Comprehensive Bowel Elimination: Development, Disorders, and Nursing Care: Lesson 9

What age do children typically learn to control bowel elimination?

By age 3.

babys learn s/s of need to go age 18m - 2 y

What factors can affect bowel elimination in pregnant women?

Growing fetus can interfere with intestinal peristalsis, leading to constipation.

prenatals can also be high in iron that can also lead to constipation

What are common causes of constipation?

Low fiber intake, inactivity, medications, and dehydration.

What is the nursing care for constipation?

Increase fiber and fluids, use stool softeners, increase mobility, and monitor bowel movements.

What are the symptoms of bowel obstruction?

No stool or gas, abdominal distension, and pain.

What nursing care is required for bowel obstruction?

NPO, NG tube (to decompress) , IV fluids, and monitor for perforation. Possibly surgery.

(from untreated constipation)

What is diarrhea and its potential complication?

Rapid transit of stool that may lead to dehydration.

What nursing care should be provided for diarrhea?

Fluid replacement, identifying the cause, and administering antidiarrheals.

What is fecal incontinence?

Loss of control over bowel elimination.

What nursing interventions are important for fecal incontinence?

Skin care, toileting schedule, barrier creams, and emotional support.

What is the purpose of an occult blood test?

To detect hidden blood in stool, often for colon cancer screening.

What is the typical time frame for bowel movement after surgery?

24-48 hours.

What are ostomy supplies used for?

For patients with colostomies or ileostomies, including wafers and stoma paste.

What is the role of laxatives in bowel care?

To stimulate bowel movements or facilitate easier stool passage.

What should be monitored in patients with altered bowel elimination?

Dehydration, electrolyte imbalance, and skin integrity.

What are some risk factors for altered bowel elimination?

Excessive medication use, cognitive impairment, and limited access to toilets.

What is a common effect of antidepressants on bowel function?

They can slow down bowel movements.

What is the significance of stoma color in ostomy care?

The stoma should be beefy red/ pink ; other colors may indicate complications.

(if stoma is dusky pink, dull, call provider immediatley and cover with a wet towel)

What are some foods that can affect bowel health?

Spicy foods, cheeses, greasy foods, bread, and spinach.

What is the nursing care for patients with a colostomy?

Clean the stoma, change the appliance, and assess skin condition, apply and barrier creams as needed (such as paste)

What is the proper technique for enema administration?

Lubricate the tip, position the patient in left Sims,' position knee up, and insert carefully.

What are the signs of GI bleeding in stool?

Bright red blood in stool indicates new blood

Black, sticky, tar-like stools indicate older blood in the stool.

What is the nursing process for patients with bowel alterations?

Assess bowel patterns, diagnose issues, plan interventions, implement, and evaluate.

What are the common clinical manifestations of constipation?

Hard, infrequent stools, distension.

What are the clinical manifestations of bowel obstruction?

Abdominal pain and no stool passage.

What nursing interventions can improve bowel elimination?

Encourage hydration, promote ambulation, and maintain privacy.

What is the purpose of using a lubricant during enema procedures?

To ensure comfort during the procedure.

occult blood

need clean stool sample, test for blood in feces

blue means blood is present

ostomy supplies

cutting guide, wafter, stoma adhesive, pouch, clip

colostomy

creation of an artificial opening into the colon

* stool is more formed (colon)

* more formed stool

wafer

cut hole 1/8 inch bigger than stoma

* (too tight can cause strangulation and kill it).

ileostomy

creation of an artificial opening into the ileum

* stool is liquid and watery (small intestine)

* loose/ watery stool

stoma powder/ paste

for extra stick, also acts as a barrier for skin irritation at the base of the stoma

lubricant

use water based lubricant (on enema tip)

older adults - age related differences

experiance peristalsis decline, esophageal emptying slows, muscle tones (like sphincter) weaken, decreased ability to chew

* Comorbidities such as spastic colon affect stool and the ability to go

bowel elimination

excretion of waste products. Breakdown of nutrients from foods ingested and elimination of waste. extends from esophagus to anus.

How many liters of water do adults need per day?

1-2 liters

Not enough liquids can show up as what?

poor skin turgor, hypotension, increased HR

Peristalsis too fast = ?

loose stool

Peristalsis too slow = ?

harder stool

High enema

lift bag 12-18 inches

regular enema

lift bag 12 inches

Low enema

lift bag 3 inches

what contraindicates an enema?

prolapsed rectum (do NOT do)

When should be stop an enema and notfiy the healthcare provider?

severe cramping, bleeding, severe abdominal pain that won't go away

enema liquid amount

750- 1,000 (warm water, cold water will cause cramps) (raise bag slowly)

what are the normal characteristics for an enema?

abdominal cramping is normal, have pt hold in water as long as possible (at least 2-5 mins )

soap suds enema

solution: Castile soap + water (non-medicated)

main purpose: cleansing

action type: irritates bowel

precautions: caution with pregnant women and older adults, mucosal irritation

tap water enema

solution: plain water (non medicated)

main purpose: cleansing

action type: hypotonic, distends colon

precautions: water toxicity risk

normal saline enema

solution: 0.9% NaCl (non-medicated)

main purpose: cleansing

action type: Isotonic, safe

precautions: Safest for all ages

hypertonic solutions (fleets) enema

solution: Sodium phosphate

main purpose: Constipation

action type: Osmotic, draws fluid in

precautions: Dehydration risk (Avoid in renal/elderly)

* contraindicated in dehydrated pts and infants

oil retention enema

solution: Mineral oil

main purpose: Soften stool

action type: Lubricates stool

precautions:Retain 30-60 min

carminative enema

solution: MGW (mag, glycerin, water) Medicated!

main purpose: Relieve gas

action type: Stimulates gas expulsion

precautions: Not for stool removal

colonoscopy prep

Avoid anticoagulants such as aspirin, ibuprofen (NSAIDs), 7 days before as they can give false possitives

avoids citrus or vitamin C 3 days before as they can give false negatives

CT

less detailed

quick look for blockages or constipation problems.

MRI

more detailed

deeper look at muscles or diseases affecting bowel control.

Endoscopy

checks the top (stomach and throat).

looks at: Esophagus, stomach, small intestine

goes in through: mouth

main purpose: Find ulcers, heartburn, bleeding, tumors

prep: NPO

sedation: yes

fecal characteristics

color: brown

odor: malodorous, may be affected by certain foods

consistency: soft, formed

frequency: twice daily to 3 times a wekk

shape: resembles diameter of rectum

constituents: undigested food, dead bacteria, fat, bile, pigment, cells lining intestinal mucosa, water

What is chyme?

comes into the small intestine as a liquid material and mixes with digestive enzymes

Colonoscopy

checks the bottom (colon)

looks at: colon and rectum

goes in through: anus

main purpose: Find colon cancer, bleeding, polyps

sedation: yes

at what age should you get a colonoscopy?

age 45 then every 10 years after that until you are 75

bristool stool chart

3-4 is NORMAL

cleansing enema

non medicated

- high, regular, and low

how often do you change the wafer and colostomy bag?

every 3-7 days

how far do you insert the enema tip?

finger length (3 inches)