Elimination - Defecation Flashcards
Peristalsis
Propels food forward throughout the gastrointestinal tract
Paralytic Ileus
condition where peristalsis stops, leading to stool buildup and a nonmechanical bowel obstruction
Defecation
Act of having a bowel movement
Gastro colic reflex
Increased peristalsis after eating, causing bowel movement
What is one way to increase a patients gastro colic reflex?
Ask pt to have certain time for bowel movement
Excrement
poop
Postoperative paralystic ileus
temporary contion that normally occurs after abdominal surgery where peristalsis stops for 3-5 days (pt may be NPO after surgery)
Occult blood
blood that cannot been seen in the stool
Melena
black, tarry stool caused by blood in GI tract
Micturition
peeing
Dysuria
painful/difficult urination
Nocturia
excess urination at night
Constipation
dry/hard stool; infrequent difficult passage of stool; and/lor the incomplete passage of stool
Another common cause of constipation is the habitual use of _______
laxatives
Impaction
Hardening of the stool; rock like that becomes lodged in rectum/colon (may require digital removal)
Diarrhea
Liquid bowel movement with increased frequency (2-3+stools/day)
Incontinence
uncontrolled bowel movements
Those who are incontinent are at risk for…
skin breakdown
Flatulence/Flatus
gas (farts)
The large intestine is _______ft long and contains ______ parts
- 5 Ft.
- 7 parts
What are the three main functions of the large intestine?
- H2O Absorption (+ some nutrients)
- Mucosal Protection
- Fecal elimination
Liquid stool enters large intestine, where fluid is _____, results in _______ stool?
removed
formed
What is the normal frequency range for defecation?
Varies greatly; Normal defecation can range from 1+/day to 2-3x/week.
What does a change in an individual’s normal defecation frequency indicate?
A change in normal frequency indicates a potential problem
T/F: Laxatives promote normal defecation
False, laxatives do NOT promote normal defecation
Should laxatives be the only recommendation for promoting regular bowel movements?
- No, never recommend only laxatives
- Instead, recommend increasing water intake, fiber (prunes), and activity levels
What is the Valsalva Maneuver?
involves exhaling with the nose and mouth closed to equalize pressure or open up certain passages
T/F: The Valsalva Maneuver should be recommended to patient with cardiac problems
False, NEVER recommend the valsalva maneuver to a patient with preexisting cardiac problems. It increases pressure in the abdominal and thoracic cavity -> decrease blood flow -> heart rate slows (can lead to death)
What are the characteristics of normal stool?
(Color, consistency, evacuation)
- Color: Brown
- Consistency: Formed and semisolid
- Evacuation: Evacuated without difficulty
Meconium
first stool passes by a newborn baby that is green/tar colored
Factors Affecting Defecation - Developmental Considerations
How are bowel movements different from a breast-fed newborn vs a formula-fed newborn
(Digestion, bowel movements per day?)
- Breast fed -> easier to digest (2-10x/day)
- Formula -> difficult to digest (1-2x/day)
Factors Affecting Defecation - Developmental Considerations
At how many months do children gain control of their spincters?
18-24 months
Factors Affecting Defecation - Developmental Considerations
Why do older adults typically have decreased bowel movements?
- Peristalsis slows (more reabsorption of water = constipation)
- ↑age = ↓response to stretching by rectal receptors = ↓GI motility
Factors Affecting Defecation - Food and Fluid
- Name examples of problem foods
- Name examples of helpful foods. How many grams of fiber is recommended daily?
- What is the relationship between fluids and constipation? How much fluid recommended?
Problem foods
- Greasy foods
Helpful foods
- Fiber (whole grains, brussel sprouts, cabbage, lentils)
- Recommended: 20-30g/day
Hydration
- 2-3L recommended
- Lack of necessary fluids may cause constipation
Factors Affecting Defecation - Activity
How does being active vs inactive affect bowel movements?
(What does it stimulate? What happens to bowel pressure?)
Active
- Stimulates peristalsis
- Increase bowel pressure – stimulate defecation
- ↑ Exercise = ↑endorphins = make you feel good/more productive
Inactive
- Lack of exercise creates a weak abdomen, ineffective defecation, low intra- abd. Pressure
- Decreased mobility → decrease in peristalsis → ineffective defecation
Factors Affecting Defecation - Psychological
How does being angry, anxious/stressed, depressed affect bowel movement?
- Anger = diarrhea
- Anxiety/Stress = diarrhea
- Depression = constipation (diarrhea; rare cases)
Factors Affecting Defecation - Medications
What 2 medications affect bowel movements? Do they cause constipation or diarrhea?
- Opioids: cause constipation
- Iron pills: cause constipation
Factors Affecting Defecation - Medical Status - Pregnancy
How does pregnancy affect bowel movements?
- Causes constipation/hemorrhoids
Factors Affecting Defecation - Medical Status - Post abdominal surgery
A patient has just underwent abdominal surgery and are now resting in their room. The nurse visits the patient.
What are two important questions the nurse should ask?
What nursing intervention should she perform?
What diet will a post-op patient who just had abdominal surgery eat? When are they allowed to have foods/liquids?
How long will it take for things to return to normal?
- Ask if pt passed gas
- Ask if pt has had bowel movement
- Ascultate for bowel sounds for 1 minute (up to 5 minutes if no sounds heard)
-> ONLY GIVE PATIENT FOOD/LIQUID ONCE BOWEL SOUNDS CONFIRMEND AS ACTIVE (if no bowel sounds, you can create a further block if you give them food) - Start with clear liquids -> full liquids -> tray
- Can take 24-48 hours for things to return to normal
Factors Affecting Defecation - Medical Status - Spinal Cord Injuries
What type of bowel movement complication would be seen with a patient who suffered from a spinal cord injury? What action may the nurse have to perform?
- Hard to manually empty their bowel (constipation and impaction)
-> Digital evacuation of stool (doctor order only)
Factors Affecting Defecation -Personal Habits
T/F: Defecation pattern can be impacted by time
True
Factors Affecting Defecation - Personal Habits
T/F: Constipation can be prevented by developing daily defecation pattern
True
Factors Affecting Defecation - Other Factors - Diagnostic Test
What is a barium swallow? What is a side effect of this?
- Barium Swallow: used to coast GI system to look at holes in x-rays
- Constipation (1-2 days after taking barium)
Factors Affecting Defecation - Other Factors - Position
What position should you be in when defecating?
What should you do if a patient is unable to get out of bed? (What do you use, position of bed?)
- Sit with legs lower than the waist
- If patient is unable to get out of bed:
-> Use bedpan
-> Position bed 60-80 degrees (or ask whats comfortable); gravity helps BM
(90 is too high and can cause discomfort and difficulty)
Select all factors that may contribute to constipation. (Select all that apply.)
- Habitual use of laxatives
- Lack of dietary fiber
- Lack of adequate hydration
- Lack of exercise
- Frequent consumption of green leafy vegetables
- Food poisoning
- Gas-forming foods
- Medications/supplements such as opioids or iron pills
- Drinking herbal teas regularly
1. Habitual use of laxatives
2. Lack of dietary fiber
3. Lack of adequate hydration
4. Lack of exercise
6. Food poisoning
7. Gas-forming foods
8. Medication/supplements: opioid or iron pills
During a physical exam in regards to bowel elimination, what 3 parts of the body will you be focusing on? What will you inspect for in these systems?
Mouth
- dentures, bleeding, tongue movement, color of gums
Abdomen
- ascultate for 1-5 minutes to determine if bowel sounds are absent or present
Anus
- inspect for hemorrhoids (internal/external)
- rectal digital exam - RN performs to assess for impactions
Why do you auscultate before you palpate the abdomen?
Focused assessment needed post-op abdominal surgery– Why??????
- Palpating can disrupt normal sounds
- Make sure patients peristalsis has returned
-> If not can cause impaction, nausea
A nurse is instructed to collect a stool sample for testing. Select all the correct steps that should be followed according to proper procedure. (Select all that apply.)
- The patient should void urine before collecting the stool sample.
- The nurse should wear gloves and perform hand hygiene before and after the procedure.
- A toilet tissue should be placed in the bedpan to absorb excess moisture.
- The specimen should be collected using a bedpan or a collection “hat”.
- The outside of the specimen container should be kept free from contamination.
- The specimen should be immediately placed in a refrigerator if testing for ova or parasites.
- The specimen must be packaged, labeled, and transported according to agency policy.
- The doctor’s order must be placed in the sleeve of the biohazard bag.
- The specimen should be sent to the laboratory immediately.
- The stool specimen is considered sterile
- Do not refridgerate if the test is for ova or parasite
1. The patient should void urine before collecting the stool sample.
2. The nurse should wear gloves and perform hand hygiene before and after the procedure.
4. The specimen should be collected using a bedpan or a collection “hat”.
5. The outside of the specimen container should be kept free from contamination.
7. The specimen must be packaged, labeled, and transported according to agency policy.
8. The doctor’s order must be placed in the sleeve of the biohazard bag.
9. The specimen should be sent to the laboratory immediately.
11. Do not refridgerate if the test is for ova or parasite
What color indicates a positive occult blood test (positive for blood in the stool) ?
Blue
If stool is black (_____) the bleeding is located in the: __________ ____________ _______
- (melena)
- Upper GI Tract
T/F: Certain foods, drugs, and menstruation interfere with test results. Eating red meats before an occult blood test can result in a false negative.
False, although it is true that certain foods, drugs, and menstruation interfere with test results, eating red meats can result in a false positive test
Compare Direct Visualzation from Indirect Visualization
complete/fill out chart on master notes
Fluid intake should average ________L/____hr
2-3L/24 hours
A nurse is developing a bowel training program for a patient experiencing incontinence. Which of the following interventions should be included in the plan?
- Increase dietary fiber intake.
- Ensure adequate hydration.
- Establish a consistent timing for defecation.
- Encourage the patient to use a standing position during defecation.
- Provide a private and comfortable environment for defecation.
- Include exercises such as abdominal settings and thigh strengthening.
- Evaluate the effectiveness of the program regularly.
- Limit fluid intake to reduce the frequency of defecation.
- Encourage complete avoidance of physical activity.
1. Increase dietary fiber intake.
2. Ensure adequate hydration.
3. Establish a consistent timing for defecation.
5. Provide a private and comfortable environment for defecation.
6. Include exercises such as abdominal settings and thigh strengthening.
7. Evaluate the effectiveness of the program regularly.
T/F: A physicians order is needed for a rectal digital exam because it may cause respiratory depression
False, although it is true that a physician order is needed for a rectal digital exam, but it is because it may cause cardiac issues (dysrhythmia)
A nurse is preparing to perform manual disimpaction for a patient. What are the incorrect steps involved in this procedure? Be able to explain why (Select all that apply.)
- Gather all necessary supplies before beginning the procedure.
- Place a mat or chuck under the patient to maintain cleanliness.
- Position the patient in a standing position.
- Wear double gloves and use water-soluble lubricant to lubricate the gloves.
- Insert a lubricated finger into the patient’s rectum through the anus.
- Break up the hardened feces into smaller pieces and remove them manually.
- If feces cannot be removed manually, administer a cleansing enema first.
- An oil retention enema can be administered prior to the procedure to soften the feces.
- Follow the procedure with a cleansing enema to clear any remaining feces.
- Assess patient for discomfort and provide reassurance throughout the procedure.
Incorrect Answers
- 3. Patient should be in a SIDE LYING position
- 7. If feces cannot be removed manually, administer a OIL RETENTION oil FIRST, followed by a cleansing enema
Several days of diarrhea will lead to _______ If IV fluids are NOT given
You would check the skin ______ to assess for this condition
dehydration
turgor
T/F: Enemas are used to treat constipation that has not been relieved by medication, such as laxatives
True
What 3 procedures are enemas usually used in preparation for?
- before diagnostic procedures
- colonoscopy
- surgical procedure
What are the 3 types of enemas?
- Cleansing Enemas
- Retention Enemas
- Harris Flush
Describe: Cleansing Enemas
or fill out chart on master notes
(Purpose, Solutive type/best, Key considerations)
Purpose
- Remove feces from the colon
- Relieve constipation
- Evacuate the bowel before surgery
- Promote visualization
Solution Types *Best
- SSE/NSE - Normal saline (isotonic)
-> Softens stools - Fleet enema (hypertonic)
-> Softens stool -
*TWE - Tap water (hypotonic)
-> Softens stool
Key Considerations
-
SSE/NSE - Normal Saline (isotonic)
-> SSE - use only castile soap enema (other soaps may cause significant recal mucosal irritation/damange) -
Fleet Enema (hypertonic)
-> Contraindicated in pt who is dehyrated
-> Draws water from interstitial space -> colon -> excreted -
TWE - Tap Water (hypotonic)
-> Water moves from colon -> interstitial space
-> Fluid and electrolyte imbalance
-> Water intoxication (tap water)
Describe: Retention Enemas
or fill out chart on master notes
(Purpose, Solutive type)
Purpose
- Retained in the bowel and soaks the stool to ease its passage from the body
Solution Types
- Oil (mineral, olive, cottonseed oil)
-> Hold for 30-60 minutes
-> Lubricates stool and interstitial mucosa - Carminative
-> Expel flatus - Medicated
- Anthelmintic (worm infestation)
T/F: It is okay to use enemas on patient with bowel obstructions or paralytic ileus
False, DO NOT USE ON PATIENTS WITH BOWEL OBSTRUCTIONS OR PARALYTIC ILEUS. This is because enemas distend the intestine and irritate the intestinal mucosa which trigger the miscles of the intestine to contract more activley (increase peristalsis).
Administering an enema would increase peristalsis AGAINST THE BLOCKAGE, leading to harmful consequences such as increased abdominal pain, potential for bowel perforation, and exacerbation of the obstruction.
In paralytic ileus, there is inhibited peristalsis. Giving an enema would be ineffective because the muscles of the intestine are not functioning properly to propel the solution or any fecal matter forward, potentially causing the enema to cause distention and symptoms of acute obstruction.
Describe: Harris Flush
or fill out chart on master notes
(Purpose)
Purpose
- Evacuate gas (flatus) from the bowels, particularly after abdominal surgery
When administering an enema, the patient must be placed in a ______ _______.
left sims position
