Bowel Elimination Flashcards
Newborn/ Infant stool considerations
Meconium
Stool color dependent upon type of milk ingested
Frequent and multiple bowel movements a day
Toddler stool
Duodenocolic reflex
Toilet training after 22 months
School age stool
Bowel function reaches adult standard
Peer pressure may contribute to constipation
Adult/ Older stool
Bowel movement frequency decreases, GI motility slows
Increased fluid and fiber in diet
Normal Feces
Frequency: 1-2x a day and 1 every 2-3 day Color: Brown Consistency: Soft, formed Shape: Cylindrical Amount: 100/300 g/d Odor: aromatic, pungent
Abnormal Feces
Frequency: depends on usual pattern Guideline: > 3/d and <1 every 3 days Consistency: Hard, loose liquid, high mucus content Shape: Narrow, pencil thin Amount:<100 g/d or >300 g/d Odor: foul, objectionable
Functions of the Intestines: Peristalsis& segmentation
Alternating contraction and relaxation of intestinal smooth muscle
Propels the intestinal contents along the entire length of the small and large intestines
What stimulates peristalsis?
walls of intestine
Absorption
Nutrient and electrolytes in duodenum and jejunum
Vitamins, iron, and fluid in ileum
Valsulva Maneuver
- Take a deep breath against a closed glottis
- Contract the abdominal muscles
- Contract pelvic floor muscles
- It drops HR and blood pressure
Nutrion impact on elimination
Soluble fiber (increases GI transit time) Oat bran, barley, and nuts
Insoluble fiber (decreases GI transit time) Whole grains, fresh fruits and vegetables
Which fiber type promotes loose stools?
Insoluble
Food intolerances
Lactose
Gluten
Fluid impact on elimination
75% of feces is water
- If body is alcking water it will take from feces
- Increased GI motility= loose stools
Exercise impact on elimination
Move less, defecate less
Lifestyle and ignoring urge to defecate
- Emotional extremes
- Changing daily routine
- Ignoring the urge leads to the urge weakening over time
Pregnancy
Iron supplements + growing fetus = constipation
Opioids cause
constipation
ABX cause
diarhea
To examine the lower GI tract with a camera, what must be out of the lower GI tract?
Stool
When the colon is diverted through a stoma
Colostomy
When the ileum is diverted through a stoma
ileostomy
-No large intestine, potential issue with loss of fluid and electrolytes
Pouches can be created surgically to give the patient control over when a bowel movement occurs
- Kock pouch
- J-pouch
Normal stoma findings
red pink, beefy
Abnromal stoma findings
bluish tint, drainage around it
Fecal Collection
Pouch connected to a stoma
The part that covers a stoma is called an appliance
When should the pouch be emptied?
When it becomes 1/4 full
What do you rinse the pouch with after emptying it?
Clean warm tap water
- 60 ml syringe
What if fecal contents leak around where the pouch is attached to the skin?
Entire bag must be removed and replaced
Abd inspection Normal
Normal Findings:
Symmetric
Slightly rounded
Ab inspection abnormal
Malnutrition? Hollow or scaphoid
Obstruction? Distended
Normal auscultation
Heard within 5-15 seconds
Abnormal auscultation
More frequent than 5 seconds? Hyperactive
How long do you listen to confirm absent?
Listen to each quadrant 1-2 mins
Constipation
Common GI issue
Patients experience bloating, fullness, an urge to defecate without an ability to pass stool, malaise, loss of appetite, nausea, vomiting, and abdominal distention.
Dependent upon a person’s baseline functioning
Less frequent
Harder stool
Persistent for at least 12 weeks in a year’s time
What is important in determining if its constipation?
Ask about the patient’s normal routine
Fecal impaction
Usually, the result of untreated and unrelieved constipation
Several days of constipation followed by an involuntary loose bowel movement that does not relieve feeling of bloating or fullness
Similar symptoms to constipation
How is fecal impaction diagnosed?
Digital rectal exam
Diarhea
- Loose and more frequent stools
- increased gastric motility
- hyperactive bowel sounds
Causes of diarhea
Medications, medical conditions, emotional changes Symptoms: Cramping Nausea Burning sensation Anal inflammation Bleeding and breakdown
Neurological injury, spinal cord injury, or altered mental status can lead to…..
fecal incontinence
Gas or flatulence is caused by
bacterial activity in the large intestine
What food increases flatulence
Introduce a person gradually into new diet high in fiber
An obstruction or tumor can lead to
distension
-requires a follow-up and investigation
What type of bowel activity could lead to an order for a stool specimen and culture?
Diarrhea
-Altered color
Stool specimen and culture
-collected by the nurse
Educate patient to avoid mixing urine with sample
Have urinal or a second bedpan nearby
Fecal occult blood test
A type of test that detects the presence of blood
-More common now for this test to be sent to the lab to be performed from a regular stool specimen rather than a bedside procedure
Recommended screening tool for colorectal cancer
Blood in stool may indicate cancer or polyps in the colon or rectum
Fecal occult blood test
XRay considerations
A radiopaque substance is swallowed or instilled in the rectum and then imaging is performed as it proceeds through the GI tract
Detects abnormalities in the large and small bowel
What is done before the test?
clear the bowels with laxatives or enemas
What is done after the test?
- Barium can harden stool and cause constipation or an impaction, increase fluids and administer a laxative
- Barium cam make the stool appear chalky or white
EGD
upper gi test
Lower GI tests
-Sigmoidoscopy
Colorectal cancer screening every 5 years
Colonoscopy
- Colorectal cancer screening every 10 years
- If high risk though, screening can be every 5 years
- Colonoscopy used more often for screening since its visualizes the entire colon
What is used in both procedures?
A flexible fiber-optic instrument to visualize certain parts of the GI tract
-Tests are used for diagnosis and treatment
What is done before lower GI tests?
Bowel- preparation: use of laxative solution to clear the bowels of stool
What is done after lower Gi tests?
Monitor for bleeding or dull abdominal pain
Tx for diarrhea
-Antidiarrheals
Loperamide
Bismuth subsalicylate
Medications that treat the cause of diarhea
Loperamide and Bismuth subsalicylate (peptmo bismal)
Fecal microbiota transplant
Used for persistent clostridium difficile infection
Healthy stool from a human donor placed in GI tract
90% effective in reducing infection rate
Bowel training
Used for individuals with a neurological impairment
Routine developed around a specific time of day to achieve a soft stool consistency
Modified for individuals with partial sphincter control
Can utilize pelvic floor exercises, abdominal massage, and biofeedback
Enema indication
Promote bowel movement
Clear bowel area before a procedure
Types of enema demonstrated
Small-volume: Mineral oil and steroids
Large-volume: tap water or saline
Return-flow: removes flatus
NG tubes indications
Gastric decompression, gastric lavage, or gastric feeding
Placement must be confirmed using?
Radiographic confirmation is the gold standard
