Ch 44. Bowl Elimination

Question 1

What causes haemorrhoids

Answer 1

Rectum: empty of fecues until just before a bowl movment. Has folds that expand to hold feces. Each fold has artery/vein and straining can cause these to be distended which is what causes hemmroids

Question 2

Position during defecation

Answer 2

the seated position with a knees elevated higher than hips, leaning forward, elbows on knees, bulging abdomen, straighten spine

Question 3

Process of defecation

Answer 3

• Distension causes relaxation of the internal anal sphincter and signals an awareness of the need to defecate.
• At the time of defecation, the external sphincter relaxes and abdominal muscles contract to force the stool out.
• If you need to intentionally use your abdominal muscles to push up the feces, you can perform what is known as the valsalva maneuver, which is done by holding your breath and exerting force with your muscles.
This action though, should be avoided in patients with heart disease because it increases intrathoracic pressure and can ultimately result in a cardiac arres

Question 4

Factors affecting normal bowel elimination

Answer 4

Diet
• Fiber is an essential part of the normal diet, it helps maintain regular bowel movements.
insoluble it’s the kind you ingest from whole grains, fruits and veggies and these moves through the GI tract.
soluble fibers however, dissolve in water and doesn’t aid in constipation prevention. However, just bulks up your stool.

Fluid intake
• impacts constipation, and an inadequate amount of water can cause the stool to harden which makes it difficult to defecate. Caffeine and artificial sweeteners are going to be quite irritating to the bowel.

Physical activity
• promotes peristalsis and immobilization depresses peristalsis

Personal bowel elimination habits

Privacy

Question 5

Patients with cardiovascular disease should be cautioned against straining while having a bowel movement. What does this help to avoid?

Answer 5

Decreased venous return to the heart

Question 6

Health history

Answer 6

Bowel elimination pattern
Characteristics of stool
Routines to promote normal patterns
Use of medications or enemas
Patient’s cognitive capacity
Changes in appetite
Diet history
Daily fluid intake
History of surgery or illnesses
Medication history
Emotional state
History of exercise
Presence of pain or discomfort
Environment and adaptive aids
Mobility and dexterity
Presence of bowel diversions

Question 7

Bristol stool form scale

Answer 7

Type 1: Separate hard lumps, like nuts (difficult to pass and can be black)
Type 2: Sausage-shaped, but lumpy
Type 3: Like a sausage but with cracks on its surface (can be black)
Type 4: Like a sausage or snake, smooth and soft (average stool)
Type 5: Soft blobs with clear cut edges
Type 6: Fluffy pieces with ragged edges, a mushy stool (diarrhoea)
Type 7: Watery, no solid pieces, entirely liquid (diarrhoea)

Question 8

Factors related to altered patterns of bowel elimination

Answer 8

• Age-related changes
• Infectious disease
• Irritable Bowel Syndrome impacts bowl elimination often causing cramping and urgency to defecate. It is impacted by stress and foods and onset maybe from a GI infection.
• Inflammatory bowl disease: autoimmune, uleratic colitis and Crohes. No cure, symptom management
• Diabetes: can cause diarrhea and constipation related to diabetic nuropothy
• Pain is abnormal
• Pelvic floor trauma: Pregnancy/delivery: decreasing muscle tone
• Acute illness or surgery can impact bowel routines, slowing the bowel completely
• Enteral feeding, which we learned about last week can cause diarrhea or constipation, depending on the rate of feeding the type of formula, the medications, the way the body absorbs
• Medications: Anticholinergics, calcium and iron all constipate. antibiotics can cause diarrhea. Psych Medications change bowl habits. Provide lacitides when needed. Stool softeners when needed. Anytime an opioid is ordered there should always be a stool softener ordered too.

Question 9

A patient states that he has recently had a change in medications and reports that his stools are now dry and hard, which makes them difficult to eliminate. What condition is this type of bowel pattern consistent with?

Answer 9

Constipation

Question 10

Causes of constipation

Answer 10

• ignoring urge to definite
• sedatary lifestyle
• low fiber diet
• low noncaffinated fluid intake
• prologes laxative use
• polyphatmacy
• neurological conditions that block nerve impulse to colon (tumors, spinal cord injuries)

Question 11

Management of bowel elimination

Answer 11

Maintenance of proper fluid and food intake
Promotion of regular exercise
Bowel retraining
Hemorrhoid care
Maintenance of skin integrity

Question 12

purpose of an NG tube

Answer 12

decompression
enteral feeding,
compression
lavage

Question 13

Location of ostomy determines the consistence of the stool.

Answer 13

• Iliostomy (bypass LI) are frequenct and liquid

- closer colostomy to the end of the LI the firmer the stool will be

Question 14

Psychological considerations of ostomies

Answer 14

Cause serious body image

• feel self conscious of smell
• not want sexual encounters

Question 15

Ostomy care

Answer 15

Irrigating a colostomy – not that common

Pouching ostomies – won’t be making these decision on your own. There’s ostomy nurses that provide care/get the right system set up. Can be expensive

Skin barriers and care – are a must. Prevent skin breakdown

Recording and reporting -type of pouch, skin barrier and condition of peristomal skin or other abnormalities. Also let the air out of the bag to “fart” them

Nutritional considerations – adequate fluid intake and avoid food that causes gas