Bowel Elimination - Lecture notes All PDF

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Lecture notes of bowel elimination from fundamentals of nursing practice with professor Allen. I received an A- in the class....

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Bowel Elimination ● Terms ○ Feces vs. Stool ○ Hemorrhoids ○ Defecation ○ Peristalsis ○ Flatus ○ Valsalva Maneuver ● Factors Affecting Bowel Elimination ○ Developmental Considerations ○ Daily Patterns ○ Food & Fluid ■ Constipating foods—cheese, lean meat, eggs, pasta ■ Foods with laxative effect—fruits and vegetables, bran, chocolate, alcohol, coffee ■ Gas-producing foods—onions, cabbage, beans, cauliflower ○ Activity & Muscle Tone ○ Lifestyle ○ Psychological Variables ○ Pathologic Conditions ○ Medications ■ Aspirin, anticoagulants—pink to red to black stool ■ Iron salts—black stool ■ Antacids—white discoloration or speckling in stool ■ Antibiotics—green-gray color ○ Diagnostic Studies ○ Surgery & Anesthesia ● Assessing-Nursing History ○ Focused Assessment Guide 38-1, p. 1425 ○ Usual pattern of bowel elimination ○ Aids to elimination ○ Recent changes in bowel elimination ○ Problems with bowel elimination ○ Presence of colostomy/ileostomy ● Assessing-Physical Assessment-Abdomen ○ Inspection—observe contour, any masses, scars, or distention ○ Auscultation—listen for bowel sounds in all quadrants ■ Note frequency and character, audible clicks, and flatus ■ Usually high-pitched, gurgling, and soft

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■ Frequency ranges from 5 to 30 bowel sounds per minute ■ Describe bowel sounds as audible, hyperactive, hypoactive, or inaudible ○ Palpation-Note muscular resistance, tenderness, enlargement of the organs, or masses. Physical Assessment-Anus and Rectum ○ Inspection and palpation ■ Lesions, ulcers, fissures (linear break on the margin of the anus), inflammation, and external hemorrhoids ■ Ask the patient to bear down as though having a bowel movement. Assess for the appearance of internal hemorrhoids or fissures and fecal masses. ■ Inspect perineal area for skin irritation secondary to diarrhea or fecal incontinence. Assessing-Stool ○ Volume - Variable ○ Color - Adult: Brown ○ Odor - Pungent; may be affected by foods ingested ○ Consistency - Soft, semisolid, and formed ○ Shape - Formed stool is about 1 inch(2.5 cm) in diameter and tubular ○ Constituents - bile, intestinal secretions, shed epithelial cells, bacteria, and inorganic material (chiefly calcium and phosphates); seeds, meat fibers, and fat may be present in small amounts Assessing Stool-Occult Blood Testing ○ Used to determine occult blood in the stool ○ Certain Conditions (ulcer disease, inflammatory bowel disorders, and colon cancer) can cause bleeding in the intestines ○ Fecal Occult Blood Test (FOBT); Hematest and guaiac test (gFOBT) are common names ○ Clean technique, hand hygiene, gloves ○ Do not collect sample from toilet (use bedpan, commode) ○ Use tongue blades to transfer stool ○ Test can be completed at the inpatient’s bedside or outpatient setting, or by patients at home Warning Signs of Colon Cancer ○ Rectal bleeding ○ Change in the bowel elimination pattern ○ Blood in the stool ○ Cramping pain in the lower abdomen Assessing-Diagnostic Studies Box 38-2 ○ Direct Visualization ■ Esophagogastroduodenoscopy ■ Colonoscopy

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■ Sigmoidoscopy ■ Wireless capsule endoscopy ○ Indirect Visualization ■ Upper gastrointestinal (UGI) ■ Small bowel series ■ Barium enema ■ Abdominal ultrasound ■ Magnetic resonance imaging ■ Abdominal CT scan Diagnosing-Bowel Elimination is the Problem ○ Constipation ○ Diarrhea ○ Bowel Incontinence Diagnosing-Bowel Elimination is the Etiology ○ Delayed Growth and Development related to child’s inability to attain bowel control secondary to inconsistency and lack of adequate parental knowledge ○ Deficient Fluid Volume related to prolonged diarrhea ○ Impaired Skin Integrity related to prolonged diarrhea, fecal incontinence ○ Ineffective Coping related to inability to accept permanent ostomy Outcome Identification & Planning ○ Have a soft, formed bowel movement without discomfort ○ Explain the relationship between bowel elimination and dietary fiber, fluid intake, and exercise ○ Relate the importance of seeking medical evaluation if changes in stool color or consistency persist ○ Maintain skin integrity Outcomes for Patients with Specific Bowel Elimination Problems ○ The patient will: ■ Describe the functioning and purpose of the ostomy ■ Ingest an adequate amount of fiber ■ Monitor the amount and consistency of stools ■ Express acceptance of the ostomy ■ Demonstrate skin care for the ostomy ■ Respond to the urge to defecate in a timely manner ■ Maintain the integrity of perineal skin Implementing ○ Promoting Regular Bowel Habits ○ Providing Comfort Measures ○ Preventing & Treating Constipation ○ Preventing & Treating Diarrhea ○ Decreasing Flatulence

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○ Emptying the Colon of Feces ○ Managing Bowel Incontinence ○ Designing & Implementing Bowel Training Programs Promoting Regular Bowel Habits ○ Timing ○ Positioning ○ Privacy ○ Nutrition ■ fluid intake (water) of 2,000 to 3,000 mL ■ high fiber intake. ○ Exercise ■ Abdominal settings ■ Thigh strengthening Providing Comfort Measures ○ Work with the patient to develop a bowel elimination routine that results in the easy passage of a soft, formed stool ○ Be attentive to perineal hygiene and the maintenance of skin integrity ○ Use warm, moist heat (sitz bath or tub bath) to soothe the perineal area ○ Encourage recommended diet (if pertinent) and exercise ○ Use medications, such as laxatives and antidiarrheals, only as needed ○ Apply ointments or astringents (witch hazel) ○ Use suppositories that contain anesthetics Preventing & Treating Constipation ○ High-fiber foods (20 to 35 g/ day) ■ bran, fruits, vegetables, whole grains ○ 60 to 80 oz (1.8–2.4 L) of water daily ○ Regular exercise Preventing & Treating Diarrhea ○ Avoid cold fluids, rich foods, especially sweets. ○ Answer the patient’ call bell immediately or ensure that a bedpan or commodes is within easy reach. ○ Remove the cause of the diarrhea. ○ If there is any indication of an impaction, further examination is necessary before using antidiarrheal medications. ○ Give special care to the region around the anus, where skin irritation is common; Keep area clean & dry; Use skin creams, moisture barriers, ointments, or powders as necessary. Diarrhea ○ Acute ■ Sudden onset and lasts several hours to several days ■ Caused by a viral or bacterial infection, a reaction to medication, or

alterations in diet. ■ Rehydration is key (oral or IV) ■ Hand hygiene imperative ■ No antidiarrheals until infection ruled out ○ Chronic ■ Lasts for more than 3 to 4 weeks ■ Irritable bowel syndrome (e.g., Crohn disease, ulcerative colitis), malabsorption syndromes, bowel tumor, metabolic disease (diabetes, hyperthyroidism), parasitic infection, side effects of drugs, laxative abuse, surgery, alcohol abuse, and radiation and chemotherapeutic agents ■ Antidiarrheals along with fluid and electrolyte replacement ● Decreasing Flatulence ○ Intestinal Distention ○ Gas-producing foods: beans, cabbage, onions, cauliflower, beer ○ Avoid reclining after meals ○ Move around in bed and ambulate to promote peristalsis and the escape of flatus ● Emptying the Colon of Feces ○ Cleansing enemas are given to: ■ Relieve constipation or fecal impaction ■ Prevent involuntary escape of fecal material during surgical procedures ■ Promote visualization of the intestinal tract by radiographic or instrument examination ■ Help establish regular bowel function during a bowel-training program ○ Retention enemas are retained in the bowel for a prolonged period for different reasons: ■ Oil-retention enemas: lubricate the stool and intestinal mucosa, making defecation easier. About 150 to 200 mL of solution is administered to adults. ■ Carminative enemas: help to expel flatus from the rectum and provide relief from gaseous distention. Common solutions include the milk and molasses enema (equal parts)and the magnesium sulfate–glycerin–water (MGW) enema(30 mL of magnesium sulfate, 60 mL of glycerin, and 90 mL of warm water). ■ Medicated enemas: provide medications that are absorbed through the rectal mucosa. ■ Anthelmintic enemas: destroy intestinal parasites. ○ Cleansing Enema-Procedure ■ Position on left Sims ■ Insert rectal tube 7-10 cm ■ Slow installation of fluid ■ Hold fluid as long as possible

■ Unexpected outcomes ● Cramping ● Abdomen becomes rock hard and distended ○ Retention Enema- Procedure ■ The equipment is included ■ Do not warm the solution ■ Place the patient in the left side-lying position or the knee-chest position ■ Instill by applying gentle pressure on the collapsible solution container, 1 to 2 minutes to administer. ○ Rectal suppositories ■ Fecal softener- useful when the stool is very hard ■ Nerve stimulant-stimulate the rectal nerves in people with weak muscle tone or poor innervation ■ Carbon dioxide suppository-liberate about 200 mL of gas, causing distention, stimulation and elimination impulses ○ Oral Intestinal Lavage ■ GoLYTLEY/Colyte ■ Used for “Bowel Prep” ○ Digital Removal of Stool ■ Guideline for Nursing Care 38-1 ■ P. 1442 ● Managing Bowel Incontinence ○ Note when incontinence is most likely to occur, and place the patient on a bedpan. ○ Keep the skin clean and dry by using proper hygienic measures. Apply a protective skin barrier after cleaning the skin. ○ Change bed linens and clothing as necessary to avoid odor, skin irritation, and embarrassment. ○ Confer with the physician about using a suppository or a daily cleansing enema. ○ Bowel training programs may be helpful. ● Evaluating ○ Nursing care is considered effective if the patient expresses satisfaction with his or her regular pattern of defecation and the ability to pass a soft, formed stool comfortably without the use of medications or laxatives. ○ The plan of care is most successful when the patient is able to accomplish the following: ■ Verbalize the relationships among bowel elimination and nutrition, fluid intake, exercise, and stress management. ■ Develop a plan to modify any factors that contribute to current bowel problems or that might adversely affect bowel functioning in the future....