E4 Bowel Elimination Flashcards
Factors influencing bowel elimination
-Age
-Diet
-Fluid intake
-Physical activity
-Psychological factors (going in public or ritualistic about going)
-Personal habits
-Positioning during defecation
-Pain
-Pregnancy
-Surgery & Anesthesia
-Medications
-Diagnostic tests
Older adult care focus for bowel elimination
-Trouble chewing
-Esophageal emptying slows
-Impaired absorption
-Weakened sphincters
Older adults have decreased
-Hydrochloric acid (start of food breakdown)
-Absorption of vitamins
-Peristalsis (motility of GI)
-Sensation to defecate
-Lipase to aid in fat digestion
Constipation is a ______ - not a _______
symptom
disease
Constipation is having ______ bowel movements a week
3
Symptoms of constipation
-Infrequent BMs
-Discomfort
-Hard, dry stools 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 & constipation
-Lack of muscle tone
-Slowed peristalsis
-Lack of exercise
-Inadequate fluid intake
-Too many dairy products
-Lack of fiber
-Medications
What does slowed peristalsis do?
Gives water more time to be reabsorbed making stool hard and firm
Complications of constipation
-Hemorrhoids
-Anal fissures
-Fecal impaction
-Rectal prolapse
Constipation prevention
-Include plenty of high fiber foods
-Drink plenty of fluids
-Stay active
-Manage stress
-Don’t ignore urge to go
-Create a schedule
What are the common types of laxatives & cathartics
-Bulk forming
-Emollient or Wetting
-Osmotic
-Stimulant Cathartics
Bulk forming laxatives
-Most natural treatment
-Methylcellulose
-Pyslliumm
-Polycarbophil
Emollient & Wetting Laxatives
-Stool softner
-Lower surface tension of feces
-Docusate Sodium
Osmotic laxatives
-Stimulants
-Increase peristalsis & pull fluid back into bowel
-Saline-based
-Magnesium Citrate
-Magnesium Hydroxide
-Sodium Phosphate
-Polyethylene
-Lactulose
Stimulant cathartics
-Bisacodyl
-Senna
How to use and what are cathartics & laxatives?
-Meds that initiate stool passage
-PO or Rectal suppositories
-Short term
-May be used to cleanse the bowel for a GI dx test, procedure, or surgery
-Potential harmful effects if overused
Treatment order for constipation
- Bulk forming agents
- PO meds such as stool softners or laxatives
- Suppository
- Enema
Enema Nursing Care
-Verify order
-Gather equipment
-Position in Left Lateral Sims
-Teach pt to hold in as long as possible
-If pt cramps or has pain slow rate by lowering height of bag
-If abdomen rigid STOP
-Document amount of enema given
Enema precautions/ complications
-Fluid & electrolyte imbalance
-Tissue trauma
-Vagal nerve stimulation
-Abdominal pain/ cramping
-Pain
-Perforation
Impaction results from
unrelieved constipation and the inability to expel the hardened feces retained in the rectum
If impaction is not resolved can lead to
intestinal obstruction
What individuals are most at risk for impaction?
-Debilitated (spinal cord injury)
-Confused
-Unconscious
Impaction symtoms
-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
-Nurses use finger to break up fecal mass and removes it in sections
-Very painful
-Risks involved (tissue damage & vagal nerve
What is diarrhea?
Loose, watery bowel movements
-Can happen frequently and with urgency
Common causes of diarrhea
-Foodborne pathogens
-Food intolerance & allergies
-Surgery
-Diagnostic testing
-Enternal feeding (tube feeding intolerance)
Common complications of diarrhea
-Skin irritation
-Dehydration
-Nutritional concerns
Antidiarrheal agents
-Decrease intestinal muscle tone to slow the passage of feces
-Body absorbs more water
-Must determine cause of diarrhea
-Ex. loperamide & diphenoxylate
Nursing care for Diarrhea
-Identify problem & eliminate
-Provide soft easily digestible food (Bland like chicken and rice)
-Does not mean to place on clear liquids
-Maintain fluid & electrolyte balance
-Prevent spread with hand hygiene
Nursing interventions for management of fecal incontinence & diarrhea
-Meticulous skin care
-Prevention & monitoring for dehydration
-Fecal management systems
Nursing interventions: Maintenance of skin integrity
-Meticulous skin care
-Frequent checks
-Apply skin barrier
-Consult WOCN
Who is at risk for C-diff?
-Antibiotics
-Elderly
-Immunocompromised
-Long-term care facility
-GI procedure
-Previous Cdiff
C-diff complications
-dehydration
-kidney failure
-toxic megacolon
-bowel perforation
-death
C-diff prevention
-Wash hands with soap & water
-Avoid unnecessary use of antibiotics
-Clean surfaces with bleach
-Place in isolation
Treatment of C-diff
-Plenty of fluids & nutrition
-Antibiotics
-Surgery
-Fecal implantation
-Probiotics
Causes of incontinence
-Muscle nerve damage
-Any physical condition that impairs the anal sphincter function
-Constipation & diarrhea
-Large volume of stools
-Surgery
-Rectal prolapse
RIsk factors of bowel incontinence
-Age
-Female
-Nerve damage
-Dementia
-Physical disability
Treatment of bowel incontinence
Anti-diarrheals or Bulk laxatives
Prevention of bowel incontinence
-Reduce constipation
-Control diarrhea
-Avoid straining
What is faltulence?
Passing Gas by burping or tooting
Symptoms of flatulence
-Abdominal distention
-Cramping
-Bloating
-Pain
Causes of flatulence
-Constipation
-Food intolerance
-GI distress
-Stress
Nursing care for flatulence
-Avoid foods that cause gas (avoid soluble fiber)
-Eat small, more frequent meals
-Eat & drink slowly
-Avoid straws
-Avoid laying down after eating
-Limit carbohydrates
-Limit carbonated drinks
-Drink water & exercise
What foods should be avoided for flatulence?
Soluble fibers- black beans, lima beans, broccoli, turnips, brussel sprouts, avocado
Hemorrhoids: what are they and treatment
-Dilated or engorged veins in lining of rectum
-Treatment: Treat cause like constipation, topical creams, warm sitz baths, surgery
Causes of hemorrhoids
-Increased venous pressure from straining
-Pregnancy
-Liver disease
-Heart failure
-Sitting on toilet for longtime
What is the 2nd leading cause of cancer death in U.S.?
Colon Cancer
Risk factors of Colon cancer
-African American
-Diet: High intake of red meat or processed meats, low fiber
-Obesity
-50+
-Lack of physical activity
-Alcohol, tobacco use
-Family hx
-Hx of inflammatory bowel disease
Colon cancer screening
-Begin screening at age 45 than depends on results & family hx for how often
-DNA & occult test but not as accurate as a scope
-Flex sigmoid Q5
-Colonoscopy Q10
If a fecal specimen sterile?
No
Fecal Occult Blood Test
-Check for hidden blood
-Ordered to detect cancer or evaluate possible causes of unexplained anemia
-Stool sample from 2 diff areas
-Often ordered for 3 different occurrences
-Be aware of false positives (redmeat)
Goal for Bowel elimination issues
Patient will have normal bowel elimination patterns
Purpose of NG tube
-Decompression (keep things out of stomach)
-Enteral feeding or medication
-Administration
-Lavage
Assessment of NG tube
-Abdominal
-Respiratory
-Nose/skin integrity
-Tube (cm tube at)
-Suction (what drainage looks like, low wall suction)
Nursing care of NG tube
-Verify HCP orders
-Assessment
-Verify placement (pH strip & X-ray)
-Know how to hook to suction
-Administration of feedings & medications
-Recording I&Os
Bowel training
-Pts with chronic constipation or fecal incontinence
-Set up daily routine
-Requires time, patience, & consistency
-Choosing patient-centered time
-Offer fluids
-Assist to comode
-Exercise & Privacy
Diet recommendations
Whole grains, legumes, fresh fruit, Veggies
Fiber intake varies per individual (increase fluid with it)
Older adult considerations
-Encourage screening
-Adequate fiber & fluid intake
-Regular exercise program
-Older adults are less able to compensate from fluid loss from diarrhea
