Ch.47 bowel elimination

Which section of the gastrointestinal tract is primarily responsible for the absorption of water and electrolytes?

Large intestine (colon)

Why must abdominal auscultation be performed before percussion and palpation during physical assessment?

Palpation and percussion stimulate intestinal peristalsis, which can alter natural bowel sounds.

What is the primary difference in stool consistency between an ileostomy and a colostomy?

An ileostomy outputs continuous liquid to semi-liquid effluent, whereas a colostomy produces more formed stool.

What position is recommended for a patient who is self-administering an enema?

Side-lying position

What adverse cardiac response can occur during digital removal of stool or rectal manipulation?

A sudden decline in heart rate (bradycardia) caused by vagus nerve stimulation.

If a patient's pulse rate drops significantly during digital removal of stool, what is the immediate nursing action?

Stop the procedure immediately and evaluate vital signs.

What is the primary indication for choosing a fracture bedpan over a standard bedpan?

Patients with hip fractures, lower extremity injuries, spinal trauma, or restricted mobility

Which type of bedpan is shown on the right side of this image?

Fracture bedpan

What physiological complication can result from repeated administration of tap water enemas?

Water toxicity or circulatory overload, because hypotonic tap water shifts into interstitial spaces.

Why is normal saline considered the safest solution for a cleansing enema?

It is isotonic and exerts the same osmotic pressure as interstitial fluid, preventing dangerous fluid shifts.

How does a hypertonic solution enema (such as a Fleet enema) promote bowel evacuation?

It exerts osmotic pressure that pulls fluid from interstitial space into the colon, distending the rectum and initiating peristalsis.

What type of soap is safe to use when preparing a soapsuds enema?

Pure castile soap

What is the therapeutic mechanism of an oil retention enema?

It lubricates the rectum and stool, softening the feces so it is easier to pass.

What is the primary function of a carminative enema?

To relieve gaseous distention and facilitate the passage of flatus.

What clinical condition is treated with a Kayexalate enema?

Hyperkalemia (by exchanging sodium ions for potassium ions in the large intestine).

What classic symptom suggests a fecal impaction in a patient who has not passed stool for several days?

Continuous oozing or seepage of liquid stool.

Identify the digestive structures highlighted in this anatomical diagram.

The major organs of the human gastrointestinal (GI) tract.

What is a paralytic ileus?

A temporary loss of intestinal peristalsis commonly triggered by abdominal surgery, direct bowel manipulation, or anesthesia.

How do opioid medications affect bowel motility?

They suppress intestinal peristalsis and prolong transit time, frequently leading to constipation.

How do cathartics differ from standard laxatives?

Cathartics produce stronger, faster, and more complete bowel evacuation than standard laxatives.

What appearance indicates a healthy, well-perfused stoma?

Bright pink or red, moist, and shiny.

Which type of ostomy pouching system is depicted in this image?

One-piece ostomy pouching system

Which type of ostomy pouching system is depicted in this image?

Two-piece ostomy pouching system

What is an ileoanal pouch anastomosis?

A surgical diversion in which the colon is removed and a pouch constructed from the distal small intestine is connected directly to the anus.

What stoma color indicates ischemia or compromised blood flow?

Pale, blue, purple, or dark brown/black.

What is the primary intervention for managing fecal incontinence in a patient with cognitive impairment?

Initiate a habit or bowel training program to establish a regular toileting schedule.

Why should antibacterial soap and talcum powder be avoided during perineal care for incontinent patients?

Antibacterial soap dries skin mucosa, and talcum powder can cake, trap moisture, and increase skin irritation.

What core dietary measures help prevent and treat chronic constipation?

Increasing dietary fiber intake and maintaining adequate fluid hydration.

How does physical activity facilitate normal bowel movement?

It strengthens abdominal and pelvic muscles and stimulates intestinal peristalsis.

What positioning on a bedpan best promotes defecation for an immobilized patient?

Elevating the head of the bed 30 to 45 degrees into a semi-Fowler's position to mimic sitting.

How does acute psychological stress influence intestinal motility?

It accelerates digestive peristalsis and GI motility, often causing diarrhea.

How does clinical depression affect gastrointestinal function?

It decreases autonomic nervous stimulation, slowing peristalsis and predisposing patients to constipation.

Why are pregnant women particularly susceptible to constipation?

Elevated progesterone slows peristalsis, and the expanding fetus compresses the rectum.

What structural condition leads to the development of hemorrhoids?

Dilated, engorged veins in the lining of the rectum and anus caused by elevated venous pressure.

What physiological event causes flatulence?

Gas accumulation within the intestinal lumen resulting from swallowed air, bacterial fermentation, or reduced motility.

What is the primary therapeutic purpose of a nasogastric (NG) tube in managing bowel obstruction?

Decompressing the gastrointestinal tract by removing accumulated fluid and air.

What is the primary mechanical function of the stomach in digestion?

Storing swallowed food, mixing it with gastric secretions, and regulating passage of chyme into the duodenum.

What are the three sequential anatomical divisions of the small intestine?

Duodenum, jejunum, and ileum.

What primary function does the small intestine perform?

Digestion and absorption of dietary nutrients, fluids, and electrolytes.

What are the key anatomical segments of the colon?

Cecum, ascending colon, transverse colon, descending colon, and sigmoid colon.

Identify the ostomy location depicted on the left abdomen in this illustration.

Colostomy (descending or sigmoid colostomy)

What body posture during defecation best facilitates stool passage?

Squatting or sitting leaning forward with feet flat and knees raised.

Why is long-term daily use of stimulant laxatives discouraged?

It degrades normal colonic muscular tone, leading to laxative dependency and chronic constipation.

What routine timing practice should nurses teach patients to manage chronic constipation?

Schedule dedicated, unhurried toilet time at the same time every day, ideally shortly after meals

Why is manual digital removal considered a last resort for fecal impaction?

It carries high risks of mucosal injury and vagal nerve stimulation leading to severe bradycardia

How does instilling fluid during a cleansing enema initiate defecation?

The fluid volume distends rectal walls, activating stretch receptors that trigger the defecation reflex.

What position should a patient assume for enema administration by a nurse?

Left side-lying Sims' position with the right knee flexed.

Why is the left Sims' position specifically chosen for enema administration?

It allows gravity to direct fluid downward through the natural curvature of the sigmoid colon and rectum.

What is the definition of bowel incontinence?

The loss of voluntary control over the passage of fecal material and intestinal gas through the anal sphincter.

What is fecal impaction?

An accumulation of hardened, dry feces wedged in the rectum that cannot be voluntarily expelled.

How does fiber aid bowel elimination?

It absorbs water to increase stool bulk and softness, promoting efficient colonic peristalsis.

How can broad-spectrum antibiotic therapy precipitate diarrhea?

By altering normal gut microbiota, enabling overgrowth of opportunistic pathogens like Clostridioides difficile.

What key nursing measure protects skin integrity in a patient with continuous diarrhea?

Cleanse and dry skin immediately after each liquid stool and apply moisture barrier ointment

How do internal and external anal sphincters differ in defecation control?

The internal sphincter relaxes involuntarily when the rectum fills; the external sphincter is under voluntary somatic control.

How does active surgical or hemorrhoidal pain contribute to severe constipation?

Patients suppress the defecation reflex to avoid discomfort, causing stool to stay in the colon longer and desiccate.

What vital safety check is essential for an ostomy pouch skin barrier cut-out?

The barrier opening should fit closely around the stoma base (leaving 1/8 to 1/16 inch space) to prevent stool effluent contact with skin

What dietary risk factor increases the likelihood of colorectal cancer?

Diets high in red or processed meats and low in dietary fiber, fruits, and vegetables.