Bowel sounds and rectal tx Flashcards
What should be assessed for bowel elimination?
usual pattern (freq, amount, consistency, changes)
flatulence-normal, gas is a good sign
Last BM (LBM) - very important info
Diet: type, last food/drink
Lifestyle; stress, exercise
general health; chronic conditions, pain, etc
past and recent bowel problems (inc anaesthetic use-neg)
past and recent use of medications or treatments for bowel needs (always ask if they have had a suppository/enema)
What are three common bowel elimination problems?
constipation
fecal impaction
diarrhea
What are some of the risks of constipation?
straining can do damage. Have them to exhale during straining to minimize this
What is important to do when toileting someone that is constipated?
do not let them stay on toilet for a very long time
is constipation a symptom or disease?
symptom
What are some causes of constipation?
Irregular bowel pattern/ignoring urge
Chronic illnesses
Diet: low fibre, high fat, high sugar, low fluid
Situational stress
Heavy laxative use
Adverse effect of medications
Aging
How can constipation be managed?
increase:
fluid intake
fibre
activity
laxatives administration according to “ bowel protocol”
What must you have to start bowel protocol?
a physician’s order
What are the different types of oral laxatives?
Stool softener - ducosate
Stimulant laxative - sennosides (inc peristalsis)
Osmotic - lactulose (brings tissue from surrounding tissue to moisten stool)
Saline - magnesium hydroxide (mom)
What are some laxative suppositories?
Glycerin
Stimulant - bisacodyl
other: acetaminophen, dimenhydrinate, stemetil
What are some common used enemas?
microlax enema
phosphate enema
cleansing
medicated
What is fecal impaction?
results from unrelieved constipation;
- feces hardens and cannot be expelled
- oozing liquid stool may indicate impaction
- other signs; anorexia, vomiting, abd distension, cramping, rectal pain
resolved with digital disimpaction
What is diarrhea?
inc number of stools
passing liquid/unformed stool
can result in fluid and electrolyte loss
may cause skin breakdown
What are some causes of diarrhea?
antibiotics, food allergies, diseases, diagnostic testing, contaminated foods
What are some treatments for diarrhea
diet modification
medications - imodium
What needs to be documented for bowel elimination?
sign for medications and document BM on bowel protocol MAR
Acute care: kardex (shift report)
Residential care: team bowel board
focus/progress notes prn
What is tenesmus?
a constant feeling of needing to pass stool despite an empty bowel
What are barborygmi?
a rumbling or gurgling noise made by the movement of fluid or gas in the small intestines
what is meconium?
earliest stool during infancy
What is paralytic ileus?
obstruction of the small intestine do to the paralysis of intestinal muscles
What are cathartics?
any substance that accelerates defecation.
What are the three types of enemas?
Hypotonic - draw water/ions out of the body to treat the bowel
isotonic - neither draw nor give water/ions
hypertonic - give water/ions to the body
How do you go about inspection in abdominal assessment?
have person stand up at bedside if possible, if not then supine
-look for xyphoid process to the symphysis pubis
- symmetry
- no masses
- normal skin color
- pain/cramping
How do you go about auscultating the abdomen for assessment?
make sure there is privacy/warmth and quiet
- put pillow under their knees
- have them empty bladder prior
- warm hands and stetho
- start in lower right quadrant then clockwise. listen to each area for 1 min if a bowel sound is not heard one; should be approx. 10 s
- if you don’t hear anything in a quad, do the rest and come back and listen for 5 mins
bowel sounds are either audible or absent
How do you go about palpation of the abdomen for assessment?
depress about 1-2cm quadrant to quadrant or back and forth on the abdomen
will find tenderness in palpation
How do you perform percussion of abdomen?
use none dominant hand on the stomach, dominant hand taps fingers
Describe an infants bowel function.
start with meconium, move to transition, and then normal stool in children
experience bowel movement with every feeding or once every 5 days
Describe toddlers’ bowel function.
have short tiny rectums
no sphincter control
What happens to the bowels during pregnancy?
hormones dilate the bowels
baby likes to lean on bowels which can cause hemorrhoids
What happens to the bowels with age?
decreased blood to intestines cause peristalsis to slow and can cause constipation
start to lose sphincter control
slow nerve impulses
weaker abd. muscles
decreased absorption of mins and proteins
What are factors that influence bowel function?
dietary pattern
fluid intake 1500-2000mls/day
personal habits
activity and exercise
medications
anaesthetics and surgery
pain
stress
illnesses
