Elimination-Homeostasis

Deborah Naccarini, DNP, RN, CNE

Notre Dame of Maryland University
Priorities of Care for Bowel Elimination

• Assessments
• Priority Nursing
Diagnoses
• Interventions
• Evaluation
 Hirschprung’s Pathophysiology
Absence of ganglion cells
Lack of innervation; peristalsis
Accumulation of stool proximal
to affected area
Megacolon
Internal rectal sphincter fails to
relax  Obstruction of stool
and flatus
Intestinal distention 
ischemia
Enterocolitis  sepsis  death
 Hirschprung’s Disease
• Diagnostic
Evaluation
– Presentation
 Hirschprung’s Disease

• Diagnostic Evaluation
– Assessment

– Barium enema
– Suction rectal biopsy/full
thickness rectal biopsy
• Surgical Treatment
 Hirschprung’s Disease

• Nursing Care
• Assessment
priority
• Interventions
• Teaching
 Encopresis
• Definition
• Signs and Symptoms
 Encopresis/Enuresis

• Diagnosis
• Collaborative
Care
– Medical
treatment
– Nursing care
• Teaching
• Association
with Enuresis
 Enuresis

• Definition
– Types
• Diagnostic
Evaluation
 Enuresis
• Nursing Care
– Assessment
– Interventions
• Medical Intervention
Hypertrophic Pyloric Stenosis

• Hypertrophy of the circular

pylorus muscle – it
becomes long and narrow.
• Usually presents between 2
weeks and 3 months of
age.
• Signs and Symptoms
 Hypertrophic Pyloric Stenosis

• Usually starts about 2-3 weeks of age and

rarely after 3 months of age
• S/S

• PE:
 Hypertrophic Pyloric Stenosis
• Diagnostic Tests
– Labs
– Abdominal US
– UGI
 Hypertrophic Pyloric Stenosis
• Pyloromyotomy is the surgery of choice
– The circular muscle fibers are released to allow the passage of
food and fluid.
– https://www.youtube.com/watch?v=zVC7Vk1H_R4
– https://www.youtube.com/watch?v=a5d2r9qRRU8
Hypertrophic Pyloric Stenosis
• Nursing Dx
– Deficient Fluid Volume r/t _________________
– Imbalanced Nutrition: Less than Body req r/t __
– Sleep Pattern Disturbed r/t ________________
– Pain r/t _______________________________
• Nursing Management
– Preoperative and Postoperative Care
 Hypertrophic Pyloric Stenosis

• Nursing Management
– Preoperative and Postoperative care