Bowel sounds and rectal tx

Question 1

What should be assessed for bowel elimination?

Answer 1

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)

Question 2

What are three common bowel elimination problems?

Answer 2

constipation
fecal impaction
diarrhea

Question 3

What are some of the risks of constipation?

Answer 3

straining can do damage. Have them to exhale during straining to minimize this

Question 4

What is important to do when toileting someone that is constipated?

Answer 4

do not let them stay on toilet for a very long time

Question 5

is constipation a symptom or disease?

Answer 5

symptom

Question 6

What are some causes of constipation?

Answer 6

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

Question 7

How can constipation be managed?

Answer 7

increase:
fluid intake
fibre
activity

laxatives administration according to “ bowel protocol”

Question 8

What must you have to start bowel protocol?

Answer 8

a physician’s order

Question 9

What are the different types of oral laxatives?

Answer 9

Stool softener - ducosate

Stimulant laxative - sennosides (inc peristalsis)

Osmotic - lactulose (brings tissue from surrounding tissue to moisten stool)

Saline - magnesium hydroxide (mom)

Question 10

What are some laxative suppositories?

Answer 10

Glycerin

Stimulant - bisacodyl

other: acetaminophen, dimenhydrinate, stemetil

Question 11

What are some common used enemas?

Answer 11

microlax enema

phosphate enema

cleansing

medicated

Question 12

What is fecal impaction?

Answer 12

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

Question 13

What is diarrhea?

Answer 13

inc number of stools

passing liquid/unformed stool

can result in fluid and electrolyte loss

may cause skin breakdown

Question 14

What are some causes of diarrhea?

Answer 14

antibiotics, food allergies, diseases, diagnostic testing, contaminated foods

Question 15

What are some treatments for diarrhea

Answer 15

diet modification

medications - imodium

Question 16

What needs to be documented for bowel elimination?

Answer 16

sign for medications and document BM on bowel protocol MAR

Acute care: kardex (shift report)

Residential care: team bowel board

focus/progress notes prn

Question 17

What is tenesmus?

Answer 17

a constant feeling of needing to pass stool despite an empty bowel

Question 18

What are barborygmi?

Answer 18

a rumbling or gurgling noise made by the movement of fluid or gas in the small intestines

Question 19

what is meconium?

Answer 19

earliest stool during infancy

Question 20

What is paralytic ileus?

Answer 20

obstruction of the small intestine do to the paralysis of intestinal muscles

Question 21

What are cathartics?

Answer 21

any substance that accelerates defecation.

Question 22

What are the three types of enemas?

Answer 22

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

Question 23

How do you go about inspection in abdominal assessment?

Answer 23

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

Question 24

How do you go about auscultating the abdomen for assessment?

Answer 24

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

Question 25

How do you go about palpation of the abdomen for assessment?

Answer 25

depress about 1-2cm quadrant to quadrant or back and forth on the abdomen

will find tenderness in palpation

Question 26

How do you perform percussion of abdomen?

Answer 26

use none dominant hand on the stomach, dominant hand taps fingers

Question 27

Describe an infants bowel function.

Answer 27

start with meconium, move to transition, and then normal stool in children

experience bowel movement with every feeding or once every 5 days

Question 28

Describe toddlers’ bowel function.

Answer 28

have short tiny rectums

no sphincter control

Question 29

What happens to the bowels during pregnancy?

Answer 29

hormones dilate the bowels

baby likes to lean on bowels which can cause hemorrhoids

Question 30

What happens to the bowels with age?

Answer 30

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

Question 31

What are factors that influence bowel function?

Answer 31

dietary pattern

fluid intake 1500-2000mls/day

personal habits

activity and exercise

medications

anaesthetics and surgery

pain

stress

illnesses