Bowel Care and Elimination Needs Flashcards
What are the 5 functions of the large bowel?
Re-absorption of water and nutrients into the blood stream
Synthesis of vitamins A&K
Formation and storage of faeces
Propelling contents down the length of the bowel to the anus
Elimination of faeces
Give 8 causes of constipation.
Poor diet/fluid intake Lack of exercise/mobility Drug therapy Neurological conditions Gastro-intestinal abnormalities Metabolic abnormalities Abdominal surgery, as handling of bowel causes spasm, and anaesthetic makes bowel atonic (lacking muscular tone) Avoiding the need to defecate
What medications can cause constipation?
opioids such as codine and morphine slow gut motility, also iron tablets (these also cause black stools)
What are the effects of constipation?
- Abdominal bloating
- General malaise
- Loss of appetite
- Infrequent hard pellet like stools
- Rectal discomfort/pain
- Co-existing conditions e.g. haemorrhoids, fissures
- Sudden or worsening urinary incontinence (due to pressure)
What can cause faecal incontinence?
- Neurological conditions
- Physical disability
- Bowel disorders e.g. Crohn’s disease (tends to affect small bowel), Irritable Bowel Syndrome
- Bowel resection
- Cognitive impairment
- Faecal impaction
- Laxative abuse
What should nurses and doctors do to assess constipation?
- Patient history, e.g. medications, surgery, diseases
- Assess “normal” and current bowel habit
- Assess symptoms
- Assess dietary and fluid intake (elderly can avoid to try and avoid going to the toilet)
- Current medication
- Rectal and stool examination
- Physical examination
- Abdominal x-ray if required
Describe each 7 stool types in the Bristol Stool Chart.
Type 1: separate hard lumps, very constipated
Type 2: lumpy and sausage like, slightly constipated
Type 3: sausage shape with cracks on surface, normal
Type 4: smooth sausage or snake shape, ideal
Type 5: soft blobs with clear cut edges, lacking finer
Type 6: mushy with ragged edges, inflammation
Type 7: liquid with no solid pieces, inflammation
What are the 4 steps to manage constipation?
- Identify cause
- Consider simple treatments first (fluids, diet, exercise and toileting regime)
- Health education advice, e.g. drink lots of fluids
- Pharmacological interventions, e.g. review current medications, prescribe laxatives
Describe bulk forming laxatives e.g. fybogel
Improve stool consistency and decrease abdominal pain. May take several days to work but excellent option for long term control.
N.B. Patients must be made aware of the need to drink adequate amounts of fluid.
Describe osmotic laxatives e.g. lactulose
Work by drawing fluid from the body into the bowel. Needs to be taken regularly. Not suitable for rapid relief of constipation.
N.B. Good fluid intake should be encouraged.
Describe stimulant laxatives e.g. senna
Act by direct stimulation of the colonic nerves to cause bowel movement. Suitable choice for short term use to allow normal bowel function to be restored.
N.B. Usually taken at bedtime to produce an effect the next morning.
When are suppositories used, and give 2 examples.
Used for rapid evacuation, typically within 1-2 hours of administration (often quicker).
e.g. glycerine, bisocodyl
When are enemas used?
to soften stool and ease defecation.
What 4 things can be used for management of faecal incontinence?
- Skin care e.g. clinisan, barrier creams/sprays
- Bowel retraining (regular toileting, posture)
- Medication e.g. glycerine suppositories, loperamide
- Continence appliances e.g. pads, anal plugs
Nursing care for patients undergoing bowel investigations should give clear explanation of and rationale for what?
investigations diet and medication advice bowel preparation e.g. laxatives time spent on procedure what to expect
