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Fundamentals > Bowel Elimination > Flashcards

Bowel Elimination Flashcards

1
Q

Common Bowel Elimination Problems

A 
Constipation
Diarrhea
Flatulence
Impaction
Incontinence
Hemorrhoids
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2
Q

Constipation

A

A symptom, not a disease; infrequent stool and/or hard, dry, small stools that are difficult to eliminate

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3
Q

Diarrhea

A

An increase in the number of stools and the passage of liquid, unformed feces

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4
Q

Impaction

A

Results from unrelieved constipation; a collection of hardened feces wedged in the rectum that a person cannot expel

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5
Q

Incontinence

A

Inability to control passage of feces and gas to anus

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6
Q

Hemorrhoids

A

Dilated, engorged veins in the lining of the rectum

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7
Q

Common causes of constipation

A

Low fiber diet, low fluid intake, physical inactivity, medications (Opioids), change in routine (being in hospital, travel), neurological conditions

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8
Q

Elimination factors

A 
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
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9
Q

Fecal specimens

A

Fecal Occult Blood Test: screening for colon cancer

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10
Q

Types of diagnostic examinations

A

Direct visualization: Colonoscopy, Sigmoidoscopy
Indirect visualization: CT scan, MRI
Bowel preparation

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11
Q

Promotion for healthy bowel elimination

A
  • Maintain routine for bowel elimination
  • Colorectal cancer screening
  • Promotion of normal defecation (Sitting position, privacy, positioning on bedpan)
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12
Q

Ileostomy

A

Stoma in small intestines
Liquid waste has digestive enzymes caustic to skin
Peri-stomal skin care priority
Function of small intestine: absorption of nutrients

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13
Q

Transverse colostomy

A

Thick liquid to soft consistency

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14
Q

Sigmoid colostomy

A

Semi-formed stool

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15
Q

Ostomy pouching system

A
  • 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
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16
Q

Ostomy complications

A
  • Redness, excoriation (skin picking), skin breakdown
  • Assess stoma: Should be beefy red
  • Dusky pink/black are signs of necrosis: call surgeon
17
Q

Care of ostomy

A
  • Empty pouch when 1/3 to 1/2 full
  • Change pouch every 3-7 days or when leaking
  • Collaborate with Wound, Ostomy, & Continence Nurse
18
Q

Laxative Medications

A
  • 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)
19
Q

Enema

A
  • 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
20
Q

Cleansing enemas

A

Promote the complete evacuation of feces from the colon by stimulating peristalsis through infusion of a large volume of solution or local irritation

21
Q

Tap water enema

A

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)

22
Q

Soapsuds enema

A

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
23
Q

Normal saline enema

A

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
24
Q

Fleets enema (hypertonic)

A

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
25
Q

Oil retention enema

A

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

26
Q

High or low cleansing enema (height = pressure)

A
  • 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
27
Q

Enema admin

A

Explain procedure, positioning (left lateral Sims), precautions to avoid discomfort, and length of time necessary to retain the solution before defecation

28
Q

Impaction removal

A

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
29
Q

Safety for enema, impaction removal

A
  • 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)
30
Q

Restorative care

A
  • 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
31
Q

Indwelling Bowel Management Systems

A

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)

Fundamentals (2 decks)

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