Bowel Elimination Flashcards
Common Bowel Elimination Problems
Constipation Diarrhea Flatulence Impaction Incontinence Hemorrhoids
Constipation
A symptom, not a disease; infrequent stool and/or hard, dry, small stools that are difficult to eliminate
Diarrhea
An increase in the number of stools and the passage of liquid, unformed feces
Impaction
Results from unrelieved constipation; a collection of hardened feces wedged in the rectum that a person cannot expel
Incontinence
Inability to control passage of feces and gas to anus
Hemorrhoids
Dilated, engorged veins in the lining of the rectum
Common causes of constipation
Low fiber diet, low fluid intake, physical inactivity, medications (Opioids), change in routine (being in hospital, travel), neurological conditions
Elimination factors
Elimination patterns Routine Bowel diversions Changes in appetite Diet history Fluid intake Surgery or illness Medication Emotional state Exercise Pain or discomfort Social history Mobility
Fecal specimens
Fecal Occult Blood Test: screening for colon cancer
Types of diagnostic examinations
Direct visualization: Colonoscopy, Sigmoidoscopy
Indirect visualization: CT scan, MRI
Bowel preparation
Promotion for healthy bowel elimination
- Maintain routine for bowel elimination
- Colorectal cancer screening
- Promotion of normal defecation (Sitting position, privacy, positioning on bedpan)
Ileostomy
Stoma in small intestines
Liquid waste has digestive enzymes caustic to skin
Peri-stomal skin care priority
Function of small intestine: absorption of nutrients
Transverse colostomy
Thick liquid to soft consistency
Sigmoid colostomy
Semi-formed stool
Ostomy pouching system
- Consists of a pouch and skin barrier
- one and two-piece systems, may be flat or convex
- Some have opening precut, others require the stoma opening to be custom cut to the patient’s specific stoma size
- Newer pouches have an integrated closure and older ones use a clip to close the pouch
- First skill to teach a pt is how to open/close the pouch
Ostomy complications
- Redness, excoriation (skin picking), skin breakdown
- Assess stoma: Should be beefy red
- Dusky pink/black are signs of necrosis: call surgeon
Care of ostomy
- Empty pouch when 1/3 to 1/2 full
- Change pouch every 3-7 days or when leaking
- Collaborate with Wound, Ostomy, & Continence Nurse
Laxative Medications
- Bulk-forming: Safest, adds fiber (Metamucil, Benefiber)
- Stool softener: Docusate sodium (Colace)
- Osmotic: pulls water into bowels (Milk of magnesia, Mag citrate, Miralax)
- Stimulant laxatives: Harshest, cramping, can lead to dependence (Bisacodyl: Dulcolax)
Enema
- Instillation of solution into the rectum, sigmoid colon
- Reason: promote defecation by stimulating peristalsis
- Breaks up the fecal mass, stretches the rectal wall and initiates the defecation reflex
- Vehicle for medications that exert a local effect
- Most commonly used for the immediate relief of constipation, emptying the bowel before tests/surgery and beginning a program of bowel training
Cleansing enemas
Promote the complete evacuation of feces from the colon by stimulating peristalsis through infusion of a large volume of solution or local irritation
Tap water enema
Hypotonic: Infused volume stimulates defecation before large amounts of water leave the bowel into interstitial spaces
-Caution: Water toxicity or volume overload could develop if body absorbs large amounts of water (by repeating enema)
Soapsuds enema
Castile soap is added to tap water or saline to create the effect of intestinal irritation to stimulate peristalsis
- Use only pure castile soap in liquid form (included in most soapsuds enema kits)
- Caution in older adults: electrolyte imbalance, damage to the intestinal mucosa
Normal saline enema
Safest with less risk of fluid overload (osmotic)
- The volume of infused saline stimulates peristalsis
- Giving saline enemas lessens the danger of excess fluid absorption
Fleets enema (hypertonic)
Exerts osmotic pressure that pulls fluids out of interstitial spaces. The colon fills with fluid and the distention promotes defecation
- Do not use in dehydrated patients or young infants (contraindicated)
- Patients unable to tolerate large volumes of fluid benefit most (low volume)
- 120 to 180 mL (4 to 6 ounces) is usually effective
Oil retention enema
Lubricate feces, feces absorb the oil and become softer and easier to pass
-Instruct patient to hold as long as possible to enhance action of the oil
High or low cleansing enema (height = pressure)
- High enemas cleanse more of the colon, low enema cleanses rectum and sigmoid colon
- After enema is infused, turn from left lateral -> dorsal recumbent -> right lateral position
- Position change ensures that fluid reaches the large intestine
Enema admin
Explain procedure, positioning (left lateral Sims), precautions to avoid discomfort, and length of time necessary to retain the solution before defecation
Impaction removal
Digital removal of stool (Impaction Removal): Use if enemas fail to remove an impaction
- Cannot be delegated to UAP
- Last resort in managing severe constipation
Safety for enema, impaction removal
- Self-administer enemas: use the side-lying position
- If patient has cardiac disease or is taking cardiac or hypertensive medication, obtain a pulse rate
- Manipulation of rectal tissue stimulates vagus nerve (cause sudden decline in pulse rate)
Restorative care
- Bowel training (habit training): daily routine
- Same time, measures that promote defecation = normal defecation pattern
- Fluid intake of 1500 mL to prevent constipation
- If fluid intake is inadequate, stool becomes hard
- High fiber diet: Adds bulk, eliminates excess fluids, promotes frequent/regular movements
- Whole grains, legumes, fresh fruits/veg eaten regularly promotes normal elimination
- Promotion of regular exercise
- Walking, bicycle, or swimming stimulates peristalsis
- At least 150 minutes of exercise each week
Indwelling Bowel Management Systems
Temporary containment device for bedridden patient with liquid stool
- Ex Flexi-seal: Rectal tube with balloon & collection
- Short-term use with high-volume diarrhea (acute care settings)
