Bowel Elimination Flashcards
Bowel Elimination
- Normal GI tract function
- Sensory awareness
- Sphincter control
Normal bowel elimination
a patient is able to have a bowel elimination without a rush to toilet, no excessive straining, no blood loss, no laxative use
Normal frequency
daily, 2-3 times a week
Normal color and consistency
brown and soft
What to ask patient?
whats their normal bowel movement and when was their last bowel movement
Factor affecting elimination
Personal habits, not comfortable using public restrooms so hold it for hours.
Fiber
absorbs fluid, promotes elimination of softer stool, peristalsis is stimulated.
Fiber intake
25g per day for females
38g for males.
About 5 servings a day
Less fluid intake develops?
hard stools, constipation
Activity level
exercise stimulates peristalsis.
Meds
antacids = slows peristalsis resulting in constipation
Antibiotics= loose stool, diarrhea
Iron supplements = causes discoloration of stool (Black stool) can cause constipation
Health history
any recent surgeries with general anesthesia = slows bowel motility.
Emotional distress
depression = peristalsis decreases, leading to constipation
Continence
asking if patient can make it to the bathroom before bowel movement
Pain
problem relating to bowel elimination. Pooping should be painless. if pain is present investigate for hemorrhoids.
Always ask patient…
if they have changes in bowel movement.
Physical Assessment
-Abdomen
look at contour of abdomen, asculatate bowel sounds, assess any tenderness with palpation
Physical Assessment
-Stool
always assessing patients stool. look at color, (gray or clay colored= liver problems)
(black or starry= melnia, blood) (streaky blood = infection) consistency : hard, soft, liquid
Stool labs:
Occult blood
Guiac or FOBT test : get specimen to get tested to see if blood in stool that you cant see with naked eye
Stool labs:
FIT test
another stool lab testing
0&P
ova and parasites testing : stool must be fresh and warm, can not be mixed with urine or water.
Sigmoidoscopy
direct visualization; every 5 years, start screenings at 50 yo. Visualing anus canal, rectum, and sigmoid canal
Colonoscopy
direct visualization; every 10 years; moves up farther in rectum than sigmoidoscopy.
EGD
direct visualization; upper GI. looks at esophagus and stomach. Scope is inserted through mouth. Purpose to do tissue biospys
KUB
flat plate- basic xray, can detect gall stones, distended bowels
Barium swallow/Enema
inserted through rectum or drink barium solution. Remain upright and rotate side to side. PUSH fluids bc barium can cause constipation
Computed Tomography (CT)
gives 3 dimensional picture, drink IV liquid. so assess for iodine or shellfish allergies. Creatinum levels needed before. Might feel nausea or warmth, push fluids to flush contrast out of body
Magnetic resonance imaging (MRI)
sensitive test, just using resonance. May receive dye but no iodine dye. Assess patient has no metal on body, jewerly, etc
Short term constipation
recently developed and resolved quickly, change in lifestyle, change in diet, etc
Chronic constipation
develop related to chronic illness, lower level of peristalsis, depress, Parkinson’s, hyperthyroidism, person who frequently uses laxatives
CM
- Infrequent stools >3 days
- Difficulty defecating
- Hard feces
- Pain
Enemas
instilling/ running fluids into rectum into colon
Fecal impaction
stuck feces, hard stool stuck in rectum.
CM of fecel impaction
- unable to pass stool
- oozing loose stool
- anorexia
- cramping
- rectal pain
Danger of fecel impaction
obstruction - EMERGENCY, needs surgery.
vagal stimulation - get gloves, lubricant, position patient, insert finger into rectum to feel hard stool. notify provider
Diarrhea
passage of liquid unformed stool.
Dangers of Diarrhea
- fluid volume deficit
- metabolic acidosis
- skin breakdown
bowel incontinence
this is the inability to control the passage of feces and gas
causes of bowel incontinence
neuromuscular disease or any of the problems that lead to diarrhea
2 dangers of bowel incontinence
skin breakdown and social embarrassment
3 treatment options for bowel incontinence
protect skin (skin moisture barriers, etc.), find ways to avoid social embarrassment, bowel training
hemorrhoids
blood vessels that sense if stool or gas needs to pass can enlarge and become irritated, causing
