Concepts: Bowel Elimination

2-3 years

Ability to control defecation occurs at __ years

1. fiber laxative

2. osmotic laxative

3. stimulant laxative

4. enema laxative

what are the 4 orders that laxatives should be taken

digest

in OA, there is decreased chewing making it harder to ___

3 L per day

2.2 L per day

what is the fluid intake in men and women per day?

bowel movements

physical activity is important for ___

increases

gas, diarrhea,

stress ___ peristalsis, increased peristalsis leads to ___

decreased

depression leads to a ___ in peristalsis

irritable bowel syndrome

what is a GI disease that is exacerbated by stress

whole grains, vegetables, fluids and fruits

what is the recommended dietary intake of foods

-age

-diet

-diagnostic testing

-fluid intake

-medications

-physical activity

-psychological factors

-personal habits

-position during defecation

-pain

-pregnancy

-surgery and anesthesia

what are 12 factors effecting bowel elimination

raise HOB

when a patient is using a bed pan, what should you do to improve defecation

CONSTIPATION

Hemorrhoids, abdominal & rectal surgery leads to defecation suppression which leads to ___

slowed peristalsis

increased fetus size causes pressure on rectum leading to ___ causing strain, hemorrhoids

ileus

___ is obstruction of the intestine, often caused by failure of peristalsis

ileus

general anesthesia decrease peristalsis, direct manipulation of bowel stops peristalsis causing ___

constipation

many medications have secondary effects on bowel elimination. opiods cause ___

intestinal bacterial flora

antibiotics decrease ___ which leads to diarrhea

probiotic

what should be taken with an antibiotic to decrease diarrhea

Laxatives or Cathartics

___ control constipation

laxatives

Avoid regular use of stimulant ___—intestine becomes dependent upon them

Anorexia and Bulimia

what 2 types of disorders will use stimulant laxatives regularly to control weight

increase gas and loosen stool

bowel elimination is affected after procedures to ___ and ___

symptom

constipation is a ___ not a disease

constipation

___ occurs when intestinal motility slows—fecal mass loses water content as it absorbed, with little water to soften & lubricate stool it becomes hardened & difficult to pass

fecal impaction

___ is a unrelieved constipation—suspect it when liquid stool continuously oozes

diarrhea

___ increases the number of stools & passage of liquid unformed feces, difficulty controlling urge to defecate, may result in dehydration, fluid & electrolyte or acid-base imbalances, meticulous skin care

dehydration, fluid & electrolyte or acid-base imbalances

dehydration may result in what 3 things

incontinence

___ is the inability to control bladder and/or bowels

body image, social isolation, impaired cognitive function

what can incontinence be caused by?

skin turgor, confusion, darker urine, long time without urination

what are 4 things that should be assessed for with bowel elimination problems

Clostridium difficile (C. diff)

___ is a bacterial infection, generally associated with antibiotic use, causing severe, watery loose stools

-antibiotic therapy

-contact with the organism

-heath care workers hands

-environmental surfaces

what are 4 ways to contract C diff

hand hygiene with soap & water

what is the only way to effectively remove C diff

hemorrhoids

___ is dilated, engorged veins in the lining of the rectum, internal or external

increased venous pressure from straining

what is the cause of hemorrhoids

Bowel Diversions

___ are temporary or permanent artificial opening in the abdominal wall

ileostomy or colostomy

a bowel diversion is a surgerical opening in the ileum or colon and is called ___ or ___

stoma

___ is an example of a bowel diversion

sigmoid colostomy

___ is a bowel diversion that causes more formed stool

Transverse Colostomy

___ is a bowel diversion that causes a thick liquid to soft consistency

-sigmoid colostomy

-Transverse Colostomy

___ 2 are easiest to perform, done as temporary means to divert stool from trauma area

ileostomy

___ is a bowel diversion that causes frequent liquid stools

loop colostomy

___ is a bowel diversion that has reversible stomas in the ileum or colon

-proximal

-distal

loop colostomy is a bowel diversion that has 2 openings through the stoma. the ___ end drains fecal effluent, ___ drains mucus

end colostomy

___ is a stoma formed with intestine turned through surgical opening and suturing it to the outer abdominal wall, permanent or reversible, rectum intact or removed

ileoanal pouch anastomosis

___ is for patients who need a colectomy for treatment of ulcerative colitis or familial adenopolyposis. Colon is removed, pouch is formed from end of small intestine and attached to anus. Pt. is continent.

continent ileostomy

___ is rarely done now, pouch created from small intestine, stoma on abdomen with a valve drained when catheter is placed in stoma several times a day

antegrade continence enema

___ is done in children with fecal soiling associated with neuropathic or structural abnormalities of the anal sphincter

fairness, confidence, & discipline.

what 3 critical thinking attitudes should you use to help a patient with bowel elimination alterations

elimination

What a patient describes as normal or abnormal is often different from factors & conditions that tend to promote normal ___

normal & abnormal

Identifying normal & abnormal patterns, habits, & the patient's perception of ___ and ___ of bowel elimination allows you to accurately determine a patient's problems

Type 1

___ on the Bristol Stool Form Scale is described as separated into hard lumps like nuts (difficult to pass)

Type 2

___ on the Bristol Stool Form Scale is described as sausage shaped but lumpy

Type 3

___ on the Bristol Stool Form Scale is described as like a sausage but with cracks on the surface

Type 4

___ on the Bristol Stool Form Scale is described as like a sausage or snake, smooth and soft

Type 5

___ on the Bristol Stool Form Scale is described as soft blobs with clear-cut edges

Type 6

___ on the Bristol Stool Form Scale is described as fluffy pieces with ragged edges, a mushy stool

Type 7

___ on the Bristol Stool Form Scale is described as Watery, no solid pieces. Entirely liquid.

bowel elimination routine

Hot liquids, specific foods, taking time to defecate during a certain time of day. Use of laxative, enemas or bulk-forming fiber additives.

these are examples of ___

Bowel Diversions

Frequency of emptying, character of feces, appearance & condition of stoma, peristomal skin condition, type pouch

these are things to look for when a person has a ___

appetite changes

eating patterns, weight gain or loss, if loss was it intentional?

these are things to assess for with ___

diet

intake of fruits, vegetables, whole grains, regularity of mealtimes

these are things to assess for with a persons ___

-emotional state

-exercise history

-fluid intake

-history of GI tract surgeries and illness

-medication

-mobility and dexterity

-pain or discomfort

-social history (living arrangements)

what are 8 things to assess for when a patient is having bowel elimination issues

-mouth

-abdomen

-rectum

what are 3 things to assess for on a physical assessment of a patient who has bowel elimination issues

-teeth

-tongue

-gums

-dentures

what are 4 things to assess for in the mouth of a patient who has bowel elimination issues

-bowel sounds

-percussion

-palpation

what are 3 things to assess for with the abdomen of a patient who has bowel elimination issues

-lesions

-inflammation

-hemorrhoids

what are 3 things to assess for with the rectum of a patient who has bowel elimination issues

-Hemoglobin & hematocrit

-Fecal specimens

-Fecal Occult Blood Test

what are 3 laboratory test to assess for with a patient who has bowel elimination issues

fecal occult blood test (FOBT)

___ measures microscopic amounts of blood in the feces

-direct visualization (endoscopy)

-indirect visualization (anorectal manometry, x-rays with/without contrast, ultrasound, CT, colonic transit study, MRI)

what are 2 radiological and diagnostic test to do with a patient who has bowel elimination issues

-Incorporate elimination habits or routines

-Reinforce routines that promote health

-Consider preexisting concerns

what are 3 goals with a patient who has bowel elimination issues

African Americans

who is colorectal cancer predominate in?

-Sitting position

-Privacy

-Positioning on bedpan -- Delegation

-Prevent muscle strain & discomfort

-Elevate head of bed 30 -- 45 degrees

what are 5 things that can cause promotion of normal defication

Cathartics

___ have a stronger & more rapid effect on the intestines than laxatives

Cathartics

__ have a harmful effect if over used

Suppositories

___ may act more quickly than oral medications

Opiates (used with caution)

what is an antidiarrheal agent

enemas

___ promote defecation or medication administration

cleansing enema

___ cause complete evacuation of feces

-tap water

-normal saline

-hypertonic solution

what are 3 types of cleansing enemas

tap water

___ is a cleansing enema that can escape into interstitial spaces, use caution if ordered to repeat—may result in water toxicity or circulatory overload

normal saline

___ is a cleansing enema that is the safest, only enema used for infants & children

hypertonic solution

___ is a cleansing enema that pulls fluid out of interstitial spaces, low volume, contraindicated for dehydrated patients, Fleet enema

before colonoscopy

why might a cleansing enema be used for

soapsuds

___ is a cleansing enema that causes intestinal irritation to stimulate peristalsis, pure castile soap only, use with caution in pregnant women & older adults

pure castile soap

___ is the only soap safe for use in enemas, reduces bowel irritation

can induce labor

why are soapsuds used with caution in pregnant females

oil retention

___ lubricate the feces, patient retains enema if possible

carminative

___ is an agent that relieves intestinal gas

Kayexalate

___ is a medicated enema for patients with dangerously high potassium levels

-Sterile technique is unnecessary.

-Wear gloves.

-Explain the procedure, positioning, precautions to avoid discomfort, and length of time necessary to retain the solution before defecation

what are the 3 steps to an enema administration

Digital removal of stool

___ is used if enemas fail to remove an impaction and this is the last resort for constipation.

can NOT

digital removal of stool __ be delegated to a nurse assistant

-decompression

-enteral feeding

-compression

-lavage

what are the 4 purposes of nasogastric tube?

decompression

___ of a NGT causes the removal of secretions and gaseous substances from GI tract

enteral feeding

___ of an NGT is used for the instillation of liquid nutritional supplements or feedings into small intestines for patients with impaired swallowing

compression

___ of an NGT is used for internal applicaiton of pressure by means of inflated balloon to prevent internal esophageal or GI hemorrhage

lavage

___ of an NGT is used for irrigation of stomach in cases of active bleeding, poisoning, or gastric dilaiton

Fine or small bore NG tube

___ tube is for medication administration & enteral feedings

Large bore NG tube

___ tube is for gastric decompression or gastric secretion removal