Alterations in Bowel Elimination

loop ostomy

- Two stomas - Temporary (bowel rest)

Recommended daily food intake includes high amounts of fiber (___-___ mg) from grains, fresh fruits, and vegetables.

20-35 mg

The nurse knows that an adult should have an intake of approximately how many ounces of fluid daily? 8 16 32 64

64 An adult should consume approximately 64 ounces of fluid daily.

Maintaining proper fluid intake—____-plus ounces per day for an adult—is also essential to establish and maintain regular bowel elimination patterns.

64 plus ounces

can be temporary or permanent, may be performed on any segment of the colon, and can be identified by the location of the stoma and the consistency of the stool.

A colostomy

surgically created when a portion of the colon (large intestine) or the rectum is removed. The remaining portion of the colon is brought out through the abdominal wall and a stoma is created.

A colostomy is

have the highest incidence of colon cancer in the U.S.

African Americans

a surgically created opening in the small intestine, usually at the end of the ileum. As with the colostomy, the intestine is brought through the abdominal wall to form a stoma.

An ileostomy

can be temporary or permanent, involves bypassing the large intestine, and is characterized by frequent, unregulated, and liquid stools.

An ileostomy

When discussing ostomy care with a patient before surgery, what does the nurse explain is the main factor determining the stool consistency? Fluid intake Laxative use Dietary fiber Anatomical location

Anatomical location Location determines the consistency of the stool when a patient has any type of ostomy.

Location: First segment of the colon; stoma located on the right side of the abdomen Stool characteristics: drainage similar to ileostomies—liquid and cannot be regulated; has an odor due to digestive enzymes Rarest type

Ascending colostomy

necessary when the patient is unable to expel stool through the rectum.

Bowel diversions

A patient on long-term antibiotic therapy is experiencing frequent, foul-smelling diarrhea. The nurse suspects that the diarrhea is most likely due to which underlying cause? Food-borne pathogens Excessive laxative use Psychological stress Clostridium difficile

Clostridium difficile Clostridium difficile is a common cause of diarrhea with a foul odor in patients treated with antibiotics.

a common cause of frequent, foul-smelling diarrhea after receiving antibiotic therapy.

Clostridium difficile, or c-diff

Diseases associated with stress include:

Colitis Crohn's disease Ulcers Irritable bowel syndrome

difficult or infrequent bowel movements; occurs with decreased peristalsis; allows excessive absorption of intestinal water; often caused by poor dietary habits or as a drug side effect

Constipation

When planning care for a patient who does not recognize the urge to defecate, what is a potential bowel elimination concern that the nurse should take into consideration? Select all that apply. Constipation Diarrhea Increased peristalsis Bowel incontinence Flatulence

Constipation Constipation may result if the patient lacks the recognition of the urge to defecate and fails to do so. Bowel incontinence Bowel incontinence can result when a patient fails to recognize the urge to defecate

The nurse knows that patients may experience which potential response to sharing a bathroom? Select all that apply. Constipation Diarrhea Stool incontinence Embarrassment Continence

Constipation Patients who share bathrooms may develop constipation due to the bathroom not being available when they are ready to defecate. Embarrassment Embarrassment is a factor that may discourage the patient from using the bathroom with another person in the room.

passing of frequent, watery stools; occurs when ingested materials move too quickly through the GI system to absorb water; often caused by pathogens, food intolerances, or medication side effects.

Diarrhea

The nurse is aware that common alterations in bowel elimination patterns include which problems? Select all that apply. Diarrhea Anorexia Bowel incontinence Constipation Flatulence

Diarrhea Diarrhea is a common alteration in bowel elimination. Bowel incontinence Bowel incontinence is a common alteration in bowel elimination. Constipation Constipation is a common alteration in bowel elimination.

When caring for a patient on antibiotic therapy, the nurse identifies which abnormal assessment finding as most likely the result of antibiotic therapy? Blood in the stool Constipation Diarrhea Impaction

Diarrhea Antibiotic therapy can cause diarrhea by interfering with the normal flora of the bowel.

The nurse is discussing a dietary plan with an obese patient who will be discharged from the hospital. Which recommendations focus on factors that affect bowel elimination? Select all that apply. Follow a high-fiber diet. Follow a low carbohydrate diet. Increase consumption of spicy foods. Drink plenty of fluids. Increase physical activity.

Follow a high-fiber diet. A low fat and high-fiber diet encourages healthy bowel elimination patterns. Drink plenty of fluids. Individuals are advised to drink at least 64 ounces of fluid a day to support healthy bowel elimination.

such as lactose, gluten, wheat, and spicy food—should be avoided to maintain regular elimination patterns

Food intolerances

decreases or stops peristalsis by blocking parasympathetic stimulation to the muscles of the colon.

General anesthesia

A nurse caring for an obese person understands the increased risk for which complication of bowel function? Hemorrhoid formation Poor nutrient absorption Decreased food intake Diarrhea

Hemorrhoid formation Due to the higher risk for developing constipation and straining to have a bowel movement, the incidence of hemorrhoids increases for obese individuals.

A patient has a history of chronic constipation. The nurse knows this can lead to which alterations? Select all that apply. Clostridium difficile Hemorrhoids Stool incontinence Impaction Diarrhea

Hemorrhoids Hemorrhoids can occur with chronic constipation. Impaction Impaction can occur with chronic constipation.

Obesity increases the risk of developing functional impairments that interfere with the ability to perform activities of daily living. This can impact elimination and increase the incidence of developing...

Hemorrhoids Incontinence Constipation

Diet: ___________ diet adds bulk to the stool, which maintains peristalsis and regular elimination patterns.

High-fiber

the most common type of ileostomy, which is not a true ostomy because there is no stoma. It is performed on patients with ulcerative colitis or familial polyps in whom the anal sphincter is still intact (not removed in previous surgery).

Ileoanal pouch

A patient with familial polyps and intact anal sphincter is scheduled for a bowel diversion procedure. The nurse knows this patient will most likely undergo which bowel diversion procedure? Kock pouch Ileoanal pouch Loop colostomy Double-barrel colostomy

Ileoanal pouch The Ileoanal pouch is a type of ileostomy and is the procedure of choice for patients with familial polyps and an intact anal sphincter.

When caring for a patient post-ostomy, the nurse knows which type of procedure would not leave a stoma on the abdomen? Double-barrel colostomy Temporary colostomy Kock pouch Ileoanal pouch

Ileoanal pouch Ileoanal pouch is a reservoir in the abdomen that collects stool. It does not have a stoma because it is connected to the anus.

Two alternative procedures to the traditional ileostomy are the

Ileoanal pouch (most common ileostomy procedure) and the Kock pouch.

a hard fecal mass that cannot be expelled; occurs with stool becoming lodged in the rectum; often caused by prolonged constipation.

Impaction

The nurse caring for a patient suffering from chronic constipation must be aware of which potential complication? Incontinence Diarrhea Continence Impaction

Impaction Chronic constipation can lead to impaction.

A nurse, conducting a patient interview, is asking questions that focus on bowel elimination. Which questions address psychological factors that can affect bowel elimination? Select all that apply. Is the patient experiencing feelings of depression? Has the patient ever had a problem with obesity? Does the patient have any food intolerances? Is the patient experiencing emotional stress? What is the patient's religion?

Is the patient experiencing feelings of depression? Patients with depression may have slowed peristalsis, resulting in constipation. Is the patient experiencing emotional stress? Stress is a psychological condition that can affect elimination.

A second alternative to the traditional ileostomy, which is a variation of the ileostomy procedure.

Kock pouch

An unconscious patient has begun enteral feedings. This places the patient at increased risk for which defecation pattern alteration? Constipation Continence Loose stools Impaction

Loose stools Enteral feeding often causes loose stools and/or diarrhea.

The nurse caring for a patient who recently had a loop colostomy performed. The nurse is aware that this type of colostomy has what characteristics? Select all that apply. Two distinct stomas One stoma with two openings Distal end of the stoma may discharge mucus Proximal end of the stoma discharges stool A permanent type of colostomy

One stoma with two openings The loop colostomy is created when a loop of bowel is brought out onto the abdominal wall and creates a large stoma with two openings. Distal end of the stoma may discharge mucus The distal end of the stoma is inactive and may discharge mucus. Proximal end of the stoma discharges stool The proximal opening of the stoma is active and discharges stool.

causes several issues for patients regarding bowel elimination

Pain

more common when the patient receives general anesthesia. It usually lasts for 24 to 48 hours following surgery. It may last longer if the patient remains inactive or is unable to eat after surgery.

Paralytic ileus (or ileus)

Patients sharing a bathroom in a hospital may encounter several issues that affect elimination.

Personal Habits

promotes peristalsis and maintains adequate tone of pelvic and abdominal floor muscles.

Physical Activity: Regular physical activity

Which findings, if present, would be considered contributing factors for development of altered bowel elimination in a patient? Select all that apply. Pregnancy High blood pressure Narcotic pain medication Urinary catheterization Decreased mobility

Pregnancy Several issues during pregnancy can affect bowel elimination. Narcotic pain medication This is a contributing factor to the alteration in bowel elimination. Decreased mobility This is a contributing factor to the alteration in bowel elimination.

accelerates peristalsis, resulting in diarrhea, nausea, and distention.

Psychological Factors: Emotional stress

Ascending colostomy

Right side of abdomen

characteristic of ileostomy because of digestive enzymes in the stool.

Skin breakdown

The nurse is preparing a presentation on ostomies and includes what information regarding ileostomies? Well-formed stool is expected. Stool drainage can be regulated. Skin breakdown is a potential complication. Permanent placement is necessary.

Skin breakdown is a potential complication. Because ileostomy stool contains digestive enzymes, it can irritate skin and cause breakdown.

loss of voluntary control of defecation; occurs when the anal sphincters are unable to prevent passage of stool; often caused by rectal muscle weakness or severe diarrhea.

Stool incontinence

Doing so during defecation or the delivery process can result in hemorrhoid formation.

Straining

A nurse planning care for hospitalized patients understands that patients may experience diarrhea due to which of these causes? Select all that apply. Stress Inadequate liquid intake Antibiotics Enteral nutrition Hemorrhoids

Stress Psychological stress can cause diarrhea. Antibiotics Antibiotics can cause diarrhea. Enteral nutrition Receiving enteral nutrition (nutritional feedings delivered through a gastric or intestinal tube) can cause diarrhea.

has no stoma and the patient has bowel continence

The Ileoanal pouch

determines the consistency of the stool. The longer stool remains in the intestines, the more water is reabsorbed which results in better-formed stools.

The anatomic location of the ostomy

the only part of the bowel diversion that is visible and is typically located on the abdomen.

The stoma

The nurse is caring for a patient with a new sigmoid colostomy and prepares supplies for drainage of stool with what characteristics? Select all that apply. Liquid stool is produced. Well-formed stool is produced. Semi-formed stool is produced. Skin breakdown is common. Evacuation can be regulated.

Well-formed stool is produced. Well-formed stool is indicative of a colostomy. The location of the sigmoid colon allows the stool to stay in the intestine longer and has a more normal consistency. Evacuation can be regulated. The frequency of discharge can be regulated with a sigmoid colostomy.

The fecal material exits the body through this, which is a small protuberance of intestinal mucosa.

a stoma

Semi-formed stool is more indicative of

a transverse colostomy.

It is common for people to experience occasional

abnormal bowel elimination patterns.

Patients who have developed diarrhea and are having frequent stools A paraplegic patient who is immobile

affected patients of stool incontinence

Factors such as illness, side effect of medication, stress, reduced mobility, pregnancy, posture, surgery and anesthesia may lead to

altered bowel elimination patterns.

Liquid stool is more indicative of

an ileostomy.

will have better formed stool

an ostomy of the colon (colostomy)

used for tight sided tumors

ascending colostomy

The gender of the caregiver (a cultural factor) can influence

bowel habits.

Very quick movement of ingested material through the intestine

cause of diarrhea

Prolonged constipation. The stool becomes wedged in the rectum and cannot be eliminated without assistance

cause of impaction

Ignoring the urge to defecate Low-fiber diet Inadequate fluid intake Hemorrhoids Spinal cord injury Narcotic pain medication

causes of constipation

Slowing of peristalsis

causes of constipation

Inability of anal sphincters to prevent passage of stool, which may result from weakening of the muscles or loss of nerve sensation in the rectum and anus, or severe diarrhea.

causes of stool incontinence

Continuous leaking of stool that occurs when liquid stool above the area of the impaction seeps around the fecal mass

characterization of impaction

Infrequent stools (less than three per week) Passing hard stool Straining sensation that occurs when the patient needs to defecate but cannot expel stool

characterizations of constipation

Hyperactive bowel sounds Urgency Abdominal pain and cramping

characterizations of diarrhea

Double-barrel colostomies

consist of 2 abdominal stomas — 1 proximal & 1 distal

Infrequent or difficult bowel movements

constipation

Patients who are taking a narcotic pain medication can experience _________ due to slowed peristalsis.

constipation

Patients who suppress the urge to defecate to avoid pain can experience For example, a patient with an inflamed hemorrhoid.

constipation

Too much water being absorbed by the intestine

constipation

Patients with physical and cognitive impairments may experience difficulty with

constipation and incontinence.

Patients may ignore the urge to defecate, which may lead to

constipation or impaction.

Episiotomies or tearing of perineal tissue during childbirth: This may increase pain. Because of the pain, the patient will resist the urge to defecate, leading to

constipation.

Fetus size: As the fetus grows, it exerts pressure on the rectum, impairing the passage of feces, leading to

constipation.

Iron: Supplements of iron from prenatal vitamins can increase the risk of

constipation.

Older adults are at increased risk for developing

constipation.

Patients with psychological depression may have slowed peristalsis, resulting in

constipation.

Food intolerance Food-borne pathogens Medication side effect Antibiotics use* Enteral nutrition (tube feeding through a nasogastric or gastric tube) Excessive laxative use Diseases of the colon Psychological stress

contributing factors of diarrhea

ileostomy

creation of an artificial opening into the ileum

Location: Final segment of the colon; stoma usually located in lower left quadrant of abdomen; descending colostomy stoma is located higher on the abdomen than the sigmoid stoma. Stool characteristics: Well-formed stool that can be regulated; mild odor Does not require the patient to wear an appliance at all times. Most common type of ostomy

descending or sigmoid colostomies

Abnormal frequency and fluidity of fecal evacuations.

diarrhea

Not enough water being absorbed by the intestine

diarrhea

Not enough water is absorbed, leaving the stool loose and watery

diarrhea

Common alterations in bowel elimination include

diarrhea, stool incontinence, constipation and impaction.

Person consumes foods that are low in fiber.

diet

The gastrointestinal (GI) system is responsible for the

digestion and absorption of nutrients.

They may lack recognition of the urge to defecate or have lost control of the muscles that control defecation.

disabled patients

ascending colostomy

done for right sided tumors

Brings two ends of bowel out onto the abdominal wall Results in two distinct stomas—functional proximal end and nonfunctional distal end Proximal one, closest to the small intestine, drains feces; distal one drains mucus Bowel between stomas is surgically severed

double barrel colostomy

has two distinct stomas

double barrel colostomy

sigmoid colostomy

formed stool; left lower quadrant

Removing the colon and most of the rectum Forming an internal pouch out of the terminal portion of the ileus Attaching the pouch to the anus so that the existing anal sphincter can be used for continence After the initial pouch creation, the patient has a temporary ileostomy to allow the anastomosis to heal

ileoanal Pouch

Can be temporary or permanent Involves removal of all or part of the colon, bypassing the large intestine Stool characteristics: Liquid consistency and contains digestive enzymes and a high volume of water and electrolytes; minimal odor Special considerations: Drainage is not regulated, so it is important that patients wear an appliance continuously. Special precautions are needed to prevent skin breakdown from digestive enzymes. Fluids and electrolyte need monitoring.

ileostomy

A hard mass of stool that forms in the rectum or colon that the patient is unable to expel

impaction

Prolonged constipation

impaction

Weakening of muscles in the rectum

incontinence

Opioids Anticholinergics Histamine antagonists Antacids Calcium supplements Iron supplements

increase likely hood of constipation

Antibiotics Laxatives Cathartics Stool softeners

increase likely hood of diarrhea

Connecting the terminal portion of the ileum to a reservoir pouch inside the abdomen Constructing a valve in the pouch and bringing out the stoma through the abdominal wall Accessing the pouch using a catheter several times a day to drain feces from the pouch

kock pouch

Sigmoid colostomy

left lower quadrant

Descending Colostomy

left sided tumors

Temporary colostomy, usually created in an emergency Location: On the right abdomen Involves bringing a loop of the bowel out onto the abdominal wall Has one stoma with two openings: the proximal end of the stoma discharges stool; the distal end may discharge mucus Results in a large stoma that may be difficult to manage because of its size and inability to be covered with available ostomy products

loop colostomy

Antacids

neutralize the acids in the stomach

Religious fasting may influence

nutrition and elimination patterns.

Bowel diversion procedures are used for patients who are unable to pass feces through the rectum. These procedures divert fecal material from its normal intestinal pathway into a surgically created opening, called an

ostomy.

paralytic ileus

paralysis of intestinal peristalsis

If the intestines are manipulated during surgery, intestinal movement stops, causing a

paralytic ileus

Patients who are too shy or embarrassed to use the bathroom Patients who have a spinal cord injury Patients who received general anesthesia

patients affected by constipation

Patients who receive high doses of antibiotics or long-term antibiotic therapy Patients who receive enteral nutrition

patients affected by diarrhea

Patients who are immobile, debilitated, confused, or unconscious

patients affected by impaction

Have a spinal cord injury Have a neurological condition such as multiple sclerosis Are unconscious or sedated

patients who have a disability who cant control defecation

Is used for treatment of colorectal cancer and lower digestive tract illnesses or diseases Involves the removal of a part of the colon Involves creation of stomas when one end of the bowel is brought out through an ostomy Involves the removal or sewing shut of the remaining intestine after the ostomy Is also known as end, or terminal, colostomy

permanent colostomy

Person chooses not to go to the bathroom while eating dinner with friends.

person habits

Lack of privacy Inconvenience Busy bathroom schedules Embarrassment

personal habits that affect elimination

Person plays a computer game rather than hiking with friends.

physical activity

a person eats foods high in fiber, it affects bowel elimination

positively

Person is experiencing high work-related stress.

psychological factors

The normal posture during defecation is

squatting.

Part of the large or small intestine is rerouted (diverted) to the skin's surface through an ostomy and fecal matter exits the body through a

stoma

Loss of voluntary control of bowel elimination.

stool incontinence

hemmorrhoids

swollen, twisted, varicose veins in the rectal region

Is performed in emergency situations Allows the lower portion of the colon to rest or heal Is designed to be closed at a later time May have one or two openings (with two, one of them will discharge only mucus)

temporary colostomy

has a stoma, the patient is incontinent and requires periodic evacuation of the pouch by using a catheter.

the Kock pouch

Transverse Colostomy

transverse colon (usually temporary). ostomy return is firm, very foul odor, pouch is worn continuously

Location: Second segment of the colon; stoma located in the upper, middle to right side of the abdomen Stool characteristics: Drainage is semi-formed liquid and cannot be regulated; malodorous Often used in emergencies such as intestinal obstruction or perforation, as it can be created quickly Versions: One opening (single-barrel), two openings (double-barrel), or loop

transverse colostomy

may result in one or two stomas

transverse colostomy

Children cannot control defecation until about the age of

two years.

Descending colostomy

upper left quadrant

Transverse colostomy

upper middle to right of abdomen