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." In the correct response, the nurse has documented what was done during the assessment and has noted that bowel sounds are inaudible.

The nurse in an outpatient health care provider office is caring for a client with persistent flatus. Which client teaching will the nurse provide?

"Certain vegetables can cause this concern." Vegetables such as cabbage, cucumbers, and onions commonly produce gas. This condition is not likely related to a parasitic infection. Inserting a rectal tube as part of an outpatient visit is unlikely. Lifestyle modifications, such as choosing other foods, can help with persistent flatus.

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.)

"Have you started a new medication?" "What are your normal bowel habits?" "Do you use laxatives?" 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 is taking home occult blood testing (FOBT) supplies. Which client statement requires nursing intervention?

"I like to eat beef, so this will be good for me before performing the test." The client should avoid eating red meat 3 days before testing, as well as refrain from consuming citrus fruits or juices for 3 days before beginning the test. Acetaminophen use is acceptable; nonsteroidal anti-inflammatory drugs (NSAIDs) must be avoided 7 days before self-collecting stool. Eating chicken is acceptable.

The nurse is teaching a client with rectal bleeding about fecal occult blood test (FOBT) testing supplies. What teaching will the nurse provide?

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

A client has been given fecal occult blood test (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.

The nurse faculty is presenting a lecture on cathartics and laxatives. Which statements, if given by the nursing students, would indicate to the faculty that teaching was effective?

"When giving a stimulant laxative, I will review the client's chart for prescription of vitamin D." "When giving an osmotic laxative, I will review the client's chart for a history of heart failure." A stimulant may interfere with absorption of calcium and vitamin D, so added precautions may be needed. Osmotic laxatives are not recommended in clients with heart failure or kidney disease. Emollients may interfere with absorbent of fat-soluble vitamins, so the nurse should review the client's chart for prescription of these vitamins. A bulk-forming laxative, such as Metamucil, usually acts within 24 hours. An emollient laxative, such as mineral oil, is usually effective within 8 hours.

The nurse is providing health teaching for four clients. Which client will the nurse teach that should consider a colonoscopy screening?

50-year-old client with a family history of polyps The nurse will teach that the 50-year-old client with a family history of polyps should consider a colonoscopy screening. Screenings should start at 50 years old and continue every 10 years thereafter. Other answers are incorrect.

A nurse is providing home care for a client with fecal incontinence. Which suggestions should the nurse give the client and his family when managing fecal incontinence? Select all that apply.

Ask the client to use moisture-proof undergarments. Ask the client to monitor the pattern of incontinence. Ask the client to eat nutritious foods regularly. The nurse can suggest that the client manage fecal incontinence by eating nutritious foods regularly and using moisture-proof undergarments to protect clothes and bed linen. Asking the client to monitor the pattern of incontinence helps to determine whether it occurs at a similar time each day. Limiting fiber intake is inadvisable and will not help resolve fecal incontinence. Asking the client to pull the abdomen inward and exhale induces forced coughing.

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

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.

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.

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 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.

The student nurse is administering a large-volume enema to a client. The client reports abdominal cramping. What should the student nurse do first?

Stop the adminstration of the enema momentarily. If the client reports abdominal discomfort or cramping, the nurse should momentarily stop the flow of solution. Increasing the flow of the enema may cause more cramping and discomfort. Cramping and discomfort are common complaints during enema administration so there is no need to notify the physician.

When caring for a client with a new colostomy, which assessment finding would be considered abnormal and would need to be reported to the physician?

The Stoma is prolapsed If the stoma is found to be prolapsed, the surgeon must be notified immediately. The stoma should be pink and remain on the abdominal surface. The mucosal tissue is fragile, so a small amount of bleeding may be normal.

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.

When reviewing data collection on a client with constipation, which factor identified by the nurse might suggest the causative factor?

The client takes Dulcolax every day. Over usage of Dulcolax may cause lazy bowel syndrome, leading to constipation. Traveling to South America usually causes a client to develop traveler's diarrhea. Drinking 8 glasses of fluid daily promotes bowel elimination. Consuming five to six small meals per day should not contribute to constipation.

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.

A nurse is caring for a client with fecal impaction. Which factors cause fecal impaction? Select all that apply.

Weak abdominal muscles Severe dehydration Unrelieved constipation Fecal impaction results from unrelieved constipation, retained barium from an intestinal x-ray, dehydration, and weakness of abdominal muscles. Clients with a fecal impaction usually report a frequent desire to defecate but an inability to do so. Insufficient mastication of food does not lead to fecal impaction but may sometimes lead to indigestion and temporary constipation. Excess intake of fibrous food, such as raw fruits and vegetables, does not lead to constipation; instead, adequate fiber helps facilitate bowel movement and elimination.

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.

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.

The nurse is assisting an older adult client into position for a sigmoidoscopy. Which position would the nurse place the client in?

left lateral The left lateral or knee to chest position is the most common position for sigmoidoscopies or colonoscopies. If the client is not able to tolerate this position, Sims' position may also be used. The right lateral, prone or semi-Fowler's positions are not routinely used for this procedure.

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.

Occult blood testing has been ordered for a hospitalized client. Which meal would be acceptable for a client receiving occult blood testing?

macaroni and cheese, corn, lettuce salad, and vanilla pudding Certain foods and medication should be avoided when occult blood testing is performed because they can cause a false-positive result. The ingestion of red meat, animal liver and kidneys, salmon, tuna, mackerel, and sardines should be avoided for 4 days prior to testing. Clients should also avoid tomatoes, cauliflower, horseradish, turnips, melon, bananas, and soybeans.

Return-flow enemas are

occasionally prescribed to expel flatus.

A nurse is performing an abdominal assessment of a client before administering a large-volume cleansing enema. Which assessment technique would be performed last?

palpation The abdominal assessment should be performed in the following sequence: inspection, auscultation, percussion, palpation.

Carminative enemas are classified as

retention enemas and are used to expel flatus from the rectum and provide relief from gaseous distention.

The most common types of solutions used for cleansing enemas

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.