Bowel elimination

A client with irritable bowel syndrome has instructions to take psyllium for constipation. Which statement is important for the nurse to include in the teaching plan?

"Each dose should be taken with a full glass of water or juice"

1. Which statement by a client with an ileostomy alerts the nurse to the need for further education?

"I am going to have a bowel movement every morning when I irrigate the stoma."

Which statement provides evidence that an older adult who is prone to constipation is in need of further teaching?

"I need to take a laxative such as Milk of Magnesia if I don't have a BM every day"

Which statement by a client with diverticulosis alerts the nurse that the client needs additional health teaching?

"I should avoid eating high-fiber cereal." and "I should hold my breath and bear down when having a bowel movement."

Which client statement supports the nurses conclusion that a client understands the need to reestablish bowel flora after a week of diarrhea?

"I should eat a container of yogurt every day for a few days."

A health care provider prescribes a tap-water enema for a client. The client asks about the purpose of the enema. What should be included in the nurses response?

"It empties the bowel of stool."

A nurse is collecting a bowel elimination history from a newly admitted client with a medical diagnosis of possible bowel obstruction. Which question takes priority?

"When was the last time you moved your bowels?"

Which nursing diagnosis is most applicable to a client with fecal incontinence?

1. Bowel incontinence 2. Disturbed body image 3. Social isolation 4. Risk for impaired skin integrity (Deficient fluid volume would be more appropriate for someone with diarrhea)

A primary health-care provider prescribes docusate sodium in liquid form for a ptwho is constipated but has difficulty swallowing tablets. The prescription is for 200 mg daily to be divided into two doses, one in the a.m. and one at hour of sleep. The package insert states that there is 50 mg/5 mL. How much solution of docusate sodium should the nurse administer per dose?

10ml

During the first 24 hours after a client has had a permanent colostomy created, the nurse observes no drainage from the colostomy. Which circumstance explains this finding?

Absence of intestinal peristalsis

A client who sustained a cerebrovascular accident (CVA, also known as "brain attack") becomes incontinent of feces. Which nursing intervention is most important for supporting the success of the client's bowel training program.

Adhere to a definite time for attempted evacuations.

A client with a new stoma who has not had a bowel movement since surgery last week reports feeling nauseas. What is the appropriate nursing action?

After assessing the stoma and surrounding skin, notify the surgeon.

Foods that thicken stools

Applesauce, bananas, bread, cheese, yogurt, pasta, rice, pretzels, peanut butter

A client in experiencing constipation. Which nursing action facilitates defecation of a hard stool?

Applying a lubricant to the anus.a warm, wet washcloth against the perianal area, Encouraging the client to rock back and forth

Which should the nurse do before collecting a stool sample for occult blood?

Ask the client to void

Foods that increase stool odor

Asparagus, eggs, fish, beans, garlic, onions, cabbage, alcohol

Interventions for constipation

Assess usual bowel habits. Assess lifestyle (diet, fluid intake, exercise, medications), inspect for distention, auscultate bowel sounds, assess for impaction. Increase fiber intake to 18-25 g daily (prunes, leafy green vegetables, whole wheat bread/pasta), increase fluid intake to 1.5-2 quarts/day. Stool softeners, laxatives, enemas

Decreasing Flatulence

Avoid gas producing foods, exercise, movement in bed, ambulation, probiotics

A client is scheduled for discharge after surgery. The medical record indicates that the client has not had a bowel movement since before his surgery, which was 4 days ago. Which prescribed medication will the nurse administer to ensure bowel movement before discharge?

Bisacodyl suppository. Usually takes effect in 15-60 minutes. Lactulose takes about 24 hours, docusate sodium takes 1-3 days, and psyllium takes 12-24 hours.

A client is admitted with lower gastrointestinal tract bleeding. Which characteristic of the client's stool should the nurse assess for that supports the medical diagnosis?

Bright red-tinged stool

36. A nurse is caring for a group of clients with a variety of gastrointestinal problems. Which of the following can cause both diarrhea and constipation? Select

Cancer of the large intestines Side effects of medications

Which measures would the nurse take to prevent skin breakdown for a confused client experiencing bowel incontinence?

Check the clients buttocks at least every two hours and clean after incontinence.

Clients should be taught that repeatedly ignoring the sensation of needing to defecate could result in which?

Constipation

A client had a colonoscopy with several polyps excised for biopsies. The nurse teaches the client routine post-procedure expectations. Which of the following should the nurse instruct the client to report to the primary health-care provider?

Continuous abdominal cramping

5. A nurse is caring for a client who is experiencing diarrhea. Which physiological response to diarrhea should the nurse be most concerned about?

Dehydration

factors affecting bowel elimination

Development, diet, fluid intake, exercise, defecation habits (need for privacy, schedule), position during defecation (immobilized clients struggle), pregnancy (fetus pressure on rectum), medication (laxatives/side effect of antibiotics), anesthesia and surgery (slows down peristalsis for 24-48 hrs), pain

A nurse is caring for a group of clients. Which client factor should the nurse identify as placing a client at risk for bowel incontinence?

Disoriented to time, place, and person

Which action is important for the nurse to teach clients about the intake of bran to facilitate defecation?

Drink at least 8 glasses of fluids daily when taking bran.

A nurse discourages client from straining excessively when attempting to have a bowel movement. Which undesirable physiological response is the primary reason why straining on defecation should be avoided?

Dysthymia

A nurse is assessing a client who has a distended abdomen resulting from flatulence. The client has a prescription for a regular diet and an activity prescription for "out of bed". Which can the nurse do to promote passage of the intestinal gas?

Encourage the client to ambulate.

25. While providing a health history, the client tells the nurse "I have gastroesophageal reflux disease". Which most serious consequence associated with this disorder should the nurse anticipate this client may develop?

Esophageal erosion

A nurse is teaching a client with a cardiac condition to avoid the Valsalva maneuver. Which should the nurse teach the client to do?

Exhale while contracting the abdominal muscles.

The nurse is caring for a client who is having diarrhea. Which client data would the nurse closely monitor to prevent an adverse outcome?

Fluid and electrolyte balance

constipation

Hard, slow stools that are difficult to eliminate; often a result of too little fiber in the diet

Which outcome is most appropriate for a client with perceived constipation?

Have a bowel movement without the use of a laxative.

A nurse determines that the teaching about a guaiac test of stool is understood when the client states that it identifies the presence of which of the following?

Hidden blood

A nurse performs a physical assessment of a newly admitted client who is incontinent of stool. For which characteristic related to bowel incontinence should the nurse assess the client?

Involuntary passage of stool

Peristalsis

Involuntary waves of muscle contraction that keep food moving along in one direction through the digestive system.

The nurse discusses the regaining of bowel control with a client who recently had surgery for a colostomy in the descending colon. Which is important to emphasize in the teaching?

Irrigation routine

Which word is specific regarding how a soapsuds enema works on the mucosa of the bowel?

Irritating

A primary health care provides prescribes and return flow enema for an adult client with flatulence. When preparing to administer this enema, the nurse compares the steps of a return flow enema with those for cleansing enemas. Which nursing intervention is unique to a return flow enema?

Lower the solution container after instilling about 150 mL of solution.

Which should the nurse do when administering a small volume hypertonic enema to an adult?

Maintain the compression of the enema container until after withdrawing the tube.

Risk factor for diarrhea

Medications, alcohol abuse, laxative abuse, tube feedings, stress, anxiety, infectious process, inflammation, parasites, mal-absorption

A nurse is implementing a prescribed bowel preparation for a client who is scheduled for a colonoscopy. Which is the most serious consequence that is prevented by an effective bowel preparation?

Misdiagnosis

Assessing bowel elimination

Normal bowel pattern, description of usual feces, recent changes, diet history, past problems, presence of ostomy. Assess the abdomen, rectum, and anus. Inspect the feces.

A nurse identifies that a clients colostomy stoma is pale. Which should the nurse do?

Notify the surgeon

A nurse is performing a physical assessment of a client concerning the gastrointestinal system. Place the interventions in order

Observe the contour and symmetry of the abdomen, Inspect the anus and perianal area visually, Auscultate the entire abdomen for bowel sounds, Percuss the abdomen for the quality of sounds, palpate the abdomen

The nurse is caring for an older adult who has constipation. Which independent nursing intervention helps reestablish a normal bowel pattern?

Offer a cup of prune juice

10. A nurse must collect a specimen for the presence of pinworms. Which action is essential to ensure accuracy of the specimen?

Perform the procedure the first thing in the morning before the first bowel movement.

A nurse is to administer an oil-retention enema, a tap-water enema, and a return- flow enema to three different clients. Which of the following should be performed with all three enemas?

Place the client in the left side-lying position. Use water-soluble jelly to lubricate the tip of the rectal probe. Pull the curtain around the client's bed and drape the client.

A school nurse is planning a health class about bodily functions. Which information should be included regarding the purpose of mucus in the gastrointestinal tract?

Protects the gastric mucosa

Interventions for diarrhea

Provide info on food that can cause diarrhea, encourage fluid intake, monitor fluid and electrolyte balance, monitor skin integrity, encourage non-spicy foods, encourage BRAT foods (Banana, rice, applesauce,toast) Meds: antidiarrheal, opiates, anticholinergics, antibiotics, lactobacillus products, probiotics.

33. A nurse is assisting a client with a regular bedpan. Which nursing action is essential?

Remain outside the curtains of the bed until the client is done using the bedpan. Elevate the head of the bed to the Fowler position after the client is on the bedpan. Raise the side rails on both sides of the bed after the client is positioned on the bedpan.

The nurse assesses a client's abdomen several days after abdominal surgery. It is firm, distended, and painful to palpate. The client reports feeling "bloated". The nurse consults with the surgeon, who orders an enema. The nurse prepares to give what kind of enema?

Return flow. This provides relief of postoperative flatus, stimulating bowel motility. Soapsuds enemas, Retention enemas, and oil retention enemas manage constipation, not flatus.

Nursing diagnoses related to diarrhea

Risk for deficit fluid volume, risk for electrolyte imbalance, risk for impaired skin integrity

20. A nurse is caring for a client with an intestinal stoma. Which intervention is most important?

Selecting a bag with an appropriate-size stomal opening

Which is most likely to validate that a client is experiencing intestinal bleeding?

Semisoft black colored stools. Blood in the upper GI tract is black and tarry.

The nurse should use a fracture bedpan for clients with which conditions?

Spinal cord injury

A client is attending the health clinic for treatment of hemorrhoids. The nurse reviews the client's history, interviews the client, and performs a focused assessment. Which of the following in the client's history does the nurse conclude may have influenced the development of the hemorrhoids?

Stands for long periods of time at work Has had multiple pregnancies Tend to have constipation Has a disease of the liver Is obese

15. A nurse is teaching a client how to irrigate a colostomy. The client asks "Why is it necessary to use the cone attachment to the irrigation catheter?" What information should the nurse include in a response to this question?

Stops enema solution from flowing out of the bowel during the procedure

Which goal is the most appropriate for clients with diarrhea related to ingestion of an antibiotic for an upper respiratory infection?

The client will return to his or her previous fecal elimination pattern

Which would the nurse include in dietary teaching for a client with a colostomy?

The diet should be adjusted to result in manageable stools

The nurse is most likely to report which finding to the primary care provider for a client who has an established colostomy?

The stoma is deep red-purple. An established stoma should be dark pink and is slightly raised above the abdomen. The skin under the appliance may remain pink/red for a while after the adhesive is pulled off. Feces from an ascending ostomy are very liquid, less so from a transverse ostomy, and more solid from a descending or sigmoid stoma.

The nurse obtains daily stool specimens for a client with chronic bowel inflammation. The nurse recognizes that the stool examinations were prescribed for which reason?

To determine the presence of occult blood

A nurse identifies that a client has tarry stools. Which problem should the nurse conclude that the client is experiencing?

Upper gastrointestinal bleeding

A nurse is teaching a client with a history of constipation about excessive use of laxatives. Which effect of laxatives should the nurse include as the primary reason why their use should be avoided?

Weakens the natural response to defecation

A nurse is providing dietary teaching to a client with acute diverticulitis who has a prescription for a low-fiber diet. Which food selected by the client indicates that the dietary teaching was understood?

White rice, soft tofu, turkey, pasta

Risk factors for constipation

abdominal muscle weakness, decreased physical activity, poor defecation habits, environmental changes, electrolyte imbalance, hemorrhoids, pregnancy, prostate enlargement, rectal impairments, post-surgical bowel obstruction, opioids, iron supplements, antihistamines, antidepressants, dehydration, decreased GI motility, change in eating habits, insufficient fiber intake, confusion, depression, emotional disturbance

Foods that loosen stools

chocolate, dried beans, fried/greasy foods, highly spiced foods, leafy green vegetables, raw fruits and juices, raw vegetables

Enemas

cleansing (tap water, normal saline, hypertonic solutions, soapsuds), oil retention, carminative and kayexalate

hemmorrhoids

dilated, engorged veins in the lining of the rectum

defecation

elimination of feces

diarrhea

frequent passage of loose, watery stools. At least 3 loose stools/day. Bowel urgency, abdominal cramping, weakness, malaise, fatigue

flatulence

gas in the stomach or intestines

gastrocolic reflex

increased peristalsis of the colon after food has entered the stomach

recent black stool

iron supplements

A client is scheduled for a colonoscopy. The nurse will provide information to the client about which type of enema?

low, small volume. Small volume enemas are used to prepare clients for this procedure. An oil retention enema is used to soften hard stool. Return flow enemas help expel flatus. Large volume enemas are seldom used due to risk of loss of fluid and electrolytes.

Impaction

results from unrelieved constipation; a collection of hardened feces wedged in the rectum that a person cannot expel

bowel incontinence

the inability to control the excretion of feces