Transcript Bowel Elimination Tool (BET)

By
Purwaningsih
OBJECTIVES
Describe the normal physiology of
bowel elimination
Recognize causes of
constipation
Discuss assessment and
interventions to achieve nursing
outcomes for bowel elimination
GI Tract is a series of hollow mucous membrane lined
muscular organs
Purpose is to absorb fluids & nutrients, prepare food for
absorption & provide storage for feces
GI Tract Anatomy
 Mouth
 Esophagus
 Stomach
 Small Intestine
 Large Intestine
 Rectum
SMALL INTESTINE
• Made up of three parts: ileum,
jejunum, and duodenum.
• Main function is absorption
Small INTESTINE
intestine
SMALL
COLON
 3 Divisions: Ascending, Transverse,
Descending
 Colon Functions: Absorption, Protection,
Secretion, & Elimination (stool and
flatus)
RECTUM
Sigmoid colon
Storage of feces
Length varies with age
When fecal mass or flatus moves into rectum, it
distends and defecation begins
 Process involves involuntary (Internal sphincter)
and voluntary control (external sphincter)
 Valsalva Maneuver- voluntary contraction of
abdominal muscles
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Physiology – Bowel Elimination
GI Motility
Enzyme breakdown
Peristalsis
Gastrocolic Reflex
Mucosal Transport
Fluids & Electrolytes
Waste
(Bisanz, 2007)
Physiology – Bowel Elimination
Defecation Reflex
• Sphincters
• CNS Impulses
• Rectal Distention
• Mechanical Assistance
Anal Sphincter Muscles
(Bisanz, 2007)
Characteristics – Bowel
Elimination
 Frequency
 Quantity
 Quality
 Consistency
 Ease of Passage
Tools for Stools
Bristol Stool Scale
http:// en.wikpedia.org./wiki/Bristol_stool_Chart
Constipation Scoring System
http://www.ncbi.nlm.nih.gov/pubmed/864957
Factors Affecting Bowel
Elimination
o Age
o Infection
o Diet
o Fluid Intake
o Physical Activity
o Psychological factors
o Personal Habits
FACTORS AFFECTING BOWEL
ELIMINATION
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Position during Defecation
Pain
Surgery and Anesthesia
Medications
Common Bowel Elimination Problems

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Constipation
Impaction
Diarrhea
Incontinence
Flatulence
Hemorrhoids
CONSTIPATION
Definition: decreased normal frequency of
defecation accompanied by difficult or
incomplete passage of excessively dry stool
(Wilkinson, J.M., 2005)
Causes - Constipation
 Poor Intake
Fluids
NPO – tests, surgery
Choices – juice, water
Positioning


Fiber
Menu choices – fresh fruit, whole grains
Causes - Constipation
Orthopedic Insult

Casts, Traction


Pain with movement
Assistive devices
Other diseases
Causes - Constipation
 Open Door Policy

↓ Privacy – visitation policy

Bathroom vs. Commode

Disruption of Routine

Therapy

Tests/Surgery
CAUSES - CONSTIPATION
Pain Medications
Opiates – P.O. or PCA
Other medications

Antacids with aluminum, anticholinergics,


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calcium channel blockers, phenothiazines,
diuretics, sedatives, etc.
(Hinrichs, Huseboe, Tang, & Titler, 2001)
LAXATIVES (+/-)
Last resort:


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Bulk-forming →
Stool softeners →
Osmotic Laxatives →
Stimulants →
Suppository/Enema
(Hinrichs, Huseboe, Tang, & Titler, 2001)
ASSESSMENT
AUDITS:
• Diagnosis
• Postoperative Day
• Medications +/• Bowel Movement
Recorded
INTERVIEWS:
•
Nurses
•
Leadership
•
Patients
INTERVENTIONAL TOOL
Pictorial Diary
 Fluids – 8 servings
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Whole grains – 3 servings
Fruits/vegetables – 5 servings
Exercise – 3-4 x/day
Bowel Movement - record
INTERVENTIONAL TOOL
Bowel Elimination Tool (BET)
INTERVENTIONAL TOOL
Directions:
Mark your selections with an X
Choose:
8 Glasses of Fluid:
Best: Water or Juices; Decaffeinated drinks
3 Servings of Whole grain breads or cereal:
Best: Whole wheat, oatmeal, bran cereals
5 Servings of Fruits or Vegetables:
Best: Fresh fruits, vegetables with skin
Exercise – 3-4 times per day
Best: Walking, physical therapy,
or exercises in bed
Record your BM
Difficult___ Easy___
Soft___ Hard___
Complete__
NURSING OUTCOMES
1) Cooperates for Bowel Management
•
P
O
O
artners for care – uses tool
•
ut of bed/ exercises – 3-4 x day
•
verview of diet
>15 gm fiber; >1500 cc fluids
•
P
rivacy and respect – toileting regime
(Moorhead, 2008)
NURSING OUTCOMES
2) Constipation alleviated as indicated:
Elimination pattern in expected range
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Stool soft and formed (soft/hard)
Stool easy to pass (easy/difficult)
Amount adequate for diet (yes/no)
Feeling of evacuation (yes/no)
(Moorhead, 2008)