bowel elimination

Question 1

the large intestine

Answer 1

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

Question 2

the small intestine

Answer 2

• 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.

Question 3

assessment of the gi system

Answer 3

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

Question 4

bowel habits and family history

Answer 4

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

Question 5

physical assessment of the abdomen

Answer 5

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

Question 6

inspection and palpation

Answer 6

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.

Question 7

process of peristalsis

Answer 7

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

Question 8

how much fluid should you drink per day

Answer 8

~2,000-3,000
ml’s of fluid
per day

Question 9

variables influencing bowel inflammation

Answer 9

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

Question 10

manifestations of chronic constipation

Answer 10

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

Question 11

complications of constipation

Answer 11

Decreased cardiac output
Fecal impaction
Hemorrhoids
Fissures (torn skin around anus)
Rectal prolapse
Megacolon

Question 12

patient learning needs for constipation

Answer 12

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

Question 13

foods affecting bowel elimination

Answer 13

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

Question 14

infants stool

Answer 14

Infants: Characteristics of stool and frequency depend on
formula or breast feedings.
o Stools may be yellow and loose during breastfeeding

Question 15

toddlers stool

Answer 15

Toddler: Physiologic maturity is the first priority for bowel
training.

Question 16

child adolescent and adult considerations

Answer 16

Child, adolescent, adult: Defecation patterns vary in
quantity, frequency, and rhythmicity.

Question 17

Older adult: Constipation is often a chronic problem;
diarrhea and fecal incontinence may result from physiologic
or lifestyle changes.

Answer 17

older adult considerations

Question 18

Test Your Knowledge!
Which food is a recommended for an
older adult who is constipated?
A. Cheese
B. Fruit
C. Cabbage
D. Eggs

Answer 18

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.

Question 19

preventing food poisoning

Answer 19

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.

Question 20

effects of medications on stool

Answer 20

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

Question 21

diarrheas affects on stool

Answer 21

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

Question 22

manifestations of diarrhea

Answer 22

Increased frequency and fluid
content of stools
Abdominal cramps
Distention
Borborygmus
Anorexia and thirst
Painful spasmodic contractions of
the anus
Tenesmus (cramping rectal pain)

Question 23

complications of diarrhea

Answer 23

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

Question 24

assessment and diagnostic findings

Answer 24

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

Question 25

nursing measures for patients with diarrhea

Answer 25

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.

Question 26

patient learning needs and treatment for diarrhea

Answer 26

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

Question 27

incontinence of bowel risk factors

Answer 27

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)

Question 28

bowel incontinence nursing interventions

Answer 28

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.

Question 29

stool collections

Answer 29

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.

Question 30

types of visualization studies

Answer 30

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

Question 31

indirect visualization studies

Answer 31

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

Question 32

scheduling diagnostic tests

Answer 32

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.

Question 33

nursing interventions for GI studies

Answer 33

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!)

Question 34

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)

Answer 34

these are methods for emptying the colon

Question 35

types of enemas

Answer 35

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

Question 36

other types of enemas

Answer 36

Cleansing- removes feces from rectum & lower bowel
Retention
o Oil
o Carminative
o Medicated
o Anthelmintic
Large volume
Small volume

Question 37

what should enemas do

Answer 37

Enemas should increase bowel sounds and promote bowel movement(s)

Question 38

bowel training programs

Answer 38

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.

Question 39

nasogastric tubes

Answer 39

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.

Question 40

percutaneous endoscopy and tube feedings

Answer 40

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

Question 41

types of ostomies

Answer 41

Sigmoid colostomy (A)
Descending colostomy (B)
Transverse colostomy (C)
Ascending colostomy (D)
Ileostomy (E)

Question 42

colostomy care

Answer 42

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.

Question 43

patient teaching for colostomies

Answer 43

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.

Question 44

reasons for colostomy

Answer 44

Bowel Incontinence
Diverticulitis
Cancer of the bowels
Obstruction of the bowels
Trauma/Injury/Emergenc
y
Crohns Disease

Question 45

patient outcome for normal identification

Answer 45

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.

Question 46

promoting regular bowel habits

Answer 46

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

Question 47

comfort measures for bowel elimination

Answer 47

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.