Chapter 31: Bowel Elimination

Question 1

Feces

Answer 1

Stool

Question 2

Peristalsis

Answer 2

Rhythmic contractions of intestinal smooth muscles that facilitate defecation

Question 3

Defecation

Answer 3

Bowel elimination

Question 4

Gastrocolic reflex

Answer 4

Increased peristaltic activity during eating

Question 5

Anal sphincters

Answer 5

Ring-shaped bands of muscle

Question 6

Valsalva maneuver

Answer 6

Closing the glottis & contracting the pelvic & abdominal muscles to increase abdominal pressure

Question 7

Discuss the components of a bowel elimination assessment.

Answer 7

Elimination - frequency, elimination aids, effort required to expel stool
Characteristics - color, odor, consistency, shape

Question 8

List the components of health education regarding bowel elimination.

Answer 8

Adults should identify their own patterns of bowel regularity; include daily exercise; eat high-fiber in a regular basis; drink 8-10 glasses of liquids day

Question 9

Identify several factors that can affect bowel elimination.

Answer 9

Types of food consumed; fluid intake; drugs; emotions; neuromuscular function; abdominal muscle tone; opportunity for defecation

Question 10

Constipation

Answer 10

Elimination problem characterized by dry, hard stool that is difficult to pass

Question 11

Primary constipation

Answer 11

Results from lifestyle factors such as inactivity, inadequate intake of fiber, insufficient fluid intake, or ignoring the urge to defecate

Question 12

Secondary constipation

Answer 12

Consequence of a pathological disorder such as a partial bowel obstruction; usually resolves when the primary cause is treated

Question 13

Iatrogenic constipation

Answer 13

Occurs as a consequence of other medical Tx

Question 14

Pseudoconstipation

Answer 14

Term used when clients believes themselves to be constipated even when they are not

Question 15

Fecal impaction

Answer 15

Occurs when a large, hardened mass of stool interferes with defecation, making it impossible for the client to pass feces voluntarily; results from unrelieved constipation, retained barium from an intestinal x-ray, dehydration, & weakness of abdominal muscles

Question 16

Flatulence (a.k.a. Flatus)

Answer 16

An excessive accumulation of intestinal gas; results from swallowing air while eating or sluggish peristalsis

Question 17

Diarrhea

Answer 17

Urgent passage of watery stool & commonly accompanied by abdominal cramping

Question 18

Fecal incontinence

Answer 18

Inability to control the elimination of stool

Question 19

Identify measures within the scope of nursing practice for treating constipation.

Answer 19

• give an oil retention enema as ordered PRN administration
• give prescribed laxative at bedtime if no movement has occurred
• encourage drinking at least 8-10 glasses of fluid per day
• instruct about high fiber foods & that intake should gradually increase as tolerated until desired effect is reached

Question 20

Suppositories

Answer 20

Oval or cone-shaped mass that melts at body temperature; most common reason is to deliver a drug that will promote expulsion of feces

Question 21

Enema

Answer 21

Introduces a solution to the rectum; given to: cleanse the lower bowel (most common); soften feces; expel flatus; soothe irritated mucous membranes; outline the colon during Dx x-rays; to treat worm & parasite infection

Question 22

Cleansing enema

Answer 22

Use different types of solutions to remove feces from the colon; defecation usually occurs 5-15 min after administration

Question 23

Tap water & NS enema

Answer 23

Preferred for their nonirritating effects

Question 24

Soap solution enema

Answer 24

Mix of water & soap; causes chemical irritation of mucous membranes

Question 25

Hypertonic saline solution

Answer 25

Draws fluid from body tissues into the bowel; increases the fluid volume in the intestine beyond what was originally instilled; acts as a local on the mucous membranes

Question 26

Retention enema

Answer 26

Solution held within the large intestine for a specified period of time (usually at least 30 min); contains mineral, cottonseed, or olive oil; used to lubricate vowel & soften stool

Question 27

Ostomy

Answer 27

Surgically created opening to the bowel or other structure

Question 28

Colostomy

Answer 28

Opens to a portion of the colon

Question 29

Ileostomy

Answer 29

Opens to the ileum

Question 30

Discuss providing ostomy care, including draining a continent ileostomy & irrigating a colostomy.

Answer 30

Providing periostomal care:
• skin breakdown prevention a high priority
• wash the stoma & surrounding skin with mild soap & water & pat dry
• apply barrier substances
Applying an ostomy device:
• stoma protrudes through an opening in center of appliance
• faceplate usually remains in place 3-5 days, unless it comes loose or causes discomfort
Draining a continent ileostomy:
• requires no appliance
• must drain accumulated liquid stool Q4-6H
Irrigating a colostomy:
• similar to administering an enema

Question 31

Identify several nursing Dx that pertain to bowel elimination & some nursing interventions for each one.

Answer 31

• constipation
• risk for constipation
• perceived constipation
• diarrhea
• bowel incontinence
• toileting self-care deficit
• situational low self-esteem