Gastrointestinal Elimination Flashcards

Waste Production and Elimination

• The small and large intestines are involved in waste production and elimination.
• Normal stool is light to dark brown, soft, and tubular, with a diameter of about 1 inch.
• Stool appearance is affected by diet and metabolism.
  • Black, sticky stool indicates bleeding in the upper intestinal tract.
  • Red blood indicates bleeding in the large intestine or rectal area.
  • Pale white or light gray stool indicates an absence of bile in the intestine.

Constipation

• Constipation is the most common problem of a hypoactive bowel; feces become compacted and hardened.
• Patients on bed rest are at risk for constipation.
• Older adults may develop constipation from a lack of fiber or decreasing fluid intake.
• If a laxative is needed, a bulk-forming type is best.

Diarrhea

• Diarrhea occurs when increased peristalsis pushes food through the intestinal tract too fast.
• Infants or older adult patients with diarrhea can become dehydrated very quickly.
• Diarrhea caused by a virus or bacteria is usually not treated with medication for 24 to 48 hours. The patient is given clear fluids and allowed to rest.
• If diarrhea does not clear within 48 hours after starting medication, consult the primary care provider.

Fecal Incontinence

• Fecal incontinence may affect people of all ages because of illness, injury, or neurogenic dysfunction.
• Bowel status should be assessed for every patient every day.
• The average patient may need assistance with elimination if there is no bowel movement for 3 days.

Promoting Regular Bowel Movements

• Encourage exercise, dietary fiber, and at least 1500 mL of fluid per day to promote regular bowel movements.

Barium X-Ray Examinations

• Patients undergoing barium x-ray examinations need to flush the bowel after the test to prevent impaction.

Rectal Suppositories and Enemas

• Rectal suppositories are used to stimulate a bowel movement.
• Enemas are given to cleanse the bowel, deliver medication, relieve distention, or soften stool.
• Fecal impaction is first treated by oil-retention enema followed several hours later by a cleansing enema; if this does not relieve the impaction, obtain an order for digital removal.
• Notify the primary care provider if the patient is not clear after three large-volume enemas.

Bowel Training Program

• A bowel training program takes 2 to 3 months or longer.

Bowel Ostomy

• A bowel ostomy is performed when fecal diversion is necessary.
• An ileostomy produces liquid effluent, whereas a colostomy produces more formed stool.
• A pale, dusky, or black stoma indicates compromised blood supply, and it should be reported to the primary care provider.

Review Questions for the Next Generation NCLEX Examination

1. Barium Enema Education:

   • Statement indicating a need for additional education: "The barium increases my risk for diarrhea."

2. Administering an Enema:

   • Action to take first when a patient complains of cramping and discomfort: Slow the flow rate and check the temperature of the solution.

3. Abnormal Stool Characteristic:

   • The greatest immediate concern: Dark black, sticky stool.

4. Self-Care Related to Diarrhea:

   • Statement indicating understanding: "I should consume clear liquids for 1 or 2 days and then try applesauce."

5. Removing Fecal Impaction:

   • Most appropriate action for a vagal response: Check the patient's pulse and blood pressure and attach to a cardiac monitor.

6. Discharge Education Plan for a Colostomy Patient should include:

   • Emptying the pouch when it is one-third to one-half full.
   • Cutting the barrier to size.
   • Inspecting skin for irritation.
   • Washing and drying skin when changing appliance.

7. Intervention for Bowel Incontinence Related to Confusion:

   • The best intervention: Assist the patient to the toilet, especially after meals.

8. Stool Sample Analysis for Diverticulitis:

   • The most serious abnormality is the presence of blood, which must be reported promptly and documented. This abnormality can be easily visible if it is fresh and has a bright red appearance. Sometimes it is not easy to detect, though, and is described as occult (hidden). In this situation the stool might only appear black, sticky.

Clinical Judgment Activities

• Scenario A: Lana Jakubowsky (Stroke and Fecal Incontinence)
  1. How to devise a bowel training program.
  2. How long it might take for her to be continent of stool again.
• Scenario B: Von Troung (Flu and Diarrhea)
  1. How to determine if Mr. Troung is experiencing an electrolyte imbalance.
  2. What to do about skin care for Mr. Troung.
  3. What measures should be taken to treat Mr. Troung's diarrhea.
• Scenario C: Carol Tweed (Hip Replacement and Colostomy)
  1. Create a care plan for her risk of developing constipation because of her intestinal diversion, narcotic analgesics, and NPO (nothing by mouth) status.
  2. What extra precautions would need to be taken in the early postoperative period for this patient?
• Scenario D: Virgil Sunsweet (Chronic Constipation)
  1. What assessment questions would you use to collect data about this patient?
  2. What dietary recommendations would you make to alleviate constipation?
  3. Discuss the use of laxatives for a person such as Mr. Sunsweet.