NURS 302: Ch. 38 Bowel Elimination

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How often do peristalsis contractions occur?

Every 3 to 12 minutes

How many times in a 24 hour period do mass peristalsis sweeps occur?

1-4 times

How much food waste is excreted in stool within 24 hrs?

1/3 to 1/2

3 Things the Large Intestine Absorbs

Water, sodium, and chloride

Valsalva Maneuver

Voluntary contraction of abdominal muscles to promote defecation.

When should a person be cautious doing the valsalva maneuver?

CV disease, glaucoma, increased IC pressure, new surgical wounds

Why is CV disease a cause for concern while doing the valsalva maneuver?

Can cause cardiac overload and cardiac arrhythmias. Basovagal response (stimulation of vagus nerve leads to a drop in BP) can cause a person to faint

Paralytic Ileus

Intestine has completely stopped (can occur temporarily [24-48 hrs] after anesthesia). Area dies (necrosis) and needs to be surgically removed quickly. Reason why monitoring bowel sounds every shift is important!

Constipating Foods

Cheese, lean meat, eggs, pasta

Foods with Laxative Effect

Fruits, veggies, bran, chocolate, alcohol, coffee

Gas-Producing Foods

Onions, cabbage, beans, cauliflower

____ ____ are a big problem with constipation

narcotic analgesics

If enteral tube feeding is too fast it can lead to ____

Diarrhea

Acute Diarrhea

Virus, food cause

Chronic Diarrhea

Brought on by disease

Common Bowel Elimination Problems

Incontinence, flatulence, hemorrhoids

Individuals at High Risk for Constipation

Patients on bed rest taking constipating meds, patients with reduced fluids or bulk in their diet, depressed patients, and patients with a CNS disease or local lesions that cause pain

Ileostomy

Bypasses large intestine, stools are frequent and liquid.

Transverse and Sigmoid Colostomy

Further down in the large intestine, stools are more solid

Size of stoma should stabilize within ____ to ____ weeks

6, 8

Normal bowel sounds occur every ____ to ____ seconds

5, 15

Abdominal Assessment (needs to be done in this order)

Skin, contour, shape, note any distention, auscultate in each quadrant

Order of listening in quadrents

Needs to listen in right lower quadrant first, then move up to right upper quadrant, across to left upper quadrant, and down to left lower quadrant

Bowel Sounds: Absent

Problem unless it's right after surgery

Bowel Sounds: Hypoactive

< 5 sounds/minute. Could be NPO or old.

Bowel Sounds: Hyperactive

35+ sounds/minute. Not feeling well

Bowel Sounds: Borborygmous

Constant churning and sounds. N&V

Palpate

Light touch, dominant hand on top and push. Ask if it hurts, same order as auscultation.

Percuss

Tap on finger and note sound. Attempting to locate and determine what you're percussing over.

Tympanic Noise during Percussion

Empty

Dull Sound during Percussion

Mass (tumor), fecal material, bone

Hyperresonance Sound during Percussion

Gas

Occult

Blood present but not visible

Guaiac Testing

Detects microscopic (occult) blood

Who should you never give a fleet enema to?

End-stage renal patient (electrolyte issues)

If medication is causing diarrhea what should you do?

Remove the med and attempt a different med

How much liquid is absorbed daily by the intestinal tract?

800-1000mL

Daytime Bowel Control is Normally Attained by ____ months of age

30

Breastfed Babies

Stool is yellow to golden, loose, little odor, and frequent (2-10 times/day)

Bottle Fed (formula) Babies

Stool is yellow to brown, paste-like, stronger odor due to decomposition of protein, and usually occur 1-2 times/day

A high ____ diet and daily fluid intake of ____ to ____mL/day facilitate bowel elimination

Fiber, 2000, 3000

What is the number 1 cause of constipation?

Overuse of laxatives

Frequent, bulky, greasy, and foul smelling stools in a child may indicate ____ ____

Cystic fibrosis

Pathologic Conditions that may cause Diarrhea

Diverticulitis, infection, malabsorption syndromes, neoplastic diseases (tumors), diabetic neuropathy, hyperthyroidism, and uremia (retention of urea in the blood)

Conditions that may cause Constipation

Diseases within the colon or rectum. Injury to, or degeneration of the spinal cord and megacolon

Opioids, antacids (not containing Mg), and anticholinergic meds ____ GI motility and can cause ____

Decrease, constipation

Who is at risk of contracting C. difficile?

Patients on antibiotics, normal flora is disrupted making it easier to grow. Usually a HAC

Recommendations for a patient preparing to take a fecal occult blood test

Avoid the foods (for 4 days) and drugs (7 days) that may alter the results, postpone test until 3 days after menstruation, postpone test if hematuria or hemorrhoids are present, postpone if patient has had a recent nose/throat bleed

Examples of Cathartics

Stronger effect on intestine than laxatives. Castor oil, cascara, senna, phenolphthalein, biscodyl (dulcolax) act chemically by stimulating peristalsis. Others such as Metamucil act by increasing intestinal bulk. Mineral oil and Colace soften fecal material

The most common types of solutions used for cleansing enemas (4)

Tap water, normal saline solution, soap solution, hypertonic solution

Large Volume Enemas that result in Rapid Colonic Emptying

Hypotonic (tap water) and isotonic (normal saline solution)

Oil Retention Enemas

lubricate stool and intestinal mucosa making defecation easier. 150-200mL for adults

Carminative Enemas

help to expel flatus from rectum and provide relief from gaseous distention (milk of molasses, magnesium sulfate-glycerin-water enema)

Medicated Enemas

provides meds that are absorbed through the rectal mucosa

Anthelmintic Enemas

destroy intestinal parasites

Carbon Dioxide Suppositories

Liberate about 200mL of gas which causes distention, causing stimulation and elimination impulses

How can using a suppository or daily cleansing enema be helpful in bowel incontinence?

Empty lower colon regularly and often help decrease incontinence

When are temporary ostomies used?

To allow the intestine to repair itself after inflammatory disease, some types of intestinal surgery, or injury

When are permanent ostomies used?

For debilitating intestinal diseases or cancer of colon/rectum

Continent Ileostomy

Internal pouch created that patient accesses through a nipple-like valve constructed from the ileum on the abdominal wall. Doesn't have to wear an external collection device, but the valve malfunctions frequently so this procedure has limited use

Ileoanal Reservoir

Terminal ileum is sutured directly to anus, pouch is created, and patient is able to control expulsion of feces through the intact anal sphincter. Has complications, candidates are carefully selected

Pale Stoma

Anemia

Dark or Purple/Blue Stoma

Compromised circulation, ishemia

Pouch that can be Drained (when is it emptied and replaced?)

Emptied when 1/3 full, replaced every 3-7 days

Nondrainable Pouches (when emptied?)

1/2 full

Are ileostomies irrigated?

No, fecal content is liquid and can't be controlled

Fiber Blockages in ileostomies

Foul-smelling watery output, abdominal cramping, distention, N&V

What should you encourage a patient with an ostomy to eat to control odor?

Dark green leafy veggies (chlorophyll deodorizes)

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