Bowel Elimination Flashcards
12 Factors that influence bowel elimination
Age Diet Fluid Intake Physical Activity Psychological Factors Personal Habits Positioning During Defecation Pain Pregnancy Surgery & Anesthesia Medications Diagnostic Tests
Factors that affect older adults bowel elimination
Trouble chewing
Esophageal emptying slows
Impaired absorption
Weakened sphincters
Decreased
Hydrochloric acid Absorption of vitamins Peristalsis Sensation to defecate Lipase to aid in fat digestion
What are the 6 common bowel elimination problems
Constipation Impaction Diarrhea Bowel Incontinence Flatulence Hemorrhoids
What is the definition of constipation
having fewer than 3 bowel movements a week
Is constipation a symptom or a disease?
symptom
What are the 3 symptoms of constipation
Infrequent BMs
Discomfort
Hard, dry stools_ difficult to pass
What are the 9 causes of constipation
Irregular bowel habits Improper diet- fiber Reduced fluid intake Lack of exercise Stress Certain medications Advanced age Ignoring the urge to defecate GI disorders
What Risks do Older adults have for change in bowel regime (7)
Lack of muscle tone (bowel & abdomen) Slowed peristalsis Lack of exercise Inadequate fluid intake Too many dairy products Lack of fiber Medications
4 complications of constipation
hemorrhoids
anal fissure
fecal impaction
rectal prolapse
5 techniques for constipation prevention
Include plenty of high-fiber foods Drink plenty of fluids Stay active Manage Stress Don’t ignore urge to go Create a schedule
What is an impaction
Results from unrelieved constipation and the inability to expel the hardened feces retained in the rectum
What happens if an impaction is not resolved
intestinal obstruction
Who are the individuals most at risk for an impaction
Debilitated
Confused
Unconscious
What examination of rectum is performed for an impaction
digital exam
What are the 7 symptoms of impaction
Inability to pass stool for several days despite repeated urge to defecate
Continuous oozing of liquid stool
Loss of appetite
N/V
Abd distention
Cramping
Rectal pain
What is Diarrhea
loose watery bowel movements that can happen frequently and with urgency
What are the 5 common causes of diarrhea
Foodborne pathogens Food intolerances & allergies Surgery Diagnostic Testing Enteral Feeding
Common complications of Diarrhea
skin irritation
dehydration
nutritional concerns
symptoms of diarrhea
urgency
nausea
cramping
bloating
What is the most common healthcare-related infection and causitive agent of diarrhea
Clostridium difficule (C diff)
2 ways to get C diff
antibiotic therapy
comming in contact with C Diff.
c diff toxins attach where
lining of intestines
who is at risk for c diff
people on antibiotics Elderly immunocompromised Patients in Long term care GI procedure Previous C diff
symptoms of C diff
diarrhea
bloated
blood in stool
distiniict smelling odor
complications of c diff
Dehydration Kidney failure Toxic megacolon Bowel perforation Death
Prevention of C Diff
Wash hands w/soap & water
Avoid unnecessary use of antibiotics
Clean surfaces with BLEACH
Place in isolation – Contact D or SPORE
C Diff diagnosis
stool sample
Treatment of C. Diff
Plenty of fluids & good nutrition Antibiotics Surgery Fecal implantation Probiotics
what is bowel incontinence
Inability to control passage of feces and gas from the anus
what are the causes of incontinence
Muscle or nerve damage Any physical condition that impairs the anal sphincter function Constipation or diarrhea Large volume of stools Surgery Rectal prolapse
Risk factors for incontinence
Age Female Nerve Damage Dementia Physical disability
Complications of incontinence
body image disturbance
Skin Irritation
Treatment of incontinence
Anti-diarrheals
Bulk laxatives
prevention of bowel incontinence
Reduce constipation
Control diarrhea
Avoid straining
what 2 ways do you make gas
Expelled via mouth (burp) or rectum (flatulence
symptoms of flatulence
Abd distention
Cramping
Bloating
Pain
causes of flatulence
Constipation
Food intolerance
GI disease: gastroenteritis, IBS, Crohns, Celiac
Stress
what are hemorrhoids
Dilated or engorged veins in lining of rectum
what causes hemorrhoids
Increased venous pressure from straining
what are the 2 types of hemorrhoids
external
internal
Treatment of hemorrhoids
Proper diet & Fluids
Activity
If bleeding or irritation
Ice
Warm sitz bath
Topical medications for swelling & painrisk factors of colon cancer
Race: African Americans Diet: High intake of red meat or processed meats Obesity being older than 50 physical inactivity history of inflammatory intestinal condition family history low fiber diet use of alcohol and tobacoo
warning signs of colon cancer
Change in Bowel habits anal bleeding blood in stool abdominal pain loss of appetitie persistent lethargy pale or jaundiced unexplained wweight loss
what age should patients start screening for colon cancer
45
when should patients have Flex Sig.
every 5 yrs
when should patients have a colonoscopy
every 10 years
when should patients be scanned for colon cancer
every 5 years
when should patients have a FOBT
every 1 year
when should patients have a FIT
every 1 year
when should patients have a DNA
every 3 years
What areas are we concerned with in a Nursing History assessment (8)
Determine usual elimination pattern
Description of stool
How does individual defecate
Dietary and fluid intake
History of GI disorders or surgeries
Medication history
Emotional state
Activity & mobility
7 Fecal Characteristics
Amount
Color
Odor
Consistency
Frequency
Shape
Constituents
what 3 areas do we inspect during the physical assessment for Bowel movements
Mouth
Abdomen
Rectum
Focused bowel assessment
Assess for presence of symptoms, precipitating factors & alleviating factors Nausea Vomiting Indigestion Diarrhea Constipation Bloating or cramping Abdominal pain Flatulence
Diet intake & tolerance
Percentage of meals
What lab tests do we do if blood is detected in stool
H&H
Types of tests we can do with a fecal specimen
Fecal Occult Blood Test (FOBT) Culture & sensitivity DNA Fats WBC Ova & Parasites (O&P)
what is a fecal occult blood test for?
Check for hidden blood
Ordered to detect cancer or evaluate possible causes of unexplained anemia
what should we be aware of for fecal occult blood tests
aware of false positives
13 Nursing problems for bowel elimination
Constipation Chronic Functional Constipation Risk for Constipation Risk for Functional Constipation Diarrhea Risk for Electrolyte Imbalance Deficient Fluid Volume or Risk for Dysfunctional Gastrointestinal Motility or Risk for Bowel Incontinence Nausea Risk for Impaired Skin Integrity Disturbed Body Image Deficient Knowledge
Resources for bowel elimination
Patient Family HCP Dietician WOC Nursing Assistant
What is the goal of bowel elimination
Patient will have normal bowel elimination pattern
Health promotion of bowel elimination
Promoting normal defecation
Promoting regular exercise
Promoting well balanced diet
Medicaitons for bowel elimination
cathartics & laxatives
enemas
antidiarrheal agents
Nursing Interventions for bowel elimination
Digital removal of stool
Inserting & maintaining a NG tube
Care of ostomies
Bowel training
Maintenance of proper food & fluid intake
Management of fecal incontinence & diarrhea
Maintenance of skin integrity
what are Cathartics & Laxatives
Meds that initiate or facilitate stool passage
routes of Cathartics & Laxatives
PO or rectal
Duration of Cathartics & Laxatives
short term
what may Cathartics & Laxatives be used for
cleanse the bowel for a GI dx test, procedure or surgery
What is a teaching point of Cathartics & Laxatives
potential harmful effects if overuse
3 bulk forming Cathartics & Laxatives
Methylcellulose (Citrucel)
Pysllium (Metamucil)
Polycarbophil (Fibercon)
1 Emollient or Wetting
Laxatives & Cathartics
Docusate Sodium (Colace, Doss)
6 Osmotic Laxatives & Cathartics
Saline- based Magnesium Citrate Magnesium Hydroxide (Milk of Magnesia) Sodium Phosphate (Fleet Phospho-Soda) Polyethylene Glycol (Miralax) Lactulose
2 stimulant cathartics
Bisacodyl (Dulcolax)
Senna (Ex-Lax, Senokot)
If patient C/O cramping or pain during enema
slow rate by lowering height of bag
I patient abdomen becomes rigid
STOP
6 Enema Precautions/Complications
Fluid & electrolyte imbalance Tissue trauma Vagal nerve stimulation Abdominal pain/cramping Pain Perforation
MOA of antidiarrheal agents
Decrease intestinal muscle tone to slow the passage of feces
Body absorbs more water
Must determine cause of diarrhea
examples of antidiarrheal agents
loperamide or diphenoxylate w/ atropine
Risk of antidiarrheal agents with opiates
caution b/c habit forming
7 areas of nursing care of bowel elimination
Diarrhea & Fecal Incontinence Flatulence Impaction NG Tubes Bowel Training Food & Fluid Intake Maintenance Older Adults
4 steps to Nursing Care: Diarrhea
Identify the problem & eliminate Provide soft easily digestible food Doesn’t mean to place on clear liquids Maintain fluid & electrolyte balance Prevent spread practice good hand hygiene
3 steps Nursing Interventions: Management of Fecal Incontinence & Diarrhea
Meticulous Skin Care
Prevention & Monitoring for Dehydration
Fecal Management Systems
3 Nursing Interventions: Maintenance of Skin Integrity
- Meticulous skin care *Frequent Checks
- Apply skin barrier
- Consult WOCN
3 Nursing Care: Flatulence
Avoid foods that cause gas
Eat small, more frequent meals
Eat & drink slowly
8 tips to reduce excessive gas and bloating
more insoluble fiber avoiid straws avoid laying down after eating limit carb intake limit carbonated drinks drink water exercise daily eat slow and mindfully
common foods that cause bloating and gas
cabbage cauliflower beans oats apples milk fluffy wheat broccoli onions corn potatoes pears soft cheese peaches
Nursing Interventions: Digital Removal of Stool
Assess Digital Removal of Stool Nurse uses finger to break up fecal mass and removes it in sections VERY PAINFUL Risks involved
5 purposes of NG tubes
Decompression Enteral feeding or medication Administration Compression Lavage
Assessment of NG tube
Abdominal Respiratory Nose/skin Tube Suction
Nursing Care of NG Tube
Verify HCP orders Assessment Verify Placement Know how to hook to suction Administration of feeding & medications Recording I&Os
what does bowel training program include
Assessment & documentation Choosing patient-centered time Offer fluids to stimulate defecation around normal time Assistance in using commode Provide privacy Normal exercise regimen
Who is bowel training for
Patients with chronic constipation or fecal incontinence
2 considerations for bowel training
Set up daily routine
Requires time, patience & consistency
considerations when choosing a diet
frequency
characteristics
types of foods
What are recommended in a well balanced diet
whole grains
legumes
fresh fruits
vegtables
T/F fiber intake varies per individual
True
What do we need to increase when taking fiber
fluid intake
5 considerations in older adults with bowel elimination
Encourage screening Adequate fiber intake Adequate fluid intake Regular exercise program Older adults are less able to compensate from fluid loss from diarrhea
5 Bowel elimination evaluation criteria
Evaluate patient’s ability and knowledge to care for themselves
Evaluate dietary intake
Evaluate fluid intake
Evaluate activity
Evaluate bowel patterns
