Ch. 37- Bowel Elimination

A woman age 76 years has informed the nurse that she has begun using over-the-counter laxatives because her friend told her it was imperative to have at least one bowel movement daily. How should the nurse best respond to this client's statement?

"Actually, people's bowel patterns can vary a lot and some people don't tend to go every day." Elimination patterns vary widely among individuals, and the expectation of a daily bowel movement is not realistic for many healthy people. This client may not require pharmacologic interventions.

A nurse has auscultated the abdomen in all four quadrants for 5 minutes and has not heard any bowel sounds. How would this be documented?

"All four abdominal quadrants auscultated. Inaudible bowel sounds."

The nurse is conducting teaching with a client who has a prescription for a wireless capsule endoscopy. Which statement by the client would indicate to the nurse that the teaching was effective?

"I can go about my daily routine while the camera is passing though my small intestine." While the camera is passing through the small intestine, the client may resume normal activities. The client can have a small meal after the first 2 hours of the study. No air is used to expand the small intestine, so the client should not feel bloated and uncomfortable. The capsule will be excreted 24 to 48 hours after ingestion via normal defecation process.

A client has been given fecal occult blood testing (FOBT) testing supplies. What teaching will the nurse provide about the purpose for this test?

"This test detects heme, an iron compound in blood within the stool." The nurse will teach that the FOBT detects heme. It does not test for allergic foods, nor does it test for infection. The fecal immunochemical test (FIT) test results have a high rate of specificity for colorectal cancer.

Which client is most likely to require interventions in order to maintain regular bowel patterns?

A client whose neuropathic pain requires multiple doses of opioids each day. Opioids have a very high potential to cause constipation. Anticoagulants, hormone replacements, diuretics, and adrenergic blockers are not among the medications commonly implicated in cases of constipation.

A 68-year-old man is in the hospital following an intestinal diversion. He has an ileostomy on his right upper quadrant and a mucous fistula. What is the most important nursing activity for the client?

Assess the color of the stoma. A bluish or dark stoma indicates impaired circulation to the stoma. This requires intervention to improve circulation to avoid permanent damage to the stoma.

An older adult woman who is incontinent of stool following a cerebrovascular accident will have which nursing diagnosis?

Bowel Incontinence related to loss of sphincter control, as evidenced by inability to delay the urge to defecate The most appropriate nursing diagnosis addresses the client's fecal incontinence, related to loss of sphincter control innervation.

Which statement accurately describes the act of defecation?

Centers in the medulla and the spinal cord govern the reflex to defecate. Two centers govern the reflex to defecate, one in the medulla and a subsidiary one in the spinal cord. Defecation refers to the emptying of the large intestine. When parasympathetic stimulation occurs, the internal anal sphincter relaxes and the colon contracts. Rectal distention leads to an increase in intrarectal pressure, causing the muscles to stretch and thereby stimulating the defecation reflex.

A client scheduled for a colonoscopy is scheduled to receive a hypertonic enema prior to the procedure. A hypertonic enema is classified as which type of enema?

Cleansing enema Explanation: The most common types of solutions used for cleansing enemas are tap water, normal saline, soap solution, and hypertonic solution. Cleansing enemas are used to relieve constipation or fecal impaction; promote visualization of the intestinal tract by radiographic or instrument examination (colonoscopy); establish regular bowel function; and prevent the involuntary escape of fecal material during surgical procedures. Carminative enemas are classified as retention enemas and are used to expel flatus from the rectum and provide relief from gaseous distention. Return-flow enemas are also occasionally prescribed to expel flatus.

A nurse caring for older adult clients in an assisted-living facility encourages clients to eat a diet high in fiber to avoid which developmental risk factor for this group?

Constipation Constipation is often a chronic problem for older adults and a diet high in fiber is recommended.

What primary risk does the nurse need to assess for among clients who use laxatives long term?

Dependence Long-term laxative use carries a higher risk of dependence than of fluid and electrolyte imbalances, rebound diarrhea, or GI bleeding. This risk is exacerbated by the fact that many laxatives are available as nonprescription drugs.

Which statement best explains why digital removal of stool is considered a last resort after other methods of bowel evacuation have been unsuccessful?

Digital removal of stool may cause parasympathetic stimulation. The procedure may stimulate a vagal response, which increases parasympathetic stimulation.

The nurse is preparing to auscultate the bowel sounds of a client with a nasogastric tube in place set to low intermittent suction. How shall the nurse approach the assessment of bowel sounds and manage the nasogastric tube?

Disconnect the nasogastric tube from suction during the assessment of bowel sounds. If the client has a nasogastric tube in place, disconnect it from the suction during this assessment to allow for accurate interpretation of sounds.

While reading a client's history, the nurse notes that a client has a colostomy. When assessing the client, the nurse notes that the output is formed stool. What should the nurse do?

Document the output, this is normal Output from a colostomy is normally formed stool. Therefore the nurse should document the output as normal. There is no need to contact the physician at this time or to assess for an obstruction or to give a laxative.

The nurse is caring for a client who is scheduled for an esophagogastroduodenoscopy (EGD). What action would the nurse take to prepare the client for this procedure?

Ensure that the client fasts 6 to 12 hours before the test as per policy. The nurse would ensure that the client fasted 6 to 12 hours before the test as per policy. The nurse would not provide a light meal before the test, nor administer two Fleet enemas for an EGD. The client would not ingest a gallon of bowel cleanser. The nurse would not give the client a barium contrast mixture to drink.

A hypertonic enema solution lubricates the stool and intestinal mucosa, making stool passage more comfortable.

False

A nurse is caring for a client with a colostomy. What type of stools would she expect to find in the colostomy bag?

Formed A colostomy is an opening of the large intestine that allows formed feces from the colon to exit through the stoma.

After data collection on a client, the nurse suspects that the client has diarrhea. Which data collection finding, if observed by the nurse, would confirm the nurse's suspicion?

Hyperactive bowel sounds Increased bowel motility, indicated by hyperactive bowel sounds, is commonly caused by diarrhea. Visible waves of abdominal peristalsis are commonly seen in intestinal obstruction. The anal area normally has increased pigmentation and some hair growth. Diarrhea stools are liquid in formation, whereas dry, hard stools are seen in constipation.

Which medication causes constipation?

Iron supplements A common side effect of iron supplements is constipation. Bisacodyl is a stool softener. Aspirin is an analgesic that does not typically cause constipation. Magnesium antacids help to decrease heartburn and do not typically cause constipation.

A client's last bowel movement was 4 days ago and oral laxatives and dietary changes have failed to prompt a bowel movement. How should the nurse position the client in anticipation of administering a cleansing enema?

Left side-lying When administering a cleansing enema, the client is most often positioned in a left side-lying (Sims') position, though positioning has not been shown to appreciably alter the result of a cleansing enema.

The nurse is administering a large-volume cleansing enema to a client who reports severe cramping upon introduction of the enema solution. What would be the nurse's next action?

Lower solution container and check temperature and flow rate. The nurse's next action would be to lower the solution container and check the temperature and flow rate. Lowering the solution container decreases the pressure of the flow of the solution. The cramping could be related to the pressure of the flow, the temperature of the solution, or a high flow rate of the solution. The nurse would not place the client in a supine position, but in a low-Fowler's position or higher. The nurse would not remove the tube and check for any fecal contents. The nurse would not modify the amount and length of the administration, as this is not causing the severe cramping.

When caring for a client with fecal incontinence, the nurse knows that fecal incontinence is the result of which of the following reasons?

Physiologic or lifestyle changes in client Fecal incontinence mainly results from physiologic or lifestyle changes that impair muscle activity and sensation of the gastrointestinal tract. Particularly in the older adult, the weakening of the intestinal walls and decreased muscle tone can lead to bowel incontinence.

The nurse is inserting a rectal tube to administer a large-volume enema. Which nursing action is performed correctly in this procedure?

Slowly and gently insert the enema tube 3 to 4 inches (7.5 to 10 cm) for an adult. The nurse would slowly and gently insert the enema tube 3 to 4 inches for an adult. The nurse would not position the client in a supine position, rather on the left side in the Sims' position. This position aids in the client's ability to retain the solution. The nurse would not introduce the solution quickly, as this will result in the client cramping. The nurse would administer the solution over 5 to 10 minutes, depending on the volume. The nurse would not encourage the client to hold the solution for at least 20 minutes, rather 5 to 15 minutes when the urge to defecate becomes strong.

While administering a cleansing enema, the client displays lightheadedness, nausea, and has clammy skin. The nurse would implement which priority action?

Stop the procedure, monitor heart rate and blood pressure. When administering an enema, the client's vagus nerve may be stimulated causing a decrease in the heart rate. The client will exhibit nausea, lightheadedness, nausea, dizziness, and clammy skin. The procedure should be stopped, heart rate and blood pressure monitored, and the health care provider notified. The other responses are not appropriate for a client exhibiting a vagal response.

When reviewing a client's chart, which data related to a client experiencing diarrhea might suggest to the nurse a causative factor?

The client returned from a foreign country two days ago. Eating native food and drinking water in a foreign country may cause problems with digestion and elimination, such as diarrhea. To promote normal bowel elimination, people should drink 2,000 to 3,000 mL fluids daily. Ignoring the urge to defecate and consuming large quantities of fiber, such as fresh vegetables, may lead to constipation.

A 5-year-old client has a gastrointestinal infection. His mother plans to send him to school tomorrow. The school nurse knows that which nursing outcome is most important to include in the care plan of the client?

The client will demonstrate good health practices to prevent spread of infection. Children should not, but may, return to a school or daycare setting during the infectious phase of their illness. Hand washing is key to preventing the spread of infection.

The newly hired graduate nurse is preparing to administer a cleansing enema. The nurse educator will intervene if which action is taken by the graduate nurse?

The graduate places the client in Fowler's position. Placing the client in Fowler's position during an enema will cause the solution to remain in the rectum and expulsion of the solutions happens rapidly with minimal cleansing to be done. The solution should be retained until the desired results are achieved. The solution should not be too hot or too cold, but administered at room temperature. Most people are uncomfortable about discussing the intestinal tract and bowel elimination, so this is an opportune time to discuss it.

The nursing student is performing a focused gastrointestinal assessment. Which action performed by the student would indicate to nurse faculty that further instruction is needed?

The student sequenced from auscultation to inspection, and percussion to palpation. The correct sequence for an abdominal assessment is from inspection, auscultation (done before palpation because palpation may disturb normal peristalsis and bowel motility), and percussion to palpitation. The client should urinate before assessment and the knees should be flexed with the abdomen during the examination.

The nurse is teaching a client with a new ostomy about skin care to preserve tissue integrity at the stomal site. Which teaching will the nurse provide regarding cleansing the stoma?

Use water and mild soap. The nurse will teach the client to use water and mild soap to cleanse the stoma. Water only will not provide cleansing; an alcohol-based sanitizer will dry the stoma; mineral oil is not appropriate for cleansing.

A nurse is assessing the stoma of a client with an ostomy. Which intervention should the nurse perform when providing peristomal care to the client to preserve skin integrity?

Wash it with a mild cleanser and water. Washing the stoma and surrounding skin with a mild cleanser and water, and patting it dry can preserve skin integrity. When using a cleanser, it is important to rinse the area thoroughly. Any residue left on the skin can cause problems with the wafer adhering. Another way to protect the skin is to apply barrier substances such as karaya, a plant substance that becomes gelatinous when moistened, and commercial skin preparations around the stoma. Cleaning the stoma with just a dry, cotton bandage is not the correct way of preserving skin integrity.

Which factor is related to developmental changes in bowel habits for older adult clients?

Weakened pelvic muscles lead to constipation. Weakened pelvic muscles and decreased activity levels contribute to constipation in older adults. Increasing dietary fiber does not decrease peristalsis. Lactose intolerance is not a developmental change in older adults. Peeling fruit does not impact bowel habits in the older adults.

The health care provider prescribes a high fiber diet for a client to promote bowel elimination. Which foods, selected by the client, would indicate to the nurse that the client can identify high-fiber foods?

Whole wheat spaghetti and broccoli To promote bowel elimination, consume 20 to 35 g of fiber daily. Foods high in fiber include fresh fruits and vegetables, bran, and whole grains. Cream of Wheat is refined cereal and fiber has been removed from apples because of cooking. Other foods low in fiber include soda crackers, chicken noodle soup, tea, and flavored water.

The nurse is presenting a lecture on ostomy bowel elimination at a community clinic. When questioned by the clients, which foods would the nurse suggest as natural intestinal deodorizers?

Yogurt and buttermilk Buttermilk, parsley, and yogurt are foods that are natural intestinal deodorizers. Dried lentils, asparagus, turnip, fish, onions, and garlic are foods that produce odor.

A nurse is caring for a client with constipation. The incidence of constipation tends to be high among clients that follow which diet?

a diet lacking in fruits and vegetables The incidence of constipation tends to be high among clients whose dietary habits lack sufficient raw fruits and vegetables, whole grains, seeds, and nuts, all of which contain adequate fiber. Dietary fiber, which becomes undigested cellulose, is important because it attracts water within the bowel, resulting in bulkier stool that is more quickly and easily eliminated. A diet lacking in glucose and water will cause dehydration first and then constipation, depending on other constituents of the diet. Diets consisting of whole grains, seeds, and nuts provide fiber, which helps in bowel movement. A diet lacking in meat and poultry products need not necessarily lead to constipation.

During the inspection of a client's abdomen, the nurse notes that it is visibly distended. The nurse should proceed with the client's abdominal assessment by next performing:

auscultation. When performing an abdominal assessment, the nurse should proceed from inspection to auscultation, since performing palpation or percussion prior to auscultation may disturb normal peristalsis and confound the assessment.

When the nurse performs a Hemoccult test on a stool specimen, blood in the stool will change the color on the test paper to:

blue.

The nurse is teaching a client about foods with high fiber. Which food will the nurse recommend that the client consume?

brown rice

A student nurse studying human anatomy knows that a structure of the large intestine is the:

cecum

Which symptom is a known side effect of antibiotics?

diarrhea

The nurse is scheduling tests for a client who is experiencing bowel alterations. What is the most logical sequence of tests to ensure an accurate diagnosis?

fecal occult blood test, barium studies, endoscopic examination There is a specific sequence that bowel tests must be performed due to the results of certain contrasts and other preps that must be given. The nurse would verify that the tests are done in the correct order: Fecal occult blood test, barium studies, and then endoscopic examination.

A nurse is caring for a client with primary constipation. Which factor is responsible for primary constipation?

inadequate intake of liquid Primary constipation results from lifestyle factors such as insufficient fluid intake, inadequate intake of fiber, inactivity, or ignoring the urge to defecate.

The type of stool that will be expelled into the ostomy bag by a client who has undergone surgery for an ileostomy will be:

liquid consistency. Stool produced from an ileostomy is liquid and contains large quantities of electrolytes.

A nurse is administering a prescribed solution of cottonseed oil to a client during an enema. What is the outcome of the use of cottonseed?

lubricates and softens stool Cottonseed, olive oil, or mineral oil lubricates and softens the stool so that it can be expelled more easily during a retention enema. Tap water and normal saline solution distend the rectum and moisten the stool, whereas a soap and water solution not only distends the rectum and moistens the stool but also irritates the local tissue. A hypertonic saline solution irritates local tissue.

Which enema solution lubricates the stool and intestinal mucosa without distending the intestine?

oil Mineral, olive, or cottonseed oil are used to lubricate the stool and intestinal mucosa without distending the intestine.

The nurse is preparing a client to receive a hypertonic enema solution. Into which position will the nurse place the client?

sims Sims position is appropriate for a client who will receive this type of enema, as it promotes gravity distribution of the solution. Other choices are incorrect positions.

The nurse is caring for an older adult client with diarrhea. Which assessment finding requires immediate nursing intervention?

skin turgor response 6 seconds Skin turgor response that is greater than 3 seconds, especially in an older adult client, requires nursing intervention. Older adults with diarrhea can more easily become dehydrated and develop fluid and electrolyte imbalances. All other assessment findings are normal.

The nurse is caring for a client with a stoma placed before the terminal ileum. Which vitamin does the nurse anticipate will be ordered?

vitamin B12 The nurse anticipates that vitamin B12 will be ordered for a client with this type of ostomy, an ileostomy, to prevent vitamin B12 deficiency anemia, since ileostomies are placed before the terminal ileum where vitamin B12 is absorbed. Other answers are incorrect.

During data collection of a client with bowel elimination concerns, which appropriate questions would the nurse ask? Select all that apply.

• "Do you use anything to help move your bowels?" • "How often do you move your bowels?" To determine the usual patterns of bowel elimination, the nurse asks, "How often do you move your bowels?" To determine if the client needs assistance in bowel elimination, the nurse asks, "Do you use anything to help move your bowels?" The client's social appetite, preference for hot or cold foods, or shopping arena are not questions to ask for bowel elimination.

A client with no significant medical history reports experiencing diarrhea over the past week. Which assessment question will the nurse ask? (Select all that apply.)

• "Do you use laxatives?" • "What are your normal bowel habits?" • "Have you started a new medication?" The nurse will ask about new medications, since these can often cause diarrhea; what the client's normal bowel habits are like, to establish a baseline; and whether the client is using laxatives, which can contribute to diarrhea. Rectal fullness and stool that is difficult to pass is associated with constipation.

A client reports constipation. Which of the following assessment questions should the nurse ask about the client's bowel habits? (Select ALL that apply)

• "Have you been under stress?" • "What medicines do you take?" This represents a broad opening statement that allows for greater subjective information. Chronic exposure to stress can slow bowel activity, resulting in decreased frequency of bowel movements. Certain medications can also cause constipation.

The nurse has presented an educational in-service about caring for clients who have newly created ostomies. The nurse asks participants, "How will you know when a client begins to accept the altered body image?" Which responses by participants indicates a correct understanding of the material? Select all that apply.

• "The client is willing to look at the stoma." • "The client makes neutral or positive statements about the ostomy." • "The client expresses interest in learning self-care."

An 86-year-old man has a history of constipation. He currently self-treats his constipation with over-the-counter laxatives. The nurse knows what to be true of these medications? Select all that apply.

• Oral laxatives take longer to effect change than laxatives administered rectally. • Older adults are at particular risk for laxative abuse. • Rectal suppositories tend to work within 60 minutes of administration. Nonpharmacologic methods, including fiber supplementation, are often sufficient to promote healthy defecation pattern.

The risk for developing colorectal cancer during one's lifetime is 1 in 19. Nurses play an integral role in the promotion of colorectal cancer screening. What are risk factors for colorectal cancer? Select all that apply.

• a history of inflammatory bowel disease • age 50 and older • a positive family history The risks for colorectal cancer increase after the age of 50, with a positive family history of colorectal cancer, and also with Crohn's disease. An important nursing responsibility is to teach clients about annual screening beginning at 50, encourage endoscopic exam every 5 years, or colonoscopy every 10 years for normal-risk individuals.