a semisolid mass; mixture of fiber and undigested food, shed epithelial cells, inorganic material, bacteria, water, fat

(bile salts make feces brown, bacteria turn yellow bile brown, bacteria also cause odor of feces)

• Wide normal range of frequency: from daily to 2-3 times a week
• Soft, Formed, Semi-Solid
• Brown
• Pungent Odor
• Passed without urgency or excessive straining/effort

• More than 3 stools a day/Fewer than once a week
• Black-Tarry (coffee ground looking) - Melena: Upper abdominal bleeding
• Frank blood: lower tract or hemorrhoids
• Narrow and pencil shaped (may be obstruction)
• Small and marble shaped (constipation)
• Dry and hard (constipation)
• Watery "loose" (diarrhea)
• Strong, foul odor (C-diff)
• Use of laxatives or enemas to maintain pattern

• Advanced Age
• decreased muscle tone, decreased activity, low-fiber diet, immobility
• Psychosocial Factors
• privacy, time, position, pain
• Personal Factors
• stress
• Nutrition
• Hydration
• Activity
• Pathologies
• food allergies, food intolerances, diverticulosis, diverticulitis
• Anesthesia/Surgery (Paralytic Ileus)
• Medications
• antacids (neutralize stomach acid, may slow peristalsis - constipation), NSAIDs (ulceration of the stomach or duodenum), antibiotics (decrease normal flora - cause diarrhea), iron (changes stool color to black), opioids (constipation), calcium (constipation), magnesium (diarrhea), vitamin C (diarrhea)

• High Fiber
• fresh fruit and berries, dried fruit, vegetables (especially leafy or raw), whole grain, flaxseed, popcorn, dried beans, peas, legumes
• Foods that slow peristalsis
• simple carbohydrates, lean meats
• Foods that produce gas
• cabbage family, onions, beans
• Probiotics
• yogurt, acidophilus
• Spicy Foods
• may cause gas and more frequent bowel movements

• Medical History/Surgeries
• Normal Bowel Pattern
• Appearance of Stool
• Change in bowel habits or stool appearance
• History of elimination problems
• Use of bowel elimination aids (laxatives, enemas)
• Diet, Fluids, Exercise, Medications

• Inspect stool for volume, color, odor, consistency, shape, and constituents
• Inspect anus for hemorrhoids
• Inspect abdomen for size, shape, and contour
• Ausculate bowel sounds (present, hypo-, hyper-, absent)
• normal - high pitched, 5-15 gurlges per minute, hyper - very high pitched and frequent, hypo - low pitched and infrequent, absent - 3-5 minutes
• Palpate and Percuss the abdomen for tenderness, prescence of air soid, and presence of masses

• Direct Visualization
• endoscopy, colonoscopy, sigmoidoscopy
• Radiographic Views
• flat plate of abdomen
• Laboratory studies of studies
• stool for occult blood, stool for ova and parasite, culture

• Occult Blood - hidden blood
• Also called a guaiac test
• Patient should restrict certain types of foods and medications for 3 days before stool testing
• red meat, chicken, fish, horseradish, radishes (false-positive)
• Vitamin C (false-negative)
• bleeding gums, anticoagulants, aspirin, NSAIDs, iron, corticosteroids, iodine, bromides, boric acid (cause GI bleeding which may be misinterpreted)
• Do not do if woman in menstruating, hematuria, or bleeding hemorrhoids
• Take small smear from two different parts of stool sample and place on windows of card, put drops of developer solution on the opposite side, positive result if slide windows turn blue

• Bowel Incontinence
• Constipation
• Risk for Constipation
• Perceived Constipation
• Diarrhea
• Toileting Self-Care Deficit
• Social Isolation
• Impaired Skin Integrity
• Distrubed Body Image
• Fluid Volume or Electrolyte Imbalance

• Establish optimal bowel function
• Absence of pain
• Intact skin
• Maintain fluid & electrolyte balance
• Demonstrate ostomy care
• Discuss feelings about colostomy

• Provide Privacy
• Correct Position
• seated upright or squatting
• some clients may need assistance
• Timing
• often occurs after meals
• Proper Diet
• 25-30 grams fiber/day
• Encourage fluids
• 8-10 glasses/day
• Exercise
• 3-5 times a week
• range of motion for clients on bedrest
• thigh strengthening/abdominal tightening

• A decrease in the frequency of BMs and the passage of dry, hard stool that requires more effort to pass
• Etiologies include
• decreased activity
• advanced age
• decreased fiber or fluid intake
• abuse of laxatives
• medication/supplement regimen (antacids, anticholinergics, anticonvulsants, antidarrheals, antihistamines, antiparkinsonians, antipsychotics, calcium channel blockers, calcium supplements, diuretics, iron supplements, lithium, NSAIDs, opioids, sympathomimetics, tricyclic antidepressants)

• Increase intake of high-fiber foods and fluids
• Increase activity/exercise
• Provide privacy/proper positioning
• Allow uninterrupted time at same time of day
• Assess for complications such as hemorrhoids or impaction
• Talk to pharmacist about medications
• Laxatives when lifestyle changes are ineffective

• Bulking agents are the preferred medication for treating constipation
• Metamucil (psyllium)
• Osmotic laxatives
• Milk of Magnesia, Miralax (polyethylene glycol), Lactulose
• Stool softeners
• Colace (docusate sodium)
• Stimulant Laxatives
• Sennakot, Ducolax (biscodyl)
• Fleets Enema
• For hemorrhoids
• Anusol cream (anti-inflammatory), Tucks Witch Hazel Pads, Kegels

• Passage of frequent loose, liquid stools
• Help determine cause
• Monitor stools to quantify diarrhea
• Monitor for alterations in perianal skin integrity
• Assess and monitor for fluid and electrolyte balance distrubance
• Replace Fluids
• Proper Dietary Teaching
• BRAT diet (bananas, white rice, applesauce, dry toast)

• Antidiarrheals
• Immodium (loperamide)
• Lotmotil (diphenoxylate and atropine sulfate) (atropine is an anticholinergic)
• Adsorbents: Pepto-Bismol (binds toxins in stool)
• Bacterial Cultures: Yogurt, Lactobacillus acidophilus
• Bulk-Forming Laxatives: Metamucil
• Anticholinergic: Bentyl

• Is acquired through the ingestion of spores usually transmitted from other patients through the hospital environment or the hands of healthcare personnel
• Alteration of the intestinal flora by antibiotics leads to proliferation of the organism
• Elderly have highest risk
• Causes diarrhea with a foul odor
• Stool culture confirms
• Need antibiotics to treat (vancomycin)
• Patient placed on contact precautions
• Hand sanitizers ineffective against spores

• Presence of a hardened fecal mass in the rectum
• Liquid stool may leak around and patient may complain of bloating and loss of appetite
• Detected by physical examination of the rectum
• Treated by digitally removing and/or administering enemas
• Stop immediately if vagal response. Prepare for resuscitation.
• Prevention is the best treatment
• Establish bowel program to prevent recurrence

• Excessive gas may lead to complaints of abdominal distention, cramping or discomfort
• Be aware of food that trigger flatulence
• Encourage ambulation and bed exercises
• Antiflatulent: Mylicon (simehicone)
• Carmitive and Return flow enemas
• Avoid carbonated beverages and straws

• Inabilitiy to control discharge of feces
• Find cause
• Nursing Diagnoses (skin integrity, social isolation)

• monitor the pattern of BMs
• provide the bedpan or assist the patient to the bathroom at regular intervals and at times BMs are most likely to occur
• change clothing and/or bed linens as soon as possible to prevent skin irritation and embarrassment
• provide prompt hygiene care after any episodes of incontinence
• monitor skin for evidence of breakdown, use moisture-barrier cream if redness or irritation is noted
• review diet, fluid intake, activity, and medicines
• consider a bowel training program
• user containment or indwelling methods to prevent fecal drainage from soilding clothing

• Histamine receptor antagonist: inhibits gastric acid secretion
• cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid)
• Proton pump inhibitor: suppresses gastric acid production
• omeprazole (Prilosec), pantoprazole (Protonix)

• Enemas are used to soften stool, distend the colon and stimulate peristalsis
• Types of Enemas
• cleansing, retention, return-flow
• Solutions Used
• hypotonic, isotonic, hypertonic
• Guidelines for Administration
• expain the purpose to patient, explain may experience some cramping
• responses to enema are governed by height of the solution container, speed or flow, concentration of the solution, resistance of the rectum
• the higher the solution container, the faster the solution flows
• place solution contain no more than 12 inches above the rectum

• Promote removal of feces from the colon
• Used to treat severe constipation or impaction; clear the colon in preparation for visualization procedures; empty the colon when starting a bowel training program
• May be given "high" or "low". Low is standard, high attempts to clear as much of large intestine and patient turns to allow fluid to follow the shape of large intestine

• 500-1000 mL of tap water
• large volume distends the colon, stimulating peristalsis
• softens stool
• BM in about 15 minutes
• adverse effects - fluid and electrolyte imbalance, especially water intoxication, is possible if enema is not expelled

• 500-1000 mL of normal saline
• Large volume distends the colon, stimulating peristalsis
• Some softening of stool
• BM in about 15 minutes
• adverse effects: fluid and electrolyte imbalance, especially sodium retention

• 120-180 mL of sodium phosphate (eg Fleets); available as acommercially prepared solution
• Attracts water into the colon, thereby causing distention
• Rapid acting: 5-10 minutes
• adverse effects: sodium retention

• Retention enemas introduce a solution into the colon that is meant to be retained for a prolonged period
• Small volume: 90-120 mL
• Oil-Retention, Carminative, Medicated, Nutritive

• Instill 90-120 mL of oil into the rectum to soften stool and lubricate the rectum
• May be used to pass hard stool or before digital removal of stool
• May be used at least 1 hour before cleansing enema

• Instill 60-180 mL of solution
• Help expel flatus and relieve bloating and distention
• May be used after abdominal or pelvic surgery when peristalsis is slow to return and patient experiences pressure from gas
• Solutions may be commercially prepared or prepared on the unit
• MGW - magnesium sulfate, glycerin water

• Medicated enemas may be used to treat infections in the rectum or anus or to introduce anthelminthic agents for treatment of intestinal worms and parasites
• Nutritive enemas administer fluid and nutrition through the rectum for patients who are dehydrated and frail, most commonly used in hospice care to provide hydration for dying patients

• Also known as a Harris flush
• Help a patient expel flatus and relieve abdominal distention
• 100-200 mL of tap water or saline is instilled
• The rectal tube and solution container then lowered below the level of the rectum to encourage return flow of the solution
• Process repeated several times, or until distention is relieved

• Stoma assessment and care
• Periostomal skin assessment and care
• Monitor type and ammount of effluent
• (the closer to ileocecal valve between the small and large intestine, the more liquid it will be; closer to the rectum the more it will resemble feces)
• Be attentive to patient's psychosocial needs
• be professional; show acceptance
• attend to odor control
• address patient participation in ostomy care
• Patient teaching for home care