bowel and urinary elimination (for bowels)

Describe the anatomy of the gastrointestinal tract.

Esophagus
Small intestine-
duodenum, jejunum, and the ileum
Large intestine
Cecum, ascending colon, tranverse colon, descending colon, sigmoid colon
Rectum and Anus technically part of the large intestine

Describe the physiology of the gastrointestinal tract.

Purpose is to provide food digestion, nutrient absorption, and fluids.

Identify common nursing problem in bowel elimination. what are they?

diarrhea, constipation, and bowel incontinence.

Integrate components of a comprehensive assessment to identify issues with bowel elimination.

with assessment of the bowel know health history, then start with inspection. auscultation, percussion, palpation. lab and diagnostic.

Outline goals for clients experiencing alterations in bowel elimination. example.

Patient will defecate formed stools within 48 hours after colonoscopy.

• Patient will pass soft stools daily during rehabilitation.

• Patient’s episodes of bowel incontinence will decrease within 48 hours after starting a bowel training program.

Implement interventions to maintain normal bowel elimination.

at home - pt can have a diet of fiber, exercise, medcation management, environmental support,

Evaluate the effectiveness of interventions to maintain normal bowel elimination.

assessment parameters, document, any physical indicator.

in the nursing process for diarrhea health history. what question do you want to ask you patient?

• When did the diarrhea start, and how long has it lasted?

• How often and how much stool is passed?

• Any recent travel (possible infection exposure)?

• What medications are you taking (antibiotics, laxatives, etc.)?

• Any new foods, diet changes, or known intolerances?

• Any recent illness or infection?

in the nursing process for diarrhea what are you looking for in physical assessment?

• Check abdomen (for pain, distension, bowel sounds).

• Take vital signs (watch for fever, low BP from dehydration).

• Monitor daily weight (detect fluid loss).

• Record intake and output (balance fluids).

in the nursing process for diarrhea for stool assessment what are you look for in the patient?

• Note frequency, consistency, amount, color, and odor.

• Check for blood or mucus in stool.

in the nursing process for diarrhea what are you looking for when monitoring for complication in (assessment)?

• Look for dehydration (dry mouth, low urine, poor skin turgor).

• Watch for electrolyte imbalance (confusion, weakness, irregular pulse).

• Check for skin breakdown around the anus.

• Assess nutritional status and energy levels.

• Ask about nausea or vomiting.

in the nursing process for diarrhea what are special considerations you need in (assessment) to keep in mind?

• Rule out C. difficile infection (especially if on antibiotics).

• Monitor older adults closely — they dehydrate faster.

in the nursing process for diarrhea for (diagnosis). what labs will you need?

• Stool culture → Identify bacteria, parasites, or C. difficile.

• Occult blood test → Check for hidden blood in stool.

• Electrolyte panel (Na⁺, K⁺, Cl⁻, HCO₃⁻) → Detect imbalances from fluid loss.

• CBC (complete blood count) → Signs of infection (↑ WBCs) or anemia.

• BUN and creatinine → Evaluate kidney function and dehydration.

• Ova and parasite test → Detect parasitic infections.

• C-reactive protein (CRP) → Assess inflammation if infection suspected.

in the nursing process for diarrhea for (planning) what goals do you want for your patient to have for fluid and electrolytes?

• Goal: Restore hydration and maintain electrolytes.

• Plan:

  • Monitor intake/output.

  • Prevent dehydration complications.

in the nursing process for diarrhea for (planning) what goals do you want for your patient to have for Nutrition Support?

• Goal: Maintain adequate nutrition.

• Plan:

  • Give small, frequent meals.

  • Modify diet as needed (bland/low-fiber if acute).

  • Provide protein/calorie supplements if needed.

  • Monitor food intake and appetite changes.

in the nursing process for diarrhea for (planning) what goals do you want for your patient to have for Medication Management

• Goal: Control diarrhea and treat cause.

• Plan:

  • Give prescribed antidiarrheal or antibiotic meds.

  • Monitor effectiveness and side effects.

  • Use probiotics if prescribed.

in the nursing process for diarrhea for (planning) what goals do you want for your patient to have for Skin Integrity?

• Goal: Prevent skin breakdown.

• Plan:

  • Keep perianal area clean and dry.

  • Apply protective barrier creams.

  • Check skin regularly for redness or irritation.

in the nursing process for diarrhea for (implementation) what need to happen first?

Priority: Fluids & Monitoring

• Monitor intake and output (I&O) closely.

• Track bowel frequency, stool appearance, and weight changes.

• Assess mucous membranes and signs of dehydration.

• Record all findings accurately.

in the nursing process for diarrhea for (implementation) what need to happen second?

Medication Administration

• Give antidiarrheals as prescribed — follow dosing limits.

• Administer bismuth subsalicylate with 6–8 oz water.

• Monitor for side effects and effectiveness.

• Provide antiemetics if the patient has nausea or vomiting.

• Use probiotics if ordered.

in the nursing process for diarrhea for (implementation) what need to happen third?

Dietary Management

• Encourage small, frequent meals.

• Avoid fried, fatty, spicy, or high-fiber foods.

• Eliminate milk if lactose intolerant.

• Offer mild, bland proteins (e.g., chicken, turkey, cheese).

• Maintain adequate hydration (oral fluids or IV if needed).

in the nursing process for diarrhea for (implementation) what need to happen fourth?

Comfort & Skin Care

• Perform frequent perineal care.

• Keep rectal area clean and dry.

• Apply protective barrier creams.

• Offer lukewarm sitz baths for irritation relief.

• Maintain overall skin integrity.

in the nursing process for diarrhea for (implementation) what need to happen last when you see improvements?

Patient Education

• Teach proper medication use and adherence.

• Review dietary guidelines and foods to avoid.

• Explain warning signs (bloody stool, severe dehydration, persistent vomiting).

• Reinforce hand hygiene to prevent reinfection.

• Discuss probiotic benefits and energy conservation (rest between meals).

in the nursing process for constipation for (assessing) what are question you want to ask the patient?

• Their bowel pattern history.

• How often do you have a bowel movement?

• What time of day do you usually go?

• What is your usual stool consistency?

• Any recent changes in pattern?

• Do you have pain or straining when passing stool?

• Do you ever need to use your fingers or laxatives/enemas to help?

• (Note: Fewer than 3 bowel movements per week suggests constipation.)

in the nursing process for constipation for (assessing) what are you looking for in physical assessment?

• Inspect and palpate the abdomen for distention, tenderness, or masses.

• Perform a digital rectal exam (if appropriate).

• Check for bowel sounds.

• Assess anal sphincter tone.

in the nursing process for constipation for (assessing) what are contributing factors for constipation to be looking for?

• What medications are they taking (opioids, iron, etc.)?

• How much fluid do they drink daily?

• How much fiber do they eat?

• What is their activity level?

• Any medical conditions or past GI surgeries?

when assessing constipation what are some red flags?

• Sudden onset constipation

• Blood in stools

• Weight loss

• Abdominal pain

• Nausea/vomiting

• Signs of bowel obstruction

in the nursing process for constipation for (diagnosis) what are some labs or physical assessment you want to have?

Physical Examination

• Digital rectal examination

• Anorectal manometry

• Sphincter tone assessment

• Abdominal examination

Imaging Studies

• Colonoscopy

• Transit time studies

• Abdominal X-rays

• Defecography

• CT scan if indicated

Laboratory Tests

• Complete blood count

• Comprehensive metabolic panel

• Thyroid function tests

• Serum calcium levels

• Electrolyte panel

what is the nursing process for constipation for (planning) what is a goal you want you patient to have first?

Bowel Function Restoration

• Goal: Promote regular, comfortable bowel movements.

• Plan: Schedule toileting at usual times, encourage proper positioning, and consider stool softeners if prescribed.

what is the nursing process for constipation for (planning) what is a goal you want you patient for lifestyle modification?

Goal: Support long-term bowel health.

• Plan:

  • Increase fluid intake.

  • Eat a high-fiber diet.

  • Encourage regular physical activity.

  • Teach healthy toileting habits (don’t ignore urge to defecate).

what is the nursing process for constipation for (planning) what is a goal you want you patient for medication Management?

• Goal: Use medications safely to relieve constipation.

• Plan:

  • Administer laxatives, stool softeners, or enemas as prescribed.

  • Monitor effectiveness and side effects.

  • Avoid overuse of stimulant laxatives.

in the nursing process for constipation for (implementation) what should you do next after assessing the patient again?

need to do fluid management.

• Encourage 6–8 glasses of water daily (unless contraindicated).

• Monitor for signs of dehydration or fluid overload in patients with heart/kidney issues

after doing fluid management for implementation for constipation what do you do next? 

Medication Administration

• Give stool softeners, laxatives, or enemas as prescribed.

• Follow dosing instructions and monitor effectiveness.

• Watch for side effects like cramping or diarrhea.

when the patient is feeling a little better what are stuff you need to educate patient on for constipation on implementation?

 teach Dietary & Lifestyle Measures

• Encourage high-fiber foods (fruits, vegetables, whole grains).

• Promote physical activity to stimulate bowel motility.

• Teach healthy toileting habits (don’t ignore urge, proper positioning).

teach Comfort & Patient Education

• Provide privacy and time for toileting.

• Teach long-term strategies for preventing constipation.

• Explain medication use and potential side effects.

in the nursing process for impaction for (assessment). what are you looking for health history?

• Check for continuous oozing of liquid stool (may indicate overflow diarrhea).

• Ask about absence of normal stool passage.

• Review recent bowel movement history.

• Determine duration of constipation and previous intervention

in the nursing process for impaction for (assessment). what are you looking for physical assessment?

• Inspect and palpate the abdomen for distention or firmness.

• Perform digital rectal exam if appropriate (to detect impacted stool).

• Listen for bowel sounds (may be hypoactive or normal).

what are the sound for hypoactive bowel movement?

• Slow and sluggish sounds

• Fewer than 5-6 sounds per minute

• Common after surgery

• May indicate developing ileus

what is the sound for hyperactive bowel movement?

• Loud, high-pitched rushing sounds

• Greater than 32 sounds per minute

• Characterized by loud gurgles (borborygmi)

• Often heard with:

  • Diarrhea

  • Inflammatory disorders

  • Early intestinal obstruction

what is the sound for normal bowel movement?

• High-pitched and gurgling

• 6-32 sounds per minute

• Irregular pattern

• Occur every 5-15 seconds

when listening to the the bowel sounds and you hear nothing for 5 mins why should you be concerned?

it requires immediate medical attention, as it may indicate obstruction or paralytic ileus.

what are signs & symptoms for impaction

• Abdominal discomfort or pain

• Nausea or loss of appetite

• Feeling of rectal fullness

• Possible liquid stool leaking around impaction

in the nursing process for impaction for (diagnosis) what labs do you need?

• CBC (Complete Blood Count) → Detect infection or inflammation if there’s fever or severe impaction.

• Electrolytes (Na⁺, K⁺, Cl⁻, HCO₃⁻) → Evaluate imbalances from chronic constipation or prolonged impaction.

• BUN & Creatinine → Check kidney function if dehydration is suspected.

• Thyroid function tests → If chronic constipation is suspected to be related to hypothyroidism.

in the nursing process for impaction for (diagnosis) what other test do you need?

• Abdominal X-ray → To visualize large fecal mass if digital exam is inconclusive.

• CT scan → Rarely, for complicated impaction or suspected bowel obstruction.

in the nursing process for impaction for (planning) what is the overall goal you want you patient to have first?

• Completely remove the impacted stool.

• Restore normal bowel function.

• Relieve pain and discomfort.

• Prevent recurrence of impaction.

in the nursing process for impaction for (planning) what short term goal you want you patient to have?

• Safely remove the fecal mass.

• Maintain skin integrity around the rectal area.

• Control liquid stool leakage.

• Manage pain levels.

• Prevent immediate complications (e.g., bowel perforation, infection).

in the nursing process for impaction for (planning) what long term goal you want you patient to have?

• Establish a regular bowel pattern.

• Improve fluid intake.

• Promote healthy dietary habits (high fiber).

• Increase mobility/activity.

in the nursing process for impaction for (implementation) what needs to happen first?

Assessment & Monitoring

• Monitor vital signs before, during, and after any procedure.

• Track intake/output and fluid balance.

• Assess abdominal distention, pain, and bowel sounds.

in the nursing process for impaction for (implementation) what needs to happen after assessing the patient?

Manual Dissipation (If Ordered)

• Perform digital rectal examination to assess impaction.

• Apply water-soluble lubricant.

• Remove fecal mass gently.

• Monitor vital signs during the procedure.

• Document procedure and patient response.

in the nursing process for impaction for (implementation) what needs to happen with medication?

Medication Administration

• Give stool softeners or laxatives as prescribed.

• Apply local anesthetic if ordered.

• Monitor for effectiveness and side effects.

• Document responses.

in the nursing process for impaction for (implementation) what do you need to be on the look out for hydration management?

• Encourage oral fluid intake if not contraindicated.

• Start IV fluids if prescribed.

• Monitor fluid balance and intake/output regularly.

what can the RN delegate to the LPN when the patient has diarrhea, constipation, or impaction?

• Medication administration for stable patients

• Routine wound dressing changes (after initial RN assessment)

• Monitoring and documenting bowel movements

• Basic patient assessments in stable conditions

• Collecting stool samples

what can the RN delegate to the UAP when the patient has diarrhea, constipation, or impaction?

• Measuring intake and output

• Assisting with toileting

• Providing perineal care

• Recording bowel movements

• Helping with ambulation of stable patients

• Obtaining routine vital signs

• Assisting with hygiene

what can the RN not delegate the the LPN or UAP?

• Initial patient assessments

• First wound assessment/dressing change

• Patient teaching

• Care evaluation

• Manual disimpaction

• Care planning

• Unstable patient care

• Clinical judgment decisions