Ch 47: Bowel Elimination - SP Implementation and Evaluation Flashcards
A bedpan is used for patients who are…
completely bedbound and unable to ambulate to a bedside commode or the bathroom.
A bedside commode is used most often with adult patients who…
can get out of bed but have difficulty with safe ambulation to the bathroom to meet elimination needs.
What are some safety concerns regarding the use of Bedpans?
- 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.
What are some safety concerns regarding the use of Bedside Commodes?
- 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.
What are some interventions that can be employed to help patients feel more comfortable using bedpans and bedside commodes?
- 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
What are Staff Hygiene factors to employ when assisting patients with their elimination needs?
- 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.
What are Patient Hygiene factors to employ when assisting patients with their elimination needs?
- 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.
To evaluate the patient’s success of using the bedpan or the bedside commode, the nurse assesses the patient’s:
- Tolerance of the procedure
- Ability to achieve a bowel movement
If the patient’s bowel elimination goals have not been met through the use of a bedpan or bedside commode, the nurse:
- 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.
What are some purposes that Ostomy care serves?
- Maintain skin integrity
- Assess stoma healing and integrity
- Prevent odors
- Promote comfort
- Maintain or increase self-esteem and dignity
- Promote normal sexual relations
What is the procedure for Ostomy care?
- 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
The nurse may not delegate ostomy care to unlicensed assistive personnel (UAP) if the ostomy is…
new or complications are present.
Why should the nurse remove the osyomy pouch carefully?
to prevent skin trauma and breakdown.
Why should the ostomy pouch be changed before a meal but not immediately before it?
residual odors may decrease appetite.
What are the factors related to cleansing a stoma?
- 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.
The must the stoma be carefully measured?
- to assure the best appliance fit
- prevent leakage and skin irritation.
The healthcare provider orders an enema to achieve a specific outcome, such as:
- 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
What are four types of Enemas?
- Cleasing
- Retention
- Carminative
- Return-flow
What are the two common types of Cleansing Enemas?
Describe each.
- 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)
What are three uses of Cleansing Enemas?
- Temporary relief of constipation or impaction
- Emptying the bowel before diagnostic tests or surgery
- Bowel training program
What is a Retention Enema?
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.
What are two common tyeps of Retention Enemas?
Describe each.
- 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)
What are two uses for Retention Enemas?
- Temporary relief of constipation
- Instillation of medications into the intestine for therapeutic purposes
What is the main use of Carminative and Return-flow Enemas?
To simulate peristalsis for the purpose of improving passage of flatus (intestinal gas).
What position should the patient be in to receive an enema?
left side-lying (Sims) position with right knee flexed to promote flow of solution into colon
What should you make sure is prepared ahead of administering an enema?
- 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
Why do we remind a patient not to flush after they void there bowels post enema?
So the outcome can be assesed
What are some safety factors to employ to promote comfort for patients receiving an enema?
- 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
What are three major drug groups that provide temporary management of diarrhea and constipation?
- Antidiarrheals,
- laxatives, and
- stool softeners
What is the purpose of Antidiarrheals vs. Laxatives and Stool Softeners?
- Antidiarrheals
- Temporary relief of diarrhea
- Laxatives & Stool Softeners
- Temporary relief of constipation
Antidiarrheals are drugs that
Slow intestinal motility or promote absorption of excess intestinal fluid
Laxatives and Stool Softeners are drugs that
act on the intestine to produce soft or liquid stools.
What are two conciderations regarding the use of Antidiarrheals?
- Use is usually limited to 48 to 72 hours
- Opiate-based drugs may become habit-forming (e.g., codeine and diphenoxylate-atropine)
What are two conciderations regarding the use of Laxatives & Stool Softeners?
- Contraindicated in presence of nausea, vomiting, or undiagnosed abdominal pain
- Prolonged use can weaken natural bowel responses and result in rebound constipation
What are four uses for NG tubes?
- 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
Describe a Salem sump NG tube.
- 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
Fecal occult blood tests are recommended
annually beginning at age 50
Describe Sigmoidoscopy and Colonoscopy.
- 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
What is a Healthy Diet to manage mowel elimination?
- High-fiber foods
- Adequate fluid intake:
- At least 6 to 8 glasses of fluid daily to maintain good health
- Hot liquids and fruit juices
For patients experiencing constipation, the nurse teaches the patient to increase daily intake of foods high in fiber, including:
- Fresh fruits
- Beans
- Vegetables
- Bran cereals
- Fruit juices (prune and apple) are also encouraged because they stimulate peristalsis.
For patients experiencing diarrhea, the nurse teaches the patient to:
- 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)
Walking __ to __ minutes per day has been shown to increase digestive function.
10 to 15
