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Bowel elimination
NURS 209 INDIANA STATE
42
Nursing
Undergraduate 3
09/30/2014

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Cards

Term
Defecation
Definition
  • the expulsion of feces from the anus & rectum
  • called a bowel movement (BM)
  • frequency and amount varies from individual to individual
  • peristaltic waves move feces into rectum where client becomes aware of need to defecate
  • when client is on toilet or bedpan, the external sphincter relaxes and feces is expulsed
  • if defecation reflux is ignored or external sphincter muscle is contracted consciously, the urge to defecate will dissapear for a few hours before occuring again
Term
Feces
Definition
  • 75% water & 25% solid materials
  • soft and formed
  • normally brown
  • adults usually produce 7-10L of gas every 24 hours 
Term
Factors affecting defecation: Age (older adult)
Definition
  • many believe they should have a BM every day and use laxatives
  • educate that decreased frequency of BM's is usually a normal result of aging is important
  • some lose teeth and can't chew food
  • peristalsis can decrease with age
  • decreased mobility-further decreases peristalsis
Term
Factors affecting defecation: diet
Definition
Bulk foods necessary to provide volume
Term
Factors affecting defecation: fluids
Definition
softens stool and increases peristalsis
Term
Factors affecting defecation: activity
Definition
  • stimulates peristalsis and weak muscles are innefective in controlling defecation
Term
Factors affecting defecation: psychologic factors
Definition
anxiety and anger can cause increased peristaltic activity (nausea & diarrhea) - depression may slow peristalsis, resulting in constipation
Term
Factors affecting defecation: medications
Definition
check side effects that can interfere with normal elimination and/or the appearance of the stool
Term
Factors affecting defecation: diagnostic procedures
Definition
barium can cause constipation/diarrhea
Term
Factors affecting defecation: anasthesia and surgery
Definition
may cause a slowing or ceasing of normal colonic movements (listen for bowel sounds after surgery)
Term
Factors affecting defecation: pain
Definition
may suppress the urge to defecate if pain is experienced (constipation a result)
Term
Assessment
Definition
  • usual defecation pattern (frequency, time of day, changes)
  • client description of feces (color, texture, shape, odor)
  • any bowel elimination problems (time it occurs, cause, what helps) 
Term
inspect feces for?
Definition
  • color - normally brown
  • consistency - normally formed, soft, semi-solid, and moist
  • shape - cylindrical, contour of rectum
  • amount - varies with client
  • odor - affected by ingested foods, meds
  • constituents - undigested food, etc...
Term
color
Definition
  • clay or white: absence of bile pigment
  • black or tarry: iron, upper GI bleed or diet high in red meat & dark green veggies
  • red: lower GI bleed, some foods (Beets) 
  • pale: diet high in milk & milk products and low in meats, malabsorption of fats
  • orange or green: intestinal infection 
Term
odor
Definition
pungent: infection or blood
Term
consistency
Definition
  • hard, dry stool: dehydration or decreased intestinal motility
  • diarrhea: increased intestinal motility
Term
shape
Definition
  • narrow, pencil-shaped or sting-like: indicative of obstructive condition of rectum
Term
constituents
Definition
  • Pus - bacterial infection
  • Mucus - inflammatory condition
  • Parasites 
  • blood - GI bleed
  • fat - malabsorption 
Term
physical exam
Definition
  • listen to bowel sounds
  • palpate abdomen
  • examin rectum and anus
Term
abdominal assessment
Definition
  • contour
    • stoop or sit to gaze across abdomen from side
      • flat
      • scaphoid
      • rounded
      • protuberant
    • symmetry
      • hernias
Term
bowel sounds
Definition
  • bowel sounds ~ auscultation
    • done out of usual sequence for assessments learned so far
    • paplation may cause a change in bowel sounds, so you want to listen before you stire things up
    • use diaphragm of stethoscope
    • place lightly against skin
    • begin in RLQ and move to all 4 quadrants
    • note characteristics and frequency of bowel sounds
      • normal is high - pitched gurgling, irregular, 5-30 times per minute
Term
Different types of bowel sounds
Definition
  • hyperactive ~ loud, high pitched, rushing
  • hypoactive ~ soft, pause between sounds
  • absent ~ must wait five full minutes
  • gurgling ~ rumbling 
Term
Occult Blood Test
Definition
  • use a tongue blade to place a small amount of stoll on a slide
  • place a few drops of reagent into smear
  • observe for color changes 
  • blue - a guaiac positive any other color is negative 
Term
specimen collection
Definition
  • have a pt. defecate into clean bedpan or commode
  • try to avoid contact with urine & tissue
  • use tongue blade to transfer specimen to container
  • usually need 1 inch or 15-30ml of liquid stool
  • may need all of stool for a timed test
Term
promoting regular defecation
Definition
  • privacy
  • timing - go when urge recognized
  • adequate fluid intake (8-10 glasses/day)
  • regular exercise
  • positioning - squatting & leaning forward if possible 
Term
constipation
Definition
a symptom, not a disease; infrequent stool and/or hard, dry, small stools that are difficult to eliminate
Term
impaction
Definition
results from unrelieved constipation; a collection of hardened feces wedged in the rectum that a person cannot expel
Term
diarrhea
Definition
an increase in the number of stools and the passage of liquid, unformed feces
Term
incontinence
Definition
inability to control passage of feces and gas to the anus
Term
flatulence
Definition
accumulation of gas in the intestines causing the wals to stretch
Term
hemorrhoids
Definition
dilated, engorged veins in the lining of the rectum
Term
fecal impaction
Definition
  • mass or collection of hardened feces
  • results from prolonged retention & accumulation of fecal material
  • may have liquid seepage (diarrhea) around impacted mass
  • may have pain in rectum
  • no BM for 3-5 days
  • may require enemas, laxatives, stool softeners, or manual removal 
Term
Bowel Diversion
Definition
  • temporary or permanent artificial opening in the abdominal wall 
    • stoma
  • surgical opening in the ileum or colong 
    • ileostomy or colostomy 
Term
care of ostomies
Definition
  • pouching ostomies 
    • an effective pouching system protects the skin, contains fecal material, remains odor free, and is confortabls and inconspicuous
  • nutritional considerations 
    • consume low fiber for the first weeks
    • eat slowly and chew food completely
    • drink 10 - 12 glasses of water daily
    • patients may choose to avoid gassy foods
  • lifestyle and body image considerations
Term
enemas
Definition
  • solution introduced into the rectum and large intestine
  • promotes defecation by distending the intestine, irritating intestinal mucosa, or softening the feces (lubricating rectum) to increase peristalsis 
Term
hypertonic enemas
Definition
  • draws fluid from the interstitial space into the colon
  • the increased volume stimulates peristalsis
  • ex. - fleets enema
  • 90-120ml of fluid - works in 5-10 minutes 
  • caution if client is dehydrated 
Term
hypotonic enemas
Definition
  • water moves from the colon into the interstitial space
  • before water moves out, it stimulates peristalsis
  • caution in clients with cardiac problems
  • ex: tap water, soap suds
  • 500-1000ml, acts in 15-20 mins
Term
isotonic enemas
Definition
  • safest - no movement of fluid between colon and interstitial fluid
  • ex. - normal saline
  • 500-1000 ml's, acts in 15-20 minutes
Term
oil retention enemas
Definition
  • oil retained for 1-3 hours
  • softens feces & lubricates rectum
  • 90-120 ml
Term
enema administration
Definition
  • sterile technique is unnecessary
  • wear gloves
  • explain the procedure, precautions to avoid discomfort, and length of time necessary to retain the solution before defecation 
Term
digital removal of stool
Definition
  • use if enemas fail to remove an impaction 
  • this is the last resort for constipation 
  • a health care provider's order is necessary to remove an impaction
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