ELIMINATION

DUMIP-IG, MARICEL
GREGORIO, KRISTINE
MILAGROSA, NINA JESUSA

BSN1-B
• Elimination is the complete removal or destruction of something.
• The expulsion of waste from body.
BOWEL ELIMINATION
• It is also known as DEFECATION.
• It is the act of expelling feces from the body. All the components of the gastrointestinal tract, especially
the components of the large intestine must function in a coordinated manner.
• GI tract is a series of hollow mucous membrane-lined muscular organs. These organs absorbs fluid and
nutrients, prepare food for absorption and use by body cells, and provide for temporary storage of
feces. The GI tract absorbs high volumes of fluids, making fluid and electrolyte balance a key function of
the GI system.
 MOUTH
Digestion begins with mastication.

ESOPHAGUS
Peristalsis moves food into the
stomach.

STOMACH
Stores food; mixes food, liquid, and
digestive juices, moves food into
small intestine.

SMALL INTESTINE
Duodenum, jejunum, and ileum

LARGE INTESTINE
The primary organ of bowel
elimination

ANUS
Expels feces from the rectum
 FACTORS AFFECTING BOWEL
ELIMINATION

AGE POSITION DURING

DEFECATION

DIET PAIN

FLUID INTAKE PREGNANCY

PHYSICAL ACTIVITY SURGERY AND

ANESTHESIA
PSYCHOLOGICAL
FACTORS MEDICATIONS

PERSONAL HABITS DIAGNOSTIC TESTS

COMMON BOWEL ELIMINATION
PROBLEMS
CONSTIPATION
Constipation occurs when stool moves through the large intestine too slowly or remains in large intestine for too long.

It is a symptom, not a disease, and there are many causes:

• IMPROPER DIET
• REDUCED FLUID INTAKE
• LACK OF EXERCISE
• CERTAIN MEDICATIONS
• EXCESSIVE DRINK OF TEA AND COFFEE

Signs of constipation:
• INFREQUENT BOWEL MOVEMENTS (less than three per week)
• HARD, DRY STOOLS THAT ARE DIFFICULT TO PASS
IMPACTION
Fecal impaction results when a patient has unrelieved constipation and is unable to expel the hardened
feces retained in the rectum. In cases of severe impaction, the mass extends up into the sigmoid colon. If not
resolved or removed, severe impaction results in intestinal obstruction.
Patients are dehydrated or too weak or unaware of the need to defecate, and the stool becomes too hard
and dry to pass.

Signs and Symptoms:

• FEELING OF FULLNESS OF RECTUM AND ABDOMEN
• SWELLING OR TIGHTNESS OR BLOATING OF ABDOMEN
• LOSS OF APPETITE
• NAUSEA AND VOMITING
INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a
patient’s body image. Physical conditions that impair anal sphincter function or large-volume liquid stools
cause incontinence. Impaired cognitive function often leads to incontinence of both urine and stool.

Causes:
• ANAL SPHINCTERS MUSCLE DAMAGE
• VAGINAL CHILDBIRTH
• DIARRHEA
FLATULENCE

Flatulence is the accumulation of excessive amount of gas in the GI tract leading to distension of the
abdomen.

Causes:
• Excessive swallowing of air with anxiety or rapid food or fluid ingestion
• Post operative patients because of effect of anesthesia
• Gas that diffuses from blood stream into the intestine
HEMORRHOIDS

Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.

Causes:
• INCREASED VENOUS PRESSURE FROM STRAINING AT DEFECATION
• PREGNANCY
• HEART FAILURE
• CHRONIC LIVER DISEASE
ASSESSMENTS

•ASSESS FOR S/S OF CONSTIPATION

–Decrease in frequency of bowel movements

–Consistency of stool
–Anorexia
–Abdominal distention and pain
–Feeling of fullness or pressure in rectum
–Straining during defecation

•ASSESS BOWEL SOUNDS

NURSING DIAGNOSIS

•(RISK FOR) CONSTIPATION R/T

–Opiate containing meds

–Decreased fiber intake
–Decreased fluid intake
–Recent anesthesia
–Stress
–Inactivity (immobility)
–Eating a large amount of dairy products

•Outcome: Pt will have a soft, formed stool in 24 hours.

THERAPEUTIC INTERVENTIONS

••Encourage fluid intake of at least 1500 ml/24hr

•Encourage activity: walk in hallway 4 times a day
•Encourage to defect whenever urge is felt
•Provide privacy
•Encourage to drink hot liquids in AM
•Administer laxatives or enemas as ordered
•Consult with HCP to check for impaction
•Teach to increase intake of foods high in fiber
•Teach importance of activity
•Teach reasons for changing opioid medication to a non-opioid medication
NURSING PROCESS
ASSESSMENT

ASSESSMENT FOR BOWEL ELIMINATION PATTERNS AND ABNORMALITIES INCLUDES A NURSING HISTORY,
PHYSICAL ASSESSMENT OF THE ABDOMEN, INSPECTION OF FECAL CHARACTERISTICS, AND REVIEW OF
RELEVANT TEST RESULTS. IN ADDITION, DETERMINE THE PATIENT’S MEDICAL HISTORY, PATTERN AND TYPES
OF FLUID AND FOOD INTAKE, MOBILITY, CHEWING ABILITY, MEDICATIONS, RECENT ILLNESSES AND
STRESSORS, AND ENVIRONMENTAL STATUS.
BRISTOL STOOL FORM SCALE
CHARACTERISTICS OF FECES
• NORMAL COLOR:
• Adult: brown
• Infant: yellow

• ABNORMAL COLOR:
• Clay or white: absence of bile pigment or diagnostic
study using barium
• Black or tarry: bleeding from GI tract, diet high in red
meat and dark green vegetables
• Red: bleeding from lower GI tract
• Pale: Malabsorption of fats, diet high in milk products
and low in meat
• CONSISTENCY
• NORMAL CONSISTENCY: Formed, soft, semisolid, moist

• ABNORMAL CONSISTENCY:
• Hard, dry, constipated stool
• Dehydration, decreased intestinal motility resulting from lack of fiber in diet, lack of exercise,
emotional upset, laxative abuse

• SHAPE
• NORMAL SHAPE: Cylindrical, about 2.5 cm (1inch) in diameter in adults
• ABNORMAL SHAPE: Narrow, pencil-shaped, or string likestool

• NORMAL AMOUNT:
• Varies with diet (about 100 to 400g per day)

• NORMAL ODOR: Aromatic, affected by ingested food and person’s own bacteria flora
• ABNORMAL ODOR: Pungent (sharply strong) caused by infection and blood
PHYSICAL ASSESSMENT

• MOUTH
• Inspect the patient’s teeth, tongue, and gums.

• ABDOMEN
• Inspect all four abdominal quadrants for contour, shape, symmetry, and skin color.
• Abdominal distention appears as an overall outward protuberance of the abdomen.
• Auscultate the abdomen with a stethoscope to assess bowel sounds in each quadrant.
• Percussion identifies underlying abdominal structures and detects lesions, fluid, or gas within the
abdomen.
• Gently palpate the abdomen for masses or areas of tenderness.
NURSING DIAGNOSIS
EXAMPLES OF DIAGNOSES THAT APPLY TO PATIENTS WITH ELIMINATION PROBLEMS INCLUDE THE FOLLOWING:
• Disturbed Body Image
• Bowel Incontinence
• Constipation
• Risk for Constipation
• Diarrhea
• Nausea
• Deficient Knowledge
• Acute Pain
• Toileting Self-care Deficit
PLANNING

• When planning care, synthesize information from multiple resources. Critical thinking ensures that the
plan of care integrates everything known about a patient and current clinical problems. Rely on
professional standards when possible.
• Help patients establish goals and outcomes by incorporating their elimination habits or routines as
much as possible and reinforcing the routines that promote health.
IMPLEMENTATION

• Teach them about proper diet, adequate fluid intake, and factors that stimulate or slow peristalsis such
as emotional stress.
• Teach them about the importance of establishing regular bowel routines, exercising regularly, and taking
appropriate measure when elimination problems develop.
• Promote Normal Defecation
• Sitting Position
• Positioning on Bedpan
How can you help someone use a bedpan?

1. Sprinkle a small amount of body powder on the rim of the bedpan to help with sliding. You can
use a bed pad under the bedpan for spills.
2. Help get the bedpan into position.
a. Have the person sit up or lift up the hips slightly and then slide the bedpan under the
person. Or if you have a helper, help the person lift his or her hips as your helper slides the bedpan
under the person's buttocks.
b. Or you can help the person turn to the side. Gently press the bedpan against his or her
bottom and then help them turn back onto the bedpan.
3. If you can leave the person alone safely, leave the room to give privacy.
After the person uses the bedpan

After the person uses the bedpan

1. Make sure to hold the bedpan in place and help the person roll off of it, away from you. Carefully
set the bedpan to the side.
2. Help the person wipe if needed.
3. Empty the bedpan into the toilet.
4. Rinse and wash the bedpan using a disinfectant diluted with water. It may help to use a small
sprayer that attaches to the toilet water supply. Dry the bedpan or let it air-dry.
5. Take off your gloves and throw them away.
EVALUATION

• When you establish a therapeutic relationship with a patient, the patient feels comfortable to discuss
the intimate details often associated with bowel elimination.
• Patients are less embarrassed as you help them with elimination needs.
• Patients relate feelings of comfort and freedom from pain as elimination needs are met within the limits
of their condition and treatment.
• Ask the patient to describe changes in diet, fluid intake, and activity to promote bowel health.
 WHEN TALKING ABOUT BOWEL HABITS, YOUR “NORMAL” IS
WHATEVER IS NORMAL FOR YOU. CONFUSED? YOU’RE NOT ALONE.

• Many people will tell you what they think are supposed to be normal bowel habits. However, studies
show having a bowel movement happens at a different frequency for everyone. If, for most of your life,
you have a bowel movement every day, that’s YOUR normal. Some people have a bowel movement
about three times a week, while others, only once a week. So, after all these years, you should know
what’s normal for you.
• Healthy bowel movements are those that allow you to empty your colon (sometimes called your
intestines) often enough that you don’t feel bloated or in pain, and you don’t have to strain hard to get
the job done.
THANK YOU FOR LISTENING 