Elimination Pattern (Fecal) MSP

Elimination Pattern
OBJECTIVES
1. Define Elimination Pattern
2. Describe factors that can alter normal elimination
pattern.
3. Discuss common problem of Elimination.(Urinary or
fecal)
4. Identify Nursing Interventions for Common
Problems of Elimination. (Urinary or fecal)
Definition
Elimination of wastes products or digestion from the
body in form of feces or stool is called “Bowel
Elimination”
Characteristic of normal
and abnormal Feces
• Color
• Odour COCA
• Consistency
• Amount
• Shape
• Constituents
Factors Affecting the Bowel
Elimination
• Development stages (meconium, control at the age of 1 ½ or 2 ½
years, elderly constipation)
• Diet (gas, laxatives, constipation)
• Fluid
• Activity
• Psychological factors
• Defecation habit
• Medication (morphine, iron)
• Diagnostic procedure
• Anesthesia and surgery
• Pathological condition
• Pain
Common Problems of
Elimination
Constipation
It is a passage of hard, dry stool or the passage of no stool for a
period of time. It occurs when stool moves through large intestine
too slowly or remains in the large intestine for too long.
Causes
???? Discussion
Defining characteristics
Decrease Frequency
Hard, dry stool
Painful defecation
Pain, anorexia, nausea, headache Etc
Cont…
Fecal Impaction
Is the mass or collection of hard stool in the folds of the rectum.
Causes
???? Discussion
Passage of Liquid Fecal and no normal stool
Digital Rectal Examination(carefully because stimulation of the
vagus nerve in the rectal wall can slow the client’s heart)
Rectal pain but not able to pass
Anorexia, Nausea, Vomiting
Abdominal Distention
Cont…
Diarrhea
Is frequent evacuation of watery stool.
Causes
???? Discussion
Loose liquid stools, more than 3x per day. Urgency, cramping
Leads to weakness, malaise
Electrolytes imbalance
Cont…
Flatulence
Flatus is the accumulation of gas in the GI tract.
Causes:
• Gas enters the GI tract from 3 sources (swallowed air, bacterial
action on the chyme in the large intestine, gas producing food)
Gastric distention
Cont…
Fecal Incontinence
It is a loss of voluntary ability to control fecal and gaseous
discharges through the anal sphincter. It may occur at specific
time or may occur irregularly.
Causes
• Impaired functioning of the anal sphincter
• Neuromuscular disease
• Tumors of the external and sphincter muscle
Important Note: Fecal incontinence is an emotional distressing
problem leading to social isolation.
Cont…
Helminths
Are common parasitic worms that infest on the intestine such as hook worm, round
worm, pin worm and tape worm. They cause indigestion, intestinal inflammation,
intestinal obstruction and anemia.
Hook Worms:
Transmitted by the soil contaminated with the larvae that comes in contact with skin
or by the contaminated food or water that is ingested (less than1cm long)
Round Worms:
Enters body through contaminated food or drink. (25 cm long with a cylindrical
shaped body)
Pin Worms:
Most common worms among children. Female pin worms comes through the anal
opening and deposits over in the surrounding area causing the anal region to itch.
This leads to scratching, contamination of the finger nails and ultimately
reinfection by mouth (1.2 cm long)
Tape Worms:
Transmitted by uncooked beef or pork. (10 meter long with flat, segmented shaped
body)
Helminths
Pin Worms
Round Worms
Cont…
Hemorrhoids
Are dilated engorged veins in the lining of the rectum
External
Internal
Assessment
Subjective Data:
– Normal pattern identification
– Risk identification
– Dysfunction identification
Objective Data:
– Physical assessment
– Measure of abdominal girth
– Per rectal examination
– Diagnostic test and procedure
• Stool specimen
• Hem occult test
• Stool culture
• Direct visualization(Endoscopy Colonoscopy )
• Indirect Visualization(X ray )
How to Assess Feces
• Normal and Abnormal Stool
• Refer to e-book Page 1361 table 49-1
Nursing Diagnosis
• Constipation related to low roughage diet

• Diarrhea related to anxiety
• Bowel incontinences related to loss of sphincter
control
Nursing Goal
• Patient will set the regular bowel habit by the end of

48/ 72 hrs (LTG)
• Patient will drink 4 glass of water in 6 hrs.
Nursing Interventions
Promoting regular defecation
• Privacy
• Timing
• Nutrition and fluids
• Exercise
• Positioning
Administering Prescribed Medications
• Cathartics (contraindicated in nausea, cramps, vomiting or
undiagnosed abdominal pain)
• Suppositories
• Administering Enemas
Digital Removal of Fecal Impaction
Decreasing Flatulence
Bowel Training Programs
Abdominal Massage
Managing Diarrhea
 Drink at least 8 glasses of water per day to prevent
dehydration
 Limit foods that aggravates the problem
 Avoid alcohol, beverages with caffeine, and
excessive cold fluid which aggravates the problem
 Limit fatty foods e.g. dairy food and packaged
processed meat
 Provide anti diarrheal medication (Lomotil)
 Ingest foods with sodium and potassium
 Pay special attention to perineal hygiene
 Use soft toilet tissue or cotton balls if the perennial
area is irritated
 Discontinue medication or food that cause diarrhea
Wellness Teaching
Defecation
 Establish a regular exercise regime
 Include high fiber food such as vegetables and fruits
in the diet
 Maintain fluid intake of 2000ml to 2500ml per day
 Do not ignore the urge to defecate
 Allow time to defecate
 Avoid over the counter medication to treat
constipation and diarrhea
 Establish normal rotiune

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Elimination Pattern

• Constipation related to low roughage diet

• Patient will set the regular bowel habit by the end of

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