Prefinal - Elimination: Fecal 2 Flashcards
A type of enema that is used to increase the water content of the stool to soften the fecal material in the rectum for easy defecation.
- Evacuant Enema
Types of evacuant enema:
Simple evacuant enema (cleansing enema)
medicated enema
cold enema
Purpose of Simple evacuant enema:
To stimulate defecation & to treat constipation
To relieve the gaseous distention by stimulating the peristalsis
To relieve the retention of urine by reflex stimulation of the bladder
To stimulate uterine contraction & to hasten the childbirth
To cleanse the bowel prior to x-ray studies, visualization of the bowels (ex: sigmoidoscopy), surgery & retention enemas
Solutions used in Simple evacuant enema:
soap & water: soap jelly 50ml to 1 liter of water
Normal saline: sodium chloride 1 teaspoon of half a liter of water
Tap water
Amount of solutions to be used in Simple evacuant enema:
Adults: 500 to 1000 ml (1 to 2 pint)
Children’s 250 to 500 ml (0.5 to 1 pint)
Infants: 250 ml or less
Temp of solution in Simple evacuant enema:
Adults: 105 to 110 degrees Fahrenheit
Children: 100 degrees Fahrenheit
Types of medicated enema:
Oil enema
purgative enema
astringent enema
Antihelminthic enema
carminative enema
this also stimulates the bowels, but the solution that is used is intended to be “held” in the body for 15 minutes or more.
- Retained Enema
Types of Retained Enema :
Stimulant enema
nutrient enema
emollient enema,
sedative enema
anesthetic enema.
Enema Timeline
Enema administration generally takes 1 hour
5 minutes to instill the solution
10 minutes for the solution to dwell in the large colon
30-45 minutes to pass the stool
Enema Tip Insertion Depth:
Adult: 7.5 to 10 cm (3 to 4 inches)
Adolescent: 7.5 to 10 cm (3 to 4 inches)
Child: 5 to 7.5 cm (2 to 3 inches)
Infant: 2.5 to 3.75 cm (1 to 1.5 inches)
Do Not Force the Tip
Nursing Diagnosis for Diarrhea
Altered Bowel Elimination: Diarrhea
Inquire about the following: Tolerance to milk and other dairy products. The presence of lactose in the intestines increases osmotic pressure and draws water into the intestinal lumen.
Food intolerances increase intestinal pressure and draw fluid into the intestinal lumen spicy, fatty, or high-carbohydrate foods, etc. may cause diarrhea.
Food preparation. Diarrhea may also be due to inadequately cooked food, food contaminated with bacteria during preparation, and foods that are not maintained at appropriate temperatures.
Medications the patient is or has been taking like laxatives, antibiotics, magnesium, and calcium supplements can also cause diarrhea.
Nursing Diagnosis
Altered Bowel Elimination: Diarrhea related to the consumption of contaminated food as
evidenced by positive/presence of salmonella on stool exam, defecated six times within
four hours, and complaining of severe abdominal pain.
Planning and Outcome Criteria
After two days of my nursing intervention, the client elimination pattern will be improved
with the following outcome criteria:
> reports less diarrhea within 24 hours.
> defecates formed, soft stool on the second day.
> has negative stool cultures.
Nursing Interventions
Encourage fluids 1.5 to 2 L/24 hr plus 200 mL to replace fluid loss.
Provide perianal care after each bowel movement and apply protective ointment as
ordered.
Encourage to eat small, frequent meals. Bland,
Encourage dietary measures to control diarrhea like avoidance of spicy, fatty foods, alcohol, and caffeine, and serve broiled, baked, or boiled foods. avoid fried foods.
Discuss the importance of fluid replacement during diarrheal episodes to prevent further dehydration
Refer client and SO to dietitian on how to prepare food properly and the importance of
good food sanitation practices and handwashing.
Provide emotional support for patients who are having trouble controlling unpredictable episodes of diarrhea. Diarrhea can be a great source of embarrassment to the elderly and can lead to social isolation and a feeling of powerlessness.
Administer IVF and medications as ordered.
Nursing Diagnosis for Constipation
Altered Bowel Elimination: Constipation
Nursing Assessment
Check on the usual pattern of elimination, including frequency and consistency of stool.
Assess the usual dietary habits, eating habits, eating schedule, and liquid intake.
Irregular mealtime, type of food, and interruption of the usual schedule can lead to constipation.
Monitor the patient’s activity level. Sedentary lifestyle such as sitting all day, lack of exercise, prolonged bed rest, and inactivity contribute to constipation.
Classify current medication usage that may lead to constipation. A lot of drugs can slow down peristalsis. Opioids, antacids with calcium or aluminum base, antidepressants, anticholinergics, antihypertensives, general anesthetics, hypnotics, and iron and calcium supplements can cause constipation.
Feel the need for privacy for elimination and fear of pain with defecation.
Nursing Diagnosis
Altered Bowel Elimination: Constipation related to delayed response to the urge of defecation as evidenced by recent hemorrhoidectomy, decreased fluid intake, and mild discomfort during defecation.
Planning and Outcome Criteria
After a day of my nursing intervention, client elimination pattern will be improved with the following outcome criteria:
> reports bowel elimination to a hard-formed stool
> able to consume 8 glasses for 8 hours
Nursing Interventions
Encourage the patient to take in fluid 2000 to 3000 mL/day, if not contraindicated medically. Sufficient fluid is needed to keep the fecal mass soft.
Assist patient to take at least 20 g of dietary fiber (e.g., raw fruits, fresh vegetables, whole
grains) per day. Fiber adds bulk to the stool and makes defecation easier because it passes through the intestine essentially unchanged.
Urge patient for some physical activity and exercise. Consider isometric abdominal and
gluteal exercises. Movement promotes peristalsis.
A gloved lubricated finger is lightly inserted into the rectum and moderately rotated in a
circular motion. This is performed for about 15 to 20 seconds until flatus/stool is
passed. Digital stimulation increases muscular activity in the rectum by raising rectal pressure to aid in expelling fecal matter.
Stool softeners/laxatives. These laxatives soften stool and lubricate intestinal mucosa.
Oil retention enema. This intervention softens the stool
are laxatives that soften stool
laxative
This intervention softens the stool.
Oil retention enema.
gastrointestinal bleeding that is not visible to the patient or physician, resulting in either a positive fecal occult blood test or iron deficiency anemia with or without a positive fecal occult blood test.
Occult Bleeding
NCCF
No Choco-colored Food
Roughage = Fiber
BRAT Diet
Banana, Rice, Applesauce, Toast
