Chapter 47: Bowel Elimination and GI Care

Bowel Elimination and GI Care begins by establishing the scientific knowledge base regarding the gastrointestinal tract, detailing the anatomy and function of the mouth, esophagus, stomach, small intestine, and large intestine in digestion, absorption, and waste elimination. The text explores the complex variables influencing bowel function, including developmental stages, dietary fiber and fluid intake, physical activity levels, psychological factors like stress, and the impact of surgery, anesthesia, and medications such as opioids and antibiotics. Significant focus is placed on common bowel elimination problems, clearly defining constipation as a symptom rather than a disease, and discussing fecal impaction, diarrhea, incontinence, flatulence, and hemorrhoids. A major section is dedicated to bowel diversions, differentiating between ileostomies and colostomies based on the location of the stoma and the consistency of the effluent, while also covering alternative procedures like ileoanal pouch anastomosis. The nursing process serves as the framework for care, detailing assessment strategies that include nursing history, physical examination of the abdomen and rectum, and the inspection of fecal characteristics using tools like the Bristol Stool Form Scale. The chapter also outlines diagnostic testing procedures, including fecal occult blood tests (gFOBT and FIT) and endoscopic examinations like colonoscopies. Finally, the summary synthesizes critical nursing interventions, ranging from health promotion and colorectal cancer screening to acute care skills such as bedpan assistance, the administration of laxatives and antidiarrheals, nasogastric tube insertion for gastric decompression, and the administration of various cleansing and retention enemas. It concludes with restorative care practices, emphasizing skin integrity, bowel training programs, and the education required for patients managing new ostomies.