FECAL ELIMINATION

• Feces/STOOL


  Excreted waste products
• Large Intestine


  • 125 to 150 cm (50 to 60 in) long
• Parts of the Large Intestine

  • Cecum
  • Ascending colon
  • Transverse colon
  • Descending colon
  • Sigmoid colon
  • Rectum
  • Anus
• Ileocecal valve


  Regulates flow of chyme and preventing backflow into the ileum
• Functions of the Large Intestine

  • Absorption of water and nutrients
  • Mucoid protection of intestinal wall
  • Fecal elimination
• Flatus


  Largely air - by-products of carbohydrates
• Peristalsis


  Wave-like movement produced by muscle fibers
• Anal canal


  Bounded by external sphincter and internal sphincter, voluntarily controlled by somatic nervous system, involuntarily controlled by autonomic nervous system
• Rectum


  Contains vertical folds containing veins and arteries
• Hemorrhoids


  Distended veins due to repeated pressure
• Defecation


  1. Expulsion of feces from anus and rectum (Bowel movement)

  2. Facilitated by thigh flexion and sitting position
• Constipation


  Ultimate result of repeated inhibition to defecate
• Feces


  75% water and 25% solid material
• Normal Fecal Characteristics


  • Color: Brown (adult), Yellow (infant)
  • Consistency: Formed, soft, semisolid
  • Shape: Cylindrical
  • Odor: Aromatic - affected by ingested food and own bacterial flora
• Meconium


  First fecal material passed by a newborn (24 hours), dark green, tarry, odorless, and sticky
• Transitional stools


  Follow meconium for about a week, greenish yellow, containing mucus, and loose
• Gastrocolic reflex


  Increased peristalsis after food has entered the stomach, causes many people to defecate after breakfast
• Laxatives


  Stimulate bowel activity and assist in fecal elimination
• Fecal elimination problems


  • Constipation
  • Fecal impaction
  • Diarrhea
  • Clostridium difficile infection
  • Bowel incontinence
• Intestinal distention


  Presence of excessive flatus leading to stretching and inflation of the intestines
• Primary sources of flatus

  • Action of bacteria on chyme in the colon
  • Swallowed air
  • Gases that diffuse between the bloodstream and intestine
• Eructation (belching)


  Expellation of swallowed gas
• Administering an enema


  1. Client is in left lateral position while acutely flexing right leg to facilitate flow to the sigmoid and descending colon

  2. Materials: bath blanket, water-soluble lubricant, bedpan, clean gloves, tissue or gauze pad
• Enema


  A solution that distends and irritates intestinal mucosa causing increased peristalsis
• Classifications of enemas


  • Cleansing enema
  • Retention enema
  • Antibiotic enema
  • Antihelminthic enema
  • Nutritive enema
  • Carminative enema
  • Retrograde enema
• Ostomy


  Opening of GI tract, urinary tract, or respiratory tract onto the skin to divert and drain fecal material
• Types of ostomies


  • Gastrostomy
  • Jejunostomy
  • Ileostomy
  • Colostomy
• Classifications of ostomies


  • Temporary colostomy
  • Permanent colostomy

  Single stoma - created when one end is brought out through an opening onto the anterior abdominal wall

  Loop colostomy

  Divided colostomy

  Double-barreled colostomy
• Materials for changing a bowel diversion ostomy

  • Moisture-proof bag
  • Stoma measuring guide
  • Bedpan
  • Ostomy pouch
  • Clean gloves
  • Washcloth
  • Tissue or gauze pad
  • Tall closure clamp
• Single Stoma - created when one end is brought out through an opening onto the anterior abdominal wall
• Loop Colostomoy - loop of bowel is brought onto the abdominal wall

  • has two openings: a. Proximal or afferent - active b. Distal or efferent - inactove
• Divided Colostomy - has two edges of bowel but separated from each other
• Double-barreled Colostomy - proximal and distal loops are sutured
• Cleansing Enema - intended to remove feces
• Retention Enema - introduces oil and medication into the rectum and sigmoind colon to soften feces and lubricates rectum and anal canal
• Antibiotic Enema - treats infections locally
• Antihelmintic enema - kill helminths
• Nutritive enema - to administer fluids and nutrients
• Carminative enema - to expel flatus
• Carminative enema - the solution releases gas causing distention thus stimulating peristalsis