Constipation and Diarrhea Flashcards
factors that influence bowel elimination
- age
- diet
- fluid intake
- physical activity
- psychological factors
- personal habits
- positioning during elimination
- pain
- pregnancy
- surgery and anesthesia
- medication
- diagnostic tests
older adult care focuses
- trouble chewing
- esophageal emptying slows
- impaired absorption
- weakened sphincters
- decreased
– HCl, absorption of vitamins, peristalsis, sensation to defecate, lipase which aids in digestion
common bowel elimination problems
- constipation
- impaction
- diarrhea
- bowel incontinence
- flatulence
- hemorrhoids
constipation
having fewer than 3 bowel movements a week
- a symptom not diseases
- need to think about it in relation to pts normal
symptoms of constipation
- infrequent BMs
- discomfort
- hard dry stool that are difficult to pass
causes of constipation
- irregular bowel habits
- improper diet –> fiber
- reduced fluid intake
- lack of exercise
- stress
- certain meds
- advanced age
- ignoring the urge to defecate
- GI disorders
older adults and constipation
- lack of muscle tone (bowels and abdomen)
- slowed peristalsis
- lack of exercise
- inadequate fluid intake
- too many diary products
- lack of fiber
- meds
complications of constipation
- hemorrhoids
- anal fissure
- fecal impaction
- rectal prolapse
constipation prevention
- include plenty of high fiber foods
- drink plenty of water
- stay active
- manage stress
- don’t ignore urge to go
- create a schedule
types of laxatives
- bulk forming (pulls bulk like fiber into stool)
- emollient or wetting (pulls water into GI)
- osmotic (stimulate urge)
- stimulant cathartics (stimulate urge)
what do laxatives and cathartics do
initiate or facilitate stool passage
- stimulate need to defecate
- not only a stool softener
implementation of cathartics and laxatives
- PO or rectal (suppository or enema)
- short term action
- may be used to cleanse the bowels for dx test, procedure, surgery
- potentially harmful so do not overuse
enemas
- verify order
- gather equipment
- position
- pt teaching
- admin of enema
things to know when admin an enema
- cramping/pain: slow rate by lowering height of bed
- abdomen rigid: stop procedure
what to document of enema
- medication
- how much was instilled
- measure color, amount, consistency
- how pt tolerated
enema precaution/complications
- fluid, electrolyte imbalance
- tissue trauma
- vagal nerve stimulation
- abdominal pain/cramping
- pain
- perforation
impaction
hardened feces that remain in the rectum when there is an inability to expel usually from unrelieved constipation
- if unresolved, can result in intestinal obstruction
ind most at risk for impaction
- debilitation
- confused
- unconscious
impaction symptoms
- inability to pass stool for several days despite repeated urge to defecate
- continuous oozing of liquid stool
- loss of appetite
- n/v
- abdominal distention
- cramping
- rectal pain
digital removal of stool
- assess
- digital removal of stool using finger to break up fecal mass and remove in sections
painful and there are risks involved
diarrhea
loose watery bowel movements that can happen frequently and w urgency
causes of diarrhea
- foodborne pathogens
- food intolerances or allergies
- surgery
- diagnostic testing
- enteral feeding
common complications of diarrhea
skin irritation
dehydration
nutritional concerns
antidiarrheal agents
- decrease intestinal muscle tone to slow passage of feces
- body absorbs more water
need to determine cause before admin
examples of antidiarrheal agents
- loperamide
- diphenoxylate w atropine
- some have opiates but use caution bc bowel forming
nursing care for diarrhea
- identify the problem
- provide soft and digestible food (prevents further irritation of lining)
- maintain fluid and electrolyte balance
- prevent the spread –> hand hygiene
nursing interventions for fecal incontinence and diarrhea
- meticulous skin care
- prevent and monitor for dehydration
- fecal management systems (only used for severe cases and often would check w health care provider first)
nursing intervention: maintenance of skin integrity
- meticulous skin care
- frequent checks
- apply skin barrier
- consult wound
C. diff
a health care associated infection caused by a spore producing bacteria
- can live on surface for up to 72 hrs
- leads to severe diarrhea
* always wash hands *
most at risk for c. diff
- antibiotics
- elderly
- immunocompromised
- long term care facilities
- GI procedure
- previously had c. diff
complication of c diff
- dehydration
- kidney failure
- toxic megacolon
- bowel perforation
- death
prevention of c diff
- wash hands w soap and water
- avoid unnecessary use of abx
- clean surfaces w bleach
- place in Contact D (or spore isolation)
diagnosis of c. diff
- hospital protocols
- stool sample (PCR)
treatment of c diff
- plenty of fluids
- good nutrition
- abx
- surgery
- fecal impaction
- probiotics
bowel incontinence
inability to control passage of feces and gas from anus
causes of bowel incontinence
- muscle of nerve damage
- any physical condition that impairs the anal sphincter function
- constipation or diarrhea
- large volumes of stools
- surgery
- rectal prolapse
risk factors for bowel incontinence
- age
- female
- nerve damage
- dementia
- physical disability
complications for bowel incontinence
- body image disturbances
- skin irritation
ensure that they know we are doing everything we can to stop this from happening to them
treatment of bowel incontinence
- anti diarrheal
- bulk laxatives
prevention of bowel incontinence
- reduce constipation
- control diarrhea
- avoid straining
flatulence
gas
- either mouth or rectum
symptoms of flatulence
- abdominal distension
- cramping
- bloating
- pain
causes of flatulence
- constipation
- food intolerance
- GI distress
- stress
nursing care for flatulence
- avoid foods that cause gas
- eat small more frequent meals
- eat and drink slowly
tips to reduce bloating (image)
- eat insoluble fibers
- avoid straws
- avoid lying down after eating
- limit carb intake
- limit carbonated drinks
- drink water
- exercise daily
- eat slowly and mindfully
hemorrhoids
dilated or engorged veins lining the rectum
- purple discoloration that can harden
cause of hemorrhoids
inc venous pressure from straining
- pregnancy
- disease like heart or liver failure
types of hemorrhoids
- internal: found in anal cavity, may be inflamed or distended
- external: clear visible protrusion of skin out of anus
treatment of hemorrhoids
- proper diet, fluids
- inc activity
- ice
- warm sitz bath
colon cancer risk factors and warning signs
- african american
- high intake of red/processed meat, low fiber
- obesity
- 50+
- lack of exercise
- alc
- tobacco
- fam hx
- hx of inflammatory bowel diseases
screenings for colon cancer
- flex sig, scan q 5 years
- colonoscopy q 10 years
- stool sample, less often used
* recheck w ppt**
assessment of pt bowel hx
- usual elimination pattern
- description of stool
- how does ind defecate
- dietary and fluid intake
- hx of GI disorders or surgeries
- med hx
- emotional state
- activity/mobility
fecal characteristics
- amount
- color
- odor
- consistency
- frequency
- shape
- constituents
physical assessments for GI issues
- mouth
- abdomen
- rectum
lab tests for GI problems general info
- no blood for GI (if blood detected in stool, we would want H&H)
- know how to collect and send to lab immediately
types of lab GI lab tests
- fecal occult blood test
- culture and sensitivity
- DNA
- fats
- WBC
- ova and parasites
fecal occult blood test
- check for hidden blood
- ordered to detect cancer or evaluate possible cause of unexplained anemia
- stoop sample should be from 2 different areas
- often ordered for 3 different occurences
- be aware of false positives
nursing problems associated w bowel elimination
- constipation
- chronic functional constipation
- risk for constipation
- diarrhea
- risk for electrolyte imbalance
- deficient fluid volume or risk for
- dysfunctional gastrointestinal mobility or risk for
- bowel incontinence
- nausea
- risk for impaired skin integrity
- disturbed body image
- deficient knowledge
goal for bowel incontinence
pt will have normal bowel elimination pattern
- how long will it take pt to achieve goal
outcome for bowel incontinence
what will pt demonstrate?
- consistent bowel elimination
- consistent consistency
- does not have incontinence
implementation of health promotion
- promote normal defecation
- regular exercise
- well balanced diet
inserting NG tube
- decompression of stomach to keep things out
- enteral feeding or medication
- administration
- lavage
assessment of NG tube
- abdominal
- respiratory
- nose
- skin
- suction
nursing care of NG tube
- verify HCP orders
- assessment
- verify placement
- know hoe to hook suction
- admin feeding and meds (and if meds is acceptable)
- recording i and o
bowel training info
- pts with chronic constipation of incontinence
- set up daily routine
- requires time patience consistency
bowel training program
- assessment and documentation
- choosing pt centered time
- offer fluids to stimulate defecation around normal times
- assist commode
- provide privacy
- normal exercise regimen
diet considerations
- recommended well balanced diet with whole grains, legumes, fresh fruit, veggies
- fiber intake varies/ind (inc fiber then inc fluids)
older adult considerations
- encourage screening
- adequate fiber and fluid intake
- regular exercise program
- older adults are less able to compensate from fluid loss from diarrhea
