BOWEL ELIMINATION - FOUNDATIONS 2 TEST 3

Large Intestine Function

Absorb Water

Form Feces

Expulsion of feces from the body

Small intestine function

Secretes enzymes aiding in protein and carb digestion

3 parts of small intestine

duodenum, jejunum, ileum

Small intestine functions

Receive liver and pancreas juice for digestion

Food digestion and nutrient absorption in the blood stream

Variables influencing bowel elimination

Developmental considerations

Food and fluid

Medications

Daily patterns

activity and muscle tone

lifestyle

Psychological variables

Pathologic Conditions

Diagnostic studies

Surgery and anesthesia

Infant Developmental Considerations for bowel elimination

Characteristics of stool and frequency depend on formula or breast feedings

Toddler Developmental Considerations for bowel elimination

Physiologic maturity is the first priority for bowel training / voluntary bowel control 22-36 months

Child Adolescent Adult Developmental Considerations for bowel elimination

Defecation patterns vary in quantity, frequency, and rhythmicity

1-2 / day to 1 every other 2-3 days

Older adult Developmental Considerations for bowel elimination

Constipation

Diarrhea and fecal incontinence may result form physiologic or lifestyle changes resulting in a decrease in motility

Constipating Foods

Cheese

Lean meat

Eggs

Pasta

Laxative like foods

Fruits and vegetables

Bran

Chocolate

Alcohol

Coffee

Gas Producing foods

Onions

Cabbage

Beans

Cauliflower

Aspirin and anticoagulant effect on stool

pink to red to black stool

Iron salts effect on stool

black stool

(PT need accurate assessment of number of BM with stool softener administration when taking iron TX)

Antacids effect on stool

White discoloration or speckling in stool

Inspection and palpation of the anus and rectum

Lesions, ulcers, fissures, inflammation, hemorrhoids

Ask the patient to bear down as though having a bowel movement. Assess for the appearance of internal hemorrhoids or fissures and fecal masses.

Inspect perineal area for skin irritation secondary to diarrhea or fecal incontinence

Stool collection

Medical aseptic technique is imperative

Hand Hygiene, before and after glove use, is essential

Wear disposable gloves

Do not contaminate outside of container with stool

Obtain stool and package, label, and transport according to agency policy.

Stool collection tests

Occult Blood

Culture and sensitivity

Pus

Ova and parasites

Stool collection instructions

Void first so that urine is not in stool sample

Defecate into the container rather than toilet bowl

Do not place toilet tissue in the bedpan or specimen container

Notify nurse when specimen is available

Occult Blood Testing - Testing for hidden blood in stool

Use solution of guaiac to test for presence of blood

Using small wooden blade smear small amount of stool on testing slide to test for presence of occult blood

Types of direct visualization studies

Esophagogastroduodenoscopy

Colonoscopy

Sigmoidoscopy

Wireless capsule endoscopy

Indirect Visualization studies

KUB

Upper gastrointestinal / Small bowel series

Barium Enema

Abdominal Ultrasound

magnetic resonance imaging

Abdominal CT Scan

How to promote regular bowel habits

Timing

Positioning

Privacy

Nutrition / hydration

Exercise (abdominal, thigh, postural)

People at high risk for constipation

Patients on bedrest taking constipating medicines

Patients with reduced fluids or bulk in their diet

Depressed patients

Patients with CNS disease or local lesions that cause pain when defecating

Nursing measures for the PT with diarrhea

Answer call bells immediately, prevents falls

Remove the cause of diarrhea whenever possible (EX MEDS)

If there is impaction, obtain physician order for rectal exam

Give special care to the region around anus

Nursing measures for the PT with fecal incontinence

Targeting toileting

Peri care with barrier cream

Keep skin and linens clean

Frequent skin assessments

Rectal tubes / incontinence devices

Methods of emptying the colon of feces

Enema

Rectal suppositories

Oral intestinal lavage

Digital removal of stool

Cleansing enema

Stimulates peristalsis through distention and irritation of colon and rectum

Retention enema

Oil

Carminative

Medicated

Anthelmintic

Encourage PT to hold the liquid for a while before BM

Large volume vs small volume enema

Large 500-1000 ml

Small Less than 500

Oil retention enema

Lubricate the stool and intestinal mucosa, easing defecation

Carminative enema

Help expel flatus from the rectum

Medicated enema

Provide medications absorbed through the rectal mucosa

Anthelmintic Enema

Destroy intestinal parasites

Manipulate factors within the patients control

Flood and fluid intake, exercise, and time for defecation

Eliminate a soft, formed stool at regular intervals without laxatives

Nasogastric Tubes

Inserted to decompress or drain stomach of fluid or unwanted stomach contents

Used to allow the GI tract to rest before or after abdominal surgery to promote healing

Inserted to monitor GI bleeding

Types of Ostomies

Sigmoid colostomy

Descending colostomy

Transverse colostomy

Ascending colostomy

Ileostomy

Ureterostomyostomie

Colostomy

Located anywhere along the length of the large intestine

The further along the intestinal tract the more solid the stool

Reusable or disposable pouch worn

Stomadhesive is cut and placed around the stoma to protect the skin from urine or stool

Ileostomy

Empties from the end of the small intestine

Water is not absorbed

Stool is liquid

May not be irrigate d

Drainage pouch is worn at all times

Ureostomy

Permanent fistula for drainage of a ureter through the abdominal wall

Ileoloop or ileoconduit

Ureter drains into a portion of the ileum which forms a pseudo bladder with an artificial opening into the abdominal wall

A straight catheter can be placed for drainage

Avoids the need for an external pouch

Post stoma operative assessment

Every 2 hours for 24 hours

Every 4 hours for 28-72 hours

Every 4-8 hours PRN

Healthy stoma appearance

Highly vascular

Beefy red/pink in appearance

Smooth skin

Assess stoma for prolapse or retraction

Stoma irritation

There are no nerve endings so then stoma may be irritated without the clients awarness

Stoma irritations that should be documented and reported

Dermatitis

Rash

Pimples

Bluish discoloration

Stoma Documentation

Amount

Color

Consistency

application of a cline pouch or dressing

client participation

Colostomy Care

Use clean technique/ clean gloves

Keep PT free of odors is possible, empty appliance when 1/4-1/3 full

Inspect for size which should stabilize within 6-8 weeks

Keep the skin around the stoma site clean and dry

Measure PT fluid intake and output

Explain each aspect of care to the PT and self care role

Encourage PT to care and look at ostomy

Enterostomal Therapist orWound Ostomy Continence Nurse

Excellent resource person for clients and healthcare personnel concerning colostomy care

Teach PT to perform ostomy self care

PT teaching for colostomies

Explain reason for bowel diversion and the rationale for treatment

Demonstrate self care behaviors the effectively manage ostomy

Describe follow up care and existing support

Report where supplies can be obtained

verbalize fears and concerns

Demonstrate a positive body image

Stoma comfort measures

Encourage recommended diet and exercise

Use medication only as needed

apply ointments or astringent

Use suppositories that contain anesthetics

Specialty ostomy sets designed by wound care nurses