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Terms in this set (63)
What factors affect bowel elimination?
-Position during defecation
-Surgery & anesthesia
Common bowel elimination problems?
constipation, impaction, diarrhea, incontinence, flatulence, hemorrhoids
What is an indication of constipation?
<3 per week with hard, dry stools
What are causes of constipation?
•Irregular bowel habits
•Chronic illnesses (arthritis, depression) or neurological conditions or chronic bowel dysfunction
•Low fiber diet high in animal fats, low fluid intake
•Changes in life or routines (pregnancy, travel
What interventions can be done for constipation?
•Diet modification and fiber
What is impaction?
•A collection of hardened feces wedged in the rectum that a person cannot expel for several days
What are risk factors for impaction?
What are signs and symptoms of impaction?
•Oozing of liquid stools
•Loss of appetite
•Nausea or vomiting
•Abdominal distention and cramping
What interventions should be done with impaction?
◦Digital rectal exam
◦Removal of impaction
What is diarrhea?
•Increase in number of stools and the passage of liquid or unformed stools
What are concerns with diarrhea?
•Fluid and electrolyte imbalance
Skin breakdown (perineum and buttocks
What are causes of diarrhea?
•Food intolerances or allergies
•Hospital acquired pathogens (C. diff, VRE)
•Food borne pathogens
What is incontinence?
•Physical condition that causes the inability to control passage of feces and gas to the anus
•Impair anal sphincter function or large volume liquid stools.
What are causes of Incontinece?
•Bowel (Crohn's disease) or neurological disease (spinal cord injuries) or malignancy (rectal cancer)
•Pathogens (C. diff, parasites)
How can incontinence impact a patient?
Harms body image or social isolation
What is flatulence?
•Gas accumulation in the lumen of intestines and bowel walls
What are symptoms of flatulence?
What are causes of flatulence?
What are hemorrhoids?
•Dilated, engorged veins in the lining of rectum
•External (clear protrusion with purplish discoloration)
• Internal (anal canal with inflammation and distention)
What are causes of hemorrhoids?
•Straining (venous pressure at defecation)
•Chronic liver disease
What should be asked in a health history about bowel elimination?
•Recent illness or stressors
What should be asked about nutrition during assessment?
•Fluid and food intake
What should be asked about bowel elimination patterns?
What needs to be assessed in the physical exam?
•Mouth, abdomen, rectum
What should be assessed for bowel elimination?
-Daily fluid intake
-Surgery or illness
-Pain or discomfort
-Mobility and dexterity
What is assessed in diagnostics & laboratory testing?
•Fecal occult blood test (FOBT)
•Fecal immunochemical test (FIT)
Nursing diagnosis for bowel elimination?
-Disturbed body image
-Risk for constipation
-Deficit knowledge (nutrition)
Acute care management: Bowel Diversions
Care of ostomies
Acute care management: Promoting normal defecation
Acute Care management: Health promotion and patient teaching
Temporary or permanent artificial opening in the abdominal wall
Ileostomy or Colostomy
Surgical opening in the ileum or colon
Thick liquid to soft consistency
2 openings: fecal (proximal) and mucus (distal)
How should you care for ostomies?
Assess stoma and skin breakdown
How should stoma look?
Pink or Red
What should be looked or stomas?
•Look for skin irritation and breakdown from GI content
•Fungal rashes, folliculitis or ulcerations
How should you care for a pouch?
•Change every 3 to 7 days
•Empty pouch when 1/3 to ½ full
Patient teaching & participation with stomas
•Psychosocial: Body image disturbances
Who do you refer a wound ostomy to?
Post operative ostomies nutritional considerations?
•Will take a few days for appetite to return
•Small servings of soft foods
Colostomies nutritional considerations?
•Regular diet with adequate fiber to keep stool soft
Ileostomies nutritional considerations?
•Risk for Dehydration: will lose fluid and salt through stoma
•Encourage drinking of 8 oz. of water after emptying pouch
Nutritional considerations with food blockage with indigestible fiber?
•Rare with ileostomies
•Corn, popcorn, raw mushrooms, fresh pineapples, Chinese cabbage
•Advise to eat small amounts (chew thoroughly) and increase fluids
How to promote defecation?
Environment & Position
How can environment help promote defecation?
•Maintain privacy and sensitivity
•Bedpan or commode for non-ambulatory patients
How can positioning help defecation?
•Types: Regular and Fracture
•Prevent muscle strain and discomfort.
•Never lift a patient onto a bed pan
•HOB elevated 30-45 degrees
Cathartics & laxatives
•Cathartics have a stronger and more rapid effect on the intestines than laxatives
•Suppositories may act more quickly than oral medications
Some agents contain opiates
◦Tap water (hypotonic)
◦Normal saline (safest)
Other types of enemas
Carminative & Kayexalate
How do you administer enema?
•Position patient in side lying position (Sims)
•Caution with patients with cardiac disease - vagus nerve stimulation
•Explain the procedure, positioning, precautions to avoid discomfort, and length of time necessary to retain the solution before defecation.
How do you digitally remove fecal impaction?
•Use if enemas fail to remove an impaction.
•Last resort in managing severe constipation.
•Loosening of fecal mass by massaging around it.
•May follow with enema or cathartics
What is the purpose of nasogastric tubes?
•Decompression, enteral feeding, compression, and lavage
What are the categories of NG tubes
•Fine- or small-bore for medication administration and enteral feedings
•Large-bore (12-French and above) for gastric decompression or removal of gastric secretions
Patient teachings for bowel training
Defecation at the same time each day
Patient teachings maintenance of proper fluid and food intake
•Well balanced with whole grains, legumes, fresh fruits and vegetables
•Increase fiber and fluids
Patient teachings promotion of regular exercise
•AHA & CDC recommends 150 minutes of exercise each week
Health promotion management of fecal incontinence or diarrhea
Consider fecal management system (FMS)
Health promotion maintenance of skin integrity
•Stool and digestive enzymes an be caustic to skin
•Meticulous perianal skin care
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