Fecal Elimination Power Point Flashcards
True or False:
ostomy’s closer to the stomach fecal matter have less smell and less liquid
True
True or False:
Ostomy’s closer to the rectum fecal matter has greater smell and is more formed
True
The function of this organ absorbs water and nutrients
small intestine
The function of this organ excretes waste, reabsorbs water and electrolytes, and stores and mixes food with secreations
Large intestine (colon)
The function of this organ forms and secretes bile that is essential for breakdown of fats
Liver
Constipation is more common in this age group because of the use of OTC, decreased activity level/ fluid and fiber intake
Older adult
Define meconium
the first fecal material passed by the newborn up to 24 hours after birth
Dark
Green
Tarry
Odorless
Sticky
What affects peristalsis?
Activity
Medications
Anesthesia
Obstructions
Adhesions
Diet
Describe a normal finding of the GI after surgery
no bowel sounds after 24 hours
hypoactive bowel without n/v/d
What is the treatment for a pt who has had GI surgery?
ambulation
True or false: the intestine are highly vascular - bleeding more easily and absorbing things more easily
true
Iron supplements and Pepto-Bismol both turn poop which color
black
Which medications affect gastric motility
opioids
antihistamines
antidepressants
Describe what normal feces looks like for the adult
o brown
o firmed, soft, semi-solid, moist
o cylindrical (contour of the rectum) ~2.5 cm / 1 inch in diameter
o odor will vary with diet
o will also vary with food ingested and persons own bacterial flora
o Constituent [made up of]: small amounts of undigested roughage, sloughed dead bacterial and epithelial cells, fat, protein
o Dried constituent of digested juices like bile pigments and inorganic matter
The recommended daily fiber is what for people 50 years and younger
men: 38 grams
women: 28 grams
The recommended daily fiber is what for people 50 years and older
men: 30 grams
women: 21 grams
What are gas producing foods?
cabbage
onion
cauliflower
bananas
apples
What are laxative producing foods?
bran
prunes
figs
chocolate
alcohol
What are constipation producing foods?
cheese
pasta
eggs
lean meat
when is it best to listen to bowel sounds
between meals
peristalsis is more active
Describe abnormal feces
clay or white (lack of bile/ pancreatic or liver diseases)
black or tarry (from drugs like iron or bleeding from upper GI [small intestine or stomach]
red (bleeding from lower GI)
Pale (malabsorption of fats)
orange or green (intestinal infection)
hard / dry (dehydration decreased intestinal motility from lack of fiber, lack of activity, laxative abuse)
diarrhea (increased motility due to bacteria in the colon)
narrow pencil shaped or string like (obstruction of the rectum)
pungent odor (infection of blood)
pus/ parasites/ blood/ large quantities of fat
What is the therapeutic response for docusate sodium (colace) and docusate calcium (Surfak)
lowering the surface tension of fecal material
allowing water into the stool
resulting in soft fecal mass
What should the nurse teach families and the pt about docusate sodium (colace) and docusate calcium (Surfak)?
drink a glass of water (or fluid juice / milk) with the medication
effectiveness of the medication is 1-3 days
DO NOT take within 2 hours of other laxatives especially mineral oil (docusate sodium (colace) and docusate calcium (Surfak) may increase the absorption of mineral oil since it absorbs water)
Discuss other forms of bowel regulation like increasing fluid, fiber, and activity.
The longer the poop is in the GI the harder and __________ it is.
dryer
In older adults who have fecal impaction may show signs of delirium, which is a sudden change in
mental status
List factors that affect elimination
diet (fiber/ water)
positioning
privacy
medications
activity (stimulates peristalsis)
defecation habits (do NOT ignore urge)
What is the purpose of soluble fiber and where is it found?
Purpose - helps with diarrhea
Dissolves in water
What is the purpose of insoluble fiber and where is it found?
mixes with stool
apples have high fiber but also found in the skin of fruits and vegetables
Describe fecal impaction
mass or collection of hardened feces in the folds of the rectum
seeps fecal liquid
no normal stool
A method to help a pt with fecal impaction is digital desimpaction. What are the risks in doing this?
vagal nerve stimulation
bleeding
fissures
perforation [hole developed through the wall of a body organ]
A pt with hypothyroidism and an slowed down metabolism can have which sx that effects elimination?
constipation
A pt with hyperthyroidism can have with sx that effects elimination ?
diarrhea
Can fiber be digested
no
If the vagal nerve is stimulated during fecal desimpaction, what can happed to the pt?
They can pass out
Describe diarrhea
passage of liquid feces AND increased frequency of defecation
gets rid of bacteria that is NOT supposed to be there
pt will be dehydrated
increased bowel sounds
A healthy daily fluid intake is how many mL
2000 - 3000
Define gastrocolic reflex
defecating after breakfast
Define ileus
this is caused when a pt has surgery where handling the intestines is necessary.
There will be 24-48 hours of bowel stoppage of intestinal movement
This is another way to treat fecal impaction
oil enema
2-4 hours later
cleansing enema
suppository or stool softener
A nurse can teach a pt how to control bowel incontinence by teaching them
modify their diet (water / fiber)
eating at a regular schedule so that they eliminate at a regular schedule
weight loss
surgery
When palpating the abdomen, what will flatulence feel like
soft
If there is blood in the stool caused by hemorrhoids, what is the characteristics and why?
The rectum is a highly vascular area, hemorrhoids are dilated veins that have ruptured and cause bleeding
bright red bleeding / stringy bleeding due to proximity of rectum
This medication induces defecation (big guns)
cathartics
Describe how a cathartic works and provide example medications
may cause cramps
has a strong emptying effect
castor oil
cascara
bisacodyl
(frequent use can cause electrolyte imbalances // and reliance on medication)
Describe how laxatives work and provide example medications
produce a soft or liquid stool
may be rapid acting or takes time
(frequent use can cause chronic constipation)
bulk forming - psyllium
stool softener - docusate
MOM - milk of magnesium
MiraLAX
Magnesium laxatives are contraindicated for pts with
renal insufficiency or ESRD
Describe constipation
under 3 BM a week
hard dry stool that is difficult to eliminate
painful BM
List contraindications for enemas
pts who have:
appendicitis
thrombocytopenia [slow blood clotting / bruising easy]
neutropenia [low neutrophils due to infection]
diverticulosis [small pouches that bulge out of colon]
What is the purpose of enemas
remove feces in constipation and fecal impaction
What are the commonly used enemas
cleansing
retention
carminative
return flow
What is the purpose of a cleansing enema
to remove feces
- prevent the escape of feces during surgery
- prepare the intestine for visualization (colonoscopy) or x ray
- remove feces due to constipation or impaction
Fleet enemas (hypertonic solution) could be contraindicated to pts with this condition
renal failure
More than one fleet enema (hypertonic solution) in _____ hours can be harmful
24 hours
What is the purpose of retention enemas
induces oil or medication to the rectum and sigmoid colon
How long should be retained for this long `
1-3 hours
Antibiotic enemas are used to treat
infections locally
Anthelmintic enemas are used to treat
worms and intestinal parasites
Nutritive enemas are used to
administer fluids and nutrients to to the rectum
What is the purpose of a carminative enema and how much fluid is instilled
primary purpose - to expel flatus
60-80 mL of fluid
What is the purpose of a return flow enema and how much fluid is instilled
primary purpose - stimulate peristalsis
secondary purpose - expel flatus
100 - 200 mL alternating 5-6 times
Purpose of hypertonic solution for an enema and example
draws in enter water in colon
fleet enema
Purpose of hypotonic solution for an enema and example
stimulates peristalsis / softens feces
tap water
This is the safest type of solution for an enema and an example is
Isotonic safe
Normal saline
stimulates peristalsis / softens feces
Purpose of soapsuds solution for an enema and example
pure soap
irritates mucosa / distends colon
Purpose of oil solution for an enema and example
lubricates feces and mucosa
mineral oil
What temperature should the solution for enema be?
warm
What is a stoma?
Opening created by an ostomy
What kind of emotional support does the pt need when they have an ostomy
the nurse needs to know that the pt has accepted it and can look at it because they will be changing it at home
A risk to ostomies or digestive enzymes is
skin irritation
Describe stools that come from a colostomy
solid
Describe stools that come from an ilieostomy
generally fluid
When does bowel diversion ostomies begin to work?
they begin to function 4-5 days post op
When does bowel diversion ostomies begin to work?
they begin to function 4-5 days post op
What are cruciferous [spouty greeny vegetables of the cabbage family] vegetables
Arugula.
Bok choy.
Broccoli.
Brussels sprouts.
Cabbage.
Cauliflower.
Collard greens.
In a bowel diversion ostomy, an ileostomy can make a pt deficient in what nutrients and why
Vit B12 (biotin)
Iron
Mg
Folic Acid
H2O
NA+
because there is no colon to absorb these vitamins into the blood stream
Dietary considerations to avoid gas for a bowel diversion is which foods
Broccoli.
Brussels sprouts.
Cabbage.
Cauliflower.
Collard greens.
carbonated drinks
alcohol
Dietary considerations to avoid odor for bowel diversion is which foods
onions
broccoli or sprouty vegetables
asparagus
eggs
fish
Describe a normal stoma
pink / red
may bleed when touched due to being highly vascular
How can a pt care for a stoma
asses the skin for irritation each time the appliance is changed
treat any irritation immediately
keep skin clean by washing off excretion and drying the skin thoroughly
colostomy irrigation
What are the different types of stool samples
fecal occult blood (guaiac)
ova / parasites
culture
What is the goal of bowel training
establish a normal defecation pattern
A pt plan for bowel training would include
fluid
fiber
exercise
hot drinks
How long should a bowel training routine be maintained
2-3 weeks
need to be consistent
List other methods used with bowel training
cathartic suppositories positioning is key
prompt the response to urges
physical positioning
What is the purpose of a fecal incontinence pouch
to get the pt to stop pooping due to rectal damage
What are the nursing responsibilities for a fecal incontinence pouch other than assessing the skin
Changing the bag every 72 hours (sooner if there is leakage)
Maintain the drainage system
Explain the process and support the pt`
What are the goals for pts with fecal elimination problems
maintain or restore bowel elimination pattern
maintain or regain normal stool consistency
Prevent risks like F&E imbalance, skin breakdown, abdominal distension, and pain
How can the nurse promote healthy defecation
giving the pt privacy
timing - the pt needs to defecate when they have the urge. ambulating and bathing should not interfere with their normal defecation pattern/ defecation routine
Nutrition and fluids
How can the nurse teach the pt how to establish a healthy defecation pattern
regular exercise
high fiber foods (vegetables, whole grains, fruits)
Fluid intake should be 2000-3000 mL /day
Do NOT ignore the urge to defecate
All the pt time to defecate - preferably around the same time everyday
avoid OTC to treat constipation and diarrhea
Describe insoluble fiber
increases peristalsis and increases bulk
Describe soluble fiber
dissolves in water to form gel-like material to help lower cholesterol and glucose levels
How can the nurse teach a pt to manage diarrhea
drink 8+ glasses of water daily/ or even electrolyte fluids
Eat foods with Na+ or K+ (meat vegetables fuits)
Increase fiber (rice, oatmeal, potatoes)
Avoid caffeine and alcohol
Limit insoluble fiber (whole wheat / whole grain cereals)
limit fatty foods
discontinue meds for diarrhea
If a pt has been having diarrhea and it is stopped, how can they reestablish normal GI flora
By eating fermented dairy products like yogurt or buttermilk
A pt needs to monitor this if they have diarrhea
hypovolemia
dehydration
A pt should seek a PCP right away if they have the following
weakness
dizziness
loose / persistent stools for more than 48 hours
