Need for Fecal Elimination

Need for Fecal Elimination Understanding Namely the process of removing unused metabolic waste from the body in the form of feces through Anus Defecation occurs due to the gastro-colic reflex, namely the peristaltic reflex in the intestine large volume produced when food enters the stomach which causes defecation Anatomy of the lower digestive tract  Small intestine: duodenum, jejunum, ileum.  Cecum-ileocecal (connects the small intestine and large intestine to prevent regurgitation)  Colon: ascending, transverse, descending, sigmoid  Rectum: 4-6 inches.  Anal: 1-2 inches has internal and external sphincters. Digestion and defecation processes  The mouth, which is the initial place where food is digested mechanically and chemically with the help of teeth and saliva secretion (containing the enzyme ptyalin which can digest and soften food elements.  Esophagus, 25 cm long where food passes through the esophagus for 15 seconds. Muscle The circulation in the esophagus prevents air from entering and refluxing food  Stomach, In the stomach, food is stored and broken down mechanically and chemicals for digestion and absorption. Before leaving the stomachÿ food is converted into semifluidÿ chyme / chyme. The stomach secretes HCL, mucus, pepsin enzyme, vitamin B12 (helps the process of forming erythrocytes)  The small intestine is 6 meters long and 6 meters in diameter. Chyme/chyme is mixed with Digestive enzymes (amylase) travel in the small intestine  The intestine consists of 3 parts: - Duodenum and jejunum to absorb nutrients, electrolytes etc - The ileum plays a role in vitamins, Fe and bile saltsu  Large Intestine, Length 6 cm x 1.5-1.8 m  The colon consists of the ascending, transverse, descending and sigmoid  Main function: 1. Absorption of water, Na, Cl and glucose. 2. Protective / protects the intestinal wall from bacterial activity and from acid trauma produced by feces 3. Secretion and elimination Process that occurs in the colon  Haustral churning: the movement of mixing chyme to help absorb water (2.5 L) in 24 hours.  Colonic peristalsis: slow mixing waves by longitudinal and circular muscles and pushes the chyme into the colon 6. Rectum and anus Nursing care regarding the need for fecal elimination 1. Assessment a. Nursing history  Elimination pattern  Habits help defecate  Changes in bowel movements  Stool characteristics  Diet history  Fluid intake  Sports history  Operation history  Assess presence of colostomy, medication use, emotional state, social history Physical examination  Mouth: inspection of teeth & gums  Abdomen: inspect shape, symmetry, skin color, presence of mass, distension/tension. Abdominal auscultation: bowel sounds Abdominal palpationÿ mass, pain Abdominal percussionÿ lesions, fluid, gas, tumors/masses.  Rectum: inspection ÿ lesions, fistulas, inflammation, hemorrhoids, masses  Palpationÿ mass Laboratory & diagnostic tests  Endoscopy  Barium enema  Anoscopy: anal examination  Prostocopy: examination of the rectum  Pritosigmoidcopy: examination of the rectum & sigmoid colon  Colonoscopy: examination of the large intestine Fecal elimination therapy  Laxatives: suppository inserted 7.5-10cm within 30 minutes  Enema: fluid inserted into the rectum and sigmoid colon functions to helps expel feces and flatus  Colostomy: permanent/temporary surgery for elimination channels in the colon Nursing diagnoses a. Constipation b/d  Inadequate fiber diet  Immobilization/inadequate physical activity  Inadequate fluid intake  Pain during defecation  Changes in routine habits (dietary input)  Laxative abuse  Delay defecation  Use of drugs that cause constipation Nursing Planning Objective  Recognize normal elimination  Return to normal defecation habits  Appropriate fluids and foods  Feeling of comfort is fulfilled  Skin integrity can be maintained  Good self-concept Evaluation criteria  Soft stool consistency  Normal defecation pattern  There is no abdominal distention, flatus and fullness before defecation  Comfortable defecation Nursing interventions  Record and assess the color, consistency, amount and time of defecation  Assess and record bowel movements  Provide adequate fluids  Provide a diet high in fiber and avoid foods containing gas  Collaborative administration of laxatives, enemas