BAKERSFIELD COLLEGELICENSED VOCATIONAL NURSING PROGRAM1ST SEMESTER FUNDAMENTALSSCIENTIFIC BASIS FOR NURSING PRACTICECHAPTER 46 – BOWEL ELIMINATIONINTRODUCTIONRegular elimination of fecal waste products is essential for normal body functioning. Disturbances in a person’s normal elimination pattern, such as constipation or diarrhea are common in many different illnesses, or can be as a result of medical therapies, impaired gastrointestinal as well as other physiological functions. Clients often become dependent on the nurse’s ability to help maintain their bowel elimination needs.OBJECTIVESUpon completion of this unit, the student will be able to:A. Theory1. Define and appropriately use the terms associated with bowel elimination.2. Recall the role of the GI organs in digestion and elimination.3. List and discuss the psychological and physiological factors that influence the elimination process.4. List nursing DX’s related to alterations in elimination.5. Discuss the relationship between the structure and function of a colostomy and an ileostomy, and the nursing care required.6. Describe nursing implications for common diagnostic examinations of the GI tract.7. List the nursing measures aimed at promoting normal elimination.8. Discuss common bowel elimination problems which require nursing care.B. Laboratory1. Assess a client’s elimination pattern. 2. State how to perform a guiac test for occult blood.3. Review the procedure for administration of an enema.ASSIGNMENTA. Read Chapter 46 - Potter & Perry, Critical Thinking Exercises # 1, 2, and Review Questions.B. Study Guide for Chp. 46 Chapter 46Bowel Elimination Scientific Knowledge Base Nursing Knowledge Base:Factors Affecting Bowel Elimination Common Bowel Elimination Problems Bowel Diversions Temporary or permanent artificial opening in the abdominal wall Stoma Surgical opening in the ileum or colon Ileostomy or colonoscopy The standard bowel diversion creates a stoma Ostomies Loop colostomy Temporary in the transverse colon End colostomy Proximal end forms stoma and distal end is removed or sewn closed Double-barrel colostomy Bowel is surgically cut and both ends are brought through the abdomen Alternative Approaches Ileoanal pouch anastomosis  Pouch is a reservoir for wastes which are eliminated from the anus Kock continent ileostomy Small intestines forms a pouch which is emptied several times a day Macedo-Malone antegrade continence enema (MACE) A procedure developed for client who has neuropathic or structural abnormality ofthe anus. Nursing Process and Bowel Elimination Assessment Nursing history Physical assessment Laboratory tests Diagnostic examinationsNursing Diagnosis and Planning The nursing assessment will help you to select the appropriate nursing diagnosis. When planning goals and outcomes for your client, you can refer to the Bristol Stool Form Scale and fecal characteristics ImplementationsAcute Care Health promotion Promotion of normal defecation Sitting position Positioning on bedpan Privacy Medications Cathartics and laxatives Bulk forming, emollient or wetting, saline, stimulants, or lubricants Antidiarrheal agents Can be over the counter Can be opiates Enemas Cleansing Tap water Normal saline Hypertonic solutions Soapsuds Oil retention Others: carminative and Kayexalate  Inserting and Maintaining a Nasogastric Tube Purposes Decompression, enteral feeding, compression, and lavage  Maintaining patencyContinuing and Restorative Care Care of ostomies  Pouching ostomies  Bowel training Skin integrity Evaluation The fifth step in the nursing process. The effectiveness of care depends on how successful the client is in achieving goals and outcomes. Nursing interventions may be altered if