Week 8 Bowell Elimination Flashcards
Drugs that act to premote bowel elimination
Cathartic
Passage of feces through the digestive tract through the rectum
Defecation
Increase in the number of stools and the passage and the passage of liquid informed feces
Diarrhea
Procedure involving introduction of a solution into the rectum for cleansing or therapeutic purposes
Enema
Intestinal gas
Flatus
Permanent dialation and engorgement of viens within the lining of the rectum. Formation is a result of vein distention from pressure during straining
Hemorrhoids
Results when a patient has unrelieved constipation and is unable to expel the hardened feces retained in the colon
Impaction
Drugs that act to promote bowel evacuation
Laxative
Rythmical contractions of the intestine that propel gastric contents through the length of the GI tract
Peristalsis
What are factors that affect bowel function
1) age
2) diet
3) fluid intake
4) physical activity
5) psychological factors
6) personal habits
7) position during defecation
8) pain
9) pregnancy
10) surgery and anesthesia
11) medication
12) diagnostic tests
Changes that occur in bowel function in infants
Less digestion
Lack of bowel control
Changes that occur in bowell function in toddlers
Nueromuscular development has occurred
Begin to have control of bowels
Toilet training starts
Recognition of sensation to poop
Changes that occur in bowell function in older adults
Lose muscle tone Decreased absorption Peristalsis slows Decreased chewing ability Decreased control of schincter
Essential data to be collected during a nursing history when assessing the patients need for bowel elimination
A) usual elimination patern B) description of pt. Stool charactoristics C) identify routines used to premote evacuation D) presence and status of bowel diversion E) changes in appetite F) diet history G) description of daily fluid intake H) history of surgery or GI illness I) medication history J) emotional status K) history of exersize L) history of pain or discomfort M) social history N) mobility and dexterity O) physical assessment
Physical assessment bowel function
Oral cavity- teeth and mucous membranes
Abdominal- Bowell sounds, flatus, distention
Rectal - hemorrhoids, lesions, fissures
Identify health promotion behavoirs in relation to fecal elimination
1) take time to deficate
2) development of routine
3) offer bedpan or nessisary assistance
4) high fiber diet
5) fluid intake 2500ml/ day
6) exersize daily
7) do not ignore the urge
8) maintain skin integ.
Identify measures which promote regular defication
1) positioning
2) provide privacy
3) promote nutrition and fluids
4) encourage increased activity
5) allow time/ develope routine
6) maintain skin integrity
7) provide ordered medication
Common causes of constipation
1) improper diet, reduced fluid, lack of exercise
2) medication
3) stress, physiological changes
4) chronic illness
Common causes of diarrhea
1) disorders affecting digestion
2) medication
3) psychological stress
4) allergies and food born pathogens
5) c diff.
Common causes of fecal incontinence
1) physical conditions that impair anal sphincter function, or large volume liquid stools
2) impaired cognitive function
3) impaired nerves to anus
4) spinal cord injury, tumors, nueromuscular disease, brain disease
Common causes of fecal impaction
1) dehydration, weakness, unaware of need to deficate
2) unrelieved constipation
3) inability to pass a stool for several days
4) medication
Common cuases of flatulence
1) gas accumulation in the lumen of the intestines
2) general anesthesia
3) abdominal surgery
4) immobility
Common causes of hemmorroids
1) increased venous pressure from straining
2) pregnancy
3) heart failure
4) liver disease
Define nursing diagnosis Bowel incontinence
Change of normal bowel elimination habbits charactoristics by involuntary passage of stool
Define nursing diagnosis constipation
Decrease in normal frequency of defecation difficult or incomplete passage of stool and or hard dry stool.
Define nursing diagnosis precieved constipation
Self-diagnosis of constipation and abuse of bowel medication to ensure daily Bowel movement
Define nursing diagnosis risk for constipation
Vulnerable to decrease in normal frequency of bowel movement accompanied by difficult or incomplete passage of stool
Dfine nursing diagnosis diarrhea
Passage of loose stool
Defining charactoristics of bowel incontinence
1) bowel urgency
2) constant passage of loose stool
3) inability to recognize urge to deficate
4) fecal staining of clothing of bedding
5) inability to recognize rectal fullness
Defining characteristics of constipation
1) feeling of rectal fullness, pressure, straining with attempt, bowel urgency
2) abdominal pain, tenderness, anorexia, distention, emesis
3) inability to deficate, hypoactive Bowel sounds
Defining characteristics of precieved constipation
1) enema, laxitive, or suppository abuse
2) expects daily bowel movement
3) expects daily bowel movement at the same time every day
Risk factors for risk for constipation
1) abdominal weakness, immobility, recent environmental changes, inadequate toileting habbits, ignored urge to deficate
2) confusion, depression, emotional disturbance
3) decrease in GI mobility, dehydration, insufficient fiber intake, inadequate dentation, insufficient fluid intake
4) iron salt, laxitive abuse, other medication, opioids
5) electrolytes imbalance, obesity, post- surgery, pregnancy, BPH
Defining charactoristics of diarrhea
1) abdominal pain
2) bowel urgency
3) cramping
4) hyperactive bowel sounds
5) loose liquid stool> 3 in 24 hour period
Nursing interventions for bowel incontinence
1) assess cognitive function
2) improve access to toileting
3) respond promptly to request for toileting
4) evaluation of medications
5) assess.for skin breakdown
6) implement Bowell training
Interventions for constipation
1) inspect, auscultation, percussion palpation
2) assess patern of defication
3) evaluation of medications
4) encourage fluids
5) increase fiber intake
6) provide privacy
Interventions for precieved constipation
1) asses usual bowel patern
2) educate client that it is not nessisary to deficate daily
3) assess emotional influences
4) advise client to gradually reduce use of laxitives, suppositories and enemas
5) advise change in diet
Interventions for risk for constipation
1) inspect, auscultation, percussion, palpation
2) asses patern of defication
3) evaluate medication
4) check for impaction
5) encourage fluids
6) increase fiber intake
7) provide privacy
Intervention for diarrhea
1) inspect auscultate, percussion, palpation
2) assess patern of defication
3) evaluation of medications
4) test for C. Diff.
5) encourage fluids to prevent dehydration
_________________- sets up a daily routine by attempting to deficate at the same time each day and using measures that promote defication
A) assist patient with incontinence to deficate normally
B) regain control of bowels
Bowel training program
Major phases of bowel training program
1) assess for patient readiness
2) assess normal bowel habits
3) develope a plan with the patient
4) implement plan
Use
Action
SE
NURSING implications of bisacodyl
Use: constipation and bowel prep for exam/ surgery
Action: stimulant laxitive
SE: nausea vomiting anorexia, cramps, diarrhea, muscle weakness, electrolyte/ fluid imbalance
Nursing implications: I and O for fluid loss, teach normal.BM does not occur daily, evaluation of therputic response, take with full.glass of water, don’t take if abdominal pain present
Use
Action
SE
Nursing implications of dosuate sodium
Use: prevention of dry hard stools; occasional constipation
Action: laxitive, emollient, stool softener
SE: nausea, anorexia, cramps, diarrhea, bitter taste, throat irritation
Nursing implications: may take 3 days to work, assess cause of constipation
Generic name for dulcolax
Bisacodyl
Generic name for colace
Docusate sodium
Generic name for imodium
Loperamide
Use
Action
SE
Nursing indications for loperamide
Use: antidiarrheal, travelers diarrhea, chronic diarrhea, decreased ileostomy discharge
Action: antidiarrheal
SE: nausea, dry mouth, vomiting, constipation, drowsiness, fatigue, anaphylaxis, angioedema
Nursing implications: dehydration, abdominal distention, response should occur after 48 hours or discontine; teach to avoid OTC; use hard candy, sips of water for dry mouth
Use
Action
SE
Nursing implications for magnesium oxide
Use: constipation, dispepsia, bowel prep
Action: antidiarrheal
SE: diarrhea nausea, dry mouth, vomiting, anorexia, electrolyte fluid imbalance, muscle weakness
Nursing implications: not for long term therapy, shake suspension well, chilling improves taste, give citrus fruit after administration to counteract unpleasant taste
Use
Action
SE
Nursing implications for psyllium hydrophilic mucilloid
Use: chronic constipation, constipation, ulcerative colitis, increase bulk in stool, increase fluid in stool
Action: bull laxative
SE: diarrhea, nausea, vomiting, anorexia, cramps, intestional or esophageal blockage
Nursing implications: teach to maintain adequate fluid consumption: I and O, don’t use if abdominal pain, teach patient that normal BMs don’t have to occur daily
Order of abdominal assessment
Inspection: four quadrants for contour, shape, symmetry, and color
Auscultation: assess bowel sounds in each quadrant
Percussion: identify underlying structures and detects fluid or gas
Palpation: checking for areas of masses or areas of tenderness
When auscutating bowel sounds the nurse sound begin in what quadrant?
Lower right
The nurse should listen for bowel sounds for up to ______
Five minutes
Bowel sounds should be heard _____to ______ times per minute
5-35
Docusate sodium will alter what aspect of a client’s bowel movement
Consistensy
Docusate sodium is a stool softener ( colace)
While preforming the digital rectal exam the nurse recognizes that the client may experience vagal nerve stimulation. This can result in what change in vital signs
Decreased pulse rate
How many mL are there in one ounce
30mL / ounce
The nurse encourages someone to drink a minimum of 2 literally of water to alleviate constipation. How many 8 ounce glasses of water should be consumed in order to reach 2 L
8.33 glasses
Hydrocholorothiazide could have what effect on fluid volume?
Hydrocholorothiazide is a diuretic- fluid volume loss
What provide the most important data about fluid volume status
Daily wieghts
Skin turgor in the eldery is best assessed by pinching a fold of skin over the ______
Sternum
A elderly patient is exhibiting skin tenting, what other symtoms might you expect with this client
Weakness
Confusion
Tachycardia
Depressed BP
A patients normal weight is 165 pounds, and when they are weighed you obtain a weight of 74 kg. What is the deviation from thier normal weight in pounds
2.2 pounds
This common occurrence in the eldery decreases drug metabolism which allows the drug to remain in the body longer and produce a greater effect
Decreased hepatic blood flow
Does the nurse need a perscription from the HCP to mintor I and O?
No the nurse can initiate and continue intake and output without a provider perscription
If the intake is greater than output what is an important assessment?
Auscutating the clients breath sounds. Fluid collection in the lungs can impair oxygen exchange and result in hypoxemia
A pt. Has abnormal breath sounds, bilateral pitting edema, and jugular vien distention. What changes in pulse can be anticipated
Increase in pulse rate and volume
Foods high in potassium
Banana, grapefruit, chicken, potato, tomato, spinach, beets, black beans, white beans, salmon, edemame, butternut and acorn squash yogurt beets, watermelon sweet potato
