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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
Q

You can use ______ of ____ to visualize GI tract.

A

ingestion of dye

26
Q

Define barium enema.

A

X ray of colon, etc after bowels empty aka GI swallowing

27
Q

What are 3 types of diagnostic examination?

A
  • visual GI tract with ingestion of dye
  • barium enema, or GI swallowing
  • endoscopic examination (colonoscopy, upper endoscope)
28
Q

Why would fecal specimens be taken?

A

test for bacteria, parasites or occult blood

29
Q

Define occult blood

A

Blood in the feces that is not apparent

30
Q

What nursing strategy can we use to promote bowel elimination?

A
  • importance of taking time to deficate
  • assist in bowel elimination routine
  • positioning (must assess capability, ensure privacy)
  • proper wiping (front to back)
31
Q

What dietary recommendations could be made for bowel elimination?

A
  • 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
Q

What is your recommended dietary fibre?

A

25-30g daily

33
Q

What is your recommended fluid intake?

A

1500-2000ml daily

34
Q

How can medication affect bowel elimination?

A
  • laxatives and stool softener can be used with caution

- some drugs cause constipation (analgesics)

35
Q

How can exercise effect bowel elimination?

A
  • 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
Q

What is bowel training?

A
  • 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
Q

When there is incontinence it is important to monitor ________.

A

skin integrity

38
Q

How can you maintain skin integrity with clients who are incontinent?

A

clean skin immediately and keep dry

39
Q

What are 7 measures to promote defection?

A

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
Q

What are common bowel problems?

A 
constipation
diarrhea
impaction
flatulence
fecal incontinence 
hemorrhoids
41
Q

Describe constipation.

A
  • not a disease but a symptom

- abdominal pain, distension, feeling full, pressure on rectum, staining on defecation

42
Q

What are some causes of constipation?

A
  • irregular habits
  • illness/disease (hypothyroidism, spinal injury)
  • low or inadequate fibre
  • stress
  • immobility
  • regular laxative use
  • aging process (decreases peristalsis)
  • polypharmacy (multiple medications)
43
Q

What is diarrhea?

A

increased bowel movements per day (liquidy, watery, unformed stool)

44
Q

What causes diarrhea?

A

bad food, antibiotics, those on enteral feeds, food allergies, stress, surgeries, laxatives, chemotherapy, C. difficult, Norwalk, cholera

45
Q

What can result from diarrhea?

A
  • severe electrolyte imbalances
  • severe dehydration
  • can irritate skin and cause breakdown
46
Q

What is impaction?

A
  • 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
Q

What is flatulence?

A
  • 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
Q

What is fecal incontinence?

A
  • 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
Q

What are hemorrhoids?

A
  • 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
Q

What are some goals you could have for bowel elimination in your nursing diagnosis?

A
  • 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
Q

How does protein affect bowel elimination?

A

too much can cause constipation

NRS 125 (6 decks)

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