Bowel Elimination (Exam 3) Flashcards
Constipation
decrease in frequency in BM or difficulty passing stool based on normal bowel pattern (range from 3x per day to every 3rd day)
CAUSES: med induced (narcotics,calcium, calcium channel blockers,iron, anticholinergics), metabolic dysfunction (hypothyroidism, hypercalcemia), IBS/IBD, laxative abuse, lifestyle factors (ignoring urge, low fiber, low fluid intake, low activity), neurological dysfunction (SCI, Parkinson’s, MS), advanced age, pregnancy
Constipation Tx
- increase fluids
- increase fiber
- ambulate
- laxatives (bulk forming before softeners, osmotics, stimulants, avoid abuse)
- bowel routine (don’t delay defecation)
- enema
- X-ray/diagnostic tests if obstruction suspected
- digital disimpaction
Diarrhea
increase in volume and frequency, loose and watery, abdominal pain
CAUSES: infection (bacterial, viral, parasitic), over use of laxatives/adverse med effects, antibiotics (C.Diff), GI disease (IBS, IBD), mal-absorption (Celiac, enzyme deficiency), Dumping syndrome
Diarrhea Tx
- hydration (PO/IV)
- avoiding caffeine and alcohol
- meds (pepto)
- probiotics, BRAT diet (+clear fluids, foods to avoid)
- low fiber
- stool specimen (fecal occult blood and stool culture, C+S, O+P, C-diff toxicity, WBC, hematocrit)
- antibiotics for C.Diff
- anti-motility (loperamide (Imodium), diphenoxylate/atropine (Lomotil)
- assess skin integrity
- educate patient on prevention (routine handwashing, avoid certain foods, unwashed raw fruits and vegetables)
Bowel Diversion
surgically created opening (temporary or permanent) to create opening for elimination
CAUSES: cancer, IBD (ulcerative), diverticulitis, inadequate blood supply, colostomy (more formed stool), ileostomy (more liquidy stool from small intestine)
Bowel Diversion Tx
- skin care (assess skin around stoma)
- toileting (assess output)
- absorbent products
- diet education
- stoma care and assessment (moist, shiny, pink, beefy red) PALE POO IS MEDICAL EMERGENCY
- therapeutic communication
Functions of Large Intestine (Colon)
peristalsis
absorption of water and electrolytes
bacterial action produces vitamins k and b
fecal matter reaches the rectum (1) activation of stretch receptors in the sigmoid colon (2) internal anal sphincters relax (3) sensory impulse that indicate the need to “go” (4) voluntary bearing down (Valsalva maneuver) (5) defecation (6)
Valsalva Maneuver
act of bearing down to defecate
increases intra-abdominal pressure; decreases return to the heart
can result in vagal stimulation
subsequent surge of cardiac output once bearing down ends
Bowel Patient Education
adequate fluid intake (2000-2400 mL/day)
balanced high fiber diet
limit sugary drinks (diarrhea)
be careful with vitamin supplements (diarrhea)
gradually increase activity level
probiotics in moderation
don’t avoid urge to defecate
establish bowel routine
seek treatment for change in bowel patterns, blood in stool, and unresolved constipation
Bowel Assessment History
GI diagnosis, surgeries, med
usual bowel pattern
character of stool (COCA)
aids in elimination (food, fluid, laxatives, enemas)
changes in bowel patterns (OLDCARTS?)
Lab Studies
occult blood
O&P
stool culture
Direct visualization
colonoscopy
sigmoidoscopy
Radographic views
flat plate of abdomen
GI series
CT
Collecting Stool Specimen
verify order
standard precautions
use appropriate container
have patient poop into bedpan, BSC, or hat
Fecal Occult Blood Test (FOBT) Guiac
follow hospital policy!
collect stool smear on card
apply reagent
blue=positive
high rate of false + or - (vitamin C)
Factors for False Positives for FOBT
red meat, fish, certain fruits and veggies
aspirin
iron
anticoagulants
menstruation
hemorrhoids
Colonoscopy
informed consent (inpatient or outpatient)
clear liquid diet then NPO
bowel prep
conscious sedation
post op (assess for bleeding or perforation)
Upper GI Series
oral barium contrast
NPO
involves fluoroscopy
pictures will follow barium as it moves through bowel
post test (laxative to eliminate barium)
Abdominal CT with Contrast
NPO
oral contrast
IV contrast (iodine allergy, risk of renal failure, hold metformin aka glucophage)
involves x-ray
Constipation Complications
hemorrhoids
fecal impaction (oozing stool)
diverticulosis
obstruction
Bowel Retraining Program
include patient in planning, modify plan based on client needs
raise fiber slowly
increase water intake to 8 glasses a day
establish daily time to poop
positioning
provide privacy
stool softener may be needed
Bulk Forming Laxatives
fiber supplements like Metamucil, Citrucel, Fiber-con
must give with fluids!
Stool Softeners
Docusate (Colace)
lubricant action, no effect on peristalsis
Osmotics
milk of magnesia (caution with renal disease), Lactulose
increase fluid in intestinal lumen
