Shared Flashcard Set


Trees- Unit 5
Bowel Elimination
Not Applicable

Additional Nursing Flashcards




a drug or dietary fiber-forming agent that relieves the symptoms of diarrhea
the removal of a small piece of living tissue from an organ or other part of the body for microscopic examination to confirm or establish a diagnosis
the compression of food that is created by mastication and moved by peristalsis into the stomach
Bowel training
is a process in which a patient develops a routine to defecate every day at the same time. E.g. by waking up every morning, attempting to defecate at the same time every day until he or she regains control of bowel reflexes. This requires time, patience and consistency on the patient half
the portion of the large intestine extending from the cecum to the rectum
inflammatory condition of the large intestine
Colostomy; ileostomy
depending on the location of the site, it is a surgical opening created with the ends of the intestines to the
abdominal wall (stoma).

- ostomy means a surgical procedure that
creates an artificial opening for the elimination of bodily wastes.
If the site at the colon it is called a colostomy and if it’s in the ileum it’s called an ileostomy
is a symptom and not a disease of improper diet; reduce fluid intake, lack of exercise and certain medications which cause constipation. Sign and symptoms follow; infrequent bowel movement difficulty passing stools, excessive straining, inability to defecate at will, and hard feces
the eliminating of feces from the digestive tract through the rectum
an increase in the number of stools and the passage of liquid with unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract
Endoscopy; Fiberoptics
Endoscopy- visualization of the interior of the organs and cavities
with an endoscope

Fiberoptics - technical process by which an internal organ or cavity
can be viewed using glass or plastic fibers to transmit light through
a specially designed tube and reflect a magnified image.
a procedure where a water base solution is introduced the rectum and sigmoid colon via anus, to promote defecation by stimulating peristalsis. The volume of the fluid instilled breaks up the fecal mass, stretches the rectal wall and initiates the defecation
Enterostomal Therapist
RN who is qualified to provide care for
persons with stomas, draining wounds, fistulae, incontinence, and actual or potential alterations in tissue integrity.
Flatulence; Flatus
presence of an excessive amount of air or gas in the stomach and intestinal tract.
Gastrocolic reflex
a mass peristaltic movement of the colon that often occurs 15-20 minutes after food enters the stomach.
Guaiac test
a test which can determine if there is blood presented
in the stool, also known as a hemoccult test. Stool is applied onto two guaiac papers. Then a developing solution is applied on the back of the guaiac paper; IFF there is blood present in the stool the paper will turn blue, if not it will remain white
is the dilation of engorged veins in the lining of the
rectum, which can cause either external or internal hemorrhoids. If the vein is hardened, there is usually a purplish discoloration.
Internal hemorrhoids have an outer mucous membrane. Excessive or
increased venous pressure from straining at defecation can lead to
fecal blood test
Transit time
time from mouth to anus
an unrelieved constipation of hardened feces, wedged in the rectum that a person cannot expel. With impaction the restricted mass beings to extend into the sigmoid colon. S/S of impaction include; the inability to pass to pass stool for several days, continuous oozing of diarrhea of stool, anorexia, nausea, abdominal distention, cramping, and rectal pain.
the physical condition which impairs the anal sphincter from functioning correctly, which leads to the inability to control passage of feces and gas from the anus
Lactose intolerance
a person who lacks the ability to produce the enzyme required to digestion of milk sugar
Laxatives; cathartics
are stool softeners, that promote peristalsis. If used correctly it maintains normal elimination patterns, however if used incorrectly it can cause the large intestines to lose muscle tone and become less responsive to stimulation via laxatives.
Paralytic ileus
a surgery that involves direct manipulation of the bowel, which temporarily stops peristalsis and usually last for about 24-48 hours
the type of movement in which the esophagus propels food
to the stomach.
Valsalva maneuver
a maneuver that assists with stool passage. By applying pressure to the abdominal muscles to contract, while maintaining a forced expiration against a close airway
Discuss the process of defecation and variables that may influence the process
Defecation begins with movement in the left colon, moving towards the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter, and an awareness of the need to defecate.

Variables that may influence the process:
1. GI tract function
2. sensory awareness
3. voluntary sphincter control
4. adequate rectal capacity
5. compliance
Identify individual factors that commonly influence bowel elimination
1. Age
2. Diet
3. Fluid intake
4. Physical activity
5. Psychological factors
6. Personal Habits
7. Position
8. Pain
9. Pregnancy
10. Surgery and Anesthesia
11. Medications
Compare and contrast normal and abnormal characteristics of feces
Normal fecal characteristics:
-Color: yellow (infants), brown (adults)
-Odor: pungent; affected by food type
-Consistency: soft, formed
-Frequency: Varies. For infants breast= fed 4-6x daily, bottle-fed infants= 1-3 daily and for adults= 2-3 times a week
-Amount: 150 g/day
-Shape: resembles diameter of rectum
-Constituents: undigested food, dead bacteria, fat, bile pigment, cells lining intestinal mucosa, water

Abnormal fecal characteristics:
Color: white or clay, black
or tarry, red, pale with fat, translucent mucus, bloody mucus
-Odor: noxious
-Consistency: liquid, hard
-Frequency: infants= more than
6 times a day or less than once every 1-2 days; adults= more than 3x/
day or less than once a week
-Amount: -----
-Shape: narrow, pencil shaped
-Constituents: blood, pus,
foreign bodies, mucus, worms, excess fat
Identify equipment used to facilitate bowel function
-Digital Removal of Stool
-Nasogastric Tube
Identify nursing diagnosis for clients with actual or risk for bowel function problems
-Bowel incontinence
-Risk for constipation
-Perceived constipation
-Toileting self-care deficit
Describe subjective and objective data used used to assess bowl function
Nursing History (subjective)
•History of illness or surgery R/T the GI tract
•Usual pattern & habits – e.g. time of day
•Usual characteristics of stool
•Routines followed to promote elimination e.g. hot fluids
•Use of artificial aids – laxatives, cathartics
•Presence & status of bowel diversions – colostomy, ileostomy
•Patient’s perception of normal or abnormal bowel elimination
•Recent change in elimination pattern
•Diet history – bulk in diet, daily fluid intake
•History of Exercise
•Travel history
•Medication history
•Emotional State
•Social history – where the patient lives may affect toileting habits; do they have to share a toilet?
•Mobility & Dexterity – getting clothes off; ability to get to bathroom
•Post Operative abdominal surgery assess
•Abdominal pain or discomfort
•Flatus within previous 8 hours
•BM within previous 12 – 24 hours
•N & V
•Feeling bloated
•Return of appetite, feeling hungry
•Abdominal cramping

Fecal Characteristics (objective)
•Color – adult brown (black = upper GI bleed, iron)
•Odor – affected by food
•Consistency – soft, formed
•Frequency – adult daily or 2 – 3 times a week
•Shape – resembles the diameter of the rectum
•Constituents – undigested food, fat, bile, water, etc.

Pertinent Laboratory and Diagnostic Tests (objective)
• Fecal/Stool Specimens – must accurately obtain & label
• Do not contaminate with urine, or toilet paper
•If test is for fecal fat need 3 – 5 day specimen collection
•Check to see if need warm specimen or can refrigerate stool
•Guaiac Test – hemoccult, fecal occult blood testing
•Diagnostic Examinations
•Direct Visualization – performed under conscious sedation
•Endoscopy – post test – no food or drink (NPO) until gag reflex returns
•Gastroscopy – post test – NPO until gag reflex returns
•Capsule Endoscopy- visualize small intestine
•Indirect Visualization
•UGI Series; Barium Enema
Discuss the mechanism of action, efficacy, and safety of current pharmacological agents used in the prevention and treatment of constipation
1. Laxatives & Cathartics
• Are used to prevent straining during defecation, prevent, & treat constipation
• May be given to prepare patients for diagnostic tests & surgery
• Cathartics have a stronger effect on the intestine
• Use with caution – Stepwise approach is best – first bulk-forming laxatives, followed by stool softeners, osmotics, stimulants, suppositories, & enemas last

-Bulk Forming Agents – considered safest of all laxatives. Absorbs H20 to ↑ bulk, which initiates reflex bowel activity e.g. psyllium (Metamucil). Can cause obstruction if not mixed with an adequate amount of H20 (240 mL)
Onset of action 12 hrs to 3 days
- Stool Softener or Emollients – prevents straining during defecation & prevents constipation by ↓ surface tension of feces allowing H20 & fat to enter. Therapeutic effect 1 – 3 days e.g. docusate sodium (Colace), docusate calcium (Surfak)
- Stimulant Laxatives– stimulates motility (peristalsis) by irritating the intestinal mucosa e.g. senna, bisacodyl (Dulcolax)
Oral route = onset of action 6 – 8 hrs; Suppository = onset of action 15 – 30 minutes
-Saline Laxatives – ↑ H20 content of feces = distention which initiate reflex bowel activity e.g. magnesium citrate, lactulose, MOM, fleet enema.
Onset of action 1 – 3 hrs
- Lubricant Laxative– coats the feces with an oily film & prevents the colon from reabsorbing water from the feces e.g. mineral oil. Avoid prolonged use – prevents absorption fat-soluble vitamins. Onset of action 6 – 8 hrs
-Hyperosmotic Agent – ↑ intraluminal osmotic pressure in the bowel. Since they are not absorbed they draw H20 into the intestine, resulting in an ↑ volume which stimulates peristalsis e.g. glycerine suppositories.
Onset of action 15 – 60 minutes after insertion.
- Combination of stool softener & stimulant e.g. docusate & senna

2. Enemas
•Types of Enemas – tap water, soap suds, oil retention, fleets, Harris flush
•Side Effect – excess F & E depletion
•Enema Administration – review in book

3. Digital Removal of Stool – review in book
• Can stimulate the Vagal Nerve = reflex slowing of the heart rate

4. Chronic Constipation
• New medication approved for chronic constipation – Amitiza (lubiprostone)
• Acts to increase fluid in small intestines – dose 24 mcg BID

5. Bowel Training
• Daily routine
Discuss the mechanism of action , efficacy , and safety or current pharmacological agents used in the treatment of diarrhea
•Do not use longer than 2 days
•Do not use if fever present
•Non – pharmacological treatment – clear liquids
•Maintenance of Skin Integrity – stool irritates skin and can cause breakdown
1. Absorbents – act by absorbing substances such as bacteria that could be the cause of the diarrhea e.g. bismuth subsalicylate (Pepto-Bismol)
2. Synthetic Opiates – are the most effective, they ↓ GI motility & slow peristalsis – e.g. paregoric, tincture of opium. Over-the-counter loperamide (Imodium) is an opiate-related agent
3. Antidiarrheal combinations – most contain a synthetic narcotic ingredient e.g. Lomotil
Describe the role of the RN management of a client experiencing dysfunction in bowel elimination
The role of the RN is to assess the history of the pt and assess a physical examination. You must auscultate to assess bowel in each quadrant and palpate for tenderness or masses.

Then the RN will then identify the correct diagnosis:

-Constipation R/T insufficient physical activity AMB no BM x 5 days
-Risk for Constipation R/T ( dehydration AWBMB no BM x 3 days
-Diarrhea R/T laxative abuse AMB 15 loose stools a day
-Risk for Diarrhea R/T anxiety AWBMB loose watery stools
-Bowel Incontinence r/t immobility AMB fecal staining of bedding and clothing
-Dysfunctional Gastrointestinal Motility r/t pharmaceutical agents AMB abdominal distention and absent bowel sounds
-Risk for Dysfunctional Gastrointestinal Motility r/t sedentary lifestyle AWBMB absent or hypoactive bowel sounds, abdominal distention and cramping, and difficulty passing stool

P: Critically think what the best strategies would be to reach the expected outcome or goals.

NI’s always work to change the etiology of the problem in order to resolve the problem
Want to incorporate the patient’s elimination habits or routines as much as possible
Least invasive nursing interventions (NI’s) and most cost effective should be initiated first – nonpharmacological treatment recommended

I: Implementation
The RN will determine the best ways to treat the problem:
Promotion of Regular Bowel Habits
Take time to defecate
Establish a routine – more likely to occur 1 hour after meals
Promotion of Normal Defecation
Squatting Position
Positioning on Bedpan
Promotion of Adequate Fluid & Food Intake
Grapefruit juice & the caffeine in coffee, tea, colas, & chocolate drinks act as diuretics & take fluids from the bowel so these liquids should not be counted as providing fluid intake for bowel activity.
Studies have shown a mixture of prune juice, applesauce, & bran can provide adequate fiber for effective bowel management. 2 cups Kellogg’s All Bran; 2 cups applesauce; 1 cup 100% prune juice.
Promotion of Regular Exercise
Promotion of Comfort
Promotion of Self-Concept
Avoiding straining and the Valsalva Manuver
Laxatives & Cathartics

E: Evaluate
The RN must determine if the pt was able meet the expected outcome.
Describe health promotion activities and interventions appropriate for clients to prevent development of dysfunction in bowel elimination pattern
∗Promotion of Regular Bowel Habits
• Take time to defecate
• Establish a routine – more likely to occur 1 hour after meals
∗ Promotion of Normal Defecation
• Squatting Position
• Positioning on Bedpan
∗Promotion of Adequate Fluid & Food Intake
• Grapefruit juice & the caffeine in coffee, tea, colas, & chocolate drinks act as diuretics & take fluids from the bowel so these liquids should not be counted as providing fluid intake for bowel activity
• Studies have shown a mixture of prune juice, applesauce, & bran can provide adequate fiber for effective bowel management
• 2 cups Kellogg’s All Bran; 2 cups applesauce; 1 cup 100% prune juice
∗Promotion of Regular Exercise
∗Promotion of Comfort
∗Promotion of Self-Concept
∗Avoiding straining and the Valsalva Manuver
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