Bowel Elimination Flashcards
Functions of the small intestine
digestion, absorption of carbs, fat and protein
functions of larger intestine
absorption of water, vitamins and minerals
Factors that affect bowel elimination
age stress dietary intake fluid intake activity medications surgery anesthesia pregnancy pathological conditions
changes in associated with constipation
decreased frequency and more water is reabsorbed from he feces. as result the stool that is passed is hard and dry and requires more effort.
changes associated with diarrhea
increase in frequency and less water is absorbed
why are bowel diversions performed
done for a variety of reasons including, cancer, ulcerations, trauma, or inadequate blood supply. temporarily done to allow healing of distal portion of bowel, permanently done when severe disease or trauma is necrotic and cannot be salvaged
Topics for nursing history
Normal bowel pattern
appearance of stool
changes in bowel habits or stool appearance
history of elimination problems
use of bowel elimination aids, including diet, exercise, medication and remedies
physical assessment steps
- inspection, auscultation, percussion and palpation
- size, shape, contour, sounds
- tenderness, presence of air or solid, presence of masses
- inspect the anus for hemorrhoids
- palpate anus for stool or masses
independent nursing actions to encourage regular eliminations
- privacy
- allow for uninterrupted time
- teach to sit or squat, drink at least 1500mL, exercise 3-5 times a week
types of enemas
cleansing
retention
return-flow (harris flush)
hypotonic enemas
Large volume, leads to rapid evacuation by intestinal distention
isotonic enemas
Large volume, leads to rapid evacuation by intestinal distention
hypertonic enemas
small volume. attacks water into the colon, causing distention and stimulating peristalsis and dedication. Patient usually retain hypotonic and isotonic longer than hypertonic solutions. hypertonic solutions are more irritating to the mucosa.
Making a patient comfortable while administering an enema
- explain purpose and what to expect
- always provide privacy
- reassure the patient you will be immediately available to help to restroom
- lubricate the time of enema and administer slowly
- have patient breath slowly through mouth
Interventions to helping a patient adapt psychologically to a bowel diversion
- being willing to talk with patient about his reaction to stoma and concerns about living with an ostomy
- taking a caring approach when providing stoma care
- allowing adequate time for the patient to learn about self-care
- coordinating a visit by a volunteer from the united ostomy association
- providing information about a community support group of people living with an ostomy or other bowel diversions
Drugs that inhibit evacuation
- antacids
- iron
- pain medication
- antimotility drugs (used to stop diarrhea)
- anestesia
drugs that promote evacuation
- antibiotics
- laxatives
normal bowel sounds
5-15 gurgles every minute
hyperactive bowel sounds
very high pitched and more frequent. Occur with small bowel obstructions and inflammatory siocrders and may produce diarrhea
hypoactive bowel sounds
low pitched, infrequent and quiet. indicates decreased peristalsis which can result in constipation
absent bowel sounds
nothing for 3-5 minutes. indicate lack of intestinal activity which may occur after abdominal surgery and indicate a paralytic ileus.
occult blood
hidden in the stool
Foods that cause diarrhea
spicy, high-fat, greasy snacks or large quantities of raw fruit and vegetables.
monitoring interventions for diarrhea
- assess frequency, amount, color and consistency
- monitor I/O, body right, and vitals to assess hydration. turgor
- monitor serum electrolyte leves
- monitor skin integrity
BRAT diet
for children with diarrhea. Bananas, white rice, applesauce, and toast
interventions for short-term constipation
- increase intake of high-fiber foods
- increase fluid intake
- increase physical activity
- provide privacy
- assist the patient to a seated or squatting position
- allow the patient to uninterrupted time to use the toilet
- encourage the patient not to ignore the urge to defecate
- assess for complications
cleansing enemas
- treat severe constipation or impactions
- clear the colon in preparation for visualization procedures
- empty the colon when starting a bowel training program
- clear the colon for surgeries of the lower GI tract and some pelvic surgeries
hypotonic enema
cleansing. large volume that distends the intestine and leads to rapid evacuation of stool
hypertonic enema
cleansing small volume. attracts water into the colon causing distention and stimulating peristalsis and defecation
retention enemas
solution is meant to be reading for prolonged period. small volume
oil-retention enema
softens stoll and lubricates the rectum. used to press hard stool or before digital removal of stool. 90-120mL
carminative enema
helps expel flatus and relieve bloating and distention. used after pelvic surgery when peristalsis is slow to return and the client experiences pressure from gas. 60-180mL
medicated enemas
used to instill antibiotics to treat infections in the rectum or anus or to introduce anthelminthic agents for treatment of intestinal worm and parasites.
nutritive enemas
for patients who are dehydrated and frail. used in hospice
interventions for incontinence
- monitor patter of BM
- provide bedpan at regular intervals or times
- change clothing ASAP to prevent skin irritation
- provide prompt hygiene
- monitor skin for breakdown
- review diet, fluid intake, activity level and medicines
- bowel training program
- consider containment or indwelling methods to prevent drainage
