Bowel elimination

Question 1

Anatomy and Physiology of Bowel Elimination

Answer 1

1. Stomach
2. Small intestine
3. Large intestine

Question 2

What is the primary organ of bowel elimination

Answer 2

Large intestine

Question 3

Where does the large intestine extend?

Answer 3

Extends from the ileocecal valve to the anus

Question 4

Functions of the Large Intestine?

Answer 4

Absorption of water
Formation of feces
Expulsion of feces from the body

Question 5

Peristalsis is under control of what?

Answer 5

Peristalsis is under control of the nervous system

Question 6

How often do peristalsis contractions occur?

Answer 6

Contractions occur every 3 to 12 minutes

Question 7

When do mass peristalsis occur?

Answer 7

Mass peristalsis sweeps occur one to four times each 24-hour period

Question 8

How much food waste is expired?

Answer 8

One third to one half of food waste is excreted in stool within 24 hours

Question 9

Variables Influencing Bowel Elimination

Answer 9

Developmental considerations
Daily patterns
Food and fluid
Activity and muscle tone
Lifestyle
Psychological variables
Pathologic conditions
Medications
Diagnostic studies
Surgery and anesthesia

Question 10

Bowel elimination developmental considerations for infants:

Answer 10

Infants: Characteristics of stool and frequency depend on formula or breast feedings

Question 11

Bowel elimination developmental considerations for toddlers:

Answer 11

Physiologic maturity is the first priority for bowel training

Question 12

Bowel elimination developmental considerations for Child, adolescent, adult:

Answer 12

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

Question 13

Bowel elimination developmental considerations for older adults

Answer 13

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

Question 14

Foods Affecting Bowel Elimination do what?

Answer 14

Constipating foods:

Foods with laxative effect:

Gas-producing foods:

Question 15

Constipating foods:

Answer 15

Constipating foods: cheese, lean meat, eggs, pasta

Question 16

Foods with laxative effect:

Answer 16

Foods with laxative effect: fruits and vegetables, bran, chocolate, alcohol, coffee

Question 17

Gas-producing foods:

Answer 17

Gas-producing foods: onions, cabbage, beans, cauliflower

Question 18

Effect of Medications on Stool

Answer 18

Opioid-induced constipation

Antacids decrease GI motility

Antibiotics, magnesium, and metformin can cause diarrhea

Question 19

Nursing History

Answer 19

Usual patterns of bowel elimination
Aids to elimination
Recent changes in bowel elimination
Problems with bowel elimination
Presence of bowel diversion

Question 20

Physical Assessment of the Abdomen: Sequence of assessing

Answer 20

The sequence for abdominal assessment proceeds from :

inspection,
auscultation, and
percussion to
palpation

Question 21

Physical Assessment of the Abdomen: Inspection

Answer 21

Inspection: observe contour, any masses, scars, or distention

Question 22

Physical Assessment of the Abdomen: Auscultation

Answer 22

Auscultation: listen for bowel sounds in all quadrants

Question 23

During auscultation, what should you note? Abdomen

Answer 23

Note frequency and character, audible clicks, and flatus

Describe bowel sounds as hypoactive, hyperactive, absent, or infrequent

Question 24

Physical Assessment of the Abdomen: Percussion

Answer 24

Percussion and palpations: performed by advanced practice professionals

Question 25

Physical Assessment of the Anus and Rectum: Technique used

Answer 25

Inspection and palpation

Question 26

Physical Assessment of the Anus and Rectum: Inspection and palpation

Answer 26

Lesions, ulcers, fissures (linear break on the margin of the anus), inflammation, and external hemorrhoids Ask the patient to bear down as though having a bowel movement. Assess for the appearance of internal hemorrhoids or fissures and fecal masses Inspect perineal area for skin irritation secondary to diarrhea or fecal incontinence

Question 27

Stool Collection: What is important?

Answer 27

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

Question 28

Stool Characteristics

Answer 28

Volume Color Odor Consistency Shape Constituents

Question 29

Types of Direct Visualization Studies (Endoscopy)

Answer 29

Esophagogastroduodenoscopy (EGD) Colonoscopy Sigmoidoscopy Wireless video capsule endoscopy

Question 30

Indirect Visualization Studies

Answer 30

Upper gastrointestinal (UGI) Small bowel series Barium enema Abdominal ultrasound Magnetic resonance imaging (MRI) Abdominal CT scan

Question 31

Patient Outcomes for Normal Bowel Elimination

Answer 31

Soft, formed bowel movement without discomfort Able to explain the relationship between bowel elimination and dietary fiber, fluid intake, and exercise Able to relate the importance of seeking medical evaluation if changes in stool color or consistency persist Skin integrity maintained

Question 32

Promoting Regular Bowel Habits

Answer 32

Timing Positioning Privacy Hygiene Nutrition Exercise (Abdominal settings Thigh strengthening)

Question 33

Individuals at High Risk for Constipation

Answer 33

Patients on bedrest or with decreased mobility Patients taking constipating medicines Patients with reduced fluids or bulk in their diet Patients who are depressed Patients with central nervous system disease or local lesions that cause pain while defecating

Question 34

Nursing Measures for the Patient With Diarrhea

Answer 34

Answer call bells immediately Remove the cause of diarrhea whenever possible (e.g., medication) If there is risk of impaction, hold antidiarrheal medications for further evaluation Give special care to the region around the anus

Question 35

Preventing Food Poisoning #1

Answer 35

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 undercooked

Question 36

Preventing Food Poisoning #2

Answer 36

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 37

Methods of Emptying the Colon of Feces

Answer 37

Enemas Rectal suppositories Oral intestinal lavage Digital removal of stool

Question 38

Types of Enemas

Answer 38

Cleansing Retention Hypotonic large volume Hypertonic small volume

Question 39

Types of retention enemas:

Answer 39

Oil Carminative Medicated

Question 40

Managing Bowel Incontinence

Answer 40

Note when incontinence is most likely to occur and assist patient to the bathroom or commode Keep the skin clean and dry Change bed linens and clothing as necessary Bowel-training programs Indwelling rectal tube External anal pouch

Question 41

Bowel-Training Programs

Answer 41

Encourage adequate fluid intake and proper diet Ensure privacy Stimulating bowel movements if needed Monitor Set a regular time for daily bowel movements Plan bowel program with patient and family/caregivers Manipulate factors within the patient's control (food and fluid intake, exercise and time for defecation) in order to eliminate soft, formed stool at regular intervals without laxatives

Question 42

Nasogastric Tubes- how are they put in?

Answer 42

Inserted to decompress or drain the stomach of fluid or unwanted stomach contents

Question 43

Nasogastric Tubes- what do they allow the GI tract to do?

Answer 43

Used to allow the gastrointestinal tract to rest before or after abdominal surgery to promote healing

Question 44

Nasogastric Tubes- Why are they inserted in?

Answer 44

Inserted to monitor gastrointestinal bleeding

Question 45

Types of Ostomies

Answer 45

Sigmoid colostomy Descending colostomy Transverse colostomy Ascending colostomy Ileostomy

Question 46

Colostomy Care

Answer 46

Keep the patient as free of odors as possible; empty the appliance frequently Inspect the patient’s stoma regularly Keep the skin around the stoma site clean and dry Measure the patient’s fluid intake and output Explain each aspect of care to the patient and self-care role Encourage patient to care for and look at ostomy Provide support for physical, psychological, and social activities

Question 47

Patient Teaching for Colostomies

Answer 47

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 48

Colostomy Diet: When should you eat low fiber diet?

Answer 48

Low-fiber foods during first 6–8 weeks

Question 49

Colostomy Diet: How much water should you drink?

Answer 49

Drink at least 2.5 quarts of fluids, preferably water

Question 50

Colostomy Diet: What foods to avoid?

Answer 50

Avoid foods that cause blockage: nuts, corn, popcorn, coconuts, mushrooms, stringy vegetables, and foods with skins and casings Avoid foods that may cause gas and/or produce odor

Question 51

Colostomy Diet: What foods to add/

Answer 51

Add foods that may help thicken stool: bananas, cheese, pasta, rice, yogurt, applesauce, potatoes