FECAL

ELIMINATION
CONCEPTS
Defecation
Feces
Factors that Affect Defecation
Fecal Elimination Problems (Constipation,
Fecal Impaction, Diarrhea, Bowel
Incontinence, Flatulence)
Enema
Ostomy and Ostomy Management
Changing a Bowel Diversion Ostomy
Appliance

Defecation or Bowel Movement
Expulsion of feces or stool from the anus and
rectum
FECES- made about 75% of water and 25%
solid materials


Characteristics of Normal and Abnormal
Feces
CHARACTERISTI
CS
NORMAL
Color ADULT: brown
INFANT: yellow
Consistency Formed, soft, semisolid, moist
Shape Cylindrical about 2.5 cm in
diameter in adults
Amount Varies with diet (100-400g/day)
Odor Aromatic: affected by ingested
food and persons own bacterial
flora
Frequency varies; usual range 1-2/day to
every 2-3 days.
Factors that Affect Defecation
Developmental stage
Diet
Fluid
Activity
Defecation habits

Fecal Elimination Problems
Constipation
Fecal Impaction
Diarrhea
Bowel incontinence
Flatulence

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Education, Inc.
Constipation
Decreased frequency of defecation
Hard, dry, formed stools
Straining at stools
Painful defecation
Causes include:
Insufficient fiber and fluid intake
Insufficient activity
Irregular habits
Nursing Interventions
Have adequate fluid intake -1.5-2L
High- fiber diet.
Establish regular pattern of defecation
Respond immediately to urge to defecate
Minimize stress.
Have adequate activity & exercise.
Assume sitting or semi squatting position
Administer laxatives as ordered
Copyright 2008 by Pearson
Education, Inc.
Copyright 2008 by Pearson
Education, Inc.
Fecal Impaction
Mass or collection of hardened feces in folds
of rectum
Passage of liquid fecal seepage and no
normal stool
Causes usually:
Poor defecation habits
Constipation
Manual extraction or fecal disimpaction as
ordered.
Increase fluid intake.
Sufficient bulk diet.
Adequate activity & exercise.

Copyright 2008 by Pearson
Education, Inc.
Nursing Interventions
Copyright 2008 by Pearson
Education, Inc.
Diarrhea
Passage of liquid feces and increased
frequency of defecation
Spasmodic cramps, increased bowel sounds
Fatigue, weakness, malaise, emaciation
Major causes:
Stress, medications, allergies, intolerance of food
or fluids, disease of colon
Replace fluid & electrolyte losses.
Provide good perianal care.
Promote rest.
Diet
Small amt of bland foods
Low fiber diet
BRAT (banana,rice am, apple, toast)
Avoid excessively hot/cold foods.
Potassium-rich foods/fluids (banana,gatorade)
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Education, Inc.
Nursing Interventions
CAUTION:
Do not administer antidiarrheal at the start
of diarrhea. It is the bodys protective
mechanism to rid itself of bacteria &
toxins.
Copyright 2008
by Pearson
Education, Inc.
Copyright 2008 by Pearson
Education, Inc.
Bowel Incontinence
Loss of voluntary ability to control fecal and
gaseous discharges
Generally associated with:
Impaired functioning of anal sphincter or nerve
supply
Neuromuscular diseases
Spinal trauma
Tumor
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Education, Inc.
Flatulence
Excessive flatus in intestines
Leads to stretching and inflation of intestines
Can occur from variety of causes:
Foods
Abdominal surgery
Narcotics
Nursing Interventions
Avoid gas- forming foods.
Provide warm fluids to drink.
Early ambulation among postoperative clients.
Adequate activity & exercise.
Limit carbonated beverages, use of drinking
straws & chewing gum.
Carminative enema as ordered.


Copyright 2008 by Pearson
Education, Inc.
Copyright 2008 by Pearson
Education, Inc.
Measures to Maintain Normal
Fecal Elimination Patterns
Privacy
Timing
Nutrition and fluids
Exercise
Positioning
BOWEL
DIVERSION
OSTOMIES
Ostomy
TYPES:
1. Gastrostomy
2. Jejunostomy
3. Ileostomy
4. Colostomy
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Stoma Care for Clients with
an Ostomy
Normal stoma should appear red and may bleed
slightly when touched
Assess the peristomal skin for irritation each
time the appliance is changed
Treat any irritation or skin breakdown
immediately
Keep skin clean by washing off any excretion
and drying thoroughly
Protect skin, collect stool, and control odor with
an ostomy appliance
Copyright 2008 by Pearson
Education, Inc.
Changing a Bowel Diversion
Ostomy Appliance: Skill 49-2
Copyright 2008 by Pearson
Education, Inc.
Changing a Bowel Diversion
Ostomy Appliance: Skill 49-2
THANK YOU!