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NRS 125 > Bowel Elimination > Flashcards

Bowel Elimination Flashcards

1
Q

What are some factors that affect bowel elimination?

A 
Age
Diet
Fluid intake
Physical activity 
Psychological factors
Personal habits
Pain
Position
Pregnancy and labour
Medications
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2
Q

How does AGE affect bowel elimination?

A
  • decreased CHEWING, degeneration of taste buds
  • decreased MOTILITY (ability to move spontaneously and actively)
  • decreased ACID SECRETIONS
  • delayed GASTRIC EMPTYING
  • decreased PERISTALSIS
  • decreased ABSORPTION
  • loss of MUSCLE TONE
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3
Q

How does DIET affect bowel elimination?

A
  • FIBRE is required to form bulk
  • absorb FLUID and increase STOOL MASS
  • the stretching of bowel walls stimulates peristalsis
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4
Q

What foods help stimulate peristalsis?

A
  • onion, cauliflower, beans, and spicy foods
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5
Q

Gas forming foods cause…

A

distension of the abdomen and increase motility

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6
Q

How does fluid intake affect bowel elimination?

A
  • inadequate fluid or increase fluid loss slows the passage of food and produces hardened stool
  • avoid caffeine, drink fruit juices
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7
Q

What is the recommended fluid intake?

A

1400-2000 ml (6-8 glasses) per day

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8
Q

Older adults are at risk for insufficient ______ intake resulting in a risk for ____________ and ________.

A

fluid
dehydration
constipation

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9
Q

How does physical activity affect bowel elimination?

A

PROMOTE PERISTALSIS, so its important to encourage early ambulation after illness or surgery

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10
Q

What physiological factors affect bowel elimination?

A
  • body systems are IMPAIRED by prolonged STRESS
  • STRESS accelerates digestion, peristalsis, diarrhea, and gaseous distension
  • DEPRESSION can decrease peristalsis
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11
Q

What personal habits help improve bowel elimination?

A
  • bowel routine
  • benefit from using own toilet
  • busy schedule may prevent response to urges
  • privacy
  • sight, sound, odour (comfort)
  • ability to move / activity tolerance
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12
Q

What position improves defecation?

A
  • when sitting on a toilet, lean forward to increase abdominal pressure
  • head of the bed must be raised on a bed pan
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13
Q

What are some conditions that may cause pain during defication?

A

hemorrhoids, rectal surgery, abdominal surgery, episiotomy

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14
Q

Define episiotomy.

A

surgical cut to the opening of the vagina to prevent tear during delivery

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15
Q

How can pregnancy and delivery affect bowel elimination?

A

3rd trimester there is increased pressure and can obstruct passage of feces and results in increased straining and hemorrhoids

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16
Q

How does surgery and anaesthesia affect bowel elimination?

A
  • surgery slows peristalsis

- narcotics slow peristalsis

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17
Q

Define endoscopy.

A

looking inside the body

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18
Q

Diagnostic tests often require….

A

colonoscopy or barium enema so they can see inside the colon

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19
Q

What kinds of medications effect peristalsis?

A
  • Iron supplements and pain medication SLOW peristalsis

- laxatives STIMULATE peristalsis

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20
Q

Gordon’s elimination pattern questions to ask regarding elimination.

A
  • normal habits, frequency, time of day
  • any changes
  • characteristics of stool
  • require laxatives,enema,or special diet
  • constipation, diarrhea, incontinence, or passage of blood or mucous
  • meds
  • excess perspiration
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21
Q

What are some examples of bowel elimination problems in nursing diagnosis?

A
  • bowel incontinence
  • constipation
  • risk of constipation
  • perceived constipation
  • diarrhea
22
Q

Assessment of Bowel elimination; nursing history.

A
  • review usual habits
  • description of characteristics of stool
  • describe usual bowel routines to promote normal elimination
  • diet history
  • daily fluid intake/hydration
  • stress
  • elimination aids at home
  • cognitive ability
  • changes in appetite
  • history of surgery or illness
  • presence of bowel diversions (ostomies)
  • med history
  • emotional state
  • social history
  • history of pain or discomfort
  • mobility/dexterity
23
Q

What does a physical assessment entail?

A
  • mouth (poor fitting denture, sores, eating difficulties)
  • abdomen (distension, contour, skin colour, shape, tenderness, presences of mass)
  • presence of bowel sounds
  • rectum (lesions, discolouration, inflammation, hemorrhoids)
24
Q

What are some characteristics of stool to observe?

A

COLOUR: (clay, red, tarry, black)
ODOUR: pungent, affected by food, presence of blood, watch for noxious (unpleasant, harmful, poisonous) changes
CONSISTENCY: soft, formed (dry hard diarrhea)
FREQUENCY: 2-3 time/wk or day
SHAPE: normal ‘S’ shape (narrow, pencil, obstructed)

25
You can use ______ of ____ to visualize GI tract.
ingestion of dye
26
Define barium enema.
X ray of colon, etc after bowels empty aka GI swallowing
27
What are 3 types of diagnostic examination?
- visual GI tract with ingestion of dye - barium enema, or GI swallowing - endoscopic examination (colonoscopy, upper endoscope)
28
Why would fecal specimens be taken?
test for bacteria, parasites or occult blood
29
Define occult blood
Blood in the feces that is not apparent
30
What nursing strategy can we use to promote bowel elimination?
- importance of taking time to deficate - assist in bowel elimination routine - positioning (must assess capability, ensure privacy) - proper wiping (front to back)
31
What dietary recommendations could be made for bowel elimination?
- teach importance of diet and its impacts on elimination - must have 25-30 g of fibre daily - always take fluid with fibre - excessive hot or cold fluids may stimulate peristalsis - fluid intake should be 1500-2000ml per day - coffee, tea, alcohol avoided because of diuretic effect - take in appropriate amount of protein - limit fatty foods and dairy
32
What is your recommended dietary fibre?
25-30g daily
33
What is your recommended fluid intake?
1500-2000ml daily
34
How can medication affect bowel elimination?
- laxatives and stool softener can be used with caution | - some drugs cause constipation (analgesics)
35
How can exercise effect bowel elimination?
- prevents constipation - should have 15-20 min work out per day (walking, riding bike, swimming, running) - can recommend chair or bed exercises for those who are unable
36
What is bowel training?
- technique used to educate and assist in achieving normal defecation - constipation should not be ignored - keep 7 day bowel record to evaluate - assess normal elimination patterns - set up routine - provide privacy
37
When there is incontinence it is important to monitor ________.
skin integrity
38
How can you maintain skin integrity with clients who are incontinent?
clean skin immediately and keep dry
39
What are 7 measures to promote defection?
a. defecate at the same time each day b. position/ sit/ lean forward c. sufficient privacy and time d. do not ignore urges e. proper diet and food as discussed f. warm drinks g. stool softeners and laxatives as required
40
What are common bowel problems?
``` constipation diarrhea impaction flatulence fecal incontinence hemorrhoids ```
41
Describe constipation.
- not a disease but a symptom | - abdominal pain, distension, feeling full, pressure on rectum, staining on defecation
42
What are some causes of constipation?
- irregular habits - illness/disease (hypothyroidism, spinal injury) - low or inadequate fibre - stress - immobility - regular laxative use - aging process (decreases peristalsis) - polypharmacy (multiple medications)
43
What is diarrhea?
increased bowel movements per day (liquidy, watery, unformed stool)
44
What causes diarrhea?
bad food, antibiotics, those on enteral feeds, food allergies, stress, surgeries, laxatives, chemotherapy, C. difficult, Norwalk, cholera
45
What can result from diarrhea?
- severe electrolyte imbalances - severe dehydration - can irritate skin and cause breakdown
46
What is impaction?
- collection of hardened faces which cannot be expelled - inability to pass stool for days - continuous oozing of diarrhea - anorexia (loss of appetite), vomitting, abdominal distension may accompany condition
47
What is flatulence?
- normal amount is 50- 500ml of gas 10-15times per day - excess causes fulness, pain, cramping - when mobility is reduced can produce severe abdominal distension, and severe pain
48
What is fecal incontinence?
- inability to control passage of faces or gas - mentally aware but physically unable to control - caused by loss of control of external sphincter - often associated with diarrhea - have little to no warning prior to episode - can harm self image - may cause social anxiety
49
What are hemorrhoids?
- DILATED and ENGORGED VIENS lining the rectum caused by increased venous pressure - can be external and internal - can cause pain - may need to be removed - can cause frequent soiling of undergarments, irritation from distend veins - avoid vigorous washing and use baby wipes after bowel movement
50
What are some goals you could have for bowel elimination in your nursing diagnosis?
- client will voice relief from constipation within 24hrs - the client will drink at least 1500ml of fluid over the next 8 hrs - the client will increase protein in diet to 25-30g/day within the next 3 days
51
How does protein affect bowel elimination?
too much can cause constipation

NRS 125 (6 decks)

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