Bowel Elimination Flashcards
A nurse is performing an abdominal assessment on a patient experiencing frequent bouts of diarrhea. The nurse first observes the contour of the abdomen, noting any masses, scars, or areas of distention. What action will the nurse perform next?
a. Auscultating the abdomen using an orderly clockwise approach in all abdominal quadrants
b. Percussing all quadrants of the abdomen in a systematic clockwise manner to identify masses, fluid, or air in the abdomen
c. Lightly palpating over the abdominal quadrants; first checking for any areas of pain or discomfort
d. Deeply palpating over the abdominal quadrants, noting muscular resistance, tenderness, organ enlargement, or masses
a
The sequence for abdominal assessment proceeds from inspection, auscultation, percussion, and then palpation. Inspection and auscultation are performed before palpation because palpation may disturb normal peristalsis and bowel motility.
A nurse is administering a large-volume cleansing enema to a patient prior to surgery. When the enema solution is introduced, the patient reports severe cramping. What nursing intervention would the nurse perform next?
a. Elevating the head of the bed 30 degrees and repositioning the rectal tube
b. Placing the patient in a supine position and modifying the amount of solution
c. Lowering the solution container and checking the temperature and flow rate
d. Removing the rectal tube and notifying the primary care provider
c
If the patient reports severe cramping with introduction of an enema solution, the nurse should lower the solution container and check the temperature and flow rate. If the solution is too cold or the flow rate is too fast, severe cramping may occur. The head of the bed may be elevated 30 degrees for the patient’s comfort if the patient needs to be placed on a bedpan in the supine position while receiving the enema.
A nurse working on a GI unit is caring for a group of patients. In patients with which health problems or issues could the assessment possibly reveal decreased or absent bowel sounds after listening for 2 minutes? Select all that apply.
a. Peritonitis
b. Prolonged bedrest
c. Diarrhea
d. Gastroenteritis
e. Early bowel obstruction
f. Postoperative paralytic ileus
a, b, f
Decreased or absent bowel sounds—documented only after listening for in the epigastric and umbilical area of the abdomen for 2 minutes or longer (Bickley et al., 2021)—signify the absence of bowel motility, commonly associated with peritonitis, paralytic ileus, and/or prolonged immobility. Hyperactive bowel sounds indicate increased bowel motility, commonly caused by diarrhea, gastroenteritis, or early bowel obstruction.
A nurse in a long-term care facility is assessing a group of patients. In which patients would the nurse anticipate increased risk for developing diarrhea? Select all that apply.
a. Patient taking opioids for pain
b. Patient taking metformin for type 2 diabetes
c. Patient taking diuretics
d. Patient who developed dehydration
e. Patient taking amoxicillin clavulanate for infection
f. Patient taking magnesium-containing antacids
b, e, f
Diarrhea is a potential adverse effect of treatment with amoxicillin clavulanate, metformin, or antacids containing magnesium. Opioids, diuretics, and dehydration may lead to constipation.
A nurse plans to administer a retention enema to a patient with a fecal impaction. Which nursing action is appropriate for this procedure?
a. Administering a large volume of solution (500 to 1,000 mL)
b. Mixing milk and molasses in equal parts for an enema
c. Instructing the patient to retain the enema for at least 30 minutes
d. Administering the enema while the patient is sitting on the toilet
c
Instruct the patient to retain the enema solution for at least 30 minutes or as indicated in the manufacturer’s instructions. The milk and molasses mixture is a carminative enema that helps to expel flatus. The patient should be instructed to lie on their left side as dictated by patient condition and comfort.
A nurse prepares to assist a patient with a newly created ileostomy. Which recommended patient teaching points would the nurse stress? Select all that apply.
a. “When you inspect the stoma, it should be dark purple-blue.”
b. “The size of the stoma will stabilize within 2 weeks.”
c. “Keep the skin around the stoma site clean and moist.”
d. “The stool from an ileostomy is normally liquid.”
e. “Eat dark-green vegetables to control the odor of the stool.”
f. “You may have a tendency to develop food blockages.”
d, e, f
Ileostomies normally have liquid, foul-smelling stool. The nurse should encourage intake of dark-green vegetables for their chlorophyll content, which helps to deodorize the feces. Explain that patients with ileostomies may tend to develop food blockages, especially when high-fiber foods are consumed. The stoma should be dark pink to red and moist. Stoma size usually stabilizes within 4 to 6 weeks, and the skin around the stoma site (peristomal area) should be kept clean and dry.
A nurse is preparing a hospitalized patient for a colonoscopy. Which nursing action is the recommended preparation for this test?
a. Having the patient consume a low-fiber diet several days before the test
b. Having the patient take bisacodyl and ingest a gallon oral polyethylene glycol solution (PEG)
c. Preparing the patient for the use of general anesthesia during the test
d. Explaining that barium contrast mixture will be given to drink before the test
a
If possible, a low-residue diet (low fiber) should be followed several days before the procedure, although some may have a full liquid diet the day before the procedure. There are multiple types of bowel preps for this procedure; the health care provider determines the best regimen for the individual.
The prep is usually given as a split dose, with half being given the night before and rest the morning of the procedure. It is recommended the second dose be given at least 5 hours before and completed at least 2 hours before the study. Occasionally, some patients may receive the prep the same day as the procedure, especially if it is scheduled for later in the day.
Conscious sedation, not general anesthesia, will be given for the colonoscopy. A chalky-tasting barium contrast mixture is given to drink before an upper GI and small-bowel series of tests.
A nurse is performing digital removal of stool on a patient with a fecal impaction. During the procedure, the patient tells the nurse they are feeling dizzy and nauseated and then vomits. What should be the nurse’s next action?
a. Reassuring the patient that this is a normal reaction to the procedure
b. Stopping the procedure, preparing to administer CPR, and notifying the primary care provider
c. Stopping the procedure, assessing vital signs, and notifying the health care provider
d. Pausing the procedure, waiting 5 minutes, and then resuming the procedure
c
When a patient reports dizziness, lightheadedness, nausea, and/or vomiting during digital stool removal, the nurse recognizes the vagus nerve may have been stimulated. The nurse should stop the procedure, assess heart rate and blood pressure, and notify the health care provider.
A nurse is scheduling tests for a patient who has been experiencing epigastric pain. The health care provider ordered the following tests: (a) barium enema, (b) fecal occult blood test, (c) endoscopic studies, and (d) an upper GI series. What is the correct order for performing the tests?
a. c, b, d, a
b. d, c, a, b
c. a, b, d, c
d. b, a, d, c
d
A fecal occult blood test is performed first to detect GI bleeding. Lower GI barium studies should be performed next to visualize GI structures and reveal any inflammation, ulcers, tumors, strictures, or other lesions. A barium enema and routine radiography should precede an upper GI series because retained barium from an upper GI series could take several days to pass through the GI tract and obscure anatomic detail on the barium enema studies. Noninvasive procedures usually take precedence over invasive procedures, such as endoscopic studies, when sufficient diagnostic data can be obtained from them.
A nurse is caring for a patient who had abdominal surgery and has a nasogastric tube attached to low suction. Which nursing actions are appropriate when caring for this patient? Select all that apply.
a. Irrigating the tube with 30-mL normal saline solution
b. Confirming tube placement via pH testing of gastric secretions
c. Positioning the air vent at the level of the patient’s umbilicus
d. Instilling irrigation via the blue air vent
e. Monitoring the patient’s abdomen for distention
f. Documenting the nasogastric irrigation and drainage with I & O
a, b, d, e, f
Care of a patient with an NG tube connected to suction includes verifying placement before administration of any fluids or medications to avoid aspiration. Radiographic evidence of the tip of the tube in the stomach, measurement of tube length, measurement of tube marking, measurement of aspirate pH, and carbon dioxide monitoring may be used. The nurse irrigates the tube with 30 mL of saline solution (or as prescribed/ per policy) with an irrigating syringe. The nurse separates the tube from the suction device, clamps the NG tube to prevent gastric secretions from leaking, and places the tip of the syringe in the tube to gently insert the saline solution. The nurse should not place irrigant in the blue air vent of a Salem sump or double-lumen tube; rather, the nurse should instill air through the vent. The air vent decreases any pressure that has built up in the stomach during suction; instilling air promotes drainage. The air vent should be placed above the stomach. Abdominal distention may indicate lack of proper drainage or delayed return of GI function. The nurse documents all irrigation and NG tube output with the I & O. If the nurse allows the irrigant to drain out, that is excluded from intake.
A nurse is planning a bowel program for a patient with frequent constipation after sustaining a spinal cord injury. What is the first step the nurse will take?
a. Offering a diet that is low in residue
b. Increasing fluid intake to 3,000 mL daily
c. Administering daily enemas to stimulate peristalsis
d. Assessing the patient’s bowel patterns
d
The nurse follows the steps of the nursing process to plan care. First the nurse assesses the patient’s bowel movements including frequency, consistency, shape, volume, and color. Based on the assessment findings, the nurse may recommend 3 of fluid daily or administer an enema, as appropriate. The nurse also monitors bowel sounds, teaches about specific foods that promote bowel regularity, ensures privacy, and encourages adequate fluid intake.
A community health nurse is providing an adult education session about colon cancer. Which signs and symptoms of this cancer will the nurse include? Select all that apply.
a. Blood in the stool
b. Previous colonoscopy
c. Passing two large bowel movements daily
d. Unintentional weight loss
e. Upper abdominal cramping
f. Previous opioid use
a, d
The nurse discusses signs and symptoms of colon cancer including rectal bleeding or blood in the stool, persistent change in bowel pattern or consistency of stool, persistent cramping or pain in lower abdomen (or gas), a feeling of incomplete bowel emptying, weakness or fatigue, and unintentional weight loss.
For a patient with which health problem or issue would a nurse expect the health care provider to order colostomy irrigation?
a. IBS
b. Left-sided end colostomy in the sigmoid colon
c. Postradiation damage to the bowel
d. Crohn disease
b
Irrigations are used to promote regular evacuation of distal colostomies. Colostomy irrigation may be indicated in patients who have a left-sided end colostomy in the descending or sigmoid colon, are mentally alert, have adequate vision, and have adequate manual dexterity needed to perform the procedure. Contraindications include IBS, peristomal hernia, postradiation damage to the bowel, diverticulitis, and Crohn disease (Kent et al., 2015).
A nurse is assisting a patient to change an ostomy appliance when they note the stoma is protruding into the bag. What would be the nurse’s first action in this situation?
a. Reassuring the patient that this is a normal with a new ostomy
b. Notifying the health care provider that the stoma is prolapsed
c. Having the patient rest for 30 minutes to see if the prolapse resolves
d. Replacing the appliance with a larger appliance
c
If the stoma protrudes into the bag after changing the ostomy appliance, the nurse should have the patient rest for 30 minutes. If the stoma is not back to normal size within that time, notify the health care provider. If the stoma stays prolapsed, it may twist, resulting in impaired circulation to the stoma.
A nurse is caring for an older adult who reports persistent constipation and has a number of laxative prescriptions on the MAR. Which medication would the nurse avoid for this patient?
a. Saline osmotic laxative
b. Bulk-forming laxative
c. Methylcellulose
d. Stool softener
a
Certain saline osmotic laxatives can lead to fluid and electrolyte imbalances and should not be used in older adults and those with kidney or cardiac disease.
