bowel elmination

encopresis

A childhood disorder characterized by repeated defecating in inappropriate places, such as one's clothing

A nurse is caring for a client who will perform fecal occult blood testing at home. Which of the following information should the nurse include when explaining the procedure to the client?

A. Eating more protein is optimal prior to testing ( some proteins can alter results such as red meat fish and poultry) B. One stool specimen is sufficient for testing ( 3 specimen from 3 different bowel movements are required) C. A red color change indicates a positive test ( blue color indicates blood in stool (correct) D. The specimen cannot be contaminated with urine or water

A nurse is talking with a client who reports constipation. When the nurse discusses dietary changes that can help prevent constipation which of the following foods should the nurse recommend?

A. mac and cheese (low residue worsens) correct: b. fruit and whole wheat toast ( high fiber promotes normal bowl elimination ) c. rice pudding and ripe bananas ( low residue) d. roast chicken and white rice (low residue)

A nurse is preparing to administer a cleansing enema to an adult client in preparation for a diagnostic procedure. Which of the following are appropriate steps for the nurse to take? (select all that apply)

A. warm the enema solution prior to instillation b. position the client on the left side with the right leg flexed forward c. lubricate the rectal tube or nozzle d. slowly insert the rectal tube about 2 inches e. hang the enema container 24 inches above the clients anus answer: a, b, c rationale: The nurse should warm the enema because cold can cause abdominal cramping, hot can injure mucosa, position allows downward flow of solution by gravity along sigmoid colon, lubrication prevents trauma or irritation to rectal mucosa d. 2 inches is appropriate for child for adult it should be 3-4 inches e. height effects speed anything over 18 inchs can cause rapid instillation and distention of colon

hemorrhoids

Also called piles - are swollen veins of the rectum and anus. the blood vessels in this area are subject to intense pressure - especially during bowel movements

impaction

An obvious sign of ________ is the inability to pass a stool for several days, despite a repeated urge to defecate.

constipation factors

CHANGE OF ROUTINES, STRESS, LOW FIBER DIET, LACK OF EXERCISE

The nurse is working with the family of an older client with bowel incontinence. Which of the following interventions will the nurse teach the family about bowel incontinence?

Do not try to stimulate stools with suppositories. Ask the client to tell the family when the urge to defecate is felt. Place the client on the commode at the same time every day. Place the client in a diaper at all times. correct Place the client on the commode at the same time every day. Rationale: The nurse teaches the family how to retrain the bowel. This is done by placing the client on the commode at the same time every day, and possibly using suppositories to stimulate the bowel. Once retraining is reestablished, the suppositories are stopped. Diapers are demeaning and should be used only if retraining fails. Asking the client to tell the family when the need to defecate is felt is not retraining the bowel.

Question 6 6 The mother of a breastfed infant calls the physician's office to report her infant is constipated. The nurse questions the mother and learns the infant last stooled four days ago and the stool was yellow and pasty and passed without straining. The infant has no other symptoms and has been eating, sleeping, and acting normally. The mother denies any change in the appearance of the infant's abdomen and says the infant does not cry when the abdomen is palpated. The nurse would tell the mother which of the following? End of Question 6

Feed the infant 2 ounces of prepared glucose water. Bring the infant to the office to be seen today. The infant's stooling pattern is normal. Give the infant 2 tablespoons of Karo syrup in 4 ounces of water. Correct Answer: The infant's stooling pattern is normal. Rationale: It is not unusual for infants to stool 2-3 times per week. While some infants may stool with each breastfeeding, others may stool less frequently and still be within normal limits. A better indicator of constipation is the passage of hard stools. Since this infant's last stool was a normal pasty yellow, the mother should be reassured that the infant's stooling pattern is normal. If the infant does not stool over the next few days or if the infant has abdominal distention, crying that does not stop with comforting, or straining to stool, the mother should call back so the infant can be seen by the provider. Karo syrup should not be given to infants under one year because it is linked to infant botulism. Glucose water may be prescribed for a constipated infant, but this infant is not constipated. There is no need for the infant to be seen by the provider today.

The nurse teaches clients that repeatedly ignoring the sensation of needing to defecate could result in:

Hemorrhoids. Diarrhea. Incontinence. Constipation. Correct Answer: Constipation. Rationale: Habitually ignoring the urge to defecate can lead to constipation through loss of the natural urge and the accumulation of feces. Diarrhea will not result—if anything, there is increased opportunity for water reabsorption because the stool remains in the colon, leading to firmer stool. Ignoring the urge shows a strong voluntary sphincter, not a weak one that could result in incontinence. Hemorrhoids would occur only if severe drying out of the stool occurs and, thus, repeated need to strain to pass stool.

Which of the following statements provides evidence that an older adult who is prone to constipation is in need of further teaching? "

I need to drink one and a half to two quarts of liquids each day." "Eating my meals at regular times is likely to result in regular bowel movements." "I need to take a laxative such as milk of magnesia if I don't have a bowel movement every day." "If my bowel pattern changes on its own, I should call you." Correct Answer: "I need to take a laxative such as milk of magnesia if I don't have a bowel movement every day." Rationale: The standard of practice in assisting elders to maintain normal function of the gastrointestinal tract is promotion of regular ingestion of a well-balanced diet, adequate fluid intake, and regular exercise. If these activities are all present and the bowel pattern is still not regular, this abnormality should be reported to the client's primary care provider. Stimulant laxatives can be very irritating and are not the preferred treatment for occasional constipation in older adults. In addition, a normal stool pattern for an elder may not be daily elimination.

fecal incontinence

INABILITY TO CONTROL PASSAGE OF FECES AND GAS FROM THE ANUS CAUSED BY PHYSICAL CONDITIONS THAT IMPAIR ANAL SPHINCTER FUNCTION OR CONTROL.

Question 5 5 The nurse chooses which of the following interventions when teaching appropriate constipation prevention to the client? (Select all that apply.)

Increase exercise activity. Use bulk-forming laxatives. Increase fluid intake. Decrease dietary fiber. Use enemas daily. Correct Answers: Increase exercise activity. Increase fluid intake. Use bulk-forming laxatives. Rationale: Clients should increase fluid intake to keep adequate water within the feces in order to reduce the risk of constipation. Exercise and activity increases bowel motility, which reduces the risk of constipation. Bulk-forming laxatives add roughage to the stool and also help to maintain and draw fluid into the feces to prevent constipation. Clients should increase, not decrease, dietary fiber. The use of daily enemas is contraindicated.

3 Which of the following physical findings is most likely to validate that a client is experiencing intestinal bleeding? End of Question 3

Narrow, pencil-shaped stool Large quantities of fat mixed with pale yellow liquid stool Brown, formed stools Semisoft tar-colored stools Your Answer: Semisoft tar-colored stools Rationale: Bleeding into the upper GI tract results in black and tarry feces. Fat in the stool can be a sign of malabsorption in an infant, Brown, formed stool is normal stool. Narrow, pencil-shaped stool is characteristic of an obstructive condition of the rectum.

Question 7 7 The nurse is assessing a client with multiple sclerosis who is in the clinic for a follow-up check. Which of the following conditions will the nurse question the client about as a risk factor for those with multiple sclerosis?

Skin breakdown Bowel incontinence Diabetes mellitus Chest pain correct: Bowel incontinence Rationale: Due to demyelization of the nerves, the client with multiple sclerosis is at risk for bowel incontinence. The client with multiple sclerosis is not necessarily at risk for skin breakdown, chest pain, or diabetes.

Question 4 4 Which of the following nursing diagnoses is most applicable to a client with fecal incontinence? (Select all that apply.)

Social Isolation Risk for Deficient Fluid Volume Disturbed Body Image Colon Incontinence Risk for Impaired Skin Integrity correct Disturbed Body Image Risk for Impaired Skin Integrity Social Isolation Rationale: The client is unable to decide when stool evacuation will occur. Client thoughts about self may be altered if unable to control stool evacuation. The client may not feel as comfortable around others. Increased tissue contact with fecal material may result in impaired skin integrity. Risk for deficient fluid volume is more appropriate for a client with diarrhea. Colon Incontinence is not an approved Nanda nursing diagnosis.

A nurse is caring with a client who has had diarrhea for the past 4 days when assessing the client the nurse should expect ( check all)

a. bradycardia b. hypotension c. fever d. poor skin turgor e. peripheral edema answer: B,C, D (all linked to dehydration)

While a nurse is administering a cleansing enema, the client reports abdominal cramping which of the following is the appropriate intervention?

a. have the client hold his breath briefly b. discontinue the fluid instillation c. remind the client that cramping is common at this time d. lower the enema fluid container answer: D- to relieve discomfort slow the rate by reducing height of enema solution container

healthy defecation

regular exercise, high fiber diet, 2000-3000 ml of fluids a day, do not ignore urge to defecate, allow time to defecate preferably the same time every day, avoid over the counter medications to treat constipation and diarrhea.

ulcerative colitis

this is characterized by mucosal lesions occurring (starting) typically in the rectal area & sigmoid colon & progressing throughout the colon. Symptoms include: fever, anorexia, weight loss, cramping, spasms, ab pain, bloody diarrhea, toxic megacolon & increased risk of colon cancer.