Bowel Elimination chapter 46

Question 1

what are the influencing factors of bowel elimination

Answer 1

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

Question 2

what are some constipating foods?

Answer 2

Cheese, lean meat, eggs, and pasta

Question 3

Foods with laxative effect

Answer 3

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

Question 4

Foods that produce gas

Answer 4

onions, cabbage, beans, cauliflower.

Question 5

Common bowel elimination problems

Answer 5

Constipation
impaction 
diarrhea
incontinence 
flatulence 
hemorrhoids

Question 6

Constipation

Answer 6

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

Question 7

What are the causes for constipation?

Answer 7

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

Question 8

Hemorrhoids

Answer 8

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

Question 9

Impaction

Answer 9

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

Question 10

Flatulence

Answer 10

Excess or trapped gas. can result from slowed mobility.

Question 11

Enemas

Answer 11

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

Question 12

types of enemas

Answer 12

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)

Question 13

diarrhea

Answer 13

-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.

Question 14

causes of diarrhea

Answer 14

Viruses and bacteria
medication
food poisoning

Question 15

Nursing measures

Answer 15

• 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.

Question 16

bowel training

Answer 16

• 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.

Question 17

Key Facts

Answer 17

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.

Question 18

treatment for diarrhea- Acute Diarrhea (hours to days)

Answer 18

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

Question 19

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

Answer 19

• many causes and treatments

- immodium, lomotil, kaopectate, peptobismol

Question 20

Physical assessment of abdomen

Answer 20

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

Question 21

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

Answer 21

observe contour, any masses palpation alters peristalsis

Question 22

Auscultation of abdomen

Answer 22

• 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

Question 23

percussion

Answer 23

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

Question 24

Palpation

Answer 24

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

Question 25

What clients should avoid straining during BM (bowel Movement)

Answer 25

``` Cardiovascular disease glaucoma increased intracranial pressure (ICP) Surgical wounds increased blood pressure ```

Question 26

individuals at high risk for constipation?

Answer 26

- 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.

Question 27

how should the nurse promote regular bowel habits?

Answer 27

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

Question 28

Bowel training programs

Answer 28

- 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.

Question 29

what are the methods for emptying the colon feces?

Answer 29

- Cathartics and laxatives - enemas - rectal suppositories - digital removal of stool.

Question 30

how to prevent food poisoning

Answer 30

- 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

Question 31

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

Answer 31

- 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

Question 32

``` Diarrhea constipation risk for constipation bowel incontinence self-care deficit: toileting self-deficit: ostomy care fluid volume deficit skin integrity, impaired pain ```

Answer 32

all Nursing Diagnoses

Question 33

implements in the Nurses process & bowel elimination

Answer 33

- 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

Question 34

Bowel diversions

Answer 34

- 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)

Question 35

Nasogastric tubes

Answer 35

-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.

Question 36

types of bowel diversions

Answer 36

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

Question 37

what does a healthy stoma look like?

Answer 37

- 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.

Question 38

post -op stoma care

Answer 38

- 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

Question 39

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

Answer 39

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