nursing 347 - bowel eliminations

auscultation

• hyperactive: more than 34 per min

• hypoactive: less than 5 per min

• absent: after listening for 2 mins/longer

patients with which health problems would have decreased or absent bowel sounds?

• peritonitis

• prolonged bed rest

• postoperative paralytic ileus

effects of medication on stool

• constipation: opioids (narcotics)

• decrease GI motility: antacids

• diarrhea:

  • antibiotics

  • magnesium

  • metformin

volume

• large diarrheal stool = disorder in small bowel or proximal colon

• small frequent stool with urgency to pass them = disorder in left colon or rectum

abnormal colors

• melena: thick, black stool (upper GI bleeding)

• red meat + dark green veggie: dark stool

shape of stool

• normal: 1 inch in diameter

• GI obstruction: narrow, pencil shaped

exercise

2 ½ hours per week for pelvic floor + rectal muscle tone

bowel-training programs

• have pt poop without laxatives

• you can use:

  • suppositories

  • digital rectal stimulation

diagnostics: direct visual

• EGD (esophagogastroduodenoscopy)

• colonoscopy + endoscopy

diagnostics: indirect visuals

• x-ray studies

• ultrasound + CT scan

• mri

constipation

• less than three bowel movements in a week

• results in dry + hard to pass bowels

constipation facts

• risk factors: immobility, narcotics/opioids

• management: bowel training program + high fiber diet + more water

diarrhea

• more than three loose stools in a day

• response to meds + microorganisms (protect body)

diarrhea facts

• risk factors: IBS + antibiotics

• complications: dehydration

• management: perineal care + rehydration

diverticulosis

• small bulging sacs or pouches forms in colon

• risk increases with age

• pt may experience: bleeding + abdominal pain

• preventive measures: high-fiber diet

• meds: take antibiotics + liquid or soft diet

diverticulitis

• diverticulosis increases risk of diverticulitis

• inflamed pouch/sac forms as a result of stool being trapped

what happens when diverticulosis or diverticulitis becomes severe?

• colon can perforate or tear

• causes infection in abdomen called peritonitis

irritable bowel syndrome

• bloating, mucus in stool, incomplete bowel emptying

• types: IBS-C, IBS-D, IBS-M

risk factors for IBS

• family history

• female

• stress, anxiety + depression

• infection in GI

• fibromyalgia

interventions for IBS

• increased use of fiber + probiotics

• no gluten

• reduce stress - sleeping, exercise, meds

paralytic ileus

• flow of intestinal contents decrease/stops

• caused by: surgery, trauma, infection, meds

• bowel sounds diminished/absent

paralytic ileus symptoms

• inability to tolerate food + pass gas

• nausea + vomiting

• slow-onset abdominal distension

• bloating

paralytic ileus treatment

• requires doctors

• NPO diet

• NG tube

• IV fluid therapy

• if patient cannot tolerate oral after week = total parenteral

ulcerative colitis

• chronic disease - inflammation + ulcerations on large intestine/colon

• might have remission (weeks/years)

risk factors for ulcerative colitis

• family history - jewish descent

• environment

• overactive intestinal immune system

manifestations of ulcerative colitis

• diarrhea with blood or pus

• fatigue, nausea, fever

• anemia

interventions for ulcerative colitis

• initially meds to reduce remission

• if meds don’t work = surgeon might have to remove entire colon bc of cancer lesion

crohn’s disease

• inflammation in GI tract

• only affects small intestine

• can experience periods of remission

risk factors for crohn’s disease

• no definitive cause

• developing at ages 20-29

• family history + tobacco use

• high-fat diet

what can crohn’s disease cause?

• fistulas

• abscesses, fissures or tears in an-us

• ulcers, malnutrition, inflammation of other body parts

manifestations of crohn’s disease

• anemia, fatigue, fever

• joint pain, nausea, painful bumps under skin

ileostomy

liquid fecal matter to be eliminated in stoma 

inspection of stoma

• dark pink to red, moist

• minimal bleeding

• peristomal skin intact

when to change colostomy bag?

when it is half full, or sooner if it leaks

colostomy diet

• low fiber foods

• add foods that thicken stool

sigmoid colostomy

descending colostomy

transverse colostomy

ascending colostomy

ileostomy image