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32 Cards in this Set
- Front
- Back
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Definition of bowel elimination
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Continuous collection and removal of solid waste products, taxins, foerign bodies and excess fluids from the GI tract
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How should you position patients with gas?
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Lying on their right, lateral side, with descending colon on top (left side)
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Describe Normal Bowel Function
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- Pattern of regular, not necessarily daily BMs
- BMs should be painless with minimal pushing and odor |
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Some non-physiological factors that can delay or prevent regular BMs
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Anxiety, unfamiliar/unclean location, lack of privacy, fear of embarassment
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What predicts bowel hygiene and habits in adulthood?
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Bowel hygiene and habits in childhood
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What are some physiological factors that can alter BM pattern?
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Food & fluid intake, immobility, illness, dehydration and medications
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Best patient position for an enema?
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Left lateral position
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What is the altered bowel condition that is the most common cause of nausea?
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Constipation
If someone has nausea, ask them when is the last time they moved their bowels. |
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Definition of constipation
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Infrequent passage of hard/dry stool, often with much painful straining/hemorrhoids
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Bowel obstruction
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blockage, stricture, trauma, fecal impaction, foreign body, adhesions
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Diarrhea
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passage of frequent, watery stools, often with skin irritation
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What is bowel incontinence?
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involuntary loss of stool/gas due to fear/anxiety, injury and diseases, medications, neurological deficits, poor sphincter tone/control
(Magnesium loosens the bowels) |
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Risk factors for altered bowel elimination
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- Developmental stage (infant, toddler, delayed)
- Advanced age (less efficient chewing, slower peristalsis - Activity & muscle tone (immobility, sedentary, obesity) - Lifestyle (busy, traveling, irregular meals) - Psychosocial factors (anxiety, disgust, shame) - Economic crisis (hunger, poverty, homelessness) - Food & Drug allergies/intolerance (lactose intolerance, celiac disease, artificial fats) - Mental illness interfering with eating, elimination - Infection (virus, bacteria, parasites) - Chronic Disease (IBS) - Medications that are binding (Iron, Bismuth, Narcotics) - Medications that cause diarrhea (antibiotics) - General anesthesia decreases peristalsis - Trauma with GI damage to mouth, colon, anus |
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What can cause black stools?
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Iron, Bismuth (Pepto Bismuth)
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Nursing assessment for altered bowel
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- History
- Physical assessment - Stool assessment (amount, color, odor, solid/liquid) - Lab Tests |
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What are some lab tests for stool?
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Guaiac test for OB (occult blood)
Stool cultures for pathogens Microscopic screening for O&P (ova and parasites) |
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Describe normal stool
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color is tan-brown
volume varies by age, size, and intake odor of normal bacteris content is mild |
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What do these abnormal colors/conditions of stool indicate?
Pale/beige/yellow Black Black and tarry (sticky) Bright red blood Abnormal gas/odors |
Pale/beige/yellow -- biliary disease (or gallbladder)
Black -- Fe supplements Black and tarry (sticky) -- coagulated blood from high in GI tract (ex; oral or stomach ulcers) Bright red blood -- recent bleed from low in GI tract (ex: hemorrhoids) Abnormal gas/odors -- malabsorption of dairy, fats, roughage |
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Anaerobes in stool
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C. difficile or Pseudomonas
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Examples of Nursing Diagnoses involving impaired bowel elimination
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Altered Bowel Elimination
Failure to thrive/malnutrition Risk for Constipation/impaction Diarrhea/Bowel incontinence Comfort Impaired Risk for deficient fluid volume (dehydration) Risk for impaired skin integrity Disturbed body image/low self-esteem Deficient knowledge Anxiety/fear/inadequate coping mechanisms |
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Impaired Bowel Elimination - Examples of Goals & Outcomes
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the client will:
- maintain or restore normal bowel elimination pattern - maintain or regain normal stool (solid-liquid) consistency - Prevent associated risks such as F&E imbalance, skin breakdown, painful BM, abdominal distention, laxative abuse, eating disorders - Minimize anxiety, shame, and low self-esteem - Contain feces with the appropriate device: adult pads, odor absorbent products, ostomy appliance |
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General Nursing Interventions for Impaired bowel Elimination
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- Teaching childhood hygiene and food safety
- Promoting regular food, fluid, BM pattern - Emotional support and acceptance - teaching medication actions and side-effects - Bowel prep with PO meds, solutions, anema - Stool specimen collecting and testing - Digital removal of fecal impaction - Bowel training programs - Stoma care and teaching |
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Impaired Bowel Function Diagnostic Studies
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- The prep often requries an empty colon; a liquid diet in advance, enema, laxative,
- X-Ray detects foreign body, abnormal colon shape - Ultrasound differentiates solid mass from fluid cyst - CT or MRI scan detects the size and location of congenital defect, trauma, disease - Endoscopy to visualize upper GI tract with microscope - Colonoscopy to visualize lower GI tract |
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Explain what fiber does and what does it help with?
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Fiber (Oat bran, psyllium) plus fluid forms a gel and provides bulk that sooths/cleans intestine, holding water for smoother passage.
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Explain what colace (stool softener) does?
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It pulls water into the stool to soften it and therefore, ease passage.
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What does an anti-diarrheal do?
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It decreases peristalsis; removes water and promotes binding of fecal materials.
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What is a stoma?
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When surgical removal (dissection) of intestinal defect/damage/tumor may require a
- temporary stoma before ressection, or a - permanent stoma to manage the disease. Stoma is a surgically created opening in the intestinal wall. the intestinal mucosa is attached to abdominal wall for stool passage, requires ostomy bag "appliance" to be applied for collection. |
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What is a colostomy?
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A stoma in the large intestine, produces semi-solid stool from the colon and is collected in a bag outside the body.
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Which of the follwoing statements by an older adult who is at risk for constipation indicates the need for more teaching?
a) "I need to drink one and a half to 2 quarts of liquid each day" b) "I need to take laxative such as milk of magnesia if I don't have a BM every day" c) "If my bowel pattern changes on its own, I should call you" d) "Eating my meals at regular times is likely to result in regular BMs" |
The answer is b.
A regular BM pattern does not always mean a BM every day. Teach the importance of well-balanced diet, adequate fluid intake and regular exercise. Older people can become dependant on lstimulant laxatives and they can be very dehydrating and irritating. |
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What is an ileostomy?
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A surgical opening (stoma) in the small intestine and drains liquid from the small bowel into a collection bag outside the body.
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The nurse is most likely to report which of the following findings to the primary care provider for a client who has an established colostomy?
a) the stoma extends 1/2 inch above the abdomen b) the skin under the appliance looks red briefly after removing the appliance c) the stoma color is deep-purple d) an ascending colostomy delivers liquid feces. |
the answer is c
A healthy established stoma should be dark pink like the buccal (oral) mucosa. If the stoma appears dark purple, the nurse should report this sign of poor oxygenation. |
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A client is taking PO antibiotics and has the common side-effect of diarrhea. Which of the following is the most appropriate goal for this client?
a) The cleint will wear a medic-alert bracelet for his antibiotic allergy b) The cleint will return to her previous elimination pattern c) The client verbalizes his need to take an antidiarrheal medication every 4 hours d) The client will increase his intake of fiber. |
The answer is b
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