bowel elimination Flashcards
alterations in regular bowel elimination are early signs of
problems in the gastrointestinal tract or other body systems
parts of digestive system
mouth esophagus stomach small intestine large intestine (colon) anus defecation
the human mouth, esophagus, stomach, small intestine, colon, and rectum contain
millions of non harmful bacteria
are GI tract procedures we perform as nurses sterile
no
mouth
digestion begins with mastication (chewing)
esophagus
peristalsis moves food into the stomach
stomach
stores food, mixes food, liquid, and digestive juices, moves food into small intestines
small intestine
duodenum
jejunum
ileum
large intestine
primary organ of bowel elimination
anus
expels feces and flatus from the rectum
digestion
begins in the mouth and ends in the small and large intestines
mechanical breakdown that results from chewing, churning, and mixing with fluid and chemical reactions in which food reduces to its simplest form
absorption
intestine is the primary area of absorption, then metabolism and storage of nutrients
the small intestine is lined with fingerlike projections called villi
absorption of carbs, protein, minerals, and water soluble vitamins occurs in the small intestine
metabolism
all biochemical reactions within the cells of the body
anabolic vs catabolic
elimination
chyme is moved through peristalsis and is changed into feces
chyme moves by peristaltic action through the ileocecal valve into the large intestine, where it becomes feces
water absorbs in the mucosa as feces move toward the rectum
peristalsis
series of involuntary wave-like muscle contractions which move food along the digestive tract
what increases and decreases peristalsis
stress and anxiety increase
surgery and anesthesia decrease
factors influencing bowel elimination
age diet fluid intake physical activity psychological factors personal habits position during defecation pain surgery and anesthesia medications
what drug can cause constipation
opioids
constipation
symptom, not a disease; infrequent stool and/or hard, dry, small stools that are difficult to eliminate
impaction
results from unrelieved constipation; a collection of hardened feces wedged in the rectum that a person cannot expel
diarrhea
an increase in the number of stools and the passage of liquid, unformed feces
incontinence
inability to control passages of feces and gas to the anus
flatulence
accumulation of gas in the intestines causing the walls to stretch
hemorrhoids
dilated, engorged veins in the lining of the rectum
bowel diversions
temporary or permanent artificial opening in the abdominal wall (stoma)
surgical opening in the ileum or colon
ileostomy or colostomy
location of an ostomy determines stool consistency
ileostomy stool consistency
thin to thick liquid
large intestine ostomy
ascending - thick liquid
transverse - thick liquid to soft
descending -soft to formed
sigmoid - more formed
three types of ostomies
colostomy
ileostomy
urostomy
colostomy types
ascending
transverse
descending
sigmoid
what characteristics should the stoma have if patient has a bowel diversion
beefy bright red, moist
blue or purple means decreased blood flow and is an emergency
effective pouching system for ostomies
protects skin, contains fecal material, remains odor free, and is comfortable and inconspicuous
nutritional considerations for ostomies
consume low fiber for the first few weeks
eat slowly and chew food completely
drink 10-12 glasses of water daily
eat food slowly and chew food completely so food breaks down easier
patient may choose to avoid gassy foods
psychological considerations with ostomies
serious body changes/self image
intimacy needs
odor
assessment for ostomies
nursing history physical assessment mouth abdomen identifying normal and abnormal patterns, habits, and the patient's perception of normal and abnormal with regard to bowel elimination not everyone eliminates feces everyday - after 3 days, we worry laboratory tests fecal specimens test stool for blood, parasites, etc diagnostic examinations
review box 47.3
47.3
collection of a stool sample
hat or collect stool from brief
wear gloves while collecting
use tongue depressor or a spoon to pick up stool and place
collect in a dry, clean, leak-proof container
usually don’t need much
make sure there’s no urine or water
seal specimen well
place specimen in a biohazard bag for transport
look for parasites, ovum, blood, black/tarry stool, in sample
notice color and consistency
send stool to lab
don’t let it go into the toilet
promotion of normal defecation
sitting position positioning on bedpan develop and promote routine privacy safety
bedpan use
if patient is immobile or it is unsafe to allow them to raise their hips, they remain flat and roll onto the bedpan
standard bedpan position
wide side up
fracture bedpan position
wide side down
cathartics and laxatives
medications that initiate and facilitate stool passage
empty the bowel
cathartics have a stronger and more rapid effect on the intestines than laxatives
laxatives can be administered via oral route or suppository route
suppositories may act more quickly than oral medications (stimulate rectal mucosa)
antidiarrheal agents
decrease intestinal muscle tone to slow passage of feces
enemas
instillation of a liquid solution into the rectum and sigmoid colon
promote defecation by stimulating peristalsis
fluid breaks up fecal mass, stretches rectal wall and initiates the defecation reflex
can also give medications via enema route
rectal suppository admin
sterile technique not necessary
explain procedure
position the patient laying left lateral sims
hand hygiene and apply gloves
lubricate finger and medication
insert approx one inch or once you feel medication bypass sphincter
place on wall of rectum - not stool
med will melt when it reaches body temp and will be absorbed
common meds given suppository route
acetaminophen
dulcolax
enema admin
sterile technique is unnecessary
wear gloves
explain procedure, positioning, precautions to avoid discomfort, length of time necessary to retain solution before defecation
administer slowly
cramping is likely
position patient on left lying position with top leg bent upwards - sim’s position
digital removal of stool
provider or nurse removing stool with fingers
when fecal mass is too difficult for patient to pass
las resort in managing severe constipation due to discomfort and risks involved
already tried other measures and they failed
order is necessary
purpose of digital removal of stool
break up fecal mass and remove it so patient can voluntarily pass stool on their own
what needs to be assessed before digitally removing stool
heart rate
digital removal of stool process
position patient side lying, educate, hand hygiene, gloves
lube finger, insert into rectum slowly
gently loosen fecal mass by massaging around it and remove all pieces slowly
what are characteristics of initial stool pieces being removed
what are characteristics of stool after hard fecal mass has been removed
patient should be able to have a bowel movement after
risks/complications of digital removal of stool
irritation to mucosa, bleeding
possible stimulation of vagus nerve (causes bradycardia); if this happens, nurse must stop procedure
bowel training
performed with patients who have chronic constipation or fecal incontinence secondary to cognitive impairment
implementing bowel training
routine - keep patient on a schedule with bowel movements
diet - increase fluids to decrease constipation and fecal impaction
promote regular exercise - improves peristalsis
management of hemorrhoids - patient will avoid a bowel movement due to pain with hemorrhoids
skin integrity - fecal incontinence will cause skin breakdown
assess skin frequently, keep area clean, use barrier ointment to protect the skin
