Bowel elimination Flashcards
Anatomy and Physiology of Bowel Elimination
- Stomach
- Small intestine
- Large intestine
What is the primary organ of bowel elimination
Large intestine
Where does the large intestine extend?
Extends from the ileocecal valve to the anus
Functions of the Large Intestine?
Absorption of water
Formation of feces
Expulsion of feces from the body
Peristalsis is under control of what?
Peristalsis is under control of the nervous system
How often do peristalsis contractions occur?
Contractions occur every 3 to 12 minutes
When do mass peristalsis occur?
Mass peristalsis sweeps occur one to four times each 24-hour period
How much food waste is expired?
One third to one half of food waste is excreted in stool within 24 hours
Variables Influencing Bowel Elimination
Developmental considerations
Daily patterns
Food and fluid
Activity and muscle tone
Lifestyle
Psychological variables
Pathologic conditions
Medications
Diagnostic studies
Surgery and anesthesia
Bowel elimination developmental considerations for infants:
Infants: Characteristics of stool and frequency depend on formula or breast feedings
Bowel elimination developmental considerations for toddlers:
Physiologic maturity is the first priority for bowel training
Bowel elimination developmental considerations for Child, adolescent, adult:
Child, adolescent, adult: Defecation patterns vary in quantity, frequency, and rhythmicity
Bowel elimination developmental considerations for older adults
Older adult: Constipation is often a chronic problem; diarrhea and fecal incontinence may result from physiologic or lifestyle changes
Foods Affecting Bowel Elimination do what?
Constipating foods:
Foods with laxative effect:
Gas-producing foods:
Constipating foods:
Constipating foods: cheese, lean meat, eggs, pasta
Foods with laxative effect:
Foods with laxative effect: fruits and vegetables, bran, chocolate, alcohol, coffee
Gas-producing foods:
Gas-producing foods: onions, cabbage, beans, cauliflower
Effect of Medications on Stool
Opioid-induced constipation
Antacids decrease GI motility
Antibiotics, magnesium, and metformin can cause diarrhea
Nursing History
Usual patterns of bowel elimination
Aids to elimination
Recent changes in bowel elimination
Problems with bowel elimination
Presence of bowel diversion
Physical Assessment of the Abdomen: Sequence of assessing
The sequence for abdominal assessment proceeds from :
inspection,
auscultation, and
percussion to
palpation
Physical Assessment of the Abdomen: Inspection
Inspection: observe contour, any masses, scars, or distention
Physical Assessment of the Abdomen: Auscultation
Auscultation: listen for bowel sounds in all quadrants
During auscultation, what should you note? Abdomen
Note frequency and character, audible clicks, and flatus
Describe bowel sounds as hypoactive, hyperactive, absent, or infrequent
Physical Assessment of the Abdomen: Percussion
Percussion and palpations: performed by advanced practice professionals
Physical Assessment of the Anus and Rectum: Technique used
Inspection and palpation
Physical Assessment of the Anus and Rectum: Inspection and palpation
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
Stool Collection: What is important?
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
Stool Characteristics
Volume
Color
Odor
Consistency
Shape
Constituents
Types of Direct Visualization Studies (Endoscopy)
Esophagogastroduodenoscopy (EGD)
Colonoscopy
Sigmoidoscopy
Wireless video capsule endoscopy
Indirect Visualization Studies
Upper gastrointestinal (UGI)
Small bowel series
Barium enema
Abdominal ultrasound
Magnetic resonance imaging (MRI)
Abdominal CT scan
Patient Outcomes for Normal Bowel Elimination
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
Promoting Regular Bowel Habits
Timing
Positioning
Privacy
Hygiene
Nutrition
Exercise (Abdominal settings
Thigh strengthening)
Individuals at High Risk for Constipation
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
Nursing Measures for the Patient With Diarrhea
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
Preventing Food Poisoning #1
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
Preventing Food Poisoning #2
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
Methods of Emptying the Colon of Feces
Enemas
Rectal suppositories
Oral intestinal lavage
Digital removal of stool
Types of Enemas
Cleansing
Retention
Hypotonic large volume
Hypertonic small volume
Types of retention enemas:
Oil
Carminative
Medicated
Managing Bowel Incontinence
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
Bowel-Training Programs
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
Nasogastric Tubes- how are they put in?
Inserted to decompress or drain the stomach of fluid or unwanted stomach contents
Nasogastric Tubes- what do they allow the GI tract to do?
Used to allow the gastrointestinal tract to rest before or after abdominal surgery to promote healing
Nasogastric Tubes- Why are they inserted in?
Inserted to monitor gastrointestinal bleeding
Types of Ostomies
Sigmoid colostomy
Descending colostomy
Transverse colostomy
Ascending colostomy
Ileostomy
Colostomy Care
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
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
Colostomy Diet: When should you eat low fiber diet?
Low-fiber foods during first 6–8 weeks
Colostomy Diet: How much water should you drink?
Drink at least 2.5 quarts of fluids, preferably water
Colostomy Diet: What foods to avoid?
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
Colostomy Diet: What foods to add/
Add foods that may help thicken stool: bananas, cheese, pasta, rice, yogurt, applesauce, potatoes
