Bowel Elimination and Care

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Questions and Answers

A patient reports infrequent bowel movements, difficulty in passing stools, and a feeling of incomplete evacuation. Which condition is the patient most likely experiencing?

  • Constipation (correct)
  • Fecal incontinence
  • Diarrhea
  • Fecal impaction

A nurse is assessing a patient's bowel elimination patterns. Which question would be most appropriate to gather relevant information?

  • Do you have a family history of gastrointestinal diseases?
  • How often do you consume caffeinated beverages?
  • What is your preferred method of stress management?
  • Can you describe the usual color and consistency of your stools? (correct)

A patient is undergoing an assessment of their bowel elimination. Which of the following assessment techniques should the nurse perform?

  • Auscultation of bowel sounds in all four quadrants. (correct)
  • Deep palpation of the liver to assess for enlargement.
  • Percussion of the abdomen to identify masses.
  • Inspection of oral mucosa for signs of dehydration.

A client has been experiencing frequent episodes of watery stools. Which nursing intervention is most appropriate for managing this condition?

<p>Encouraging consumption of a clear liquid diet. (D)</p> Signup and view all the answers

A patient is scheduled for a colonoscopy. Which type of enema would the nurse anticipate being prescribed?

<p>Hypertonic enema. (D)</p> Signup and view all the answers

A nurse is caring for a patient who reports excessive flatulence. Which dietary modification is most likely to alleviate this symptom?

<p>Limiting consumption of beans and legumes. (B)</p> Signup and view all the answers

A patient with a history of cardiac disease is constipated. Which type of enema is contraindicated for this patient?

<p>Large volume enema (B)</p> Signup and view all the answers

A patient reports having black, tarry stools. What condition should the nurse suspect?

<p>Occult blood (A)</p> Signup and view all the answers

A patient is scheduled for an ostomy surgery due to ulcerative colitis. Where is the most likely location for the ostomy placement?

<p>Sigmoid colon (B)</p> Signup and view all the answers

A nurse is preparing to administer an enema to a patient. Which position will facilitate the procedure and promote optimal results?

<p>Side-lying (Sims') (A)</p> Signup and view all the answers

A nurse is teaching a patient how to manage their new colostomy. What should the nurse emphasize regarding skin care around the stoma?

<p>Washing the area with mild soap and water and patting dry. (C)</p> Signup and view all the answers

A patient with a new ileostomy is concerned about maintaining adequate hydration. What should the nurse advise this patient?

<p>Consume electrolyte-rich beverages to replace losses. (C)</p> Signup and view all the answers

A nurse is reviewing the fecal occult blood test (FOBT) results for a patient. Which statement accurately describes this diagnostic test?

<p>It identifies the presence of hidden blood in the stool. (D)</p> Signup and view all the answers

A patient with a sigmoid colostomy reports constipation. What initial intervention should the nurse recommend?

<p>Increasing fluid and fiber intake. (A)</p> Signup and view all the answers

A patient with an ileostomy is experiencing a blockage. Which dietary instruction is most crucial for the nurse to provide?

<p>Avoid foods high in insoluble fiber. (A)</p> Signup and view all the answers

A nurse assesses a patient who has not had a bowel movement in 4 days. The patient reports abdominal discomfort and distention. Which condition is most consistent with these findings?

<p>Constipation (D)</p> Signup and view all the answers

A patient who has been taking antibiotics for an extended period develops diarrhea. Which intervention is most appropriate in this case?

<p>Suggest consuming yogurt with live cultures. (B)</p> Signup and view all the answers

A nurse is caring for a patient with fecal incontinence. What is the priority nursing intervention?

<p>Maintaining skin integrity. (B)</p> Signup and view all the answers

A patient complains of abdominal cramping and frequent, urgent bowel movements containing mucus and blood. Which condition should the nurse suspect?

<p>Ulcerative colitis (C)</p> Signup and view all the answers

A patient with a colostomy is preparing to travel by air. What advice should the nurse provide to help manage their bowel elimination needs during the flight?

<p>Pack extra ostomy supplies in a carry-on bag. (B)</p> Signup and view all the answers

A nurse is providing education to a patient with chronic constipation. Which of the following lifestyle modifications is most effective?

<p>Increasing dietary fiber and fluid intake. (C)</p> Signup and view all the answers

A patient reports experiencing a vagal response during the administration of an enema. Which of the following is the most appropriate initial action by the nurse?

<p>Discontinuing the enema and monitoring the patient's heart rate and blood pressure. (D)</p> Signup and view all the answers

A nurse is caring for a patient with a history of Crohn's disease who reports frequent episodes of steatorrhea. Which dietary modification should the nurse suggest?

<p>Limiting fat intake to decrease stool fat content. (A)</p> Signup and view all the answers

A patient with a new ileostomy is being discharged. What teaching point should the nurse emphasize regarding medication administration?

<p>Expect delayed absorption of enteric-coated medications. (D)</p> Signup and view all the answers

A nurse is assessing a patient with a colostomy. What characteristic of the stool would be expected from an ascending colostomy?

<p>Liquid stool (D)</p> Signup and view all the answers

A patient who is recovering from surgery is prescribed opioid pain medication and has not had a bowel movement in three days. What intervention should the nurse implement first?

<p>Encourage increased fluid and fiber intake. (B)</p> Signup and view all the answers

A nurse is preparing to perform digital removal of stool for a patient with a fecal impaction. What potential complication should the nurse closely monitor for?

<p>Vagal response (D)</p> Signup and view all the answers

A patient with a history of heart failure is prescribed an enema for severe constipation. Which type of enema is safest to administer?

<p>Normal saline enema (C)</p> Signup and view all the answers

A nurse discovers that a patient's stoma is pale and dusky. What should the nurse do first?

<p>Notify the health care provider immediately. (D)</p> Signup and view all the answers

A nurse is teaching a patient about the BRAT diet for managing diarrhea. What foods are included in this diet?

<p>Bananas, Rice, Applesauce, Toast (D)</p> Signup and view all the answers

A patient awaiting ostomy surgery asks the nurse what to expect regarding the color of a healthy stoma. What's the most accurate response?

<p>&quot;It should be brick red.&quot; (D)</p> Signup and view all the answers

A nurse is caring for a patient with fecal incontinence due to a neurological disorder. What should be included in the nursing care plan?

<p>Implementing a bowel training program. (A)</p> Signup and view all the answers

A nurse is teaching a patient with a new colostomy how to irrigate their colostomy at home. What should the nurse include?

<p>Use of tap water is appropriate (A)</p> Signup and view all the answers

For a patient experiencing severe diarrhea, what would be the most appropriate initial dietary modification?

<p>A clear liquid diet (B)</p> Signup and view all the answers

During assessment of a patient, the nurse notes an abdominal mass with palpation. What is the next best action?

<p>Notify the provider of the findings (C)</p> Signup and view all the answers

A patient with frequent liquid stools from an ileostomy is most at risk for what complication?

<p>Dehydration (B)</p> Signup and view all the answers

Which of the following is a common cause of constipation?

<p>Use of opioid medications (B)</p> Signup and view all the answers

A patient is scheduled for a hemoccult test, and asks the nurse what it screens for. What is the best answer?

<p>Hidden blood (C)</p> Signup and view all the answers

Flashcards

What is defecation?

The process of bowel elimination, involving the contraction of intestinal muscles to move waste.

What is peristalsis?

Rhythmic wave-like movements that propel food through the GI tract.

What is flatus?

Intestinal gas.

Factors affecting bowel elimination?

This includes types of food, fluid intake, medications, emotions, neuromuscular function, opportunity for defecation, surgery and allergies.

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Components assessed during bowel assessment?

Gathering data about elimination patterns and stool characteristics.

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Physical examination during bowel assessment?

Inspecting the abdomen's shape and auscultating for bowel sounds are parts of this.

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Alterations in bowel elimination?

Changes in frequency, consistency, or ease of passing stool.

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What is constipation?

Infrequent or difficult bowel movements.

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What is diarrhea?

Loose, watery stools.

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What is a fecal impaction?

A mass of hardened stool in the rectum.

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What is fecal incontinence?

Involuntary passage of stool.

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Nursing interventions for diarrhea?

Clear liquid diet, push fluids, BRAT diet (Bananas, Rice, Applesauce, Toast).

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What is steatorrhea?

An abnormal amount of undigested fat in the stool.

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What is frank blood?

Bright red blood in the stool.

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What are culture and sensitivity (C&S) tests?

Tests for microorganisms and their antibiotic sensitivities in stool.

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What are ova and parasite (O&P) tests?

Tests for parasitic worms and their eggs in stool.

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Nursing interventions to promote bowel function?

Increase physical activity, ensure adequate fluid, increase fiber intake.

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What is a rectal suppository?

A medication inserted into the rectum to stimulate bowel movement.

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What are enemas?

Solutions used to cleanse the bowel or deliver medication.

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Contraindications to an enema?

Rectal surgery, severe hemorrhoids, ulcerative colitis, rectal fissure.

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Cancerous tumor, ulcerative colitis, traumatic abdominal injury.

Conditions that may necessitate a bowel diversion.

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What is an ostomy?

Surgical opening in the abdomen for waste elimination.

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Ileostomy Stool?

Liquid stool.

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Colostomy Stool?

Ascending: frequent, liquid stools, Transverse: semi-solid. Descending: near-normal stool

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What is Stoma and Peristomal Care?

Involves cleaning the stoma and surrounding skin.

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What is ostomy irrigation?

This involves flushing the stoma to promote regular emptying.

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Study Notes

Bowel Elimination and Care

Defecation

  • Defecation refers to the process of bowel elimination or bowel movement.
  • Peristalsis involves rhythmic, wavelike movements that propel food boluses through the GI tract.
  • These movements become more active upon eating and rely on the contraction of circular and longitudinal muscles in the GI tract walls, starting from the esophagus down to the rectum.
  • Flatus is intestinal gas
    • Interventions can relieve discomfort and help to "eliminate” gas.

Key Anatomy

  • The small intestine is 20 feet long:
    • Made up of the duodenum, jejunum, and ileum.
  • The large intestine is 5 feet long:
    • Composed of the cecum, colon, and rectum.
  • The pathway of food materials follows:
    • Mouth → Pharynx → Esophagus → Stomach → Small Intestine (duodenum, jejunum, ileum) → Large Intestine (cecum, colon- ascending, transverse, descending, sigmoid, rectum) → Anus.

Factors Affecting Bowel Elimination

  • Types of food
  • Fluid intake
  • Drugs
  • Emotions
  • Neuromuscular function
  • Abdominal muscle tone
  • Opportunity for defecation
  • Surgery
  • Allergies
  • Pregnancy
  • Laxative abuse
  • Aging
  • Structural changes
  • Chemical changes

Assessment of Bowel Elimination

  • Elimination Patterns and Characteristics of Stool.
    • Inspect the shape of the abdomen.
    • Auscultate the bowel sounds.
    • Palpate the abdomen.
    • Ask about pain.

Alterations in Bowel Elimination

  • Constipation
    • Primary
    • Secondary
    • Iatrogenic
    • Pseudo constipation
  • Diarrhea
  • Impaction
  • Fecal incontinence

Nursing Interventions for Diarrhea

  • Clear liquid diet helps rest and heal the GI tract.
  • Push fluids, such as Gatorade and Pedialyte.
  • BRAT Diet includes Bananas, Rice, Applesauce, and Toast.
  • Yogurt and probiotics

Abnormal Conditions of Stool:

  • Steatorrhea: stool containing an abnormal amount of undigested fat.
    • Indicates a malabsorption disorder like Crohn's ("fluffy and floats").
  • Frank blood: bright red blood in the stool.
    • May indicate caused by hemorrhoids, intestinal bleeding, or hemorrhage.
  • Occult blood: hidden blood in the stool.
    • Guaiac test detects blood in the stool.

Laboratory Tests

  • Culture and sensitivity (C&S): Identifies microorganisms infecting the stool and the antibiotics that can kill them.
  • Ova and parasite test (O&P): Detects the presence of parasitic worms and their eggs.

Nursing Interventions to Promote Bowel Function

  • Increase physical activity levels.
  • Ensure adequate fluid intake of at least 2,500 mL/day.
  • Increase fiber intake to 20 to 30 g/day gradually.
  • Provide privacy.
  • Position patients upright for elimination.
  • Provide stimulants like a cup of hot coffee before breakfast.

Measures to Promote Bowel Elimination

  • Rectal Suppository and Enemas.
    • Types: Cleansing and Retention; Enemas given as a 30 min retention

Cleansing Enemas Solutions

  • Tap Water
  • Normal Saline
  • Soapsuds
  • Hypertonic Solution

Contraindications to an Enema

  • Rectal surgery
  • Severely bleeding hemorrhoids
  • Ulcerative colitis or Crohn's disease
  • Rectal fissure
  • Rectal cancer
  • Potential for excessive bleeding
  • Heart conditions i.e. MI, unstable angina.

Enema Complications

  • Vagal Response: Monitor for signs/symptoms and be prepared with interventions.
  • Perforation of colon.
  • Cancerous tumor
  • Infarcted area with ischemic/died walls
  • Disease process
  • Ruptured diverticulum
  • Ulcerative colitis
  • Traumatic abdominal injury

Ostomies

  • Ileostomy:
    • Liquid stool.
  • Colostomy utilizes the colon.
  • Continent ostomy uses a Kock pouch.
    • Requires draining every 4-6 hours and patient teaching.

Colostomy Types

  • Ascending colostomy: Frequent, liquid stools.
  • Transverse colostomy: Semi-solid, some form, soft stool.
  • Descending colostomy: Near-normal stool.

Ostomies Care

  • Focus on Stoma and Peristomal areas.
  • Irrigation is necessary for solid stool.
    • The process is similar to administering an enema.

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