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Fundamentals 2 > Bowel Elimination > Flashcards

Bowel Elimination Flashcards

1
Q

12 Factors that influence bowel elimination

A 
Age
Diet
Fluid Intake
Physical Activity
Psychological Factors
Personal Habits
Positioning During Defecation
Pain
Pregnancy
Surgery & Anesthesia
Medications
Diagnostic Tests
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2
Q

Factors that affect older adults bowel elimination

A

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
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3
Q

What are the 6 common bowel elimination problems

A 
Constipation
Impaction
Diarrhea
Bowel Incontinence
Flatulence
Hemorrhoids
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4
Q

What is the definition of constipation

A

having fewer than 3 bowel movements a week

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5
Q

Is constipation a symptom or a disease?

A

symptom

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6
Q

What are the 3 symptoms of constipation

A

Infrequent BMs
Discomfort
Hard, dry stools_ difficult to pass

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7
Q

What are the 9 causes of constipation

A 
Irregular bowel habits 
Improper diet- fiber
Reduced fluid intake
Lack of exercise
Stress
Certain medications
Advanced age
Ignoring the urge to defecate
GI disorders
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8
Q

What Risks do Older adults have for change in bowel regime (7)

A 
Lack of muscle tone (bowel & abdomen)
Slowed peristalsis
Lack of exercise
Inadequate fluid intake
Too many dairy products
Lack of fiber
Medications
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9
Q

4 complications of constipation

A

hemorrhoids
anal fissure
fecal impaction
rectal prolapse

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10
Q

5 techniques for constipation prevention

A 
Include plenty of high-fiber foods
Drink plenty of fluids
Stay active
Manage Stress
Don’t ignore urge to go
Create a schedule
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11
Q

What is an impaction

A

Results from unrelieved constipation and the inability to expel the hardened feces retained in the rectum

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12
Q

What happens if an impaction is not resolved

A

intestinal obstruction

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13
Q

Who are the individuals most at risk for an impaction

A

Debilitated
Confused
Unconscious

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14
Q

What examination of rectum is performed for an impaction

A

digital exam

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15
Q

What are the 7 symptoms of impaction

A

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

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16
Q

What is Diarrhea

A

loose watery bowel movements that can happen frequently and with urgency

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17
Q

What are the 5 common causes of diarrhea

A 
Foodborne pathogens
Food intolerances & allergies
Surgery
Diagnostic Testing
Enteral Feeding
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18
Q

Common complications of Diarrhea

A

skin irritation
dehydration
nutritional concerns

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19
Q

symptoms of diarrhea

A

urgency
nausea
cramping
bloating

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20
Q

What is the most common healthcare-related infection and causitive agent of diarrhea

A

Clostridium difficule (C diff)

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21
Q

2 ways to get C diff

A

antibiotic therapy

comming in contact with C Diff.

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22
Q

c diff toxins attach where

A

lining of intestines

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23
Q

who is at risk for c diff

A 
people on antibiotics
Elderly
immunocompromised
Patients in Long term care
GI procedure
Previous C diff
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24
Q

symptoms of C diff

A

diarrhea
bloated
blood in stool
distiniict smelling odor

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25
Q

complications of c diff

A 
Dehydration
Kidney failure
Toxic megacolon
Bowel perforation
Death
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26
Q

Prevention of C Diff

A

Wash hands w/soap & water
Avoid unnecessary use of antibiotics
Clean surfaces with BLEACH
Place in isolation – Contact D or SPORE

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27
Q

C Diff diagnosis

A

stool sample

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28
Q

Treatment of C. Diff

A 
Plenty of fluids & good nutrition
Antibiotics
Surgery
Fecal implantation
Probiotics
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29
Q

what is bowel incontinence

A

Inability to control passage of feces and gas from the anus

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30
Q

what are the causes of incontinence

A 
Muscle or nerve damage
Any physical condition that impairs the anal sphincter function
Constipation or diarrhea
Large volume of stools
Surgery
Rectal prolapse
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31
Q

Risk factors for incontinence

A 
Age
Female
Nerve Damage
Dementia
Physical disability
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32
Q

Complications of incontinence

A

body image disturbance

Skin Irritation

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33
Q

Treatment of incontinence

A

Anti-diarrheals

Bulk laxatives

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34
Q

prevention of bowel incontinence

A

Reduce constipation
Control diarrhea
Avoid straining

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35
Q

what 2 ways do you make gas

A

Expelled via mouth (burp) or rectum (flatulence

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36
Q

symptoms of flatulence

A

Abd distention
Cramping
Bloating
Pain

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37
Q

causes of flatulence

A

Constipation
Food intolerance
GI disease: gastroenteritis, IBS, Crohns, Celiac
Stress

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38
Q

what are hemorrhoids

A

Dilated or engorged veins in lining of rectum

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39
Q

what causes hemorrhoids

A

Increased venous pressure from straining

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40
Q

what are the 2 types of hemorrhoids

A

external

internal

41
Q

Treatment of hemorrhoids

A 
Proper diet & Fluids
Activity
If bleeding or irritation
	Ice
	Warm sitz bath
        Topical medications for               swelling & pain
42
Q

risk factors of colon cancer

A 
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
43
Q

warning signs of colon cancer

A 
Change in Bowel habits
anal bleeding
blood in stool
abdominal pain
loss of appetitie
persistent lethargy 
pale or jaundiced
unexplained wweight loss
44
Q

what age should patients start screening for colon cancer

A

45

45
Q

when should patients have Flex Sig.

A

every 5 yrs

46
Q

when should patients have a colonoscopy

A

every 10 years

47
Q

when should patients be scanned for colon cancer

A

every 5 years

48
Q

when should patients have a FOBT

A

every 1 year

49
Q

when should patients have a FIT

A

every 1 year

50
Q

when should patients have a DNA

A

every 3 years

51
Q

What areas are we concerned with in a Nursing History assessment (8)

A

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

52
Q

7 Fecal Characteristics

A

Amount

Color

Odor

Consistency

Frequency

Shape

Constituents

53
Q

what 3 areas do we inspect during the physical assessment for Bowel movements

A

Mouth
Abdomen
Rectum

54
Q

Focused bowel assessment

A 
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

55
Q

What lab tests do we do if blood is detected in stool

A

H&H

56
Q

Types of tests we can do with a fecal specimen

A 
Fecal Occult Blood Test (FOBT)
Culture & sensitivity
DNA
Fats
WBC
Ova & Parasites (O&P)
57
Q

what is a fecal occult blood test for?

A

Check for hidden blood

Ordered to detect cancer or evaluate possible causes of unexplained anemia

58
Q

what should we be aware of for fecal occult blood tests

A

aware of false positives

59
Q

13 Nursing problems for bowel elimination

A 
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
60
Q

Resources for bowel elimination

A 
Patient
Family
HCP
Dietician
WOC
Nursing Assistant
61
Q

What is the goal of bowel elimination

A

Patient will have normal bowel elimination pattern

62
Q

Health promotion of bowel elimination

A

Promoting normal defecation
Promoting regular exercise
Promoting well balanced diet

63
Q

Medicaitons for bowel elimination

A

cathartics & laxatives
enemas
antidiarrheal agents

64
Q

Nursing Interventions for bowel elimination

A

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

65
Q

what are Cathartics & Laxatives

A

Meds that initiate or facilitate stool passage

66
Q

routes of Cathartics & Laxatives

A

PO or rectal

67
Q

Duration of Cathartics & Laxatives

A

short term

68
Q

what may Cathartics & Laxatives be used for

A

cleanse the bowel for a GI dx test, procedure or surgery

69
Q

What is a teaching point of Cathartics & Laxatives

A

potential harmful effects if overuse

70
Q

3 bulk forming Cathartics & Laxatives

A

Methylcellulose (Citrucel)
Pysllium (Metamucil)
Polycarbophil (Fibercon)

71
Q

1 Emollient or Wetting

Laxatives & Cathartics

A

Docusate Sodium (Colace, Doss)

72
Q

6 Osmotic Laxatives & Cathartics

A 
Saline- based
Magnesium Citrate
Magnesium Hydroxide (Milk of Magnesia)
Sodium Phosphate (Fleet Phospho-Soda)
Polyethylene Glycol (Miralax)
Lactulose
73
Q

2 stimulant cathartics

A

Bisacodyl (Dulcolax)

Senna (Ex-Lax, Senokot)

74
Q

If patient C/O cramping or pain during enema

A

slow rate by lowering height of bag

75
Q

I patient abdomen becomes rigid

A

STOP

76
Q

6 Enema Precautions/Complications

A 
Fluid & electrolyte imbalance
Tissue trauma
Vagal nerve stimulation
Abdominal pain/cramping
Pain
Perforation
77
Q

MOA of antidiarrheal agents

A

Decrease intestinal muscle tone to slow the passage of feces

Body absorbs more water

Must determine cause of diarrhea

78
Q

examples of antidiarrheal agents

A

loperamide or diphenoxylate w/ atropine

79
Q

Risk of antidiarrheal agents with opiates

A

caution b/c habit forming

80
Q

7 areas of nursing care of bowel elimination

A 
Diarrhea & Fecal Incontinence
Flatulence
Impaction
NG Tubes
Bowel Training
Food & Fluid Intake Maintenance
Older Adults
81
Q

4 steps to Nursing Care: Diarrhea

A 
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
82
Q

3 steps Nursing Interventions: Management of Fecal Incontinence & Diarrhea

A

Meticulous Skin Care

Prevention & Monitoring for Dehydration

Fecal Management Systems

83
Q

3 Nursing Interventions: Maintenance of Skin Integrity

A
  • Meticulous skin care *Frequent Checks
  • Apply skin barrier
  • Consult WOCN
84
Q

3 Nursing Care: Flatulence

A

Avoid foods that cause gas

Eat small, more frequent meals

Eat & drink slowly

85
Q

8 tips to reduce excessive gas and bloating

A 
more insoluble fiber
avoiid straws
avoid laying down after eating
limit carb intake
limit carbonated drinks
drink water
exercise daily
eat slow and mindfully
86
Q

common foods that cause bloating and gas

A 
cabbage
cauliflower
beans
oats
apples
milk
fluffy wheat
broccoli
onions
corn
potatoes
pears
soft cheese
peaches
87
Q

Nursing Interventions: Digital Removal of Stool

A 
Assess 
Digital Removal of Stool 
Nurse uses finger to break up fecal mass and removes it in sections
VERY PAINFUL
Risks involved
88
Q

5 purposes of NG tubes

A 
Decompression
Enteral feeding or medication
Administration
Compression
Lavage
89
Q

Assessment of NG tube

A 
Abdominal
Respiratory 
Nose/skin
Tube
Suction
90
Q

Nursing Care of NG Tube

A 
Verify HCP orders
Assessment
Verify Placement
Know how to hook to suction
Administration of feeding & medications
Recording I&Os
91
Q

what does bowel training program include

A 
Assessment & documentation
Choosing patient-centered time
Offer fluids to stimulate defecation around normal time
Assistance in using commode
Provide privacy
Normal exercise regimen
92
Q

Who is bowel training for

A

Patients with chronic constipation or fecal incontinence

93
Q

2 considerations for bowel training

A

Set up daily routine

Requires time, patience & consistency

94
Q

considerations when choosing a diet

A

frequency
characteristics
types of foods

95
Q

What are recommended in a well balanced diet

A

whole grains
legumes
fresh fruits
vegtables

96
Q

T/F fiber intake varies per individual

A

True

97
Q

What do we need to increase when taking fiber

A

fluid intake

98
Q

5 considerations in older adults with bowel elimination

A 
Encourage screening
Adequate fiber intake
Adequate fluid intake
Regular exercise program
Older adults are less able to compensate from fluid loss from diarrhea
99
Q

5 Bowel elimination evaluation criteria

A

Evaluate patient’s ability and knowledge to care for themselves

Evaluate dietary intake

Evaluate fluid intake

Evaluate activity

Evaluate bowel patterns

Fundamentals 2 (5 decks)

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