema:-
Cleansing enemas are given to remove feces from the
colon.
Equipment
• Solution as ordered by the physician at a temperature of
105 F to 110 F (40C to 43C) for adults in the prescribed amount.
• Disposable enema set, which includes a solution container and tubing
• Water-soluble lubricant
• IV pole
• Waterproof pad
• Bath thermometer (if available)
• Bath blanket
• Bedpan and toilet tissue
• Disposable gloves
• Additional PPE , as indicated
• Paper towel
• Washcloth, soap, and towel
Implementation , Nursing Intervention
1. Verify the order for the enema. Bring necessary equipment
to the bedside stand or over bed table.
2. Perform hand hygiene and put on PPE, if indicated.
3. Identify the patient.
4. Provide patient privacy.
5. Explain what you are going to do and why you are going to
do it to the patient.
6. Discuss where the patient will defecate. Have a bedpan,
commode, or nearby bathroom ready for use.
bedpan commode
7. Warm solution in amount ordered, and check temperature
with a bath thermometer, if available and test on inner wrist.
8. Add enema solution to container.
9. Adjust bed to comfortable
working height, usually elbow
height of the caregiver .

10. Position the patient on the

left side (Sims’ position). Place
a waterproof pad under the
patient’s hip.

11. Put on nonsterile gloves.

12. Elevate solution so that it is on higher than 18 inches (45
cm) above level of anus. Hang the container on an IV pole .

13. Lubricate the end of the rectal

tube 2 to 3 inches (5 to 7 cm).
14. Lift buttock to expose anus. Slowly and gently insert the
enema tube 3 to 4 inches (7 to 10 cm) for an adult. Direct it at
an angle pointing toward the umbilicus, not bladder. Ask
patient to take several deep breaths during insertion tube.

15. If resistance is met while

inserting tube, permit a small
amount of solution to enter,
withdraw tube slightly, and then
continue to insert it.
Do not use force to insert the
tube.
16. Introduce solution slowly over a period of 5 to 10 minutes.

17. Clamp tubing of the lower container if patient has desire to

defecate . Instruct the patient to take small, fast breaths .

18. Remove additional PPE. Perform hand hygiene

19. When patient has a strong urge to defecate, place him or
her in a sitting position on a bedpan or assist to commode or
bathroom . Offer toilet tissues , if not in patient’s reach.

20. Put on gloves and assist patient with cleaning of anal area.
Offer washcloths, soap, and water for handwashing. Remove
gloves.

21. Leave the patient clean and comfortable.

22. Perform hand hygiene

23. EVALUATION
A. The expected outcome is met when the patient expels
feces.
B. The patient decreased discomfort.
C. Abdominal distention is absent; and the patient remains
free of any evidence of trauma to the rectal mucosa .
24. DOCUMENTATION
A. Document the amount and type of enema solution used.
B. Amount, consistency, and color of stool.
C. Pain assessment rating.
D. Assessment of perineal area for any irritation, tears, or
bleeding.
2.Administer a small-volume cleansing enema.