Bowel Elimination Chapter 28

Question 1

What are the major functions of the small intestine and large intestine?

Answer 1

Answer:

The intestine has the following major functions:

● Small intestine. The major function of the small intestine is the digestion and absorption of carbohydrates, fat, and protein.

● Large intestine. The major function of the large intestine is the absorption of water, vitamins, and minerals.

Question 2

How do the rectum and anus control elimination of feces from the body?

Answer 2

Answer:

Normally, the rectum is free of waste products until just before defecation. Feces and flatus (gas) are expelled from the rectum through the anus. The anus has two ringlike muscles that function as sphincters. The internal sphincter relaxes and opens when feces is present in the rectum. This is an involuntary reaction. The external sphincter is under voluntary control. Relaxation of the external sphincter allows feces, or stool, to be expelled from the body.

Question 3

What is a normal defecation pattern?

Answer 3

Answer:

There is a wide range of “normal.” The frequency of BMs may range from several times per day to once per week. Bowel function may be regarded as normal as long as stools are passed without excessive urgency (needing to rush to the toilet), with minimal effort and no straining, without blood loss, and without the use of laxatives.

Question 4

Identify the factors that affect bowel elimination.

Answer 4

Answer:

The following factors affect bowel elimination:

● Age

● Stress

● Dietary intake

● Fluid intake

● Activity

● Medications

● Surgery

● Anesthesia

● Pregnancy

● Pathological conditions (e.g., food allergies and intolerances, diverticulosis, diverticulitis)

Question 5

What changes in bowel elimination are associated with constipation? With diarrhea?

Answer 5

Answer:

The following changes in bowel elimination are associated with these conditions:

● Constipation is a decrease in frequency of BMs. As the length of time between BMs increases, more water is reabsorbed from the feces. As a result, constipation is also associated with passage of dry, hard stool that requires more effort to pass.

● Diarrhea is an increase in the frequency of BMs. As transit time through the colon decreases, less water is reabsorbed and stools are often watery.

Question 6

Why are bowel diversions performed?

Answer 6

Answer:

A bowel diversion is a surgically created opening for elimination of digestive waste products from the bowel. This procedure is performed for clients with a variety of conditions, including cancer, ulcerations, trauma, or inadequate blood supply. Temporary diversions are performed to allow healing of the distal portion of the bowel; permanent diversions are performed in instances of severe disease or trauma when the bowel is necrotic or cannot be salvaged.

Question 7

What determines the nature of the effluent from a bowel diversion?

Answer 7

The effluent may range from liquid to solid depending on the part of the bowel that is being diverted. The lower in the bowel the colostomy is placed (i.e., the closer to the rectum and anus), the more solid the effluent. Because the fecal matter stays in the bowel longer, more water can be absorbed from it, and it becomes more solid.

Question 8

What should you discuss with your client when performing a nursing history focused on bowel elimination?

Answer 8

Answer:

The following items should be part of a nursing history focused on bowel elimination:

● 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, medications, and remedies

Question 9

Describe the physical assessment you would perform for a client with constipation.

Answer 9

Answer:

Physical assessment for bowel elimination includes examination of the abdomen, rectum, and anus.

● Recall that in abdominal assessment, the order of the exam is inspection, auscultation, percussion, and palpation.

● Observe the size, shape, and contour of the abdomen, and listen to bowel sounds.

● Percuss and palpate the abdomen for tenderness, presence of air or solid, and presence of masses.

● Inspect the anus for signs of hemorrhoids.

● Depending on the policies of your institution as well as your skill with assessment, you might also palpate the anus and rectum for the presence of stool or masses.

Question 10

Identify at least five independent nursing actions that you could take to encourage regular elimination in a well client.

Answer 10

Answer:

The following nursing actions encourage regular elimination in a well client:

● Provide privacy when using the bathroom

● Allow for uninterrupted time to defecate, especially after meals

● Teach the client to do the following:

● Assume a seated or squatting position when attempting to have a BM

● Drink at least 1,500 mL (preferably 8 to 10 glasses, or 2,000 to 2,400 mL) of fluid per day

● Exercise 3 to 5 times per week

Question 11

Identify the types of enemas available for use.

Answer 11

Answer:

Enemas may be classified as follows:

● Cleansing

● Retention

● Return-flow (Harris flush)

Question 12

How do hypotonic and isotonic enemas differ from hypertonic enemas?

Answer 12

Answer:

The enemas have the following differences:

● Hypotonic and isotonic enemas are large-volume enemas. The volume causes intestinal distention and leads to rapid evacuation of stool.

● Hypertonic enemas are usually smaller volume (2.5–4 ounces or 70–120 mL). The hypertonic solution attracts water into the colon, causing distention and stimulating peristalsis and defecation. Patients are usually able to retain hypotonic and isotonic longer than hypertonic solutions. Hypertonic solutions are more irritating to the mucosa.

Question 13

What actions can you take to make the patient more comfortable when he receives an enema?

Answer 13

Answer:

The following actions make the patient more comfortable when receiving an enema:

● Explain the purpose of the enema and what the patient can expect.

● Always provide privacy when administering an enema.

● Reassure the patient that you will be immediately available to help the patient to the restroom or onto the bedpan.

● Lubricate the tip of the enema and administer the solution slowly.

● Have the patient breathe slowly through the mouth.

Question 14

What are the major patient care concerns associated with bowel incontinence?

Answer 14

Answer:

Major concerns associated with bowel incontinence include patient embarrassment, anxiety, social isolation, and lowered self-concept. In addition, clients with bowel incontinence are at risk for skin breakdown.

Question 15

What are the elements of a bowel training program?

Answer 15

Answer:

A bowel training program includes the following elements:

● Planning the program with the patient and caregiver

● Gradually increasing fluid, fiber, and activity to promote regular bowel movements

● Initiating a designated uninterrupted time, in private, to defecate

● Developing a staged treatment plan when constipation develops

● Regularly modifying the plan based on the patient’s response

Question 16

How can you help a patient adapt psychologically to living with a bowel diversion?

Answer 16

Answer:

The following nursing interventions help a patient adapt psychologically to a bowel diversion (other answers are possible):

● Being willing to talk with a patient about his reaction to the 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 diversion

Question 17

What does a healthy stoma look like?

Answer 17

Answer:

A healthy stoma is colored from deep pink to brick red regardless of skin color and is shiny and moist at all times. The stoma will protrude above the level of the abdomen by approximately 0.5 to 1.0 inches.

Question 18

Why is skin care around a stoma so important?

Answer 18

Answer:

Skin care around a stoma is essential to prevent skin breakdown, which may lead to infection, discomfort, and leakage of ostomy output from around the appliance.

Question 19

Which of the following subjective data gathered from the client would indicate a risk for constipation?

A. Use of vitamin C and caffeine

B. Taking Maalox often for heartburn

C. Drinking 1,500 mL of water during the day

D. Eating yogurt for breakfast and taking a magnesium supplement

Answer 19

Answer:

B. Taking Maalox often for heartburn

Response:

Maalox is an antacid, which would slow peristalsis. Between 1,500 and 2,000 mL of water should be adequate for normal bowel function. Vitamin C and caffeine do not slow peristalsis, nor do yogurt and magnesium; they stimulate peristalsis.

Question 20

The physician orders a test for occult blood to be done on Mrs. Petrowski’s stool. The result has come back negative. To be sure you do not have a false negative reading, which information do you need to ask Mrs. Petrowski? Whether she has been

A. using iron preparations

B. eating red meat in the past 3 days

C. taking vitamin C

D. taking the diuretic, furosemide

Answer 20

Answer:

C. taking vitamin C.

Rationale:

Iron preparations and red meat can cause a false positive result, but not a false negative result, so there is no need for the nurse to obtain this irrelevant data. Response D, furosemide, has no connection whatever to a fecal occult blood test result, so it too is irrelevant. Vitamin C can cause a false negative result.

Question 21

Mrs. Addie is 70 years old. While the nurse is gathering admission assessment data, the patient states, “I’ve taken a tablespoon of Milk of Magnesia every day for 3 years, and I still don’t have a BM every day.” Which nursing diagnosis is most appropriate for the nurse to use in her plan of care?

A. Diarrhea

B. Constipation

C. Risk for Dysfunctional GI Motility

D. Perceived Constipation

Answer 21

Answer:

D. Perceived Constipation

Rationale:

There are no defining characteristics to support responses Diarrhea, Constipation, or Risk for Dysfunctional GI Motility. Daily laxative use by Mrs. Addie and her statement, “I still don’t have a BM every day,” suggest that she perceives she is constipated, and the nurse would gather further assessment data related to the client’s bowel pattern.

Question 22

The physician has ordered enemas for Mr. Gray until the return is clear. The nurse is to use a hypertonic solution. The nurse would question the order if Mr. Gray had which of the following conditions?

A. Constipation

B. Chronically elevated BUN and creatinine

C. Peptic ulcer disease

D. Multiple sclerosis

Answer 22

Answer:

B. Chronically elevated BUN and creatinine

Rationale:

An elevated BUN and creatinine could indicate the presence of chronic renal disease. Hypertonic solutions are sodium based and could exacerbate water retention in this client if used repeatedly.

Question 23

What is the correct nursing action for an Impaction

Answer 23

Remove stool manually

Question 24

What is the correct nursing action for Pinworms

Answer 24

Test for eggs with tape

Question 25

What is the correct nursing action for a Valsalva maneuver

Answer 25

Discourage the post-MI (heart attack) patient from using

Question 26

What is the correct nursing action for an Ileostomy

Answer 26

Assess surrounding skin every shift

Question 27

What is the correct nursing action for Constipation

Answer 27

Encourage a high-fiber diet

Question 28

When teaching the client about his or her colostomy, the first thing the nurse should do is to demonstrate all of the available ostomy products.

Answer 28

Answer:

False

Rationale:

The nurse must first gather data about how the patient is adjusting to the presence of the ostomy.

Question 29

A meconium stool in a 1-day-old infant is a normal finding.

Answer 29

Answer:

True

Question 30

The recommended daily intake of fiber is 10 to 15 grams.

Answer 30

Answer:

False

Rationale:

The recommended intake is 25 to 30 grams a day.

Question 31

1.Normal flora contained in the colon aid digestion and produce which nutrients?

1) Vitamin A
2) Vitamin B
3) Vitamin C
4) Vitamin K
5) Iron
6) Zinc

Answer 31

Answer:

2) Vitamin B
4) Vitamin K

Rationale:

The normal flora in the colon produce vitamin K and several of the B vitamins. They are not responsible for production of vitamins A and C, iron, and zinc.

Question 32

2.When a patient with heartburn takes antacids, for which problem is he especially at risk?

1) Diarrhea
2) Constipation
3) Stomach ulceration
4) Flatulence

Answer 32

Answer:

2) Constipation

Rationale:

Antacids slow peristalsis, placing the patient at risk for constipation. Antibiotics increase the risk for diarrhea. Stomach ulceration is an adverse effect associated with nonsteroidal anti-inflammatory drugs (NSAIDs). Iron supplementation may cause flatulence.

Question 33

3.Which type of bowel diversion allows the patient to be free from an appliance?

1) Colostomy in the transverse colon
2) Double-barreled colostomy
3) Ileostomy
4) Kock pouch

Answer 33

Answer:

4) Kock pouch

Rationale:

A Kock pouch, also known as a continent ileostomy, creates an internal pouch to collect ileal drainage. To drain the pouch, the patient inserts a tube through the external stoma into a pouch several times a day. This allows the patient to be free from an appliance. A colostomy, double-barreled colostomy, and ileostomy all require an appliance.

Question 34

4.The nurse has taught a client how to manage constipation. Which action by the client would provide evidence of learning? (Select all that apply.) The patient:

1) increases his intake of high-fiber foods.
2) drinks at least four 8-ounce glasses of water a day.
3) goes to the bathroom to evacuate after meals.
4) takes a daily laxative.

Answer 34

Answer:

1) increases his intake of high-fiber foods.
3) goes to the bathroom to evacuate after meals.

Rationale:

The urge to defecate typically comes after eating; the nurse can help manage the patient’s constipation by assisting the patient to the bathroom after meals. The nurse should also encourage the patient to increase his intake of high-fiber food and drink at least eight glasses of water a day (not four). Laxatives should be administered or taken only when absolutely necessary.

Question 35

5.A patient is admitted to the hospital with severe diarrhea. The patient should be monitored for which complication associated with diarrhea?

1) Hypokalemia
2) Hypocalcemia
3) Hyperglycemia
4) Thrombocytopenia

Answer 35

Answer:

1) Hypokalemia

Rationale:

Diarrhea causes fluid loss and hypokalemia, not hypocalcemia, hyperglycemia, or thrombocytopenia.

Question 36

6.For a patient with a newly fractured pelvis, not yet in a cast, which of the following actions is appropriate when placing the patient on a bedpan?

1) Place the patient in semi-Fowler’s position to defecate.
2) Ask the patient to push up with his feet to lift his hips while you place the bedpan.
3) Place a fracture pan under the buttocks, small end toward the feet.
4) Raise the side rail on the opposite side from where you are working.

Answer 36

Answer:

4) Raise the side rail on the opposite side from where you are working.

Rationale:

The nurse should always raise the side rail on the opposite side from where he is working to protect the patient from falls. Placing the patient in semi-Fowler’s position or asking the patient to push up with his feet would cause pain and possible dislocation of the fracture. A fracture pan should be used, but the small large end is pointed toward the feet.