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Nursing Technologies > 6.2 Bowel Elimination > Flashcards

6.2 Bowel Elimination Flashcards

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1
Q

Bowel Elimination

A
  • Primary organ is Large Intestines
  • Function is to absorb water, form feces, expel feces
  • Peristalsis contractions occur every 3-12 minutes
  • Mass peristalsis occurs 4 times each 24 hours
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2
Q

Developmental Considerations

A
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3
Q

Infants

A
  • Stool consistency/pattern depend on breast feeding vs bottle fed
  • Breast fed have yellow/pasty stools 2-10 times a day
  • Formular pass 1-2 times a day, yellow/brown, seedy, and strong odor
  • No bowel movements several times a day is normal if stool is still soft in consistency
  • Diarrhea and Constipation monitoring is important after introduction of food around 6 months of age
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4
Q

Toddlers

A
  • Toilet training depends in child’s ability to control anal sphincter and communication
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5
Q

School Aged/Adolescents/Adults

A
  • Defecation patterns vary in quantity/frequency/rhythmically
  • Diarrhea/Constipation can be caused by diet change, depression, anxiety, stress
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6
Q

Older Adults

A
  • Rectal receptors have decreased response to stretching.
  • This causes a loss of urge to defecate which causes fecal impaction (prolonged retention to form larger mass) or fecal incontinence (inability to prevent passing of a stool)
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7
Q

Daily Patterns

A
  • Patterns depend on diet, routine, lifestyle.

- Proper positioning and privacy also contribute

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8
Q

Food and Fluid

A
  • Increased fiber necessary to move feces through intestines
  • Diarrhea/gas/cramping due to digestion difficulty alters elimination (beans, cabbage, milk)
  • Constipation (cheese, pasta, iron supplements)
  • Laxatives (prunes, bran, coffee)
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9
Q

Activity and Muscle Tone

A
  • Regular exercise improves GI motility

- Bedrest decreases motility and causes constipation/gas

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10
Q

Psychological Variables

A
  • Anxiety can cause diarrhea

- Chronic worry, hold onto problems, negative feelings may experience constipation

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11
Q

Pathologic Conditions

A

Narrow/Ribbon Like - Tumor obstruction through colon

Frequent/Bulky/Greasy/Foul - Cystic Fibrosis

Diarrhea - Bacterial/Viral Infection, Malabsorption syndromes (vitamins/minerals), neoplastic disease (tumors), diabetic neuropathy (neurological disorder), hyperthyroidism, uremia (retention of urea in blood)

Constipation - Disease with colon or rectum, injury/degeneration of spinal cord and megacolon (extremely dilated colon)

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12
Q

Pathologic Conditions (cont)

A 
Changes in color/odor/appearance
- Conditions that traumatize stomach or intestines or interfere with normal digestion
Mechanical Obstructions (Pressure on intestinal walls)
- Tumors of colon/rectum, diverticulum, adhesions from scar tissue, stenosis, strictures, hernia, volvulus (twisting of a part of a colon) 
Non Mechanical Obstructions
- Inability of intestinal musculature to move contents through bowel.
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13
Q

Medications

A
  • Laxatives - Promote peristalsis
  • Antidiarrheals - Inhibit Peristalsis
  • Opioids/antacids/anticholinergic medications cause constipation
  • Antibiotics (metformin) - cause diarrhea
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14
Q

Diagnostic Studies

A
  • Bowel preparations for cleansing during visualization empty everything
  • Barium enema promote constipation
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15
Q

Surgery and Anesthesia

A

Paralytic Ileus
Direct manipulation of bowel during surgery inhibits peristalsis. May last 3-5 days. Food and oral fluids are withheld (ambulation encouraged). Opioids used for pain relief can exacerbate situation.
Worsening signs include abdominal distension, decreased bowel sounds.

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16
Q

Surgery/Anesthesia (cont)

A

Inhaled general anesthesia - Inhibits peristalsis by blocking parasympathetic impulses to intestines.

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17
Q

Stool Collection

A
  • Medical Aseptic Technique
  • Hand hygiene before and after glove use
  • Avoid contamination on outside of stool container
  • After collection, package, label, and transport
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18
Q

Guidelines for stool collecting

A
  • Void first so urine is not in stool sample
  • Defecate into container not toilet bowl
  • Do not place toilet paper in bedpan
  • Avoid contact with soap, detergents, disinfectants as it may affect results
  • Notify nurse when specimen is available
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19
Q

Types of Diagnostic Testing

A

Stool Culture - Used when infection from bacteria/virus/fungi is suspected

Pinworm Specimens - Parasitic worm that deposits eggs and night and retreats back during the day. Symptoms include perianal itching. Collect specimen using clear cellophane tape at anal opening before urination or defecation

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20
Q

Types of Diagnostic Testing

A

Occult Blood Test

  • Conditions that cause intestinal bleeding like ulcers, inflammatory bowel disease, colon cancer can be evaluated for blood
  • Fecal Occult Blood Testing (FOBT) is used to detect it with guaiac or hemoccult test.
  • Aspirin, steroids, iron supplements, and anticoagulants may lead to false positive readings.
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21
Q

Endoscopy

A
  • Direct visualization of body organ or cavity using long flexible tube with light and camera
  • Name of endoscope describes organ being examined
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22
Q

Esophagogastroduodenoscopy

A
  • Esophagus, stomach, duodenum
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23
Q

Colonoscopy

A
  • Large intestines anus to ileocecal valve
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24
Q

Sigmoidscopy

A
  • Sigmoid colon, rectum, anal canal
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25
Q

Wireless Capsule Endoscopy

A

Camera that is swallowed that visualizes the entire GI system it passes through

26
Q

Barium Enema and X-Ray

A

Radiographs that examine large intestines after rectal installation of barium sulfate to differentiate body structures from pathologic conditions.

27
Q

Abdominal Ultrasound

A
  • Ultrasound waves to visualize organs via transducer placed on skin of abdomen
28
Q

Magnetic Resonance Imaging (MRI)

A

Provides detailed anatomic views of tissue using superconducting magnet and radiofrequency signals

29
Q

Abdominal CT Scan

A
  • Uses beams of x-rays directed and moved around abdomen. Results in computer manipulated pictures that are not obscured by other anatomy.
30
Q

Promoting Regular Bowel Habits

A
  • Ask patients their normal time to go to bathroom
  • Promote natural position of sitting upright
  • Maintain privacy for patient
  • Promote proper nutrition/exercise/increasing fluid and fiber.
  • Walking as soon as a patient is able to is important
  • Inactivity can lead to constipation, distension, and impaction.
31
Q

Bedside Exercise

A
  • Helpful for patients who are immobile
    Abdominal exercises
  • Patient lies supine, tighten and holds abdominal muscle for 6 seconds and relax.
    Thigh muscle strengthening
  • Bring knees to chest one at a time than lowering to bed.
    REPEAT THESE EXERCISES SEVERAL TIMES DURING EACH WAKING HOUR
32
Q

Toilet Options

A

Bedside Commode
- Portable toilet placed next to bed. Used when patients can get out of bed but not walk to bathroom.
Bed Pans
- Used when patients are immobile.
Standard bedpan is wide, rounded shelf, like toilet seat.
Fractured bedpan has an angled thin end for limited mobility patients
- Patients should have their bed raised to 30-45 degrees to allow comfortable position.
- IF IT IS UNSAFE FOR PATIENTS TO RAISE HIPS OR HEAD REMAIN FLAT AND ROLL ONTO BEDPAN (PREVENTS MUSCLE STRAIN AND DISCOMFORT)

33
Q

Patient outcomes for Bowel Movements

A
  • Patient has soft formed movement every 1-3 days without discomfort
  • To maintain normal bowel movement patient should be able to explain relationship with diet, fluid and exercise.
  • Patient should know when to seek medical evaluation in stool color or consistency
34
Q

Constipation

A
  • Not frequency of defecation. Described as hard, dry, and difficult to pass. Easy to pass stool is not constipation
    Nutrition
  • Increase fluid and fiber
35
Q

Laxatives

A

Bulk-forming Laxatives - Absorbs water into intestines to soften stool and increase stool bulk size

Osmotic Laxatives - Not absorbable, brings water into intestines.

Stimulant Laxatives - Increases motility through irritation of intestinal mucosa and increased water in stool

Saline-osmotic Laxatives - Draw water into intestines, stimulating peristalsis, caution with patients with renal disease

36
Q

Diarrhea

A
  • Passage of 3+ loose stools a day
    (consistency over frequency)
  • Protective response or Infection
    Irritant is in intestinal tract
37
Q

Nursing Measures of Diarrhea

A
  • Answer call bell immediately to ensure embarrassing situation does not occur
  • Remove cause of diarrhea when possible (medication)
  • For impactions, obtain physician order for rectal examination
  • Give special care to region around anus to avoid skin irritation (cream, moisture barrier, ointments)
  • Provide antidiarrheal medications
  • Replace lost fluid and electrolytes
38
Q

Preventing Food Poisoning

A
  • Ensure food is stored and prepared properly
    Patient knowledge
  • Avoid buying food with damaged packaging
  • Take food that require refrigeration home immediately
  • Separate cutting boards for different foods
  • Washing all fruits and vegetables
  • Do not wash meat, poultry, or eggs
  • Ensure use of food thermometer
  • Unpasteurized milk, cheese, and honey can harbor bacteria
  • Give only pasteurized fruit juice to small children
39
Q

Preventing Travelers Diarrhea

A
  • Caused by bacterial enteropathogens (fecal-oral route), viruses, or parasites.
  • Teach patient frequent hand hygiene
  • Tap water culprit for most traveler diarrhea
    (Avoid tap water, ice cubes, fruit juices, unpeeled raw fruit and vegetables, unpasteurized milk, open buffets, undercooked/reheated foods)
    SAFE FOODS
    Fruits consumed after peeled, hot foods cooked thoroughly, bottled beverages
  • Boiled beverages are also safe also beverages treated with iodine or chlorine.
40
Q

Decreasing Flatulence

A

Excessive formation of gases in stomach/intestines

  • Intestinal Distension (gas accumulation)
  • Avoid beans, cabbage, onions, cauliflower, beer
41
Q

Rectal Suppositories

A
  • Oval shaped substance that can be inserted into body cavity easily
  • Melts at body temperature
  • Used to stimulate bowel in constipated patient
42
Q

Oral Intestinal Lavage

A
  • Administered before diagnostic testing that require clear bowel for visualization (intestinal surgery)
  • Evacuation of feces begins 1 hour after first glass and finished in 4-6 hours
  • Clear diet for 24 hours speeds the process
43
Q

Digital Removal of Stool

A
  • Removing stool manually
  • May cause great discomfort, irritation and bleeding
  • Can also stimulate vagus nerve which may slow heart rate. If this happens stop procedure immediately and monitor heart rate and blood pressure and call PCP
  • Oil-retention enema may be ordered to soften stool
44
Q

Enema

A
  • Introduction of solution into large intestines to remove feces or administer medication
  • Distends intestines and irritates causing peristalsis
  • Begin with smaller volumes and progress to larger
45
Q

Cleansing Enema

A
  • Remove Feces
  • Relieve constipation or impaction
  • Prevent involuntary escape of fecal matter during surgery
  • Promote visualization of intestines by radiographic or instrument examination
  • Help establish regular bowel function during bowel training
46
Q

Retention Enema

A
  • Small amount of fluid
    Oil - Lubricate the stool/mucosa easing defecation
    Carminative - Expel flatus from rectum
    Medicated - Provides medication absorbed through rectal mucosa
    Anthelmintic - Destroys parasites
47
Q

Administering Fleets Enema

A
  • Always administer enema in side lying position (left)

- Do not administer sitting on toilet or bedside commode

48
Q

Assessment before Enema

A
  • Assess abdomen before and after including auscultation of bowel sounds and palpation for tenderness and firmness
  • Anus should be assessed for fissures, hemorrhoids, sores, rectal tears.
  • Platelet count and WBC count should be evaluated
  • Due to vagus stimulation patient should be assessed for dizziness, lightheadedness, diaphoresis, clammy skin.
49
Q

Contraindications for Enema

A
  • Severe abdominal pain
  • Bowel Obstruction
  • Bowel Inflammation or Bowel Infection following rectal, prostate, or colon surgery
50
Q

Safety Guidelines for Enema

A
  • Side lying position
  • Tip of edema directed towards umbilicus to avoid damaging rectal mucosa
  • Patients with cardiac disease or hypertensive medication, obtain pulse rate due to rectal tissue stimulating vagus nerve
51
Q

Documentation following Edema

A
  • Amount and type of edema used
  • Amount, consistency and color of stool
  • Pain assessment rating
  • Assessment of perineal area for irritation, tear, or bleeding
  • Patient reaction to procedure
52
Q

Fecal Incontinence Pouch

A
  • Collection device secured to anal opening with adhesive to collect drainage of liquid stool and protect perianal skin.
  • Assess perianal skin for excoriation, if present, remove device, cleanse skin, apply skin barrier to dry skin, and reapply pouch
53
Q

Bowel Training Programs

A
  • For people with history of chronic constipation.
  • Help patients manipulate factors in their control
    Food, fluid intake, exercise and time of defecation
  • Journals aid the process of planning timing of bowel movements and tracking food choices that help or hinder process
54
Q

Nasogastric (NG) Tubes

A
  • Tube inserted through nose to stomach that allow feeding, administration of meds, removal of gastric secretions or air.
  • Can also be attached to intermittent/continuous suction to allow GI Tract rest before surgery
55
Q

Levin Tube

A
  • Single lumen tube used for feeding and medications
56
Q

Salem Lump Tube

A

Double Lumened - one that empties stomach and the other provides airflow to prevent damage of stomach mucosa

  • Airflow lumen is one way to prevent gastric reflux through airflow lumen.
  • NG Tubes used for decompression require irrigation with 30-60 mL of normal saline every 4-8 hours to maintain patency
57
Q

NG Tube instilling solutions

A
  • Verify placement is in stomach and not lungs
    (X-ray, measure tube length, measure tube marking, aspiration of gastric contents, monitor CO2)
  • Radiography is the most accurate way (usually only when it is first put in)
  • Do not auscultate as a way of checking
58
Q

NG Tubes

A
  • Oral hygiene every 2-4 hours to prevent drying tissue and relieve thirst
  • Lubricate lips generously
  • Clean nares and apply lubricant
  • Analgesic throat lozenges to ease local irritation
  • Ensure tube is secured to nose and gown to prevent tension and tugging
59
Q

NG Tubes

A
  • Smaller the size smaller the diameter
  • Marked in centimeters
  • Measure length from nose, to pinna of ear, then to xiphoid process (mark with tape)
  • Use lubricant and insert until marked point. Allow patient to drink water to ease going in
  • Secure with split tape on nose
  • ## Check placement by withdrawing stomach acid with syringe and x-ray
60
Q

Orogastric Tubes

A
  • Used for infants for gavage medications or feeding.
  • Measured from mouth to ear to xiphoid process
  • Insert tube in mouth until marked point

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