Bowel Elimination (Exam 2) Flashcards
Older Adults Care Focus
-Trouble chewing
-Esophageal emptying slows
-Impaired absorption
-Weakened sphincters
Older Adult Decreases
-Hydrochloric acid
-Absorption of Vitamins
-Peristalsis
-Sensation to defecate
-Lipase to aid in fat digestion
Constipation
-Symptom not a disease
-Having fewer than 3 BM per week
Consipation: Symptoms
-Infrequent BM’s
-Discomfort
-Hard, dry stools. Hard to pass
Constipation: Causes
-Irregular bowel habits
-Improper diet
-Reduce fluid intake
-Lake of exercise
-Certain medications
-Age
-Ignoring the urge
Older Adults and Constipation
-Lack of MT
-Slowed Peristalsis
-Lack of exercise
-No fluid
-Too much dairy
-Lack of fiber
-Medications
Complications of Constipation
Hemorrhoids
Anal Fissure
Fecal Impaction
Rectal Prolapse
Constipation prevention
-High fiber foods
-Drink plenty of water
-Stay active
-Manage stress
-Don’t ignore the urge
-Create schedule
Laxatives and Cathartics
-Other than bulk forming… Do not take these regularly
Implementation: Cathartics and Laxatives
-Medications that initiate stool passage
-Short Term
-May be used to cleanse bowl
-Potential harmful effects of overuse. Can cause dependance
Nursing Care: Enema
-Left laterally sim side
-Hold Enema as long as they can
-Later thing we try. Last resort after
Enema Precautions and Complications
-Fluid and electrolyte imbalance
-Tissue trauma
-Vagal nerve stimulation
-Abdominal pain/cramping
-Pain
-Perforation
Impaction
Results from unrelieved constipation and the inability to expel the hardened feces rained in the rectum
If impaction is not resolved it can lead to
Intestiinal Obstruction
Most at risk for Impaction
-Debilitated
-Confused
-Unconscious
Impaction Symptoms
-Inability to pass toll for several days despite the urge to defecate
-oozing of liquid stool around
-Loss of appetite
-N/V
-Distention
-Cramping and Rectal Pain
Impaction Treatment: Digital Removal of Stool
-Assess
-Digital removal
-Nurse uses finger to break up fecal mass and removed it in sections
-Very painful
-Risks involved
Diarrhea
Loose watery Bowel Movements
Diarrhea: Causes
Foodborne pathogens
Food intolerances
Surgery
Testing
Enteral Feeding (Not tolerating)
Diarrhea: Common Complications
-Skin irritation
-Dehydration
-Nutritional Concerns
Antidiarrheal Agents
-Decrease muscles tone to slow the passage of feces
-Body absorbs more water
-Must determine cause of diarrhea (Sometimes you want diarrhea)
Nursing Care: Diarrhea
-Identify the problem and eliminate
-Provide soft digestible foods
-Maintain fluid and electrolyte balance
-Prevent spread… Good hand hygiene
Fecal Management System
Folly Cath for GI tract
Can be affective but can not stay in for long. Can lead to ulcers and erosion
Nursing Interventions: Maintenance of skin integrity
-Meticulous skin care
-Frequent checks
-Apply skin barrier
-Consult with WOCN
C-Diff
-Health care associated infection.
-Spore forming and can live for a very long time
C-Diff: Who is at risk
Anitboitics
Elderly
Immunocompromised
Long term care
Previously had it
C. Diff: Complications
Dehydration
Kidney failure
Toxic megacolon
Bowel perforation
Death
C.Diff Prevention
-Wash hands w/soap and water
-Avoid use of antibiotics
-Clean surfaces with clean
-Place in CONTACT D
C.Diff Diagnoses and Treatment
Diagnosis:
Stool sample 48 hrs
Treatment:
Plenty of fluids and nutrition
Antibiotics
Surgery
Fecal implantation
Probiotics
Bowel Inctontinence
-Inability to control passage of feces and gas from the anus
Bowel Incontinence: Causes
-Muscle or nerve damage
-Any physical condition that impairs the anal sphincter function
-Large volume stools
-Surgery
-Rectal Prolapse
Bowel Incontinence: Risk Factors
-Age
-Female
-Nerve damage
-Dementia
-Physical Disability
Bowel Incontinence: Treatment
Anti-diarrheals
Bulk laxatives
Bowel Incontinence: Complicaitons
-Body image
-Skin irritation
Bowel Incontinence: Prevention
-Reduce Constipation
-Control Diarrhea
-Avoid straining
Flatulence: Symptoms
-Distention
-Cramping
-Bloating
-Pain
Flatulence: Causes
-Constipation
-Food
-Gi disease
-Stress
Nursing Care: Flatulence
Avoid foods that cause gas
Eat small and eat slowly
Eat more insoluble fiber
Hemorrhoids
Dilated or engorded veins in lining of rectum
Hemorrhoids: Causes
-Increased pressure from straining
-External or Internal
Hemorrhoids: Treatment
Treat the problem
Topical agents
Surgery but high risk
Colon Cancer
2 leading cause of cancer deaths in the US
Colon Cancer: Risk Factors and Warning Signs
-African Americans
-Diet: High intake of red meat or processed meats, low fiber
-Obesity
-50+
-Lack of PA
-Alcohol
-FX
Colon Cancer Screening
Start at 45
Want a flex sig q 5
Colonoscopy every 10
Assessment: Nursing History
Head to toe questions
GI tract: Physical Assesment
-Starts at mouth
-Abdomen
-Rectum
Laboratory Tests
No blood test for most GI disorders
Of blood is in stool order H&H
Fecal Specimens
Not sterile
Test for C.Diff
DNA test
Fecal Occult Blood Test
-Check for hidden blood
-Ordered to check cancer or evaluate possible causes of anemia
-Stool sample from 2 different areas
-Often ordered from 3 different occasions
-Can be false positives
Goals and Outcomes for Bowel elimnination
-Developing the goal consider the patient as a whole. How long will it take my patient to reach this goal
Outcome:
Ask yourself what will the patient demonstrate to prove their bowel elimination pattern is normal
Implementation: Health Promotion
Promote Normal Defecation
Promote well balanced diet
NG TUBE
On the PT Lecture
Bowel Training
Patients with chronic constipation or fecal incontinence
-Set up daily routine
-Requires time, patience, and consistency
Bowel Training: Program Includes
-Assessment and Documentation
-Choosing Patient-Centered time
-Offer fluids to stimulate defecations around normal time
-Assistance in using commode
-Provide privacy
