LOWER DIGESTION SYSTEM APPLICATIONS

LOWER DIGESTION SYSTEM

APPLICATIONS

ISTANBUL GELISIM UNIVERSITY

BASIC PRINCIPLES AND PRACTICES OF NURSING II

Assist. Prof. Dr. Funda Karaman

INTESTINAL SYSTEM

Parts of intestinal system

Cecum

Colon

Rectum

Anus

GASTROINTESTINAL SYSTEM EVALUATION

Listening to the bowel sounds; listen each

parts for at least 15 seconds.

0-4: Hypoactive

4-12: Normal

Above 12: Hyperactive

Bowel Elimination (Defecation)

◊ Bowel Elimination (Defecation) is a natural process by which the soiled waste products of digestion (feces or stool) are eliminated from the bowel.

Psychological/ PhysiologicalFactors Affecting Elimination

Positive factors◊ Stress-free environment

◊ Good bowel habits

◊ Fiber foods

◊ Normal Fluid Intake

◊ Exercise

◊ Adequate provision of squatting position

◊ Proper use of laxatives

Negative factors

Emotional Stresses

Carbohydrate and Fat-

rich Diet Habits

Reduction of liquid

intake

Inactivity

Age

Lack of adequate squatting

position

Next month of pregnancy

Medications

General anesthesia

Pain

Common Bowel Elimination

Problems

1) Constipation: Infrequent bowel movements,

difficulty passing stools, excessive straining,

inability to defecate at will, and hard feces

2) Diarrhea: an increase in the number of stools and

the passage of liquid.

3) Fecal Impaction: a result of constipation; collection

of hardened feces wedged in the rectum

4)Anal Incontinence: inability to control passage of

feces and gas from the anus

5) Abdominal distention : gas; can cause

abdominal distention and severe, sharp pain

CONSTIPATION:

Constipation is not a disease but a subjective

symptom

Normal elimination is three per day or once

in three days

Two or fewer bowel movements per week are

described as constipation

Why Does It Happen?

Not being active

Not enough water or fiber in your diet

Resisting the urge to feces

Stress

Overuse of laxatives

Some medications (especially strong pain drugs such

as narcotics, antidepressants, and iron pills)

Pregnancy

Nursing Interventions

Check on the usual pattern of elimination, including

frequency and consistency of stool

Encourage the patient to take in fluid 2000 to 3000 mL/day,

if not contraindicated medically.,

Assist patient to take at least 20 g of dietary fiber (e.g., raw

fruits, fresh vegetable, whole grains) per day.

Encourage a regular period for elimination.

Urge patient for some physical activity and exercise.

DIARRHEA

Causes of diarrhea;

Infection, inadequate hygiene

Psychological reasons,

Some foods,

Medicines

The most important principle in diarrhea; to put back the liquid and electrolytes as soon as possible.

Loss of fluid is prevented by IV or oral administration.

Nursing interventions

Factors causing / affecting diarrhea are assessed,

Weigh patient daily and note decreased weight.

Encourage the patient to take in fluid 2000 to 3000 mL/day, if not

contraindicated medically.,

Monitor and record intake and output;

The laboratory results (especially the electrolyte status) are

evaluated,

Evaluate dehydration by observing skin turgor

Provide perianal care after each bowel movement

FECAL IMPACTION

It may be caused by long standing

constipation and some medications used.

Symptoms are loss of appetite, abdominal

tenderness, nausea and vomiting.

Nursing interventions

Help for the patient's regular defecation,

Measures to prevent constipation should be taken

Oily enema can be done but doctor shoud write

The last step is to intervene with the finger.

The intervention is done by the doctor

ANAL INCONTINENCE

Causes of anal incontinence

Spinal cord injury

Tumor in anus sphincter muscles

Birth complication

Nursing care

Provide perianal care

Give education and encourage a regular period for elimination.

ABDOMINAL DISTENSION

Abdominal distension is the process of

increasing abdominal pressure resulting in

increased pressure in the stomach and the

abdominal wall.

Normally, the individual has about 150 cc of

gas in his or her body (stomach and

intestine).

This gas is removed by mouth and anal route.

in patient;

Abdominal fullness

Strain

Pain, cramp

Respiratory distress is seen.

If the patient can not produce gas spontaneously, a rectal tube is applied.

Bowel Elimination Administrations

1-Rectal Tube Administration

2-Enema Administration

3- Removal of Fecal Impaction

4-Giving the patient a bedpan

5-Bowel Training

1-Rectal Tube Administration

In case of excessive gas in the intestines,

this is an application for the removal of

this gas.

The rectal tube is selected as appropriate

for the age of the patient. in adult people

are used 22-30 Fr., in children are used 16-

24 Fr.

Patient is given sims position or left lateral

position

The vaseline-infused tube is inserted into

the patient's rectum without force (10-12

cm in adult, 5-7 cm in child).

To control the gas outlet, the rectal tube is

placed in a water-filled bottle.

* Rectal tube is removed after being kept

for 15-20 minutes.

A rectal tube may be placed to relieve flatulence(excess gas in the intestines) if the gas cannot be passed naturally. The small bag connected to the end of the rectal tube is used to collect any liquid stool that may escape with the flatus.

Important points;

To check doctor’s order

Explain procedure to patient

Provide privacy

Document patient's response to the

procedure.

2-Enema Administrations

An enema

administration is a

technique used to

stimulate stool

evacuation.

It is a liquid treatment

most commonly used to

relieve severe

constipation.

CLEANSING ENEMA

41-43°C Children receive between

150-500 cc of solution

45 cm

5-7 cm

Other form:

Rapid enema (libalax);

Important points:

The enema solution, the patient should be

kept inside 10-20 min.

Patient, do not go to the toilet immediately.

Enema should not be done more than 3

times.

3. REMOVAL OF FECAL IMPACTION

PURPOSE:

To remove hardened stools from the rectum

to prevent interference with the normal

passage of feces.

4-Giving the patient a bedpan

Bedpan is an object used for the toileting of a

bedridden patient in a health care facility,

usually made of a metal, glass, or plastic

receptacle.

A bed pan can be used for both urinary and

fecal discharge

Many patients may be confined to a bed

temporarily as a result of a temporary

illness, injury, or surgery, thereby

necessitating the use of a bed pan.

Important points:

Explain procedure to patient

Provide privacy

Position

Provide perianal care

5. Bowel Training

To prevent constipation and achieve control of bowel evacuation on a regular basis.

Encourage maximum mobility and physical activity within the

limits of the patient's ability.

Encourage adequate fluid intake (30 mL/kg body weight per

day) each day unless contraindicated.

A well-balanced diet taken at regular times each day will

facilitate success with a bowel program.

For the success of a bowel program, it is important to

establish a regular evacuation time each day.

Laxatives or enemas used on a routine basis leads to loss of

natural, normal bowel habit and can inhibit the success of a

bowel program.

Narcotics and antidepressants have strong anticholinergic

properties resulting in constipation.

A daily bowel movement is not necessary but time between

bowel movements should not exceed three days.

Teach patient to respond quickly when urge is felt to stool.

Videos

https://www.youtube.com/watch?v=4_O

4TngV5ac

https://www.youtube.com/watch?v=iJvKx

xn40zE

https://www.youtube.com/watch?v=TYQ-

Z8yesB0

https://www.youtube.com/watch?v=Bzvz

COu_l5c

References

Ay F. A. (2013). Basic Concepts And Skills

In Health Practices. Nobel Medical

Bookstore, Istanbul.

Astı T. A., Karadag A. (2016). Nursing

Fundamentals Nursing Science and Art.

Academy Press And Publishing, Istanbul.