CNA Chapter 17 Bowel Elimination

Defecation

Bowel elimination; passing feces from the large intestine out of the body through the anus

Feces; stool; bowel movements

Medical names for poop

Normal

Characteristics of _________ stool is brown in color, soft or formed, and tubular in shape.

Appearance

Food, medication, supplements, illness can all change the ________ of stool

Black

Stool can appear _______ if the resident is taking iron supplements or if there is old blood in the stool.

Red

Stool can appear _______ if the resident consumes red food coloring beets or tomato juice. It may also contain fresh blood like from lower intestinal bleeding.

Liver

Stool may appear _________ if the resident has issues with the liver affecting the production of bile.

Normal

Normal or report:

Stool is soft and formed

Report

Normal or report:

Whiteish, black, red, or hard stool

Report

Normal or report:

Hard stool or liquid stool

Report

Normal or report:

Diarrhea

Report

Normal or report:

Constipation

Normal

Normal or report:

Stool that is brown in color

Report

Normal or report:

Flatulence or gas in excess

Report

Normal or report:

Pain when having a bowel movement

Report

Normal or report:

Fecal incontinence

Normal

Normal or report:

Stool that is tubular in shape

Report

Normal or report:

Blood, pus, mucus, or discharge in the stool.

Peristalsis

Involuntary contractions of the smooth muscle in the organs of the digestive tract that move food through the gastrointestinal system.

Slows; longer; absorbed

Normal changes of aging in bowel elimination:

Peristalsis _______

Digestion takes ________ and is less efficient

Proteins, vitamins, and minerals are not _______ as well.

Decreased; tooth; taste; appetite

Normal changes of aging in bowel elimination:

______ saliva production

Possible _____ loss

Medication use and dulled sense of ____ may result in a poor _______.

Fluids; dentures; hands; clean; dry

Nursing Assistants can promote normal bowel elimination by:

Encouraging ________

Encouraging nutritious meals

Making meals enjoyable

Ensuring _______ fit properly and are cleaned well

Performing oral care

Helping resident wash their _____ after elimination

Keeping residents with fecal incontinence _____ and ______.

Psychological

___________ factors that affect bowel elimination:

Stress, anger, fear, depression, and a lack of privacy.

Increase

Stress, anger, anxiety, and fear can _________ peristalsis.

Decrease

Depression can ________ peristalsis

Privacy; rushing

Nursing assistants can help reduce psychological factors affecting bowel elimination by

Providing ______ and closing the bathroom door, not _______ the resident or interrupting, reporting signs of depression or anxiety, and reporting changes in frequency.

Fiber

Consuming _______ can help elimination. This can be found in fruits, whole grains, and raw vegetables.

Constipation

Meats, animal fats, cheese and foods high in processed sugars can cause ____________.

Flatulence

Gas

Help

Flatulence can _____ bowel elimination.

Flatulence

High fiber foods including the following can also cause ____________:

Beans

Fruits

Whole grains

vegetables

dairy products

carbonated drinks

Low

_______ fluid intake can cause constipation because water is reabsorbed from feces in the intestines.

Fluids; fiber

Nursing assistants can promote normal bowel elimination by offering ____ and foods high in ______.

Exercise

Physical activity and ______ promotes bowel elimination by strengthening abdominal and pelvic muscles.

Walks

Nursing assistants can promote normal bowel elimination by offering to take the resident on ______ or making exercise fun for the resident.

Pattern

A resident’s ________ of bowel elimination depends on the person, on their habits, on the amount and type of food and drink they have consumed.

After meals

When does elimination usually occur?

Squatting and leaning forward

What is the best position for bowel elimination?

Supine position

What is the worst position for bowel elimination?

Laxatives

This type of medication promotes elimination and may cause excessive elimination.

Slow

Pain relievers, antacids, and iron supplements may _______ elimination.

Antibiotics

This medication is given to fight bacterial infections but may also cause diarrhea.

Constipation

The inability to eliminate stool or infrequent difficult and painful elimination of hard dry stool.

Constipation

Factors that can cause ______:

decreased fluid intake, poor diet, lack of fiber, inactivity, medications, aging, certain disease, ignoring the urge to eliminate, and holding in stool for long periods of time.

Constipation

Signs and symptoms of ________:

Abdominal swelling, gas, irritability, and a record of no recent bowel movement.

Distention

Abdominal Swelling

Increase; suppositories

Ways to treat constipation include:

_______ the amount of fluid and fiber consumed, increase activity level, and medications including enemas and _______.

Document

It is very important to _______ bowel movements accurately. Every bowel movement should be recorded.

Enema

A specific amount of water with or without an additive introduced into the solon to stimulate the elimination of stool.

Suppository

Medication given rectally to cause a bowel movement

Fecal Impaction

Hard stool that is stuck in the rectum and cannot be expelled

Fecal Impaction

Unrelieved constipation can cause _________ ___________

Fecal Impaction

Signs and symptoms of _________ ___________:

No stool for several days, oozing of liquid stool, cramping, abdominal swelling, rectal pain.

Fingers

If a resident has a fecal impaction a nurse, doctor, or CNA must reach into the rectum with 1 or 2 gloved _____ to break up the mass so it can be passed.

Hemorrhoids

Enlarged veins in the rectum. Can be external or internal.

Hemorrhoids

Causes of _______:

Chronic constipation, obesity, pregnancy, chronic diarrhea, overuse of laxatives or enemas, straining during bowel movements, sitting for long periods on the toilet.

Hemorrhoids

Signs and symptoms of _______:

Rectal itching, rectal burning, pain, bleeding.

Sitz Baths

Treatments for hemorrhoids includes:

Increasing fiber and fluid intake, medications, cold compresses, __________ ________, surgery, and a cream called preparation H.

Diarrhea

Frequent elimination of liquid or semisolid feces

Diarrhea

Signs and symptoms that may accompany ________:

Abdominal cramps, urgency, nausea, vomiting

Diarrhea

Causes of ________:

Bacterial and viral infections, microorganisms in food or water, irritating foods, medications.

Immodium

Diarrhea can be treated with the following:

Medications like ________, increase in water and electrolytes to replace what is lost, and the BRAT diet.

Dehydrated

It is important to remember that residents with diarrhea may become _________ due to excessive loss of water in the stool.

Banana, Rice, Apple, Toast

The BRAT diet is used for patients with diarrhea. What does it stand for?

Fecal Incontinence

The inability to control the bowels leading to involuntary passage of stool. Not a normal part of aging.

No

Is fecal incontinence a normal part of aging?

Fecal Incontinence

Treatment for ___________:

Change in diet, medication, bowel training, and surgery.

Fecal Incontinence

Causes of ______ ______:

Constipation, muscle and nerve damage, loss of storage capacity in the rectum, and diarrhea.

Flatulence

Air in the intestine that is passed through the rectum. Can result in cramping or abdominal pain.

Air; fiber

The following can cause flatulence:

Swallowing ____ while eating

Eating high ______ foods

Eating foods that you can’t tolerate

Antibiotics

Malabsoprtion

Malabsorption

When the body can’t absorb or digest a particular nutrient properly.

Lactose Intolerance

The inability to digest lactase a sugar found in milk and dairy products. A deficiency in the lactase enzyme. It can cause bloating, diarrhea, and flatulence. Resolved with a dairy-free diet or lactaid pills.

Gastrointestinal Reflux Disease

What does GERD stand for?

GERD

A chronic condition where the liquid contents of the stomach come back up into the esophagus. The stomach acid causes damage to the esophagus.

GERD

If ____________ if left untreated it can cases inflammation of or damage to the esophagus, bleeding or ulcers in the esophagus, and scars and tissue damage to the esophagus. It can make swallowing difficult. It can cause ulceration of the esophagus.

Heartburn

What is the most common symptom of GERD

Heartburn

Weakening of the sphincter muscle that joins the esophagus and the stomach causes GERD and ____________.

Antacids

What medications are used to treat GERD?

Medications; 3-4; 2-3

Residents with GERD…

May take ________ like Pepsid or Prevacid

Should have their last meal ____-_____ hours before bed

Not lying down ___-____ hours after eating

Pillows; largest; fast

Residents with GERD…

May have extra _____ to keep the body upright

Have the ____ meal at lunch and eating several small meals throughout the day

Reducing _______ foods, fatty foods, and spicy foods

Smoking; alcohol; loose

Residents with GERD…

May have to stop _______ or drinking _______

May wear _______-fitting clothing

Peptic Ulcer

Raw sores in the stomach caused by excessive acid secretion

Peptic Ulcers

Signs and symptoms of _____ ___________:

Dull/burning pain 1-3 hours after eating in the upper abdomen area

Belching

Vomiting

Bleeding or black and tarry stool

Peptic Ulcer

Treatments for __________:

Antacids, antibiotics (if caused by bacteria), medications, change in diet, bland diet, no smoking, no alcohol.

Bland

What type of diet would a resident with Peptic Ulcers be on?

Irritable Bowel Syndrome

A condition of inflammation of the large intestine. AKA colitis. A condition that causes diarrhea, constipation, or both on a regular basis. It can cause bloating, abdominal pain, and gas. Stress, certain foods, and beverages can cause flare-ups. Caused by problems with communication between the nervous system and the digestive track, causing the bowel to function less efficiently.

Ulcerative Colitis

Chronic inflammatory disease of the large intestine. Caused by ulceration and sores that form in the colon. It is usually a continuous area of damage that may spread.

Ulcerative Colitis

Signs and symptoms of ________ ________:

Cramping, diarrhea, pain on one side of the lower abdomen, rectal bleeding, loss of appetite, weight loss, abdominal bleeding, and it may lead to death.

Irritable Bowel Disease

A group of conditions where the bowel is chronically inflamed and it is caused by an immune response. It includes Ulcerative Colitis and Crohn’s disease.

Intestinal Bleeding or death

What can UC cause if left untreated?

Crohn’s Disease

Inflammation in the small intestine. It usually occurs in patches of damaged tissue. Ulcers and sores in the small intestine.

Medications and surgery

Treatments for UC and Crohn’s

Colostomy

What type of surgery would be performed for UC?

Ileostomy

What type of surgery would be performed for Crohn’s disease?

Colostomy

A surgical opening created into the large intestine created to allow stool to be expelled.

Stoma

The artificial opening through the abdomen that allows for stool to be eliminated. The section of intestine that protrudes from the abdomen.

Colorectal Cancer

Cancer of the gastrointestinal tract specifically the colon and rectum.

Colorectal Cancer

Signs and Symptoms of ________ _________:

Changes in normal bowel patterns

Cramps

Abdominal Pain

Rectal Bleeding

Bowel Resection

Colorectal cancer is treated with surgery including a ______ ______ and colonostomy.

Milk of Magnesia

What is step one if a resident hasn’t had a BM in four days?