Bowel Elimination Student View PDF

1 NURS 3125 CHAPTER 47  2 Class objectives  Reading: Fundamentals of Nursing, P&P, Chapters 46 & 47 Explain the function and role of urinary system structures in urine formation a...

1 NURS 3125 CHAPTER 47  2 Class objectives  Reading: Fundamentals of Nursing, P&P, Chapters 46 & 47 Explain the function and role of urinary system structures in urine formation and elimination. (CO 1) Understand factors that commonly impact urinary elimination. (CO 1,7) Know common alterations associated with urinary elimination. (CO 8) Interpret features of normal and abnormal urine. (CO 2) Be familiar with common diagnostic tests of the urinary system. (CO 1,2) Know the role of the gastrointestinal organs and their physiological function in digestion and elimination. (CO 1) Understand how psychological and physiological factors may alter the elimination process. (CO 4,5) Discuss nursing interventions that promote normal elimination. (CO 7) Pages 1301-1304 are covered in Lab this semester, Pages 1305-1311 Inserting and Maintaining an NG Tube is a skill next semester You do need to read 1311-1314 Pouching an Ostomy Bag  3 Introduction  Regular elimination of bowel waste products is essential for normal body functioning.  Alterations are early signs problems in the gastrointestinal tract or other body systems  Supportive nursing care respects a patient's privacy and emotional needs  4 Quick review GI tract=alimentary canal and it’s accessory organs Teeth Tongue Salivary glands Liver Pancreas Gallbladder Is the GI tract sterile?  5 Factors that can influence normal bowel elimination  Position during  Age defecation  Diet  Pain  Fluid intake  Pregnancy  Physical activity  Surgery and  Psychological factors anesthesia  Medications  Personal habits  Diagnostic tests  6 Recognize Cues  History  Physical assessment  Mouth  Abdomen- What might you see? Hear?  Diagnostic Data  Laboratory tests- H & H, liver profile  Fecal specimens- stool culture; occult blood,  Diagnostic tests- abdominal x-rays, CT, Ultrasound, barium swallow/enema, endoscopy  7 Common elimination problems- Analyze Cues  Constipation- a symptom not a specific disease  Impaction-unrelieved constipation, hardened stool is not expelled, may ooze liquid around the impaction  Diarrhea-increase in number and passage of unformed stool  Incontinence-inability to control passage of gas and/or feces  Flatulence  Hemorrhoids Who is at risk of experiencing these difficulties? 8  9 Assessment  Through your nursing history, physical assessment, review of data and test results  Ask specific questions  Explain procedures  Client may be too embarrassed to discuss their bowel habits  10  Things to look up… Hint: use your textbook or Nursing Prioritize Care Plan book  Bowel Hypotheses Incontinence  Constipation  Risk for Constipation  Diarrhea  Lack of Knowledge of Dietary Regime  11 SETTING PRIORITIES  Patients often have multiple diagnoses Generating  TEAMWORK AND COLLABORATION solutions  IS THE PROBLEM URGENT?  WHAT CAN BE DONE NOW?  12 Generate solutions- Health promotion  Prevention and Privacy!!  Promotion of normal defecation  Sitting position preferred  Bedside commode  Routines are good  Positioning on bedpan  Regular bedpan  Fracture pan Take Action for Constipation: 13 Laxatives and Cathartics  Laxatives  Bulk Forming-Citrucel, Metamucil, Fibercon  Absorb water and increase bulk  Lest irritating, safest  Stool Softeners  Colace, Surfak  Lower surface tension of stool, allowing water and fat to penetrate  Short term therapy to relieve straining  14 Laxatives and Cathartics  Osmotic Laxatives  Magnesium citrate, Milk of Mag, Fleet Phospho-Soda, Lactulose  Osmotic effect increases pressure in bowels to stimulate peristalsis, pull fluid into the bowel to soften  Used for acute emptying of bowel. NOT for long-term management of constipation!!  Table 47.2 Common Types of Laxatives  15 Cathartics  Have a stronger and more rapid effect on the intestines than laxatives  Suppositories may act more quickly than oral medications  Can cause severe cramping, not for long term use  May be needed for those with constipation related to opioid use  16 Take Action- Diarrhea treatment  Antidiarrheal agents  lopermide (Immodium AD); OTC  diphenoxylate/atropine (Lomotil); RX controlled substance  Pepto-Bismol  Opiates used with caution  17 Take Action-Enemas  Cleansing Enemas  Tap Water  Normal Saline  Hypertonic Solutions-Fleets enema  Contraindicated in dehydrated clients and young infants  Oil Retention  Other types  Carminative and Harris Flush-provide relief from gas  Kayexalate-used to treat dangerously high serum potassium levels  18 Take action- enemas and impactions  Enema administration  Sterile technique is unnecessary  Wear gloves  Explain the procedure, positioning, precautions to avoid discomfort, and length of time necessary to retain the solution before defecation  In what position do you place the patient?  You will learn this skills in lab! Take action- fecal impaction 19  Impaction – severe constipation and retention of stool- backs upward from colon- complication- bowel obstruction  Who is at risk for impaction?  Cues: oozing liquid stool; decreased appetite, pain, cramping  Digital removal of stool  Use if enemas fail to remove an impaction  Last resort in managing severe constipation  20 Take action- Nasogastric tubes  Inserting and Maintaining a Nasogastric Tube-general info  Categories of nasogastric (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 (suction)  Clean technique  Maintaining comfort  Assessment for inflammation  Maintain patency  21 Bowel Diversions  Sigmoid Colostomy  22  Ostomy Video  23 Bowel Diversions Ileoanal Pouch Ileostomy Anastomosis  24  Care of ostomies  Irrigating a colostomy  Pouching ostomies  Nutritional considerations  Psychological Considerations Take action-Continuing and 25 Restorative Care- Health Promotion  Bowel training- routine is key!  Avoid overuse of laxatives  Maintenance of proper fluid and food intake  What dietary measures do you recommend?  What type of foods are low-residue?  How much fluid is recommended?  Promotion of regular exercise  Management of the patient with fecal incontinence or diarrhea  Maintenance of skin integrity  26 Evaluate outcomes  Incorporate elimination habits or routines  Reinforce routines that promote health  Consider preexisting concerns  Develop a therapeutic relationship  Evaluate a patient’s level of knowledge  Determine the extent to which the patient accomplishes normal defecation  Ask the patient to describe changes in diet, fluid intake, and activity to promote bowel health  Review medication list and consider side effects  27 Safety Guidelines for Nursing Skills  Instruct clients who self-administer enemas to use the left side lying position  If a client has cardiac disease or is taking cardiac or hypertensive medications; obtain a pulse rate  Manipulation of rectal tissue can stimulate the vagus nerve and sometimes can a sudden decline in pulse rate  28 Case Study  Chavela Mendez 78 year-old female  widowed, lives alone in a 1st floor condo in a community for active older adults  History of Hypertension, osteoarthritis, frequent constipation  She is now home post left knee replacement  You are her home health nurse assessing her post- op status and ability to perform ADL’s at her home 3 days after hospital discharge  29 Case Study  You find Mrs. Chavez uncomfortable, rubbing her knee incision and abdomen.  VS: BP 132/84, P 86, RR 20, T 36.7C(98F)  Client states she does not feel hungry because her abdomen feels “bloated and tight”  Reports no BM since she has been home  Rates pain ranging from 3/10 to 6/10 with activity  Currently taking prescribed oxycodone, BP medication, daily multivitamin with iron, stool softener  30  What other assessment data and information should you gather?  RECOGNIZE CUES  ANALYZE CUES  PRIORITIZE HYPOTHESIS  GENERATE SOLUTIONS & TAKE ACTION  EVALUATE OUTCOMES 31  32 Sample Questions  A client reports a long-term problem with constipation. What should the nurse instruct the client to do to help minimize this problem?  A. Include more bananas in your diet  B. Drink a minimum of one quart fluid per day  C. Hold your breath when bearing down to have a bowel movement  D. Attempt to have a bowel movement after drinking a warm liquid in the morning  33 Sample Questions  A client report frequent episodes of constipation. Which should the nurse teach to client to do to help relieve this problem? Select all that apply.  A. Use a prepackaged 4 oz enema once a week  B. Drink at least 2 quarts of fluid per day  C. Exercise at least 15 minutes every day  D. Eat fresh vegetables two times a day  E. Take a laxative three times a week  34 Sample Questions  A nurse is caring for a client adjusting to a colostomy in the descending colon. The client is concerned about eating foods that may cause a blockage. What foods should the nurse teach the client to avoid? Select all that apply.  A. Cranberry Juice’  B. Green Beans  Fresh Pears  Popcorn  Rice