Ch. 47 Bowel Elimination
A patient is admitted with diarrhea caused by clostridium difficile. Which question would the nurse ask to obtain information about how the organism was acquired?
"Are you taking antibiotics?" rationale: patients acquire C. difficile infection in one of two ways: by antibiotic therapy that causes an overgrowth of C. difficile and by contact with the C. difficile organism. Patients are exposed to the organisms from a health care worker's has or direct contact with environmental surfaces contaminated with it. One cannot contract the C. difficile infection by walking barefoot outside the home because it does not enter the skin. Traveling to foreign countries is not a risk factor because the bacteria is already present in the intestines. Not all bowel problems indicate a C. difficile infection
The nurse provides education for a nursing student about laxatives and cathartics. Which statement by the student nurse indicates effective learning?
"Suppositories usually start acting within 30 minutes of application" rationale: Suppositories such as bisacodyl act within 30 minutes. Although the terms laxative and cathartic are often used interchangeably, cathartics generally have a stronger and more rapid effect on the intestines. Laxatives prepared as suppositories may act more quickly than oral laxatives because of their stimulant effect on the rectal mucosa. A suppository should be given shortly before a patient's usual time of defecation or immediately after a meal
A nursing student reviews the procedure for administering high-cleansing soapsuds enemas to patients. Which statement by the student indicates effective learning?
"This type of enema is not recommended for pregnancy-related constipation" "Liquid soap can be mixed with either tap water or saline to create this enema" rationale: A soapsuds enema has to be used with caution in pregnant women and older adults because it could cause electrolyte imbalance or damage to the intestinal mucosa. A soapsuds enema kit contains only pure Castile soap that comes in a liquid form, which can be mixed with tap water or saline to create the effect of intestine irritation to stimulate peristalsis.
The nurse prepares to remove a small-bore NG tube from a patient. In which sequence does the nurse perform the steps of the procedure?
1. 2. 3. 4. 5. 6. 7. 8.
Steps for digital removal of stool from a patient's rectum
1. Perform hand hygiene, obtain patient's baseline vital signs, assess patient's level of comfort, and palpate for abdominal distention 2. help the patient lie on the left side with knees flexed and back toward the nurse 3. drape the trunk and lower extremities with a bath blankets and place a waterproof pad under the buttocks, keeping a bedpan next to the patient 4. lubricate the index finger of the dominant hand with water-soluble lubricant 5. instruct the patient to take slow, deep breaths while inserting the index finger into the rectum 6. loosen the fecal mass via massage 7. work the feces downward toward the end of the rectum
Preparation of a soapsuds enema
1. add warmed aline solution to the enema bag 2. add Castile soap 3. raise the container, release the clamp, and allow the solution to flow long enough to fill the tubing 4. reclamp the tubing 5. about 6 to 8 cm of the tip of the rectal tube is lubricated with water-soluble lubricating jelly 6. gently separate the patient's buttocks, locate the anus, and instruct the patient to relax by breathing out slowly through the mouth 7. insert the tip of the enema tube slowly by pointing the tip in the direction of the patient's umbilicus
List the steps to apply an ostomy push in the correct order
1. apply clean gloves 2. remove the used pouch and skin barrier 3. gently cleanse the peristomal skin with warm tap water 4. measure the stoma 5. cut an opening on the pouch 6. press the adhesive backing of the pouch smoothly against the skin 7. close the end of pouch with clip or integrated closure
An enema is prescribed for an adolescent. Which length is appropriate for insertion of the enema tube into the patient's rectum?
7.5 to 10 cm (3-4 in) rationale: The appropriate length of insertion of the tip of the enema tube into the rectum in adults and adolescents ranges from 7.5 to 10 cm In infants, the appropriate length of insertion ranges from 2.5 to 3.75 cm In children, the appropriate length of insertion ranges from 5 to 7.5 cm Lengths greater than 10 cm are too long
A cleansing enema is prescribed for an adult patient before intestinal surgery. Which is the maximum amount of fluid the nurse should give?
750 to 1000 mL rationale: more than 1000 mL of fluid causes distention to the point of rupturing the bowel
Which patient benefits the MOST from an enema prepared with a hypertonic solution?
A patient who is unable to tolerate large volumes of liquid rationale: An enema prepared with a hypertonic solution is designed to be low volume. Patients unable to tolerate large volumes of fluid benefit most from this type of enema. This type of enema is contraindicated for young infants and dehydrated patients. An enema containing steroid medication is appropriate for patients with acute inflammation in the lower colon
Antegrade continence enema
A procedure in which the surgeon creates a continence value with Ann opening to the intestine of the abdomen; this allows the patient or caregiver to insert a tube and administer an enema that comes out through the anus
Docusate calcium
A stool softener and is used as a short-term therapy to relieve straining on defecation
Docusate sodium laxative
A stool softener that increases the secretion of water by the intestine. It is a short-term therapy that may be prescribed to a patient to relieve straining on defecation. It lowers the surface tension of feces, allowing water and fat to penetrate.
The HCP prescribes a guaiac fecal occult blood testing for a patient who reports constipation and a family history of colon cancer. Which instruction does the nurse provide to the patient? A. "Avoid eating red meat for 3 days before testing" B. "Repeat the test at least 2x on two separate bowel movements" C. "Take vitamin C supplements and citrus fruits and juices before the test" D. "Stop taking aspirin, ibuprofen, naproxen, and other NSAIDs for 4 days before the test"
A. rationale: A patient who is schedules for guaiac fecal occult blood testing should be instructed to avoid eating red meat for 3 days before testing to prevent altered results. This test should be repeated three times on three separate bowel movements. The patient should also avoid vitamin C supplements and citrus fruits and juices for 3 days before the test to prevent a false-negative result. The nurse should also instruct the patient to stop taking aspirin, ibuprofen, naproxen, or other NSAIDs for 7 days, not 4 days, before the test to prevent a false-positive test result
Which type of enema should be used with caution specifically in pregnant women and older adults? A. soapsuds enema B. tap-water enema C. oil-retention enema D. normal saline enema
A. rationale: soapsuds enemas may cause electrolyte imbalance or damage to the intestinal mucosa in pregnant women and older adults. All people should use caution if ordered to repeat tap-water enemas because water toxicity or circulatory overload develops if the body absorbs large amounts of water. Oil-retention enemas and normal saline enemas may not have any adverse effect. Normal saline enemas are the safest
A patient reports passing clay-colored stools. Which condition does the nurse suspect?
Absence of bile rationale: the absence of bile results in white or clay-colored stools. White or clay-colored stools may be caused by liver, common bile duct, or pancreas disorders.
Loperamide
An antidiarrheal agent
Colonoscopy
An endoscopic examination of the large intestine using a lighted fiber-optic tube A clear fluid diet is prescribed for the patient the da before the test A colonoscopy is a method of direct visualization of the large intestine Performed every 10 years
Diarrhea
An increase in the number of stalls and passage of liquid, unformed feces May be associated with fever chills, weight loss, or abdominal pain
Causes of diarrhea
Antibiotic use Clostridium difficile Surgeries and diagnosis testing of the lower GI tract
Which laxative is MOST likely to be used in a patient who experiences constipation caused by frequent opioid use? A. psyllium B. caster oil C. lactulose D. magnesium hydroxide
B. rationale: caster oil is a stimulant cathartic prescribed to patients with constipation from frequent opioid use. Psyllium is a bulk-forming agent, and lactulose and magnesium hydroxide are saline-based agents. Neither bulk-forming agents nor saline-based agents are specifically recommended for people with constipation caused by frequent opioid use
Which medication is considered to be a bulk-forming laxative? A. bisacodyl B. methylcellulose C. docusate sodium D. magnesium hydroxide
B. rationale: methycellulose is a bulk-forming agent. bisacodyl is a stimulant cathartic. docusate sodium is a stool softener magnesium hydroxide is an osmotic agent
Where does normal defecation begin? A. anus B. colon C. stomach D. small intestine
B. rationale: normal defecation begins with movement in the left colon, moving stool toward the anus. It does not begin in the anus, stomach, or small intestine
A patient reports a noxious change is odor while defecating. Which is MOST likely to be the cause of this?
Blood in feces rationale: Blood in the feces can cause a noxious change in the odor of feces. The ingestion of beets may cause the feces to appear red. The absence of bile in feces causes the feces to become white or clay-colored. Malabsorption syndrome causes oily stools
Which risk is associated with bulk-forming enema?
Bulk-forming enemas are not recommended in patients for whom large fluid intake is contraindicated. The chronic use of stimulant cathartics may cause fluid and electrolyte imbalances. Emollient or wetting agents are of little value for treatment of chronic constipation; bulk-forming agents are drugs or voice for chronic constipation. Bulk-forming enema agents in powder form could cause constipation if not mixed with at least 240 mL of water or juice and swallowed quickly
Which examination is noninvasive and involves an x-ray examination of the body from many angles using a scanner analyzed by a computer? A. ultrasound imaging B. plain film of the abdomen C. computed tomography (CT) scan D. magnetic resonance imaging
C. rationale: A CT scan is an x-ray exa of the body from many angles using a scanner analyzed by a computer, sometimes using a contrast solution.
A patient presents with a dangerously high serum potassium level. Which type of enema would the nurse anticipate a prescription? A. MGW solution B. Neomycin solution C. Sodium polystyrene sulfonate D. Enema containing steroid mediation
C. rationale: Sodium polystyrene sulfonate is a medicated enema used to treat patients who have dangerously high serum potassium levels. An MGW solution, containing 30 mL of magnesium, 60 mL of glycerin, and 90 mL of water, is a carminative enema. Neomycin solution is a medicated antibiotic enema that is used to reduce bacteria in the colon before bowel surgery. An enema containing steroid medication may be used for acute inflammation in the lower colon
The nurse reviews types of enemas and determines that a hypertonic solution enema is MOST appropriate for which patient? A. an infant who is unable to defecate B. a dehydrated patient who has constipation C. a patient who cannot tolerate a large volume of fluid D. a patient with a dangerously high serum potassium level
C. rationale: enemas that use hypertonic solutions are low in volume and are designed for patients who cannot tolerate a large volume of fluid. This type of enema is contraindicated in infants and dehydrated patients. A patient with a dangerously high serum potassium level may receive a medicated enema that contain sodium polystyrene sulfonate
Constipation
Characterized by infrequent bowel movements (less than three per week) and hard, dry stools that are difficult to pass Improper diet, reduced fluid intake, lack of exercise, and certain medications may cause constipation. Patients with constipation may have to strain to have a bowel movement and may have abdominal or rectal pain when they have a bowel movement.
The nurse provides information about factors related to bowel elimination in the older population for a group of nursing students. Which information does the nurse include?
Chewing ability decreases esophageal emptying slows absorption by the intestinal mucosa is impaired muscle tone in the anal sphincter weakens causing difficulty controlled defecation peristalsis decreases
In which method of indirect visualization of the GI tract would the patient swallow a capsule containing radiopaque markers and have an x-ray done after 5 days?
Colonic transit study rationale: In a colonic transit study, the patient swallows a capsule containing radiopaque markers; an x-ray film exam is performed on the patient 5 days after ingestion
Which procedure requires the patient to undergo a bowel-cleansing program before it can be performed?
Colonoscopy Computerized tomographic colonography
Which agent is osmotic and is used to treat constipation? A. polycarbophil B. casanthranol C. docusate potassium D. sodium phosphate
D. rationale: Sodium phosphate is an osmotic agent used to treat constipation Polycarbophil is a bulk-forming agent. Casanthranol is a stimulant cathartic. Docusate potassium is an emollient
Which procedure would the nurse follow when collecting a stool specimen for an occult blood laboratory test? A. only liquid stools are collected for this test B. the samples should be collected over a 3- to 5-day period C. at least 4 mL of liquid stool should be collected D. a 3-cm (1 in) mass of formed stool is an adequate sample size for this test
D. rationale: Tests performed by the lab for occult (microscopic) blood in the stool require only a small sample. If the patient passes formed stools, a 3-cm mass of formed stool sufficient. The patient does not need to pass only liquid stools for the test to be performed. Tests for measuring the output of fecal fat require a 3- to 5-day collection of stool. A single sample is sufficient for performing a fecal occult blood test. If the patient passes liquid stools, the amount of fecal matter requires to test for fecal occult blood ranges from 15 to 30 mL
Which part of the gastrointestinal tract plays a major role in bowel elimination? A. stomach B. esophagus C. small intestine D. large intestine
D. rationale: The main functions of the large intestine, or colon, are absorption, secretion, and elimination. Therefore, the large intestine plays a major role in bowel elimination. The main functions of the stomach include storage of swallowed food and liquid, the mixing of food with digestive juices into a substance, and regulating emptying of its contents into the small intestine. The esophagus is the part of the GI tract through which food reaches the upper end of the stomach. It is not involved in elimination. The small intestine is involved in digestion and absorption, but not elimination
Which stool finding is consistent with a patient's diagnosis of pancreatic cancer? A. pus B. blood C. mucus D. oily stool
D. rationale: oily stool is associated with pancreatic disease. Pus, blood, and mucus in stools are associated with internal bleeding, infection, or inflammation
Which antidiarrheal is the MOST effective? A. codeine B. polycarbophil C. tincture of opium D. diphenoxylate with atropine
D. rationale: the opioids are the most effective nonspecific antidiarrheal agents (eg., loperamide, diphenoxylate with atropine). codeine or tincture of opium may be used to manage chronic severe diarrhea in patients with diseases such as Crohn's diseases, ulcerative colitis, and AIDs. Polycarbophil is a bulk-forming laxative that is used to relieve mild diarrhea
Which statement is true regarding the bowel preparation associated with magnetic resonance imaging (MRI)? A. No bowel preparation is required B. laxatives are taken the day before the procedure C. an enema is administered to empty out stool particles D. no food or fluids are given orally 4 to 6 hours before the exam
D. rationale: the preparation required for an MRI is that no food or fluids are given to the patient orally 4 to 6 hours before the exam
Antibiotics
Decrease intestinal bacterial flora, thereby causing diarrhea
Long term management solutions for constipation
Diet change change in defecation schedule
Which examination may be recommended for a patient in whom fecal impaction is suspected?
Digital examination of the rectum rationale: digital examination of the rectum may be recommended for a patient in whom fecal impaction is suspected. Gastroscopy is used to gain visualization of the upper GI tract. A barium swallow is a radiographic exam using opaque contrast medium to examine the structure and motility of the upper GI tract. The fecal occult blood test is a stool test to measure microscopic amounts of blood in feces. These examinations may not be recommended for a patient in whom fecal impaction is suspected
The nurse provides care for a patient with diarrhea. Which medication would the nurse expect the HCP to prescribe?
Diphenoxylate with atropine rationale: the most commonly used antidiarrheal agents are loperamide or diphenoxylate with atropine
Guaiac fecal occult blood test
Done on multiple samples at home and is performed annually
Screening guidelines for the early detection of colorectal cancer
Every 3 years, starting at age 45 Average-risk asymptomatic people should begin regular screening at age 45.
Which statement is true regarding the difference between fecal impaction and fecal incontinence?
Fecal impaction is common in debilitated, confused, or unconscious patients, whereas fecal incontinence is common in patients with impaired cognitive function
Which bowel elimination problem is associated with abdominal fullness; cramping; distention; and severe, sharp pain?
Flatulence rationale: flatulence may cause abdominal fullness; cramping; distention; and severe, sharp pain Flatulence is caused by an accumulation of gas in the lumen of the intestines.
The nurse observes a caregiver administer an enema to a patient who is scheduled for a colonoscopy. For which action performed by the caregiver would the nurse intervene?
Gives the enema with the patient sitting on the toilet rationale: The nurse should not give an enema to a patient sitting on the toilet because the position of the rectal tubing could injure the rectal wall. When giving an enema to an immobilized patient, it is always recommended that the patient be positioned on a bedpan. The use of sterile technique is not necessary when administering an enema because the colon already contains bacteria. However, the nurse should wear gloves to prevent the transmission of fecal microorganisms. It is appropriate to ask the patient to retain the enema solution for a specific length of time before defecation
The nurse provides care for a patient with GI bleeding. Which test will be prescribed to determine whether the patient has anemia?
Hematocrit rationale: For a patient with has GI bleeding, the health care provider would prescribe hemoglobin and hematocrit tests to help determine anemia from GI bleeding if present. The health care provider prescribes serum lipase, serum amylase, and liver function tests to assess for hepatobiliary diseases and pancreatitis
Which patient cue will the nurse anticipate when assessing the GI system of a patient in the third trimester of pregnancy?
Hemorrhoids rationale: peristalsis slows down in pregnancy, increasing the risk of constipation, which can cause hemorrhoids
Which condition may be caused by frequent straining during defecation ?
Hemorrhoids rationale: Increased venous pressure from straining at defecation, pregnancy, heart failure, and chronic liver disease causes hemorrhoids.
Which reason is appropriate for use of an enema?
Immediate relief of constipation Beginning a program of bowel training Emptying the bowel before diagnostic tests or surgery rationale: Enemas are used for the immediate relief of constipation, to begin a program of bowel training, and to empty the bowel before a diagnostic test or surgery. To reestablish regular bowel habits, a patient should try to defecate at the same time every day. An ice pack or a warm sit bath provide temporary relief of pain caused by hemorrhoids
Constipation is a symptom, not a disease, and had many possible causes
Improper diet Reduced fluid intake Lack of exercise Certain medications
Barium swallow
Involves using barium as an opaque contrast medium to examine the structure ad motility of the upper gI tract, including the pharynx, esophagus, and stomach
Methylcellulose
Is a bulk-forming stool softener that absorbs water and increases solid intestinal bulk. It is a drug of choice for chronic constipation and is available in powder form. The nurse should instruct the patient to mix the powder with at least 250 mL of water or juice and swallow it quickly; if not, it could cause constipation. Bulk forming agents are least irritating, most natural, and safest type of laxatives. Regular use of stimulant laxatives should be avoided to prevent dependence on the stimulus for defecation. May cause the passage of stills 12-24 hours after taking the medication. Therefore the patient need not report to the HCP if he or she does not pass stools within 8 to 10 hours of taking the medication. Increased gas formation and flatus may occur when the patient first starts taking methyl cellulose; this will subside after 4 or 5 days. Therefore the nurse should not instruct the patient to stop taking the medication in such situations
Fecal incontinence
Is the inability to control the passage of feces and gas from the anus Physical conditions that impair anal sphincter function or large-volume liquid stools may cause incontinence
lactose intolerance
Lack of the enzyme needed to digest the milk sugar lactase Food intolerance that increases peristalsis
Type 3 stools
Like a sausage but with cracks on the surface
Type 4 stools
Like a sausage or a snake, and are smooth and soft
What is the mode of acton of emollient laxatives?
Lowering the surface tension of feces rationale: Emollient laxatives, or stool softeners, are detergents that lower surface tension of feces, allowing water and fat to penetrate. Saline based laxatives have an osmotic effect that increases pressure in the bowel to act as a stimulant for peristalsis. Stimulant cathartics cause local irritation to the intestinal mucosa, increase intestinal motility, and inhibit reabsorption of water in the large intestine
The nurse examines a patient's stool specimen and notes that the stool is oily. The nurse suspects which cause of this assessment finding?
Malabsorption syndrome rationale: May lead to oily stool
Fecal impaction
May be indicated by the inability to pass stool for several days despite the repeated urge to defecate. The patient may also experience loss of appetite (anorexia), rectal pain, continuous oozing of liquid stool, nausea and/or vomiting, and abdominal distention and cramping.
Codeine and opium tincture
May be used to manage chronic severe diarrhea in patient's with Crohn's disease, ulcerative colitis, or acquired immunodeficiency syndrome
Infestation of parasites
May lead to the presence of blood, pus, mucus, and worms in the stool
Infection and intestinal irritation
May lead to the presence of mucus in the stool
Anorectal manometry
Measures the pressure activity of internal and external anal sphincters and reflexes during rectal distention, relaxation during straining, and rectal sensation.
Which type of enema is used for infants and children?
Normal saline rationale: NS enemas are used in infants and children because they are at greater risk of fluid imbalances. Soapsuds enemas and tap water enemas should not be used in infants and children. Hypertonic solution enemas are contraindicated in infants
Laxatives and cathartics
Often prescribed to promote defecation in patients with constipation
Saline-based agents
Only for acute emptying of the bowel
Which medication may cause constipation?
Opioid analgesics rationale: opioid analgesics slow peristalsis and contractions, thereby causing constipation.
The nurse is performing nasogastric intubation on a patient for gastric decompression. Which step taken by the nurse promotes the patient's ability to swallow during the procedure?
Positioning the patient in the high-Fowler's position with pillows behind the head and shoulders
Which condition is a predisposing factor for the development of hemorrhoids?
Pregnancy Heart Failure Chronic liver disease rationale: these conditions increase intraabdomnal pressure, leading to engorgement of the blood vessels of the rectum
For which reason is a Sengstaken-Blakemore NG tube primarily used?
Prevention of internal esophageal or GI hemorrhage using pressure Rationale: the tube is used for compression. It applies pressure internally using an inflated balloon to prevent an internal esophageal or GI hemorrhage
For which reason is a Sengstaken-Blakemore NG tube primarily used?
Prevention of internal esophageal or GI hemorrhage using pressure rationale: The Sengstaken-Blakemore tube is used for compression. It applies pressure internally using an inflated balloon to prevent an internal esophageal or GI hemorrhage. Tubes used for lavage, such as the Salem pump, provide irrigation of the stomach in cases of active bleeding, poisoning, or gastric dilation. Tubes used for decompression, such as the Miler-Abbott tube, help remove secretions and gaseous substances from the GI tract. Tubes used for enter feedings such as the Dubhoff, instill liquid nutritional supplements or feedings into the stomach or small intestine for patients who have impaired swallowing
A patient is admitted for LOWER GI bleeding. Which color of stool would the nurse anticipate the patient to have?
Red rationale: Red stools indicate lower GI bleeding. Upper GI bleeding would result in black stool. Clay-colored stools indicate the absence of bile. Green and orange stools are not indicators of bleeding
Fecal impaction
Results when a patient has unrelieved constipation and is unable to expel the hardened feces retained in the rectum
Which description is accurate about the mouth's role in the digestive process?
Saliva produced by salivary glads helps to dilute ad soften the food rationale: Saliva produced by the salivary glands in the mouth dilutes and softens the food in the mouth for easier swallowing.
Type 2 stools
Sausage-shaped but lumpy
A patient presents to the hospital with symptoms of pancreatitis. Which lab test does the nurse anticipate will be prescribed?
Serum lipase rationale: A serum lipase test is used to check for pancreatitis. Hematocrit and hemoglobin tests are used to figure out whether a patient with GI bleeding has developed anemia. Liver function tests are used to assess hepatobiliary diseases
A flexible sigmoidoscopy
Should be performed every 5 years
Which information about tap-water enemas is true?
Should be repeated with caution rationale: tap-water enemas should be used with caution if they need to be repeated because water toxicity or circulatory overload develops if the body absorbs large amounts of water. A hypertonic solution enema is contraindicated for patients who are dehydrated. Tap-water enemas are not associated with any particular advisory that they should be used with caution in pregnant women. A normal saline enema is associated with a decreased risk of excess fluid absorption
Type 5 stools
Soft blobs with clear-cut edges
Which statement is accurate regarding the guaiac fecal occult blood test and the fecal immunochemical test for measuring microscopic amounts of blood in the feces?
The FIT requires no dietary restrictions Rationale: A FIT requires no preparation or dietary restrictions. The gFOBT requires that the patient follow certain dietary restrictions before testing. A patient about to undergo the gFOBT has to stop taking aspirin, ibuprofen, naproxen, and any other NSAIDs 7 days prior to the test because these could cause a false-positive test result. The FIT is a more sensitive test than the gFOBT. Patients about to undergo the gFOBT need to avoid vitamin C supplements and citrus fruits and juices at least 3 days before testing to avoid a false-negative result. The FIT has no such restrictions. For both tests, the nurse or the patient needs to repeat the test at least 3 times on three separate bowel movements
Nutrient absorption process
The ileum absorbs fats and bile salts, and iron and vitamins The jejunum absorbs carbs and proteins Nutrients and electrolytes are absorbed in the small intestine plant fiber is not digested in the small intestine; the undigested fiber is emptied into the cecum
The nurse cares for a patient who is scheduled to receive a saline-based agent. Which inference does the nurse make based on this prescription?
The patient is scheduled for an endoscopic examination the next day rationale:A saline-based agent is an osmotic laxative used for the acute emptying of the bowel, which is done before an endoscopic examination. Emollient agents are used to relieve straining on defecation, which served to relieve hemorrhoids. Bulk-forming agents are laxatives that are used to relieve mild diarrhea. A saline-based agent is not used for the long-term management of constipation. Instead, blue-forming agents are most likely to be used
The nurse is assigned to a patient who is schedules to undergo a colonic transit study. Which statement is true about the procedure?
There is a gap of a few days between the patient swallowing radiopaque markers and the x-ray film examination rationale: Fos a colonic transit study, the patient swallows a capsule containing radiopaque markers and then maintains a normal diet and fluid intake for 5 days. On the fifth day, an x-ray film exam is performed. For a colonic transit study, the patient is not given medications that affect bowel function. An enema can be given to empty out stool particles before performing a barium swallow/enema. No metallic objects, including metal objects on clothes, are allowed in the room during magnetic resonance imaging. An IV contrast solution is used during a CT scan, not a colonic transit study
The nurse is caring for a patient with Crohn's disease who has developed chronic severe diarrhea. The nurse anticipates that which medication will be prescribed?
Tincture of opium rationale: tincture of opium is an antidiarrheal drug that is used to manage chronic severe diarrhea in patients with diseases such as Crohn's disease, ulcerative colitis, and acquired immunodeficiency syndrome
The nurse gives a patient an enema using a prepackages disposable container. For which reason would the nurse expel air from the enema container before inserting the tip into the patient's rectum?
To minimize distention and discomfort in the colon rationale: the nurse expels air from the enema container before inserting the tip of the bottle into the rectum to minimize the introduction of air into the colon. Introducing air into the colon causes distention and discomfort
Casanthranol
Used to cleanse and prepare the bowel for diagnostic procedures
Polycarbophil
Used to treat constipation
Which step is associated with an upper endoscopy?
Using a lighted fiber-optic tube to gain direct visualization of the upper GI tract rationale: an endoscopy involves using a lighted fiber-optic tube to gain direct visualization of the upper GI tract.
For which use is docusate calcium often prescribed? A. Hemorrhoids B. Perianal surgery C. Low-residue diet D. Suspected poisoning E. Endoscopic examination
a, b rationale: Docusate calcium is an emollient and stool softener that is used for short-term therapy to relieve straining on defecation. Patients with hemorrhoids and patients who have undergone perianal surgery should avoid straining during defecation; docusate calcium can be used to soften stools to prevent straining. A low-residue diet is likely responsible for chronic constipation. Suspected poisoning and endoscopic examinations both call for the acute emptying of the bowel; saline-based agents are often used for this task
Which statement describes accurate information regarding the large intestine? A. straining during a bowel movement can cause hemorrhoids B. When peristaltic contractions slow down, constipation occurs C. The duodenum and jejunum absorb most nutrients and electrolytes D. The colon has 3 functions: absorption, secretion, and elimination E. The large intestine secretes hydrochloric acid to help digest food
a, b, d rationale: Hemorrhoids can occur in the rectum of the large intestine as a result of straining. If peristaltic contractions slow down in the large intestine, water continues to be absorbed and a hard mass of stool forms, resulting in constipation. The colon has three functions: absorption, secretion, and elimination. The duodenum and jejunum are part of the small intestine, and hydrochloric acid is secreted in the stomach
The nurse is explaining to a patient with gastritis about the tasks performed by the stomach. Which physiological function would the nurse include in the teaching? SATA A. storage of food B. reabsorption of nutrients C. secretion of intrinsic factor D. production of HCl acid E. mucus secretion to aid protein digestion
a, c, d rationale: The functions of the stomach include storage of food and liquids, as well as secretion of intrinsic factor, which is responsible for absorption of vitamin B12. The stomach also produced hydrochloric acid, which, along with pepsin, helps in protein digestion. Reabsorption of nutrients occurs in the small intestine, not in the stomach. Mucus is secreted from the stomach, but it does not aid in protein digestion. Instead, it forms a protective barrier on stomach mucosa
Which information is true about the large intestine? SATA A. It is shorter than the small intestine B. It has no absorptive role C. It has a role in the elimination function D. It can develop hemorrhoids E. It has longitudinal muscles that prevent regurgitation
a, c, d rationale: The large intestine is larger in diameter than the small intestine, but it is shorter. It is the primary organ for bowel elimination and fluid absorption. Each fold of the rectal part of the large intestine has blood vessels that become distended from pressure during straining, which results in hemorrhoid formation. The large intestine is responsible for absorption of water, sodium, and chloride from the digested food. The circular muscles are responsible for preventing regurgitation
The nurse performs an abdominal assessment of a patient. Which finding is likely to indicate that the patient has an intestinal obstruction? SATA A. observable peristalsis B. no auscultated bowel sounds C. tympanic note audible on percussion D. hypoactive bowel sounds on auscultation E. high-pitched and hyperactive bowel sounds
a, e rationale: Peristaltic waves cannot be seen normally. Observable peristalsis is often a sign of intestinal obstruction. High-pitched and hyperactive bowel sounds occur with a small intestine obstruction and inflammatory disorders. No auscultated bowel sounds to hypoactive bowel sounds occur with an ileum, such as after abdominal surgery, but this may also mean that the bowel sounds could not be captured by the nurse during an assessment. Gas or flatulence created a tympanic not audible on percussion
Signs and Symptoms of flatulence
abdominal fullness pain caused by the accumulation of gas in the intestines cramping
The nurse provides care for a patient who reports constipation. Which food item does the nurse recommend for the patient to include in the diet to relieve the condition? SATA A. meats B. whole grains C. legumes D. fresh fruits E. vegetables
b c, d, e rationale: A well balanced set with whole grains, legumes, fresh fruits, and vegetables eaten regularly promotes normal elimination. Low-fiber diets high in animal fats (eg., meats and carbohydrates) are common causes of constipation and should be avoided by the patient
The nurse reviews the medical record of a patient with diarrhea. Which potential cause would be identified for the condition? SATA a. use of opioid drugs b. use of antibiotics c. food allergies d. prolonged stress e. hypothyroidism
b, c, d rationale: use of antibiotics may cause diarrhea by disrupting the normal flora of the intestine. Food allergies and prolongs stress cause increased peristalsis, resulting in diarrhea The use of opioid drugs and hypothyroidism cause constipation by decreasing peristalsis
Which statement regarding osmotic laxatives is correct? SATA A. causes severe cramping B. not meant for the long-term management of constipation C. unsuitable for patients who have kidney dysfunction D. may cause constipation if not mixed with at least 240 mL of water E. not recommended for people on fluid restriction
b, c, e rationale: osmotic agents such as saline-based agents are not for long-term management of constipation or for patients who have kidney dysfunction because they may cause a toxic buildup of magnesium. Phosphate salts are a type of osmotic agent that are not recommended for patients on fluid restriction. Stimulant cathartics cause severe cramping. Bulk-forming agents may cause constipation if they are not mixed with a least 240 mL of water or juice and swallowed quickly
The nurse performs an abdominal assessment of a patient. Which observation is consistent with normal functioning? A. dull note on percussion B. high-pitched bowel sounds C. lack of visible peristaltic waves D. outwardly protruded abdomen E. bowel sounds audible every 10 seconds
c, e rationale: Peristaltic waves cannot be seen normally. So a lack of visible peristaltic waves indicates normal functioning. Normal bowel sounds occur every 5 to 15 seconds. Therefore bowel sounds that are audible every 10 seconds are a normal observation. Masses, tumors, and fluid are dull to percussion. High-pitched and hyperactive bowel sounds occur with small intestine obstructions and inflammatory disorders. An overall outward protuberance of the abdomen indicates intestinal gas, large tumors, or fluid in the peritoneal cavity
While inspecting the area around a patient's anus, the nurse notices lesions; discoloration; inflammation; and dilated, engorged veins in the rectum. Which instruction provided by the nurse will help manage the patient's condition? SATA A. "take codeine as prescribed" B. "take loperamide as prescribed" C. "take warm sty bath frequently" D. "include meats and carbohydrates in your diet" E. "perform regular exercise"
c, e rationale: lesions, discoloration, and inflammation of the area around the rectum and dilated, engorged veins in the rectum indicated hemorrhoids. The primary goal for the tx of hemorrhoids is passage of soft-stool. This may be facilitated by regular exercise ad proper fluid intake. The nurse should instruct patents with hemorrhoids to take warm sit baths frequently because the provide temporary relief to swollen hemorrhoids. Codeine tincture and loperamide are antidiarrheal agents that should be given to patients with diarrhea, not hemorrhoids. A low-fiber diet high in animal fats such as meats and carbohydrates, may cause constipation
Short term solutions to constipation
enemas laxatives cathartics
Factors influencing the process of bowel elimination
fluid intake (a fluid intake of 3.7 L per day for men and 2.7 L per day for women is recommended) stress (during emotional stress, the digestive process is accelerated, and peristalsis is increased; this may cause diarrhea and gaseous distention) age (in older adults, muscle tone in the perineal floor and anal sphincter weakens, which causes difficulty controlled defecation) position during defecation (squatting allows a person to lean forward, exert intraabdminal pressure, and contract the gluteal muscles. This position facilitates easy defecation)
Signs of constipation
infrequent bowel movements (fewer than three per week) hard, dry stools that are difficult to pass assessment findings also include a firm left abdominal quadrant feeling of abdominal fullness
Contraindications for the use enemas
intracranial pressure glaucome recent abdominal, rectal, or prostate surgery
The nurse cares for a patient with a NG tube in place for gastric decompression. Which action does the nurse include in the plan of care to prevent adverse effects related to the tube?
irritate the tube with saline administer frequent oral hygiene measure the length of the exposed tube measure the pH of the aspirated tube contents frequently lubricate the nares to minimize discomfort
The HCP has prescribed a cleansing enema for a patient with constipation. Which enema can be administered to the patient?
tap-water enema NS enema Soapsuds enema rationale: cleansing enemas are used for complete evacuation of feces. The large volume of solution infused stimulates peristalsis, causing bowel evacuation. The cleansing enema also acts by causing local irritation of the mucosa of the colon. Tap-water is hypotonic and promotes bowel evacuation by fluid movement from the bowel lumen. NS is the safest solution for enemas; it promotes peristalsis through the large volume infused. Soapsuds can be added to tap water or NS and used as an enema solution. This solution irritates the mucosa and causes peristalsis.
