Chapter 30 Bowel Elimination and Care

Single Opening

if distal colon is permanently removed as with cancer of the descending or sigmoid colon the stoma will have a ________________

Impaction

blockage of the movement of contents through the intestines by a bulk mass of very hard stool

Very Dark Brown/Black

color of stools after ingestion of iron supplements or pepto bismol

Incised, Two Stomas

colostomy preformed due to severe inflammatory disease (Chrons) distal portion may not need to be removed so the colon may be _________ and there are ___________________

Effluent of Ileostomy

contains enzymes making it corrosive to the skin surrounding the stoma

1/8-1/4 Inch of Peristomal Skin

correct size will fit around the stoma and leave ____________________________ to show

Tenesmus

cramping

1/3-1/2 full

how full should the ostomy bag be before it is emptied

3-5 Days

how often is the faceplate changed

Ileostomy

ostomy using part of the small intestine

Impaired Blood Supply

pallor, cyanosis, dusky colored ostomy indicates:

Liquid

Effluent from an ileostomy is __________ because the majority of water is not absorbed until it reaches large bowel

Small Intestine

absorbs nutrients

Guaiac Test

done to determine the presence of occult blood

Double-Barreled Colostomy

when two stomas are formed

To promote regular bowel movements

A 60-year-old patient reports passing dry, hard stools. The nurse advises the patient to defecate 1 hour after meals. What is the reason behind this advice? 1. To reduce the risk of dehydration 2. To increase the patient's appetite 3. To prevent infections in the colon 4. To promote regular bowel movements

Place the patient in the left lateral position, and slowly administer the fluid.

A healthcare provider orders a 750-mL tap-water enema. In order to achieve the best outcome, what nursing action is most appropriate to promote retention of the fluid volume? 1. Administer the fluid rapidly and have the patient take deep breaths. 2. Place the patient in the left lateral position, and slowly administer the fluid. 3. Have the patient take shallow breaths, and keep the fluid at body temperature. 4. Warm the fluid to lukewarm temperature and place the patient in the right lateral position.

Relieve abdominal distention

A healthcare provider orders a rectal tube for a postoperative patient. What is the main purpose for the tube that the nurse needs to discuss with the patient before inserting the tube? 1. Facilitate administering an enema 2. Dilate the anal sphincters 3. Relieve abdominal distention 4. Visualize the intestinal mucosa

"Have you had small amounts of liquid stool?"

A newly admitted patient reports not having had a good bowel movement in 10 days. What question should the nurse ask the patient to identify the possibility of a fecal impaction? 1. "Have you had small amounts of liquid stool?" 2. "Are you passing any gas?" 3. "Do you have hemorrhoids?" 4. "Are you having any vomiting?"

Is experiencing emotional problems

A nurse collected information from several patients. What information indicates the patient at the highest risk for developing diarrhea? 1. Is physically active 2. Drinks a lot of fluid 3. Eats whole-grain cereal 4. Is experiencing emotional problems

Upper gastrointestinal bleeding

A nurse identifies that a patient has tarry stools. Which problem should the nurse conclude that the patient is experiencing? 1. Upper gastrointestinal bleeding 2. Pancreatic dysfunction 3. Lactulose intolerance 4. Inadequate bile salts

Eat a container of yogurt every day for a few days."

A nurse identifies that a patient understands the need to reestablish bowel flora after a week of diarrhea when the patient states, "I'm going to: 1. wean myself off of the antibiotics one day after my temperature is normal." 2. eat a container of yogurt every day for a few days." 3. add rice to my diet one meal each day." 4. drink eight glasses of water today."

Hypertonic fluid

A nurse is caring for a debilitated patient who is constipated and unable to tolerate a large volume of enema solution. What solution should the nurse anticipate that the healthcare provider will order? 1. Hypertonic fluid 2. Normal saline 3. Soapy water 4. Tap water

Side effects of medications

A nurse is caring for a group of patients with a variety of gastrointestinal problems. Which factor can influence the occurrence of both diarrhea and constipation? 1. Inability to perceive bowel cues 2. Side effects of medications 3. High-solute tube feedings 4. Increased metabolic rate

Steatorrhea

A nurse is caring for a patient who has an episode of diarrhea with frothy, odorous stool that contains an excessive amount of fat. The nurse accurately documents the findings as: 1. chyme 2. melena 3. meconium 4. steatorrhea

"Retain the enema solution as long as possible to promote evacuation."

A nurse is caring for a patient who has an order for a saline laxative enema to be self-administered at home the morning of ambulatory surgery. What is most important for the nurse to teach the patient about this enema? 1. "Insert the tube 6 inches into the rectum to ensure it is beyond the internal rectal sphincter." 2. "Retain the enema solution as long as possible to promote evacuation." 3. "Lay on your right side as the solution is administered for best results." 4. "Warm it in the microwave for 1 minute to promote comfort."

Send it to the laboratory promptly to avoid a degraded specimen.

A nurse is caring for a patient who has an order for a stool specimen. What should the nurse do when collecting this specimen? 1. Wear sterile gloves to maintain the sterility of the specimen. 2. Send it to the laboratory promptly to avoid a degraded specimen. 3. Send it to the laboratory promptly to avoid a degraded specimen. 4. Collect several inches of formed stool to ensure an adequate sample.

Bran cereal

A nurse is caring for a patient who is constipated. Which food is most appropriate for the nurse to teach the patient to eat? 1. Celery 2. Grapefruit 3. Bran cereal 4. Sunflower seeds

Dehydration

A nurse is caring for a patient who is experiencing diarrhea. About which physiological response to diarrhea should the nurse be most concerned? 1. Dehydration 2. Malnutrition 3. Excoriated skin 4. Urinary incontinence

Black, tarry stool

A nurse is caring for a patient who was admitted to the hospital with upper gastrointestinal bleeding. For which clinical indicator most associated with gastrointestinal bleeding should the nurse assess the patient? 1. Pale, clay-colored stool 2.Yellow-greenish stool 3. Hard, dry brown stool 4. Black, tarry stool

Ensure the tubing is free from kinks and is not being compressed.

A nurse is caring for a patient with a Salem sump tube attached to continuous low suction following abdominal surgery. The patient reports feeling nauseated and begins to vomit. The nurse identifies that the patient's abdomen is distended. What should the nurse do first? 1. Ensure the tubing is free from kinks and is not being compressed. 2. Reposition the patient and instruct the patient to cough. 3. Administer the prescribed antiemetic to the patient. 4. Instill the blue pigtail with 30 mL of air.

Change the faceplate of the appliance every 3 to 5 days or when necessary

A nurse is caring for a patient with a colostomy who has a two-piece ostomy appliance. What is important for the nurse to do when caring for this patient? 1. Tuck some gauze into the stoma after cleaning it until the new faceplate and bag is applied. 2. Cut an opening in the faceplate so that it is at least ½ inch away from around the stoma. 3. Empty the bag from the bottom, avoiding disconnecting the bag from the faceplate. 4. Change the faceplate of the appliance every 3 to 5 days or when necessary

Aspirate stomach contents through the tube.

A nurse is caring for a patient with a nasogastric tube. What should the nurse do to best assess for correct placement of the tube? 1. Auscultate the lungs. 2. Place the end of the tube in water. 3. Instill a small amount of normal saline. 4. Aspirate stomach contents through the tube.

Selecting a bag with an appropriate-size stomal opening

A nurse is caring for a patient with an intestinal stoma. Which intervention is most important? 1. Cleansing the stoma with cool water 2. Spraying an air-freshening deodorant in the room 3. Selecting a bag with an appropriate-size stomal opening 4. Wearing sterile nonlatex gloves when caring for the stoma

Discuss the patient's reason for taking a cathartic daily.

A nurse is caring for an older adult who was admitted to the hospital from the emergency department for rehydration therapy. The nurse reviews the patient's clinical record and interviews the patient. Which nursing intervention is the most important for this patient regarding self-health management after discharge? 1. Discuss the patient's reason for taking a cathartic daily. 2. Schedule monthly checkups with the primary healthcare provider. 3. Have a social worker assist the patient with transportation to the local senior center for socialization. 4. Teach the need to change position slowly to allow time for the body to adjust to the change in position.

Spinach

A nurse is teaching a patient about the best foods to eat to avoid constipation. Which vegetable selected by the patient from the hospital menu indicates that the teaching was effective? 1. Carrots 2. Spinach 3. Zucchini 4. Cabbage

Weakens the natural response to defecation

A nurse is teaching a patient with a history of constipation about the excessive use of laxatives. What should the nurse include is the primary reason why their use should be avoided? 1. Weakens the natural response to defecation 2. Results in distention of the intestines 3. Causes abdominal discomfort 4. Precipitates incontinence

Raises intra-abdominal pressure

A nurse teaches a person to lean forward when attempting to defecate. What should the nurse include is the primary rationale why leaning forward specifically promotes fecal passage? 1. Relaxes rectal sphincters 2. Raises intra-abdominal pressure 3. Uses gravity to facilitate elimination 4. Elongates curves of the sigmoid colon

Passage of a small amount of brown liquid from the rectum

A nurse working in a nursing home identifies that a patient may have a fecal impaction. Which clinical manifestation is most specific to this problem? 1. Passage of a small amount of brown liquid from the rectum 2. Lack of a bowel movement for several days 3. Distension of the abdomen 4. Feeling of rectal fullness

Increases bulk fiber to help normalize bowel function and maintain regularity

A patient come to the clinic complaining of constipation. The nurse takes a dietary history and finds that the patient has been eating large amounts of cheese and bananas. The nurse suggests that the patient eat beans and salad. What is the rationale for including beans and salad in the diet? 1. Creates a stimulant effect 2. Increases fluid resorption to help normalize bowel function 3. Increases protein to help normalize bowel function 4. Increases bulk fiber to help normalize bowel function and maintain regularity

Eat a high-fiber diet. Increase fluid intake. Drink prune juice every morning.

A patient comes to the clinic reporting abdominal bloating. The primary healthcare provider identifies that the patient has slowed intestinal peristalsis. What should the nurse encourage the patient to do to minimize abdominal bloating? Select all that apply. 1. Eat a high-fiber diet. 2. Increase fluid intake. 3. Use laxatives sparingly. 4. Drink prune juice every morning. 5. Raise the head of the bed thirty degrees when sleeping.

"When was the last time you had a similar stool?"

A patient has a loose watery stool in the morning. What question should the nurse ask the patient to determine if the patient has diarrhea? 1. "What did you have for dinner last night?" 2. "Are you experiencing abdominal cramping?" 3. "Have you been drinking a lot of fluid lately?" 4. "When was the last time you had a similar stool?"

Verify that the tubing is intact and patent.

A patient has a nasogastric tube connected to intermittent wall suction for decompression of the stomach. What should the nurse do first to ensure that the nasogastric tube is functioning effectively? 1. Verify that the tubing is intact and patent. 2. Position the patient below the level of the collection canister 3. Elevate the head of the patient's bed to a semi-Fowler position. 4. Ensure that the collection canister is attached to a humidification adaptor.

Black

A patient is admitted with a diagnosis of upper gastrointestinal bleeding. What should the nurse expect the color of this patient's stool to be? 1. Red 2. Pink 3. Black 4. Brown

"This may be a result of spinal cord injuries."

A patient is brought to the emergency room after being involved in a serious motor vehicle accident. During the assessment, the nurse notes the patient has possible paralysis and has had an involuntary bowel movement during the examination. What explanation about the involuntary bowel movement does the nurse expect the health care provider to give to the patient? 1. "This may be a result of cardiac issues." 2. "This may be a result of taking pain medication." 3. "This may be a result of spinal cord injuries." 4. "This may be a result of a low-fiber diet."

Ribbon-shaped stool

A patient is scheduled for surgery related to a partial intestinal obstruction secondary to an intestinal mass. The nurse is assessing the patient's bowel movements before surgery. Based on the patient's clinical presentation, what should the nurse expect? 1. Light-brown stool 2. Mucus in the stool 3. Ribbon-shaped stool 4. Pungent odor to the stool

Urine is dark pink in color.

A patient just had a kidney biopsy. What information identified by the nurse is most important to report to the primary healthcare provider? 1. Urine is dark pink in color. 2. Incisional discomfort is mild, but tolerable. 3. Dressing requires reinforcement after patient ambulation 4. Pulse and respirations are slightly higher than before the procedure.

"Attempt to have a bowel movement after drinking a warm liquid in the morning."

A patient reports a long-term problem with constipation. What should the nurse instruct the patient to do to help minimize this problem? 1. "Include more bananas in your diet." 2. "Drink a minimum of 1 quart of fluid a day." 3. "Hold your breath when bearing down to have a bowel movement." 4. "Attempt to have a bowel movement after drinking a warm liquid in the morning."

Drink a minimum of 2 quarts of fluid daily. Exercise at least 15 minutes every day. Eat fresh vegetables 2 times a day.

A patient reports frequent episodes of constipation. What should the nurse teach the patient to do to help relieve this problem? Select all that apply. 1. Use a prepackaged, 4-ouce enema once a week. 2. Drink a minimum of 2 quarts of fluid daily. 3. Exercise at least 15 minutes every day. 4. Eat fresh vegetables 2 times a day. 5. Take a laxative 3 times a week.

4,5,3,2,1

A patient reports not having a bowel movement for several days. Place the nurse's actions in order of priority. Obtain an order for an enema. Request a prescription for a laxative. Encourage the patient to drink more fluids. Ask the patient when the last bowel movement occurred. Explore with the patient how much fiber is being consumed in the diet.

Empties the bowel of stool

A practitioner orders a tap water enema for a patient. The patient asks about the purpose of the enema. What specific information about the purpose of a tap water enema should be included in the nurse's response? 1. Reduces abdominal gas 2. Drains the urinary bladder 3. Empties the bowel of stool 4. Limits nausea and vomiting

The volume of instilled water stimulates peristalsis.

A primary healthcare provider orders a tap-water enema. The patient says, "How does this type of enema work?" The nurse answers the patient's question based on knowledge of which therapeutic action? 1. Water causes excessive interstitial fluid loss. 2. The volume of instilled water stimulates peristalsis. 3. Soapsuds reduce the surface tension of water. 4. The hypertonic nature of the water irritates the intestinal mucosa.

Protects the gastric mucosa

A school nurse is planning a health class about bodily functions. What information should be included regarding the purpose of mucus in the gastrointestinal tract? 1. Activates digestive enzymes 2. Protects the gastric mucosa 3. Enhances gastric acidity 4. Emulsifies fats

Continual

In an ileostomy the expulsion of effluent is _____________

True

Ostomy bags can be reused, true or false

"I should heat the water to 113°F (45°C) in a microwave oven."

The nurse educator is teaching a student nurse the irrigation process of colostomy. Which statement made by the student nurse indicates the need for additional teaching? 1. "I should heat the water to 113°F (45°C) in a microwave oven." 2. "I should position the patient in a left lateral side-lying position." 3. "I should slowly increase the rate of flow of irrigating solution." 4. "I should place the moisture-proof pads across the patient's lap."

The patient may have decreased water intake.

The nurse is assessing an elderly patient with dementia who has constipation. The nurse advises the unlicensed assistive personnel (UAP) to provide fluids to the patient every 15 to 20 minutes. What is the reason behind this instruction? 1. The patient may have fecal incontinence. 2. The patient may have decreased water intake. 3. The patient may have been administered steroids. 4. The patient may be having restricted movements

Remaining with patient while providing privacy when patient uses bedpan

The nurse is caring for a bedridden patient who needs to go to the bathroom. Which is the best nursing intervention to provide comfort to the patient? 1. Asking the visitor to assist the patient to the bedpan 2. Helping the patient to the bathroom and leaving after closing the door 3. Placing a bedside commode and leaving after pulling a curtain 4. Remaining with patient while providing privacy when patient uses bedpan Rationales

The patient has reduced normal flora.

The nurse is caring for a patient with diarrhea. After assessment, the primary health care provider advises the nurse to include yogurt in the patient's diet. What does the nurse infer from this instruction? 1. The patient has inflammation in the colon. 2. The patient has reduced normal flora. 3. The patient has an imbalance in electrolytes. 4. The patient has a blockage in the intestine.

Encourage the patient to increase dietary fiber.

The primary care physician orders bed rest, regular diet, and morphine sulfate (10 mg every 4 hours) for pain for a patient who has been in a severe motor vehicle crash. What action can help limit the complications related to immobility and pain medication? 1. Prolong the times between the administrations of pain medication. 2. Teach the patient why yogurt should be ingested daily. 3. Encourage the patient to increase dietary fiber. 4. Place the patient on oxygen therapy.

Gastrointestinal bleeding

What does the nurse consider to be the cause of black, tarry stools? 1. Overproduction of bile 2. Gastrointestinal bleeding 3. Decreased absorption of fat 4. Deficient pancreatic enzymes

Peristalsis increases after ingestion of food.

What should the nurse consider when planning for the elimination needs of a patient? 1. Peristalsis increases after ingestion of food. 2. Emotional stress initially decreases peristalsis. 3. Enema solutions should be administered at room temperature. 4. Intrathoracic pressure decreases when straining during defecation.

Eat whole-grain foods every day.

What should the nurse encourage the patient to do to best promote intestinal peristalsis? 1. Use a bulk cathartic weekly. 2. Take castor oil once a month. 3. Eat whole-grain foods every day. 4. Self-administer a stool softener daily.

Older Adult, Pregnant Women

Which patients are at the greatest risk for developing constipation? Select all that apply. 1. Toddler 2. Adolescent 3. Older adult 4. Middle-age man 5. Pregnant woman

Stop the fluid until the cramping subsides

While receiving an enema, a patient reports abdominal cramping. What should the nurse do? 1. Lower the fluid container several inches. 2. Stop the fluid until the cramping subsides. 3. Turn the patient to the right lateral position. 4. Have the patient flex the knees toward the abdomen.

Kayexalate Enema

administered for the purpose of lowering a very high potassium level

Steatorrhea

appears fluffy, floats on water,

Decreases, Constipation

as a person ages peristalsis __________________ causing the elderly to be more prone to ___________________

Necrosis

black ostomy depicts:

Melena

black, tarry appearance in stool

Water Faceplate

bag attaches to this in two piece enemas

Objective Data

data such as contour/curve of abdomen, scars, surgical site preparation, dressings, drains, appearance of stoma, size, edema, color and moisture of stoma, appearance of skin surrounding the peristomal site

Subjective Data

data such as reason for ostomy, ostomy performed, type of ostomy, type of bag in use,last changed, self care patient is able to perform

Soft, Formed, Light Yellowish Brown-Dark Brown, Slightly odiferous and slightly curved

describe a normal stool

Ileostomy

diversion created in the ileum portion of the small intestine, created at the end of the ileum due to removal of large colon

Kock Pouch

diversion using the terminal portion of the ileum to form and internal pouch or reservoir to collect and store the effluent prior to evacuation from the body

Beets

eating this may cause red tinited stools

Spinich

eating this may result in greenish black streaks in the feces

2-3 Weeks

edema of ostomy will shrink to a small size over the first _____________ postsurgery

Ascending Colon

effluent that is liquid-mushy with a foul odor

Bulk

fiber intake affects the ______________ of the stool

Kock Pouch

forms a flap that closes the reservoir preventing leakage of the thin and watery effluent, drains reservoir with catheter several times a day

Child into Adult

gain voluntary control of bowels and has a BM 1-2 times a day

Flatus

gas

Maintain pts normal frequency of BM

goal of elimination care

Stomach

here enzymes break down the bolus of food converting it into chyme

Occult Blood

hidden blood

Postoperative pain

if ostomy is new assess the patient for

3 Days

individual should have a BM at least every ___________________

Constipation

less frequent, hard, formed stools that are difficult to expel

Color, Shape, Consistency, Odor, Frequency

list the 5 characteristics of stool

Diarrhea

loose or watery stools occurring three or more times a day

Malnutrition and Electrolyte Imbalance

loss of a large amount of ileostomy drainage can lead to symptoms of: ___________________ and ___________________

Fecal Incontinence

loss of voluntary control of rectal sphincters

Normal Flora

main function is to prevent infection

Protective Barrier Cream

may be used around the stoma to protect the small area of skin showing after appliance is in place

Stoma

mouth of ostomy

Right Transverse

mushy to semi formed effluent

Breastfed Infants

normally have a bright yellow, pasty seedy appearing stool

Cow's Milk Babies

normally have a darker yellowish/tan colored stool that is firm and formed

Newborns

normally have black, shiny, sticky, stools

Bowel Elimination

occurs after nutrients are moved through the GI tract

Mucus

only drainage from distal stoma

Subjective Data

ostomy care begins with

Colostomy

ostomy using part of the large intestine

Defecation

process of bowel elimination

Peristalsis

rhythmic wavelike movements beginning in esophagus and continuing toward rectum

Loop Stoma

seen in tx of inflammatory diseases, loop of bowel is brought to the surface of the abdomen and a bridge is positioned under the loop of the colon to keep it outside of the body

Left Transverse

semi formed to soft effluent

Single Barreled or End Stoma

single opening of a colostomy stoma is called: (2)

Descending/Sigmoid

soft to hard formed stool

Siphon Enema

sterile water enema used in a post surgical patient to remove gas from the bowel

Steatorrhea

stool containing an abnormally high amount of undigested fat

Distention

stretching out of the intestinal walls and making them appear inflated

Pink-Red, Shiny and Moist

three characteristics of a new stoma

Smaller, Pinkish-Red, Drier

three characteristics of an established stoma

Warm, Mild, Rinse, Pat

to a wash a stoma use a soft washcloth, _______ water, _______ soap then __________ thoroughly and ___________ dry

Continent Ostomy

type of ostomy where pt has control over when the reservoir is changed

30 min-1 hr

urge to defecate occurs _____________________ after eating

Same Time, Morning

when irrigating a descending or sigmoid colostomy the goal is to train the ostomy to evacuate at the ______________________ each day, the ______________ is the best time of day for this

Proximal, Distal, Anastomosed

when two stomas are formed, the stool will empty from the ____________ stoma and the ___________ stoma leads to portion of the colon thats rested and allowed to heal, after the top is healed the loop is

Infants

will normally have between 3-6 BMs daily