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fundamentals 3 > Bowel Elimination chapter 46 > Flashcards

Bowel Elimination chapter 46 Flashcards

1
Q

what are the influencing factors of bowel elimination

A 
Age
daily patterns 
food and fluid intake 
activity and muscle tone
lifestyle, psychological variables 
pathologic conditions
medications 
diagnostic test 
surgery and anesthesia 
pregnancy
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2
Q

what are some constipating foods?

A

Cheese, lean meat, eggs, and pasta

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3
Q

Foods with laxative effect

A

fruits and vegetables, bran, chocolate, alcohol and coffee.

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4
Q

Foods that produce gas

A

onions, cabbage, beans, cauliflower.

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5
Q

Common bowel elimination problems

A 
Constipation
impaction 
diarrhea
incontinence 
flatulence 
hemorrhoids
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6
Q

Constipation

A
  • Bowel movement fewer than every 3 days
  • Hard, dry stool; difficulty to eliminate
  • excessive straining, bloating, and the sensation of a full bowel.
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7
Q

What are the causes for constipation?

A 
not enough fiber in diet
lack of physical activity 
some medication 
milk, cheese, 
irritable bowel syndrome 
changes in life routine 
laxative misuse
ignoring the urge to have a bowel elimination 
dehydration 
specific disease or conditions 
problems with the colon or rectum
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8
Q

Hemorrhoids

A

Dilated veins in rectum from straining painful: itchy can be external or external.

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9
Q

Impaction

A

Feces/stool obstruction. liquid stool may “ooze” or leak around hardened stool.

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10
Q

Flatulence

A

Excess or trapped gas. can result from slowed mobility.

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11
Q

Enemas

A

Procedure involving introduction of a solution into the rectum for cleansing or therapeutic purposes.

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12
Q

types of enemas

A

Isotonic (normal saline)- 1)Distends the colon. 2) Stimulates peristalsis 3) softens feces

soap suds- irritate mucosa; distends the colon.

Hypertonic-Draws water into colon

Hypotonic-Distends the colon. 2) stimulates peristalsis 3) softens feces

Oil retention- Lubricates and softness stool
Return- flow/ carminative to relieve fetus.

medicated- Kayexale (to remove potassium rapidly) Neomycin (before colon surgery)

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13
Q

diarrhea

A

-Liquid stools
-often intestinal cramping
-large amounts of fluids and electrolytes depleted. places person at risk for complication: fluid and electrolyte imbalance.
-infants, young children, elderly at greater risk.
skin excoriation and breakdown.

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14
Q

causes of diarrhea

A

Viruses and bacteria
medication
food poisoning

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15
Q

Nursing measures

A
  • answer call lights immediately
  • remove the cause of diarrhea whenever possible
  • if there is impaction, obtain physician order for rectal examination.
  • give special care to the region around the anus
  • after diarrhea stops, suggest the intake of fermented dairy products.
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16
Q

bowel training

A
  • assessing normal bowel elimination pattern and recording the times pt is incontinent.
  • incorporating principles for older pts.
  • choosing time to initiate defecation control measures
  • giving stool softeners orally every day or suppository 1/2 an hour before defecation time
  • offering hot drink, fruit juice, or fluids before defecation to stimulate peristalsis.
  • Helping pt to lean forward @ hips while on toilet, applying pressure on abdomen and bear down but not strain to stimulate colon emptying
  • not criticizing or conveying frustration
  • maintaining normal exercise /in pts ability.
17
Q

Key Facts

A

raise side rail on pt’s LEFT: assist pt into left-side lyinh position (sims) w/ right knee flexed; enter slowly at pt’s hip level; lower container to decrease the flow; clamp tubing if cramps start.

18
Q

treatment for diarrhea- Acute Diarrhea (hours to days)

A

-Rehydration is most important
-skin care
antidiarrheal meds usually after bacteria ruled out.

19
Q

Treatments for diarrhea- Chronic diarrheal 3-4 weeks or more

A
  • many causes and treatments

- immodium, lomotil, kaopectate, peptobismol

20
Q

Physical assessment of abdomen

A

1) Inspecition
2) auscultation
3) percussion
4) palpation

21
Q

While assessing a clients abdomen what should the nurse look for during the inspection phase?

A

observe contour, any masses palpation alters peristalsis

22
Q

Auscultation of abdomen

A
  • precedes palpation because alters peristalsis
  • listen for bowel sounds in all quadrants
  • note frequency and character, audible clicks and flatus
  • describe bowel sounds as audible, hyperactive, hypoactive, or inaudible
23
Q

percussion

A

areas of increased dullness may be caused by fluid, a mass or tumor.

24
Q

Palpation

A

note any muscular resistance, tenderness, enlargement of organs or masses.

25
Q

What clients should avoid straining during BM (bowel Movement)

A 
Cardiovascular disease
glaucoma 
increased intracranial pressure (ICP)
Surgical wounds 
increased blood pressure
26
Q

individuals at high risk for constipation?

A
  • pts on bed rest taking constipating medicines.
  • pts with reduced fluids or bulk in their diet
  • patients who are depressed
  • patients with central nervous system disease or local lesions that cause pain.
  • pts with narcotics.
27
Q

how should the nurse promote regular bowel habits?

A
  • Timing: after meals and exercise.
  • Positioning: bedside commode or toilet vs bedpan
  • Privacy
  • Nutrition: fluids, fiber, fruits and veggies
  • exercise
28
Q

Bowel training programs

A
  • Manipulate factors within the pt’s control
  • food and fluid intake, exercise, consistent time for defecation, privacy
  • ideal outcome: eliminate a soft, formed stool as regular intervals without laxatives.
  • when achieved, discontinue use of suppository if one was used.
29
Q

what are the methods for emptying the colon feces?

A
  • Cathartics and laxatives
  • enemas
  • rectal suppositories
  • digital removal of stool.
30
Q

how to prevent food poisoning

A
  • never buy food with damaged packaging
  • never use raw eggs in any form
  • do not eat ground meat uncooked
  • never cut meat on a wooden surface
  • do not eat seafood that is raw or has a strong unpleasant odor
  • clean all vegetables and fruits before eating
  • refrigerate leftovers within 2 hours of finishing eating
  • give only pasteurized fruit juices to small children
31
Q

what are the guidelines the nurse must inform the pt that needs to provide a stool sample.

A
  • To void first so urine is not in stool sample
  • defecate into the container rather than toilet bowl
  • do to not place toilet tissue in the bedpan or specimen container
  • notify nurse when specimen is available
32
Q 
Diarrhea
constipation 
risk for constipation 
bowel incontinence
self-care deficit: toileting 
self-deficit: ostomy care 
fluid volume deficit 
skin integrity, impaired 
pain
A

all Nursing Diagnoses

33
Q

implements in the Nurses process & bowel elimination

A
  • promoting regular defecations
  • teaching about medications decreasing flatulence
  • administering enemas
  • digital removal of a fecal impation
  • instituting bowel training programs
  • applying a fecal incontinence pouch
  • ostomy management
34
Q

Bowel diversions

A
  • Temporary or permanent artificial opening in the abdominal wall (stoma)
  • may be emergent or planned
  • surgical opening in the ileum or colon (ileostomy or colostomy)
35
Q

Nasogastric tubes

A

-decompression- remove gas and secretions from GI tract.
-enteral feeding
-lavage- wash out poison, blood
-tube into nostril, down throat into stomach.
for decompression: might be hooked to low intermittent suction.
provide excellent oral care.

36
Q

types of bowel diversions

A 
Ileostomy :
    -injuries: gunshot
    -familial polyposis
   - cancer
    -perforated diverticulitis
    -inflammatory disease: ulcerative colitis,   
       crohn's disease    
Colostomy:
-Injuries 
-cancer
-fistulas
37
Q

what does a healthy stoma look like?

A
  • inside lip is a good beginning example
  • deep reddish pink
  • moist
  • no areas of impaired circulation or necrosis
  • no signs of infection
  • skin-no erosion, breakdown, irritation.
38
Q

post -op stoma care

A
  • odors
  • red, moist (pale-anemia; dark poor circ)
  • size
  • skin-clean and dry
  • fluid intake and output
  • new colostomy- BM in 2 days or so
  • teaching, coaching, emotional support
  • referrals
  • low-fiber diet first few weeks
39
Q

what are some of the problems the older adults face about bowel elimination

A

Older adults also lose muscle tone in the perineal floor and anal sphincter . Although the integrity of the sphincter remains intact, they often have difficulty controlling bowel evacuation and are at risk for incontinence. In addition, nerve impulses to the anal region slow, causing some individuals to become less aware of the need to defecate. Older adults, especially residents in long-term care facilities, sometimes develop irregular bowel movements and an increased risk for constipation

fundamentals 3 (8 decks)

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