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z_NUR112: Exam 4 > Ch 47: Bowel Elimination - SP Implementation and Evaluation > Flashcards

Ch 47: Bowel Elimination - SP Implementation and Evaluation Flashcards

1
Q

A bedpan is used for patients who are…

A

completely bedbound and unable to ambulate to a bedside commode or the bathroom.

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2
Q

A bedside commode is used most often with adult patients who…

A

can get out of bed but have difficulty with safe ambulation to the bathroom to meet elimination needs.

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3
Q

What are some safety concerns regarding the use of Bedpans?

A
  • Use of bedpans increases the risks of impaired skin integrity and infection.
  • Frequent incontinency can alter skin integrity related to moisture and buildup of bacteria.
  • Consider interventions to improve patient continence.
  • Do not leave the patient on the bedpan longer than 10 minutes. Doing so can result in impaired skin integrity and formation of pressure ulcers.
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4
Q

What are some safety concerns regarding the use of Bedside Commodes?

A
  • The nurse should:
    • Provide level of assistance the patient requires to safely move to and from the commode.
    • Stay with the patient if patient is too weak to be left alone, since there is an increased risk for falls and injury when using the bedside commode.
    • Note the patient’s tolerance to the bedside commode.
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5
Q

What are some interventions that can be employed to help patients feel more comfortable using bedpans and bedside commodes?

A
  • Promptly respond to patient’s call for toileting, since a delay may result in incontinence.
  • Maintain patient privacy
    • Close the curtain around patient’s bed.
    • Cover the patient with bed linens.
    • Provide a call light and toilet paper.
  • Minimize patient discomfort
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6
Q

What are Staff Hygiene factors to employ when assisting patients with their elimination needs?

A
  • Perform hand hygiene before and after assisting with a bedpan.
  • Wear gloves when handling a bedpan.
  • Wear appropriate personal protective equipment (PPE)—gloves, gown, and mask with an eye shield—when cleaning a bedpan due to possibility of splashing.
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7
Q

What are Patient Hygiene factors to employ when assisting patients with their elimination needs?

A
  • Perform or assist with perineal care after use of bedpan or bedside commode.
    • Wash area with soap and water and dry thoroughly.
    • Observe skin integrity.
    • Apply barrier cream after performing perineal care if patient is at risk for skin breakdown.
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8
Q

To evaluate the patient’s success of using the bedpan or the bedside commode, the nurse assesses the patient’s:

A
  • Tolerance of the procedure
  • Ability to achieve a bowel movement
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9
Q

If the patient’s bowel elimination goals have not been met through the use of a bedpan or bedside commode, the nurse:

A
  • Reviews the plan of care
  • Considers revising current interventions related to bowel elimination
  • Includes the patient in the revision of the plan of care to meet his or her needs.
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10
Q

What are some purposes that Ostomy care serves?

A
  • Maintain skin integrity
  • Assess stoma healing and integrity
  • Prevent odors
  • Promote comfort
  • Maintain or increase self-esteem and dignity
  • Promote normal sexual relations
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11
Q

What is the procedure for Ostomy care?

A
  • Careful removal and disposal of used ostomy pouch
  • Cleansing the area around the stoma
  • Assessment of the stoma and integrity of adjacent skin
  • Application of skin protectant (if ordered)
  • Measurement of stoma
  • Preparation of new pouch to fit stoma
  • Application of the pouch
  • Assessment of the seal
  • Documentation
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12
Q

The nurse may not delegate ostomy care to unlicensed assistive personnel (UAP) if the ostomy is…

A

new or complications are present.

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13
Q

Why should the nurse remove the osyomy pouch carefully?

A

to prevent skin trauma and breakdown.

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14
Q

Why should the ostomy pouch be changed before a meal but not immediately before it?

A

residual odors may decrease appetite.

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15
Q

What are the factors related to cleansing a stoma?

A
  • Do not use soap to clean the stoma or peristomal area to prevent complications of dry skin.
  • Use only warm water, along with an adhesive remover, if obvious residue remains.
  • Implement proper cleansing technique to promote skin adherence to the appliance.
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16
Q

The must the stoma be carefully measured?

A
  • to assure the best appliance fit
  • prevent leakage and skin irritation.
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17
Q

The healthcare provider orders an enema to achieve a specific outcome, such as:

A
  • Relieving constipation (most common)
  • Promoting bowel cleansing
  • Emptying the bowel before diagnostic tests or surgery
  • Instilling medications into the intestine for therapeutic purposes
  • Beginning a program of bowel training
18
Q

What are four types of Enemas?

A
  1. Cleasing
  2. Retention
  3. Carminative
  4. Return-flow
19
Q

What are the two common types of Cleansing Enemas?

Describe each.

A
  • Hypertonic:
    • Uses osmotic pressure to draw fluid from interstitial spaces into colon (e.g., Fleet Enema)
  • Isotonic:
    • Uses instillation of enema solution to directly distend the colon (e.g., normal saline)
20
Q

What are three uses of Cleansing Enemas?

A
  1. Temporary relief of constipation or impaction
  2. Emptying the bowel before diagnostic tests or surgery
  3. Bowel training program
21
Q

What is a Retention Enema?

A

Enemas that are held within the bowel for a specific period of time (e.g., 30 minutes) to allow absorption of enema contents either into the intestinal wall or into feces.

22
Q

What are two common tyeps of Retention Enemas?

Describe each.

A
  • Oil retention:
    • Feces absorbs oil to soften the stool and lubricate the rectum and colon for easier feces evacuation
  • Medication:
    • Intestinal wall absorbs the drug in enema solution (e.g., antibiotics to treat localized infection or anti-inflammatory to treat localized inflammatory disease)
23
Q

What are two uses for Retention Enemas?

A
  • Temporary relief of constipation
  • Instillation of medications into the intestine for therapeutic purposes
24
Q

What is the main use of Carminative and Return-flow Enemas?

A

To simulate peristalsis for the purpose of improving passage of flatus (intestinal gas).

25
Q

What position should the patient be in to receive an enema?

A

left side-lying (Sims) position with right knee flexed to promote flow of solution into colon

26
Q

What should you make sure is prepared ahead of administering an enema?

A
  • Make sure a bedpan, commode, or toilet is accessible before beginning
  • For patients who will be using the bathroom, ensuring the patient has non-skid footwear
27
Q

Why do we remind a patient not to flush after they void there bowels post enema?

A

So the outcome can be assesed

28
Q

What are some safety factors to employ to promote comfort for patients receiving an enema?

A
  • Using a warm solution to prevent abdominal cramping
  • Using lubricated tip of rectal tubing to prevent trauma to tissue and aiding with insertion
  • Inserting rectal tubing slowly to prevent tissue trauma
  • Administering enema at a slow rate to prevent distention
  • Providing perineal care, if needed, after bowel evacuation
29
Q

What are three major drug groups that provide temporary management of diarrhea and constipation?

A
  1. Antidiarrheals,
  2. laxatives, and
  3. stool softeners
30
Q

What is the purpose of Antidiarrheals vs. Laxatives and Stool Softeners?

A
  • Antidiarrheals
    • Temporary relief of diarrhea
  • Laxatives & Stool Softeners
    • Temporary relief of constipation
31
Q

Antidiarrheals are drugs that

A

Slow intestinal motility or promote absorption of excess intestinal fluid

32
Q

Laxatives and Stool Softeners are drugs that

A

act on the intestine to produce soft or liquid stools.

33
Q

What are two conciderations regarding the use of Antidiarrheals?

A
  • Use is usually limited to 48 to 72 hours
  • Opiate-based drugs may become habit-forming (e.g., codeine and diphenoxylate-atropine)
34
Q

What are two conciderations regarding the use of Laxatives & Stool Softeners?

A
  • Contraindicated in presence of nausea, vomiting, or undiagnosed abdominal pain
  • Prolonged use can weaken natural bowel responses and result in rebound constipation
35
Q

What are four uses for NG tubes?

A
  • Administration of medication or enteral feedings
  • Decompression of the GI tract:
    • For example, a post-surgery patient with absent peristalsis
  • Compression of internal hemorrhage:
    • For example, a patient who is actively bleeding in the stomach due to an ulcer
  • Gastric lavage:
    • For example, a patient who requires cleaning out (irrigation of) stomach contents to remove a poison or blood
36
Q

Describe a Salem sump NG tube.

A
  • Has two lumens
  • Main lumen runs the entire length of the tube and is used for suction of gastric contents
  • Second lumen connects to the main lumen; acts as an air vent; if the main lumen is attached to a suction source, this lumen acts as a continuous air vent
  • It is the preferred NG tube for gastric decompression
37
Q

Fecal occult blood tests are recommended

A

annually beginning at age 50

38
Q

Describe Sigmoidoscopy and Colonoscopy.

A
  • Screens for colorectal polyps and early signs of cancer
  • Begins at age 50 for most people (every 5 to 10 years)
  • Begins before age 50 for those with a family history of:
    • Colorectal cancer
    • A personal history of inflammatory bowel disease
39
Q

What is a Healthy Diet to manage mowel elimination?

A
  • High-fiber foods
  • Adequate fluid intake:
    • At least 6 to 8 glasses of fluid daily to maintain good health
  • Hot liquids and fruit juices
40
Q

For patients experiencing constipation, the nurse teaches the patient to increase daily intake of foods high in fiber, including:

A
  • Fresh fruits
  • Beans
  • Vegetables
  • Bran cereals
  • Fruit juices (prune and apple) are also encouraged because they stimulate peristalsis.
41
Q

For patients experiencing diarrhea, the nurse teaches the patient to:

A
  • Consume bland, small meals
  • Drink fluids at tepid temperatures to prevent dehydration
  • Avoid foods and fluids that irritate or stimulate the stomach, such as:
    • Milk products
    • Spices
    • Caffeine
    • Gas-producing foods
    • Certain fruit juices (prune and apple because they worsen the diarrhea)
42
Q

Walking __ to __ minutes per day has been shown to increase digestive function.

A

10 to 15

z_NUR112: Exam 4 (12 decks)

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