bowel elimination Flashcards
the large intestine
Primary organ of bowel elimination
Extends from the ileocecal valve to the
anus
About 5 feet long
Functions
o Absorption of water
o Formation of feces
o Expulsion of feces from the body
the small intestine
- The small intestine
(small bowel) is about 20
feet long and about an
inch in diameter. - Its job is to absorb
most of the nutrients
from what we eat and
drink.
assessment of the gi system
Health history:
o Information about abdominal pain, dyspepsia,
gas, nausea and vomiting, diarrhea,
constipation, fecal incontinence, jaundice, and
previous GI disease is obtained
Pain:
o Character, duration, pattern, frequency,
location, distribution of referred abdominal
pain, and time of the pain vary greatly
depending on the underlying cause
Pediatrics:
o Subjective: Lifestyle & Family history, Diet and
Elimination patterns
bowel habits and family history
Change in bowel habits and stool
characteristics
o May signal colonic dysfunction or
disease
o Constipation, diarrhea
Past health, family and social history
o Oral care and dental visits
o Lesions in mouth
o Discomfort with certain foods
o Use of alcohol and tobacco
o Dentures
physical assessment of the abdomen
The sequence for abdominal assessment proceeds from
inspection, auscultation, and percussion to
palpation. Auscultation must be completed before manipulation
of the abdomen because it has an impact on motility
Inspection: observe contour, any masses, scars, or
distention
Auscultation: listen for bowel sounds in all quadrants
o Note frequency and character, audible clicks, and
flatus.
o Describe bowel sounds as hypoactive, hyperactive,
absent or infrequent. (be sure to listen 2 min or longer for
absent bowel sounds)
Percussion and palpations: performed by advanced
practice professionals
inspection and palpation
Inspection and palpation
o Lesions, ulcers, fissures (linear break on the
margin of the anus), inflammation, and external
hemorrhoids
o Ask the patient to bear down as though having a
bowel movement. Assess for the appearance of
internal hemorrhoids or fissures and fecal masses.
o Inspect perineal area for skin irritation secondary
to diarrhea or fecal incontinence.
process of peristalsis
Process of Peristalsis
Peristalsis is under control of the
nervous system.
Contractions occur every 3 to 12
minutes.
Mass peristalsis sweeps occur one to
four times each 24-hour period.
One-third to one-half of food waste is
excreted in stool within 24 hours.
Intestinal gas (flatus) may occur
how much fluid should you drink per day
~2,000-3,000
ml’s of fluid
per day
variables influencing bowel inflammation
Developmental considerations
Daily patterns
Food (high fiber foods 25-30 grams) and fluid intake
o Fiber good to help lower cholesterol
Activity and muscle tone
Lifestyle
Psychological variables
Pathologic conditions
Medications
Diagnostic studies
Surgery and anesthesia
manifestations of chronic constipation
Fewer than three bowel movements per week
Abdominal distention, pain, and bloating
A sensation of incomplete evacuation
Straining at stool
Elimination of small-volume, hard, dry stools
Chronic constipation: 3-6 months or greater
complications of constipation
Decreased cardiac output
Fecal impaction
Hemorrhoids
Fissures (torn skin around anus)
Rectal prolapse
Megacolon
patient learning needs for constipation
Normal variations of bowel patterns
Establishment of normal pattern
Dietary fiber and fluid intake
Responding to the urge to defecate
Exercise and activity
Laxative use
Increase daily intake of water as a first line of prevention
foods affecting bowel elimination
Constipating foods: cheese,
lean meat, eggs, pasta
Foods with laxative effect:
fruits and vegetables, bran,
chocolate, alcohol, coffee
Gas-producing foods: onions,
cabbage, beans, cauliflower
Lactose Intolerant: cannot
tolerate dairy/milk products
o Symptoms: cramping,
diarrhea, bloating, flatulence
infants stool
Infants: Characteristics of stool and frequency depend on
formula or breast feedings.
o Stools may be yellow and loose during breastfeeding
toddlers stool
Toddler: Physiologic maturity is the first priority for bowel
training.
child adolescent and adult considerations
Child, adolescent, adult: Defecation patterns vary in
quantity, frequency, and rhythmicity.
Older adult: Constipation is often a chronic problem;
diarrhea and fecal incontinence may result from physiologic
or lifestyle changes.
older adult considerations
Test Your Knowledge!
Which food is a recommended for an
older adult who is constipated?
A. Cheese
B. Fruit
C. Cabbage
D. Eggs
Answer: B. Fruit
Rationale: Fruits and vegetables have a laxative
effect on the system. Cheese and eggs have a
constipating effect and cabbage, although a
vegetable, produces gas in the system.
preventing food poisoning
Never buy food with damaged packaging.
Take items requiring refrigeration home immediately.
Wash hands and surfaces often.
Use separate cutting boards for foods.
Thoroughly wash all fruits and vegetables before eating.
Do not wash meat, poultry, or eggs to prevent spreading
microorganisms to sink and other kitchen surfaces.
Never use raw eggs in any form.
Do not eat seafood raw or if it has an unpleasant odor.
Use a food thermometer to ensure cooking food to safe internal
temperature.
Keep food hot after cooking; maintain safe temperature of 140°F or
above.
Give only pasteurized fruit juices to small children.
effects of medications on stool
Aspirin, anticoagulants:
o pink to red to black stool
Iron salts:
o black stool
Bismuth subsalicylate used to treat diarrhea
o can also cause black stools.
Antacids:
o white discoloration or speckling in stool
Antibiotics:
o green-gray color
diarrheas affects on stool
Increased frequency of bowel
movements (more than three per day)
with altered consistency (i.e., increased
liquidity) of stool
Usually associated with urgency,
perianal discomfort, incontinence, or a
combination of these factors
May be acute, persistent, or chronic
Causes include infections, medications,
tube feeding formulas, metabolic and
endocrine disorders, and various
disease processes
manifestations of diarrhea
Increased frequency and fluid
content of stools
Abdominal cramps
Distention
Borborygmus
Anorexia and thirst
Painful spasmodic contractions of
the anus
Tenesmus (cramping rectal pain)
complications of diarrhea
Fluid and electrolyte imbalances
o Infants are most at risk
Dehydration
Cardiac dysrhythmias
Chronic diarrhea can result in skin
care issues related to irritant
dermatitis
Weight loss
assessment and diagnostic findings
Complete Blood Count (CBC)- helps to check for anemia or infection
Serum chemistries (Ex: Phosphate level)
o Results are usually normal or mildly elevated; abnormal results early in the disease are generally due to vomiting
or dehydration
Urinalysis
Stool examination
Endoscopy (EGD) or barium enema
o Helps to evaluate upper abdominal pain, nausea, vomiting, bleeding, or
difficulty swallowing
nursing measures for patients with diarrhea
Answer call bells immediately.
Remove the cause of diarrhea whenever possible
(e.g., medication, food).
If there is impaction, obtain physician order for
rectal examination.
Give special care to the region around the anus.
patient learning needs and treatment for diarrhea
Recognition of need for medical treatment
Rest
Diet and fluid intake
Avoid irritating foods, including caffeine,
carbonated beverages, very hot and cold
foods
Perianal skin care
Medications
o Loperamide (Imodium)
May need to avoid milk, fat, whole grains,
fresh fruit, and vegetables
Lactose intolerance
incontinence of bowel risk factors
Bowel Incontinence: The inability for the anal sphincter to
control the discharge of fecal and gaseous material.
Common Causes:
o Dietary habits
o Often related to changes in the function of the rectum and anal
sphincter related to aging, neurologic disease, and childbirth.
o The patient may also not be able to perceive the urge to move the
bowels or completely empty the rectum after a bowel movement
o Cognitive impairment (mental illness)
o Although bowel incontinence is seldom life-threatening, patients with
bowel incontinence suffer embarrassment, may become depressed, and
pose a challenge for nurses because of the risk for skin breakdown.
o Toddlers- Environment and privacy (hospital settings)
bowel incontinence nursing interventions
Assist patient to the bathroom during likely times of incontinence
o If there is no pattern, offer toileting at regular intervals, such as every few hours.
Keep the skin clean and dry by using proper hygienic measures.
o Apply a protective skin barrier after cleaning the skin, as ordered
Change bed linens and clothing as necessary to avoid odor, skin irritation,
and embarrassment.
o Disposable bed pads and moisture-proof undergarments can be considered but should not
be used until other measures have been tried.
Confer with the primary care provider about using a suppository or a daily
cleansing enema.
o These measures empty the lower colon regularly and often help to decrease incontinence.
Bowel-training programs may also be helpful.
Toddlers- make environment as “normal” as you can.
stool collections
Medical aseptic technique is imperative.
Hand hygiene, before and after glove use, is essential.
Wear disposable gloves.
Do not contaminate outside of container with stool.
Obtain stool and package, label, and transport according to agency
policy.
Patient instructions/guidelines:
Void first so that urine is not in stool sample.
Defecate into the container rather than toilet bowl.
Do not place toilet tissue in the bedpan or specimen container.
Notify nurse when specimen is available.
types of visualization studies
Esophagogastroduodenoscopy (EGD)
Colonoscopy
o Watch for rectal bleeding post-op
o https://www.bing.com/videos/search?q=sigmoidoscopy&&view=detail&mid=3775793F2DC
ECFB4D48F3775793F2DCECFB4D48F&&FORM=VRDGAR (~2.5 minutes)
Sigmoidoscopy (looks for ulcers & polyps)
Wireless capsule endoscopy- non-invasive
indirect visualization studies
Upper gastrointestinal (UGI)
Small bowel series
Barium enema
o Monitor for bleeding post-procedure
o High fluid intake important after surgery (evacuates the barium)
Abdominal ultrasound
Magnetic resonance imaging (MRI)
Abdominal CT scan
scheduling diagnostic tests
1: fecal occult blood test (non-invasive)
o Occult blood- cannot be detected with the unassisted eye. Can be
seen in screening tests (hematest).
2: barium studies (should precede UGI) (invasive)
3: endoscopic examinations (invasive)
Noninvasive procedures take precedence over invasive procedures
and should be done first.
nursing interventions for GI studies
Providing needed information about the test and the activities required
Informing the primary provider of known medical conditions or abnormal
laboratory values that may affect the procedure
Assessing for adequate hydration before, during, and immediately after the
procedure, and providing education about maintenance of hydration
Know what procedures require NPO status and make sure the patient & family
are well educated on this requirement
Helping the patient cope with discomfort and alleviating anxiety (Explain the
procedure and what to expect!)
Enemas
Rectal suppositories
Oral intestinal lavage
Digital removal of stool
Bowel Prep for procedures
o Typically take the day before the procedure
o Pills and liquid (Golytely)
these are methods for emptying the colon
types of enemas
Oil-retention: lubricate the stool and
intestinal mucosa, easing defecation
Carminative: help expel flatus from the
rectum
Medicated: provide medications
absorbed through the rectal mucosa
Anthelmintic: destroy intestinal
parasites
other types of enemas
Cleansing- removes feces from rectum & lower bowel
Retention
o Oil
o Carminative
o Medicated
o Anthelmintic
Large volume
Small volume
what should enemas do
Enemas should increase bowel sounds and promote bowel movement(s)
bowel training programs
Manipulate factors within the patient’s control.
o Food and fluid intake, exercise, and time for
defecation
o Eliminate a soft, formed stool at regular intervals
without laxatives.
When achieved, continue to offer assistance with
toileting at the successful time.
o Bedpans do not facilitate downward pressure so offer
a bedside commode or walking to the bathroom
Goals: Gain control of bowel movements and develop a
regular pattern of elimination without the use of
laxatives.
nasogastric tubes
Inserted to decompress or drain the stomach of fluid or
unwanted stomach contents
o Bowel obstruction
Used to allow the gastrointestinal tract to rest before or after
abdominal surgery to promote healing
Inserted to monitor gastrointestinal bleeding
The NG tube is passed through the nasopharynx into the
stomach. Tubes for decompression typically are attached to
suction. Suction can be applied intermittently or
continuously.
percutaneous endoscopy and tube feedings
Elimination Side Effects
Diarrhea is one of the most common side effects of tube feeding
The right solution and rate of the tube feeding is important to
prevent dehydration from loose stools
Check medications as they may be what is causing the loose stools
vs the tube feeding itself
Try adding a soluble fiber product to your daily tube feeding regimen
or switching to a fiber-containing formula to help make your stools
more formed.
Consider using probiotics as an effective method in treating diarrhea.
Most people can stay on standard tube feeding formulas, which are
generally isotonic, lactose-free, low in fat and well tolerated
Tube feedings: start as tolerated, make sure HOB is >30-45 degrees
to avoid aspiration.
Why is a PEG needed?
* Patient is unable to eat or swallow properly for a variety of
reasons (i.e. stroke, elderly), injury or trauma, failure to thrive
types of ostomies
Sigmoid colostomy (A)
Descending colostomy (B)
Transverse colostomy (C)
Ascending colostomy (D)
Ileostomy (E)
colostomy care
Keep the patient as free of odors as possible; empty the appliance frequently.
Inspect the patient’s stoma regularly.
o Note the size, which should stabilize within 6 to 8 weeks.
o Keep the skin around the stoma site clean and dry.
Measure the patient’s fluid intake and output.
o Encourage the patient to drink lots of water particularly with a new colostomy.
Explain each aspect of care to the patient and self-care role.
Encourage patient to care for and look at ostomy.
patient teaching for colostomies
Explain the reason for bowel diversion and the
rationale for treatment.
Demonstrate self-care behaviors that effectively
manage the ostomy.
Describe follow-up care and existing support
resources.
Report where supplies may be obtained in the
community.
Verbalize related fears and concerns.
Demonstrate a positive body image.
reasons for colostomy
Bowel Incontinence
Diverticulitis
Cancer of the bowels
Obstruction of the bowels
Trauma/Injury/Emergenc
y
Crohns Disease
patient outcome for normal identification
Patient has a soft, formed bowel
movement every 1 to 3 days without
discomfort.
The relationship between bowel
elimination and diet, fluid, and
exercise is explained.
Patient should seek medical
evaluation if changes in stool color or
consistency persist.
promoting regular bowel habits
Timing
o Children
teach them not to hold a bowel movement
Avoid negative words like “nasty or gross”
Positioning
Privacy
Nutrition (High fiber!)
o Apples, prunes, kiwi, flaxseed, pears, beans
Exercise
o Abdominal settings
o Thigh strengthening
comfort measures for bowel elimination
Encourage recommended diet and exercise.
o CDC recommends to engage in two and a half hours of moderate
exercise plus two strength-training sessions per week
Use medications only as needed.
o Laxatives (don’t use frequently)
Apply ointments or astringent (witch hazel).
o Helpful for hemorrhoids
Use suppositories that contain anesthetics.
