LOWER DIGESTION SYSTEM APPLICATIONS ISTANBUL GELISIM UNIVERSITY BASIC PRINCIPLES AND PRACTICES OF NURSING II Assist. Prof. Dr. Funda Karaman
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
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https://www.youtube.com/watch?v=iJvKx
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https://www.youtube.com/watch?v=TYQ-
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https://www.youtube.com/watch?v=Bzvz
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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.