Bowel Elimination

Which statement by a client with an ileostomy alerts the nurse to the need for further education?

"I am going to have a bowel movement every morning when I irrigate the stoma."

Causes of paralytic ileus

- abdominal surgery - peritoneal injury - opioid pain medication during/after surgery

Which nursing diagnosis is most applicable to a client with fecal incontinence?

1. Bowel incontinence 2. Disturbed body image 3. Social isolation 4. Risk for impaired skin integrity (Deficient fluid volume would be more appropriate for someone with diarrhea)

Fluid intake recommendations

2-3L/day

Fiber intake recommendations

25-38 g/day

enema insertion inches

3-4 inches in and max 18 inches above anus

During the first 24 hours after a client has had a permanent colostomy created, the nurse observes no drainage from the colostomy. What explains this finding?

Absence of intestinal peristalsis

A client who sustained a cerebrovascular accident (CVA) becomes incontinent of feces. Which nursing intervention is most important for supporting the success of the client's bowel training program.

Adhere to a definite time for attempted evacuations.

A client with a new stoma who has not had a bowel movement since surgery last week reports feeling nauseas. What is the appropriate nursing action?

After assessing the stoma and surrounding skin, notify the surgeon.

Foods that thicken stools

Applesauce bananas bread cheese yogurt pasta rice pretzels peanut butter

The nurse is caring for a client who is having diarrhea. Which would the nurse closely monitor?

Fluid and electrolyte balance

Which outcome is most appropriate for a client with perceived constipation?

Have a bowel movement without the use of a laxative.

unrelieved constipation; a collection of hardened feces wedged in the rectum that a person cannot expel

Impaction

Which word is specific regarding how a soapsuds enema works on the mucosa of the bowel?

Irritating

Assessing bowel elimination includes

Normal bowel pattern Description of usual feces Recent changes Diet history Past problems Presence of ostomy Assess the abdomen, rectum, and anus Inspect the feces

A nurse identifies that a clients colostomy stoma is pale. Which should the nurse do?

Notify the surgeon

Involuntary waves of muscle contraction that keep food moving along in one direction through the digestive system.

Peristalsis

A nurse is to administer an oil-retention enema, a tap-water enema, and a return-flow enema to three different clients. Which of the following should be performed with all three enemas?

Place the client in the left side-lying position. Use water-soluble jelly to lubricate the tip of the rectal probe. Pull the curtain around the client's bed and drape the client.

Laxatives/Stool Softeners

Promote bowel movements Ex. Magnesium hydroxide, bisacodyl

33. A nurse is assisting a client with a regular bedpan. Which nursing action is essential?

Remain outside the curtains of the bed until the client is done using the bedpan. Elevate the head of the bed to the Fowler position after the client is on the bedpan. Raise the side rails on both sides of the bed after the client is positioned on the bedpan.

Nursing diagnoses related to diarrhea

Risk for deficit fluid volume Risk for electrolyte imbalance Risk for impaired skin integrity

A nurse is caring for a client with an intestinal stoma. Which intervention is most important?

Selecting a bag with an appropriate-size stomal opening

A nurse identifies that a client has tarry stools. Which problem should the nurse conclude that the client is experiencing?

Upper gastrointestinal bleeding

what is a non pharmacological treatment for constipation?

a cup of prune juice, fiber

Laxative overuse can cause

chronic constipation

Flatulence is known as

gas in the stomach or intestines

if patient has cramping during enema administration

slow flow of solution

Return flow enema (Harris flush)

used to expel flatus * alternates flow of 100 - 200 mL in and out * stimulates peristalsis * repeated 5 or 6 times until flatus is expelled and abdominal distention is relieved

Colostomy irrigations

used to stimulate emptying of colon

what should you eat to reestablish bowel flora after a week of diarrhea?

yogurt

Which statement by a client with diverticulosis alerts the nurse that the client needs additional health teaching?

"I should avoid eating high-fiber cereal." and "I should hold my breath and bear down when having a bowel movement."

A health care provider prescribes a tap-water enema for a client. The client asks about the purpose of the enema. What should be included in the nurses response?

"It empties the bowel of stool."

A nurse is collecting a bowel elimination history from a newly admitted client with a medical diagnosis of possible bowel obstruction. Which question takes priority?

"When was the last time you moved your bowels?"

when a pt has constipation, what is the order for treatment?

- Bulk forming products first- ex psyllium (Metamucil) - Then stool softeners (ex. Docusate sodium (Colace), Docusate sodium & Senna (pericolace) - Then Stimulants- bisacodyl (Dulcolax) avoid @ night - Enemas are last resort

treatment of bowel incontinence

- determine cause - provide perineal care, skin integrity

complications of constipation

- fecal impaction - hemorrhoids/rectal fissures - bradycardia - hypotension - syncope

purpose of enemas (4)

- to relieve constipation or fecal impaction - to promote visualization of intestinal tract during x-ray - prevent the escape of feces during surgery - treat parasite and worm infestations

factors affecting bowel movements

-diet -fluid intake -physical activity -psychosocial factors (emotional distress, depression) -personal habits -positioning - pain -pregnancy -surgery and anesthesia

fecal impaction treatment

-enemas, suppositories, stool softeners -digital removal of stool with lubricated gloved finger -careful with stimulating vagus nerve -if bradycardia or heart rhythm changes stop procedure

A primary health-care provider prescribes docusate sodium in liquid form for a ptwho is constipated but has difficulty swallowing tablets. The prescription is for 200 mg daily to be divided into two doses, one in the a.m. and one at hour of sleep. The package insert states that there is 50 mg/5 mL. How much solution of docusate sodium should the nurse administer per dose?

10ml

fecal occult blood test (guaic)

3 different defecations - blue result means positive - may be false positive with food (red meat, citrus fruit, raw vegetables) or medications

The oil-retention enema is retained for at least

30-60 minutes

A client in experiencing constipation. Which nursing action facilitates defecation of a hard stool?

Applying a lubricant to the anus.a warm, wet washcloth against the perianal area, Encouraging the client to rock back and forth

Which should the nurse do before collecting a stool sample for occult blood?

Ask the client to void (pee)

Foods that increase stool odor

Asparagus, eggs, fish, beans, garlic, onions, cabbage, alcohol

Ostomy care

Assess for skin irritation Cut 1/16 to 1/18 bigger than stoma If stoma looks purple/blue/brown report; normal is red/pink/moist/beefy Empty pouch once bag is 1/4-1/2 full

Interventions for constipation

Assess usual bowel habits. Assess lifestyle (diet, fluid intake, exercise, medications), inspect for distention, auscultate bowel sounds, assess for impaction. - Increase fiber intake to 18-25 g daily (prunes, leafy green vegetables, whole wheat bread/pasta) - Increase fluid intake to 1.5-2 quarts/day. Stool softeners, laxatives, enemas

What prescribed medication can a nurse administer to ensure bowel movement before discharge?

Bisacodyl suppository (quickest effect). Usually takes 15-60 minutes. Psyllium takes 12-24 hours. Lactulose takes about 24 hours Docusate Sodium takes 1-3 days

A client is admitted with lower gastrointestinal tract bleeding. Which characteristic of the client's stool should the nurse assess for that supports the medical diagnosis?

Bright red-tinged stool

what can cause both diarrhea and constipation?

Cancer of the large intestines Side effects of medications

Which measures would the nurse take to prevent skin breakdown for a confused client experiencing bowel incontinence?

Check the clients buttocks at least every two hours and clean after incontinence.

Types of Enemas and purpose of each (5)

Cleansing- water based, held in rectum to flush or "clean" rectum (tap water, normal saline, hypertonic solutions, soapsuds) Oil - lubricate stool and intestinal mucosa Carminative - expel flatus (gas) Medicated - provide medications absorbed through rectal mucosa Anthelmintic - used for intestinal parasites

repeatedly ignoring the sensation of needing to defecate could result in

Constipation

A client had a colonoscopy with several polyps excised for biopsies. The nurse teaches the client routine post-procedure expectations. Which of the following should the nurse instruct the client to report to the primary health-care provider?

Continuous abdominal cramping

factors affecting bowel elimination

Development Diet and Fluid intake Exercise Pain Defecation habits (need for privacy, schedule) Position (immobilized clients struggle) Pregnancy (fetus pressure on rectum) Medication (laxatives/side effect of antibiotics) Anesthesia and Surgery (slows down peristalsis for 24-48 hrs)

Causes of constipation

Diet: too little fluid or fiber Lack of physical activity Medications: opiates, anticholinergics Medical illness: IBS, diabetes, hypothyroidism Depression Neurologic disease: Parkinson's, MS immobilization

A nurse is caring for a group of clients. Which client factor should the nurse identify as placing a client at risk for bowel incontinence?

Disoriented to time, place, and person

Which action is important for the nurse to teach clients about the intake of bran to facilitate defecation?

Drink at least 8 glasses of fluids daily when taking bran.

A nurse is assessing a client who has a distended abdomen resulting from flatulence. The client has a prescription for a regular diet and an activity prescription for "out of bed". Which can the nurse do to promote passage of the intestinal gas?

Encourage the client to ambulate.

The nurse discusses the regaining of bowel control with a client who recently had surgery for a colostomy in the descending colon. Which is important to emphasize in the teaching?

Irrigation routine

When preparing to administer return flow enema, what should you do?

Lower the solution container after instilling about 150 mL of solution.

Which should the nurse do when administering a small volume hypertonic enema to an adult?

Maintain the compression of the enema container until after withdrawing the tube.

Risk factor for diarrhea (things that may cause it)

Medications Alcohol abuse Laxative abuse Tube feedings Stress and anxiety Infectious process Inflammation Parasites Mal-absorption

A nurse is performing a physical assessment of a client concerning the gastrointestinal system. Place the interventions in order

Observe the contour and symmetry of the abdomen, Inspect the anus and perianal area visually, Auscultate the entire abdomen for bowel sounds, Percuss the abdomen for the quality of sounds, palpate the abdomen

The nurse assesses a client's abdomen several days after abdominal surgery. It is firm, distended, and painful to palpate. The client reports feeling "bloated". The nurse consults with the surgeon, who orders an enema. The nurse prepares to give what kind of enema?

Return flow. This provides relief of postoperative flatus, stimulating bowel motility. Soapsuds enemas, Retention enemas, and oil retention enemas manage constipation, not flatus.

Which is most likely to validate that a client is experiencing intestinal bleeding?

Semisoft black colored stools. Blood in the upper GI tract is black and tarry.

The nurse should use a fracture bedpan for clients with which conditions?

Spinal cord injury

what can influence the development of hemorrhoids?

Standing for long periods of time at work Multiple pregnancies Constipation Disease of the liver Obesity

Which would the nurse include in dietary teaching for a client with a colostomy?

The diet should be adjusted to result in manageable stools

the nurse should report what finding to the primary care provider for a client who has an established colostomy?

The stoma is deep red-purple. An established stoma should be dark pink and is slightly raised above the abdomen. The skin under the appliance may remain pink/red for a while after the adhesive is pulled off. Feces from an ascending ostomy are very liquid, less so from a transverse ostomy, and more solid from a descending or sigmoid stoma.

A nurse is teaching a client with a history of constipation about excessive use of laxatives. Which effect of laxatives should the nurse include as the primary reason why their use should be avoided?

Weakens the natural response to defecation

A nurse is providing dietary teaching to a client with acute diverticulitis who has a prescription for a low-fiber diet. Which food selected by the client indicates that the dietary teaching was understood?

White rice, soft tofu, turkey, pasta

volume of enema cleansing is dependent on

age

Foods that loosen stools

chocolate dried beans fried/greasy foods highly spiced foods leafy green vegetables raw fruits and juices raw vegetables

hemorrhoids are caused by

chronic constipation and straining (sitz bath and ice pack for comfort)

colostomies end in the

colon

Hard, slow stools that are difficult to eliminate; often a result of too little fiber in the diet

constipation

Diarrhea is a common clinical sign of a variety of diseases. Which of the following disease is it common in? a. Canine parvovirus b. Campylobacteriosis c. Feline infectious enteritis d. Inflammatory bowel disease

d. Inflammatory bowel disease

Frequent passage of loose, watery stools is known as _____________ At least 3 loose stools/day. Bowel urgency, abdominal cramping, weakness, malaise, fatigue

diarrhea

A client with irritable bowel syndrome has instructions to take psyllium. What is important when taking this?

each dose should be taken with a full glass of water or juice

Risk factors for constipation

electrolyte imbalance, hemorrhoids, pregnancy, prostate enlargement, rectal impairments, post-surgical bowel obstruction, opioids, iron supplements, antihistamines, antidepressants, dehydration, decreased GI motility, change in eating habits, insufficient fiber intake, confusion, depression, emotional disturbance

to decrease flatulence avoid

gas producing foods exercise movement in bed ambulation probiotics

increased peristalsis of the colon after food has entered the stomach

gastrocolic reflex

dilated, engorged veins in the lining of the rectum

hemmorrhoids

ileostomies end in the

ileum

recent black stool

iron supplements

A client is scheduled for a colonoscopy. The nurse will provide information to the client about which type of enema?

low, small volume. Small volume enemas are used to prepare clients for this procedure. An oil retention enema is used to soften hard stool. Return flow enemas help expel flatus. Large volume enemas are seldom used due to risk of loss of fluid and electrolytes.

changes with aging and bowel elimination

more likely to have constipation = fecal impaction less likely to compensate for fluid losses with diarrhea

Cathartics

promote peristalsis/evacuation of bowels

stool specimens should be

promptly sent to lab

positioning for enema

sim's position, left lateral

normal positioning for bowel movements

squatting

ostomies

temporary or permanent allowing fecal matter to exit

meds for diarrhea (causes and treatment)

treatment - Opioids: Diphenoxylate & atropine (Lomotil) - Antidiarrheal: Loperamide (Imodium) - Probiotics - Anticholinergics causes - Antibiotics - Lactobacillus products