Bowel elimination

• Peristalsis

  stool movement of waste in intestines, occurs every 3-12 minutes
• Defecation

  bowel movement / emptying of large intestine
• Achalasia

  absence of peristalsis in lower esophagus, impairs patient swallow
• Digestion

  churning of food
• Dyspepsia

  indigestion
• Flatus

  intestinal gas
• Small intestine


  Duodenum, jejunum, ileum

  Responsible for digestion of food/ absorption of nutrients into blood stream
• Large intestine

  “the colon”

  Responsible for bowel elimination/ absorption of water/ formation of feces
• High Fiber Foods:

  whole grains/bran, dried peas/beans, fruits/ veggies
• Constipating Foods

  processed cheese, lean meat, eggs, pasta, rice, white bread, iron/calcium supplements
• Laxative Effects


  prunes, bran, chocolate, spicy food, coffee, alcohol
• Gas Producing Foods

  onions, cabbage, beans, cauliflowers
• Changes in Older Adults

  * Constipation is common / can be chronic

  * Slow motility [ causes diarrhea/ fecal incontinence ]

  * Decrease muscle tone

  * Decrease absorption

  * Decrease mucous secretion
• Bed Pan


  Start supine, then fowlers or High fowlers once bed pan is placed
• Distended abdomen

  caused by fluid (ascites), severe constipation, flatus
• Inspection, Auscultate, Palpate

  [ start right lower quadrant, listen for 5-35 second each quadrant ] If cannot listen to bowel movements after 2 minutes, bowelsounds are considered Absent
• Hyperactive

  intense with increased frequency
• Hyperactive caused by

  diarrhea
• Hypoactive

  diminished bowel motility
• Hypoactive caused by

  constipation
• Black, tarry stools mean.

  upper GI bleed
• Bright red, frank blood

  lower GI bleed
• Occult blood

  blood that is hidden in the stool or cannot be seen on gross examination

  [ can be detected by screening test such as fecal occult blood testing, need 3 consecutive bleeding conditions ] Avoid red dye. beets

  * some meds may create false positive for occult blood test such as: warfarin, ferrous sulfate, prednisone
• Gross blood

  blood that can be seen
• Stool for C. Diff

  detects parasites RN responsible for collection of stool, labeling, and taking to lab
• Stool for C. Diff Educate

  want to void first, defecate in container (bed pan/ commode), let nurse know immediately, take to lab right away. if cannot take to lab right away may freeze stool
• Culture specimen

  get culture first then administer antibiotics
• for esophagus treatment

  numbing of throat occurs, so we want to assess gag reflex prior to starting food/drinks, NPO 8-10 hours prior, require informed consent]
• Medication Consideration

  Aspirin

  could cause occult blood

  Educate about avoiding red- dye foods, beets
• Medication Consideration

  Iron

  can make black stool
• Abdominal CT Scan

  with or without contrast, done for upper GI, for renal impairmentTypically: NPO 4 hours prior, need informed consent
• Endoscopic Studies


  organs, cavities within GI tract
• Esophagogastroduodenoscopy

  esophagus to stomach
• Colonoscopy

  large intestine through anus
• Sigmoidoscopy

  sigmoid colon, rectum [may need colon prep]
• Upper Gastrointestinal Series (UGI) & Small Bowel Series (SBS)

  small intestine, esophagus, stomach both. take barium, NPO prior, informed consent
• Barium Enema

  large intestine, barium through enema, x-rays needed, NPO prior, informed consent, afterwards drink lost of fluids
• Abdominal Ultrasound

  noninvasive, NPO 8 hours prior, don’t want food when visualizing the stomach, want empty tummy
• Magnetic Resonance Imaging (MRI)


  detailed image of tissues, some patients require sedation for comfortability, teach safety, implanted metals, screen for pregnancy, if contrast used monitor IV site
• Barium

  chalky, taken prior to testing, stool should be grayish/ white, can get hard and constipation/ impaction may occur from lack of fluids, encourage 1-2 Liters of fluid (best is water), may need laxative, but if no bowel movement 2 days after, notify provider