bowel and urinary elimination bowel and urinary elimination

At what age does voluntary bowel control develop?

2–3 years old.

Normal bowel movement frequency

1–2 times per day.

Older adults and bowel elimination

Decreased peristalsis → higher risk of constipation.

Normal stool appearance

Soft, formed, curved, light yellowish-brown to dark brown, slightly odorous.

Foods that cause stool color changes

Spinach → green-black stool; Beets → red tint; Iron supplements → dark brown/black.

Infant stool: newborn

Black, sticky meconium.

Infant stool: breastfed baby

Bright yellow, pasty, seedy.

Infant stool: formula-fed baby

Darker yellow-brown or tan, more formed.

Rapid intestinal transit results in:

Watery stool (may appear green).

Definition of diarrhea

Several liquid stools per day.

Test used to detect hidden blood in stool

Guaiac test (occult blood test).

Encourage activity because:

It stimulates peristalsis and helps bowel movement.

Recommended ambulation for constipation prevention

3–4 times per day or reposition every 2 hours if on bedrest.

Recommended fluid intake

1,500–2,400 mL per day (unless contraindicated).

Recommended fiber intake

25–35 grams per day (fruits, vegetables, whole grains).

Best position for defecation

Upright or sitting (high/semi-Fowler’s if in bed).

Purpose of privacy during elimination

Promotes relaxation and proper bowel movement.

Safer laxatives to use

Stool softeners and bulk-forming agents.

Enema water temperature

105°F–110°F (40.5°C–43.3°C).

Enema insertion length

3–4 inches into the rectum, patient in left side-lying position.

Why not insert an enema while patient is on toilet

Increases risk of rectal injury.

Definition of fecal impaction

Blockage of stool movement due to hardened feces in rectum or sigmoid colon.

Common causes of fecal impaction

Elderly age, dehydration, prolonged bedrest, laxative abuse.

Symptoms of fecal impaction

Small amounts of liquid stool, abdominal fullness, rectal pressure.

Complications if untreated

Bowel obstruction or perforation.

Treatment for fecal impaction

Oil retention enema before digital removal; pain medication may be needed.

Vagal response during disimpaction

Bradycardia or dizziness; stop procedure and notify provider.

Initial diet for diarrhea

Clear liquids (water, electrolyte drinks, herbal teas).

Liquids to avoid during diarrhea

Hot or cold liquids; apple juice (can worsen diarrhea).

Diet after 24–36 hours of diarrhea

Add full liquids and cooked fruits/vegetables (e.g., applesauce, carrots).

Medications used for diarrhea

Antidiarrheals or probiotics (Lactobacillus acidophilus).

Perineal care for diarrhea

Clean with no-rinse products or wipes, pat dry, apply barrier cream.

Bowel training schedule

Upon waking, after meals, or when urge occurs—goal: regular elimination pattern.

Ileostomy

From ileum; liquid effluent, continuous drainage.

Colostomy

From colon; stool consistency depends on location.

Single-barrel colostomy

One opening for stool elimination.

Double-barrel colostomy

Two openings: proximal (stool) and distal (mucus).

Normal stoma appearance

Pink-to-red, shiny, moist.

Abnormal stoma appearance

Pale, dusky, or black → impaired circulation.

When is stoma swelling normal?

First 2–3 weeks post-surgery.

When to empty ostomy pouch

When ⅓–½ full.

How often to change ostomy faceplate

Every 3–5 days or when loose.

Key skin care for ostomy

Wash gently, pat dry, apply barrier cream.

Emotional care for new ostomy

Encourage education and self-participation in care.

Clean-catch (midstream) urine collection

Clean meatus, start voiding, stop, then collect midstream urine.

Urinalysis (UA)

Tests for infection, stones, or disease.

24-hour urine collection

Discard first void, then collect all urine for next 24 hours.

Strained urine

Used to detect kidney stones.

Reagent or dipstick test

Checks for pH, protein, glucose, ketones, or blood in urine.

Minimum urine output

30 mL per hour (240 mL in 8 hours).

Intake greater than output means:

Fluid overload.

Output greater than intake means:

Dehydration.

Straight catheter (single-lumen)

Used for one-time drainage or sterile urine sample.

Indwelling (double-lumen / Foley catheter)

Stays in bladder for continuous drainage; balloon holds it in place.

Three-way (triple-lumen) catheter

Used for continuous bladder irrigation after prostate surgery.

Coude catheter

Curved tip for easier insertion in males with enlarged prostate.

Suprapubic catheter

Inserted surgically through abdomen for long-term drainage.

Condom (Texas) catheter

External device for males; used when voluntary control is intact but incontinence occurs.

External female urine collection device

Non-invasive suction or cup device that collects urine without inserting a catheter.

Monitor after catheter removal

Patient should void within 8 hours; if not, report to provider.