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Unit 21 - Bowel Elimination
Test 4
105
Nursing
Undergraduate 3
04/24/2014

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Term
How much of your stool is water?
Definition
75%
Term
What is the remaining 15% of poop?
Definition
fiber, live and dead bacteria, miscellaneous cells and mucus.
Term
What is the Bristol Stool Chart?
Definition
The Bristol Stool Chart is a handy tool that may help you learn what you’re going for. Ideally, your stool should approximate Types 3, 4 and 5, “like a sausage or a snake, smooth and soft” to “soft blobs that pass easily.” Type 4 is the Holy Grail
Term
What is type 1?
Definition
Separate, hard to pass, lumps
Term
What is type 2?
Definition
Sausage shaped but lumpy
Term
What is type 3?
Definition
Like sausage but with cracks on its surface
Term
What is type 4?
Definition
Like sausage, snakes, smooth and soft.

HOLY GRAIL
Term
What is type 5?
Definition
Soft blobs with clear cut edges
Term
What is type 6?
Definition
Fluffy pieces w/ ragged edges. Mushy
Term
What is type 7?
Definition
Watery. No solid pieces. ENTIRELY LIQUID
Term
What is fiber?
Definition
Fiber tends to bulk up your stool and acts like glue to keep the stool stuck together, instead of in pieces. If your stool is on the softer side, short of diarrhea (“soft serve,” as some call it), it could be related to lactose intolerance, artificial sweeteners (sorbitol and Splenda), or a reaction to fructose or gluten
Term
What is a healthy stool?
Definition
-Medium to light brown
-Smooth and soft, formed into one long shape and not a bunch of pieces
-About one to two inches in diameter and up to 18 inches long
-S-shaped, which comes from the shape of your lower intestine
-Quiet and gentle dive into the water...it should fall into the bowl with the slightest little “whoosh” sound – not a loud, wet cannonball splash that leaves your toosh in need of a shower
-Natural smell, not repulsive (I’m not saying it will smell good)
-Uniform texture
-Sinks slowly
Term
What is an unhealthy stool?
Definition
-Stool that is hard to pass, painful, or requires straining
-Hard lumps and pieces, or mushy and watery, or even pasty and difficult to clean off
-Narrow, pencil-like or ribbon-like stools: can indicate a bowel obstruction or tumor – or worst case, colon cancer; narrow stools on an infrequent basis are not so concerning, but if they persist, definitely warrant a call physician
-Black, tarry stools or bright red stools may indicate bleeding in the GI tract; black stools can also come from certain medications, supplements or consuming black licorice; if you have black, tarry stools, it’s best to be evaluated by your healthcare provider
-White, pale or gray stools may indicate a lack of bile, which may suggest a serious problem (hepatitis, cirrhosis, pancreatic disorders, or possibly a blocked bile duct), so this warrants a call to your physician; antacids may also produce white stool
-Yellow stools may indicate giardia infection, a gallbladder problem, or a condition known as Gilbert’s syndrome – if you see this, call your doctor
-Presence of undigested food (more of a concern if accompanied by diarrhea, weight loss, or other changes in bowel habits)
-Floaters or splashers
-Increased mucus in stool: This can be associated with inflammatory bowel disease like Crohn’s disease, or ulcerative colitis, or even colon cancer, especially if accompanied by blood or abdominal pain
Term
What is stinky shit associated w?
Definition
A malabsorptive disorder
Celiac disease
Crohn’s disease
Chronic pancreatitis
Cystic fibrosis
Term
How does cystic fibrosis effect poop?
Definition
abnormally thick, sticky mucus, which builds up and causes life-threatening lung infections and serious digestive problems
Term
What is newborn poop?
Definition
Mecomium.

Sticky, green and black.
Term
How often should you move your bowels?
Definition
Normal bowel habits vary. When we talk about regularity, what we’re really talking about is what’s regular for you. Three bowel movements per day to three per week is considered the normal range.
Term
What is more important than frequency?
Definition
Ease.
Term
What is constipated?
Definition
defined as passing hard, dry stools that you have to strain to move, and it’s typically accompanied by decreased frequency of defecation.

Straining is not normal, nor are experiencing feelings of incomplete elimination, bloating, crampiness, or sluggishness after going number two.
Term
What does chronic constipation cause?
Definition
can lead to fecal impaction, which can be a serious medical condition.
Term
What are common causes of decreased bowel movement/frequency/constipation?
Definition
-Change in diet, less fiber, less fruits and vegetables
-Pregnancy, childbirth, or hormonal disturbances
-Emotional stress
-Problems with the muscles or nerve in the intestine, rectum or anus
-Ignoring the urge to “go,” scheduling factors that cause you to hold it
-Irritable bowel syndrome (IBS)
-Insufficient exercise
-Diabetes
-Inadequate hydration
-Hypothyroidism (underactive thyroid)
-Calcium or iron supplements
-Local pain or discomfort around the anus, such as from fissures or hemorrhoids
-Drugs such as narcotic painkillers (codeine, for example), diuretics, antacids, antidepressants, and excess or overused laxatives
-Less often: diverticulitis, intestinal obstruction, colorectal cancer, multiple sclerosis, Parkinson’s disease and spinal cord injury
-Food allergies
Term
How can you resolve poop problems?
Definition
-Remove gluten from your diet (the most common sources are wheat, barley, rye, spelt and other grains)
-Eat a diet that includes whole foods, rich in fresh, organic vegetables and fruits that provide good nutrients and fiber; most of your fiber should come from vegetables, not from grains
-Avoid artificial sweeteners, excess sugar (especially fructose), chemical additives, MSG, excessive amounts of caffeine, and processed foods as they are all detrimental to your gastrointestinal (and immune) function
-Boost your intestinal flora by adding naturally fermented foods into your diet, such as sauerkraut, pickles, and kefir (if you tolerate dairy); add a probiotic supplement if you suspect you’re not getting enough beneficial bacteria from your diet alone
-Try increasing your fiber intake; good options include psyllium and freshly ground organic flax seed (shoot for 35 grams of fiber per day)
-Make sure you stay well hydrated with fresh, pure water
-Get plenty of exercise daily
-Avoid pharmaceutical drugs, such as pain killers like codeine or hydrocodone which will slow your bowel function, Antidepressants, and antibiotics can cause a variety of GI disruptions
-Address emotional challenges with tools like relaxation
-Consider squatting instead of sitting to move your bowels; squatting straightens your rectum, relaxes your puborectalis muscle and encourages the complete emptying of your bowel without straining, and has been scientifically shown to relieve constipation and hemorrhoids
Term
What is a hiatal hernia?
Definition
In a hiatal hernia (also called hiatus hernia) the stomach bulges up into the chest through that opening in the diaphragm.
Term
What happens in a sliding hiatal hernia?
Definition
In a sliding hiatal hernia, the stomach and the section of the esophagus that joins the stomach slide up into the chest through the hiatus. This is the more common type of hernia.
Term
What happens in a paraesophageal hernia?
Definition
The esophagus and stomach stay in their normal locations, but part of the stomach squeezes through the hiatus, landing it next to the esophagus. Although you can have this type of hernia without any symptoms, the danger is that the stomach can become "strangled," or have its blood supply shut off.
Term
What is GERD?
Definition
GERD (gastroesophageal reflux disease) is severe or chronic acid reflux that can lead to complications, such as cancer. Heartburn or acid reflux symptoms include chronic cough and chest pain and burning
Term
What is Laryngopharyngeal reflux?
Definition
is similar to another condition -- GERD -- that results from the contents of the stomach backing up (reflux).
Term
What causes gastritis?
Definition
caused by irritation due to excessive alcohol use, chronic vomiting, stress, or the use of certain medications such as aspirin or other anti-inflammatory drugs.
- H. pylori
- Pernicious Anemia
- Bile Reflux
- Infections
Term
What is gastritis?
Definition
inflammation, irritation, or erosion of the lining of the stomach. It can occur suddenly (acute) or gradually (chronic).
Term
What are the symptoms of gastritis?
Definition
Nausea or recurrent upset stomach
Abdominal bloating
Abdominal pain
Vomiting
Indigestion
Burning or gnawing feeling in the stomach between meals or at night
Hiccups
Loss of appetite
Vomiting blood or coffee ground-like material
Black, tarry stools
Term
What is cholelithiasis?
Definition
Gallstones are crystal-like deposits that develop in the gallbladder -- a small, pear-shaped organ that stores bile, a digestive fluid produced by the liver. These deposits may be as small as a grain of sand or as large as a golf ball; they may be hard or soft, smooth or jagged. You may have several gallstones or just one.
Term
What are the symptoms of gallstones?
Definition
yet most of those who have the condition do not realize it. These "silent" stones usually go unnoticed unless they show up in an ultrasound exam conducted for some other reason.
Term
When do symptoms occur?
Definition
because the gallstone has moved and become lodged within a duct that carries bile, such as the cystic duct, a small conduit that connects the gallbladder to another tube called the common bile duct. The typical symptom is abdominal pain, perhaps accompanied by nausea, indigestion, or fever. The pain, caused by the gallbladder's contraction against the lodged stone, generally occurs within an hour of eating a large meal or in the middle of the night. Stones can also clog the common bile duct, which carries bile into the small intestine, and the hepatic ducts, which take bile out of the liver.
Term
What is dia?
Definition
Diarrhea occurs when there is an increase in the number of bowel movements or bowel movements are more watery and loose than normal. When the intestines push stools through the bowel before the water in the stool can be reabsorbed, diarrhea occurs. It can also occur when inflammation of the bowel lining causes excess fluid to leak into the stool. Abdominal cramps, nausea, vomiting, or a fever may occur along with the diarrhea.
Term
What causes diarrhea?
Definition
food, untreated water, medications, virus,
Term
What is a bowel obstruction?
Definition
small or large intestine is partly or completely blocked. The blockage prevents food, fluids, and gas from moving through the intestines in the normal way. The blockage may cause severe pain that comes and goes.
Term
What causes a bowel obstruction?
Definition
Tumors, scar tissue (adhesions), or twisting or narrowing of the intestines can cause a bowel obstruction. These are called mechanical obstructions .


Large int - cancer
Small int - scar tissue
Term
What is a appendicitis?
Definition
Appendicitis is an inflammation of the appendix, a 3 1/2-inch-long tube of tissue that extends from the large intestine.

MEDICAL EMERGENCY THAT REQUIRES PROMPT SURGERY
Term
What are the classic symptoms of appendicitis?
Definition
Dull pain near the navel or the upper abdomen that becomes sharp as it moves to the lower right abdomen. This is usually the first sign.
Loss of appetite
Nausea and/or vomiting soon after abdominal pain begins
Abdominal swelling
Fever of 99-102 degrees Fahrenheit
Inability to pass gas
Term
What is peritonitis?
Definition
inflammation of the peritoneum, the tissue that lines the inner wall of the abdomen and covers and supports most of your abdominal organs. Peritonitis is usually caused by infection from bacteria or fungi.
Term
What does untreated peritonitis cause?
Definition
can rapidly spread into the blood (sepsis) and to other organs, resulting in multiple organ failure and death.
Term
What are the symptoms of the peritonitis?
Definition
-poor appetite and nausea, and a dull abdominal ache that quickly turns into persistent, severe abdominal pain, which is worsened by any movement.

-others:
Abdominal tenderness or distention
Chills
Fever
Fluid in the abdomen
Extreme thirst
Not passing any urine, or passing significantly less urine than usual
Difficulty passing gas or having a bowel movement
Vomiting
Term
What causes peritonitis?
Definition
-primary spontaneous peritonitis, an infection that develops in the peritoneum

-secondary peritonitis, which usually develops when an injury or infection in the abdominal cavity allows infectious organisms into the peritoneum
Term
What is inflammatory bowel disease symptoms?
Definition
abdominal cramps, bloody diarrhea, and fever. Other symptoms of IBD can include weight loss.
Term
What is Ulcerative Colitis?
Definition
inflammatory bowel disease that causes sores in the colon.
Term
What are the symptoms of UC?
Definition
abdominal pain and diarrhea, sometimes bloody
Belly pain, often described as cramping. Your belly may be sore when touched.
Constipation
Loss of appetite.
Fever
Weight loss
anemia because of low iron levels caused by bloody stools or intestinal inflammation
Term
How do you treat UC?
Definition
over-the-counter anti-diarrhetics and prescription steroids or aminosalicylates.
Term
What's the difference between UC and crohn's?
Definition
The difference is that UC occurs only in the large intestine, while Crohn's can occur in various places throughout the digestive tract, so symptoms may occur anywhere from the small intestine to the mouth.
Term
What is diverticulitis?
Definition
formation of numerous tiny pockets, or diverticula, in the lining of the bowel.
formed by increased pressure on weakened spots of the intestinal walls by gas, waste, or liquid
Term
What are the complications r/t diverticulitis?
Definition
Peritonitis (a painful infection of the abdominal cavity)
Abscesses ("walled off" infections in the abdomen)
Obstruction (blockages of the intestine)
Term
Where does digestion begin?
Definition
The mouth
Term
What is the flow of food through the digestive tract?
Definition
1. Mouth
2. Esophagus
3. Stomach
4. Small In
5. Large In
6. Anus
Term
What moves the food from the esophagus to the stomach?
Definition
Peristalsis
Term
What is the fxn of the stomach?
Definition
Stores food; mixes food, liquid, and digestive juices; moves food into small intestines
Term
What are the different sections of the small intestine?
Definition
Duodenum, jejunum, and ileum
Term
What is the primary organ of bowel elimination?
Definition
Large intestine
Term
What is the fxn of the anus?
Definition
Expels feces and flatus from the rectum
Term
What are the factors affecting bowel elimination?
Definition
- Age
- Diet
- Fluid Intake
- Physical activity
- Pyschological Factors
- Personal habits
- Position during defecation
- Pain
- Pregnancy
- Surgery/Anesthesia
- Medications/Laxatives/Cathartics
- Diagnostic Tests
Term
Food high in ______ content and increased_____ intake keep feces soft.
Definition
Fiber/Fluid
Term
What is flatulence?
Definition
Accumulation of gas in the intestines causing the walls to stretch
Term
What is hemorrhoids?
Definition
Dilated, engorged veins in the lining of the rectum
Term
What does diarrhea cause?
Definition
Fluid and electrolyte imbalance
Term
What is bowel diversion?
Definition
Temporary or permanent artificial opening in the abdominal wall
STOMA!
Term
What is an ileostomy or a colostomy?
Definition
Surgical opening in the ileum or colon
Term
What is a loop colostomy?
Definition
a loop of colon is exteriorized over a plastic rod for temporary fecal diversion. It is usually a temporary large stoma constructed in the transverse colon.
Term
What is an end colostomy?
Definition
permanent (end) colostomy
The terminal end of the descending or sigmoid colon is brought out through the peritoneum and muscle and is sutured to the skin.
Term
What is a double barrel colostomy?
Definition
Both ends of the transected colon are brought out to the skin.
2 stomas
Term
What is an ileoanal pouch anastomosis?
Definition
a surgical procedure that is used in patients who need to have a colectomy for treatment of ulcerative colitis or familial polyps
Term
What is a kock pouch?
Definition
Two 15-cm limbs are used to create a pouch, and one 15-cm limb is used to fashion a nipple valve and stoma
Term
What is a macedo-malone antegrade continence enema?
Definition
The MACE procedure improves continence in patients with fecal soiling associated with neuropathic or structural abnormalities of the anal sphincter. This procedure isolates a 3-cm (1.2-inch) flap on the left colon. A Foley catheter placed on the surface of the flap creates a tubular passage. This produces a continence valve mechanism. The surgeon takes the distal end of the tube and makes a V shape to the skin flap.
Term
. A newly admitted patient states that he has recently had a change in medications and reports that stools are now dry and hard to pass. This type of bowel pattern is consistent with
Definition
Constipation.
Term
What is important HHQ to ask when assessing elimination processes?
Definition
What a patient describes as normal or abnormal is often different from factors and conditions that tend to promote normal elimination.
Identifying normal and abnormal patterns, habits, and the patient’s perception of normal and abnormal with regard to bowel elimination allows you to accurately determine a patient’s problems.
Term
What do you look at during the physical assessment?
Definition
Mouth, abdomen, and rectum
Term
What are the lab tests?
Definition
Fecal characteristics
Fecal specimens
Term
What are the diagnostic examinations?
Definition
Radiologic imaging, with or without contrast
Endoscopy
Ultrasound
Computed tomography (CT) or magnetic resonance imaging (MRI)
Term
What is a fecal occult blood test?
Definition
-Collect about 2.54 cm (1 inch) of formed stool or 15 to 30 mL of liquid diarrhea stool. Tests for measuring the output of fecal fat require a 3- to 5-day collection of stool. You need to save all fecal material throughout the test period.
-After obtaining a specimen, label and tightly seal the container, and complete all laboratory requisition forms. Record specimen collections in the patient’s medical record. It is important to avoid delays in sending specimens to the laboratory. Some tests such as measurement for ova and parasites require the stool to be warm. When stool specimens remain at room temperature, bacteriological changes that alter test results may occur.
You need to repeat the test at least 3 times while the patient refrains from ingesting foods
Term
What are the nursing diagnoses r/t elimination?
Definition
-Constipation
-Risk for constipation
-Perceived constipation
-Bowel incontinence
-Diarrhea
-Toileting self-care deficit
Term
How can you implement acute care?
Definition
Promotion of normal defecation
Establish a routine an hour after a meal, or maintain the patient’s routine.
Sitting position
Privacy
Positioning on bedpan
Term
Who uses a fracture bedpan?
Definition
The smaller fracture pan, designed for patients with lower extremity fractures, has a shallow upper end about 1.3 cm (1 2 inch) deep. The shallow end of the pan fits under the buttocks toward the sacrum; the deeper end, which has a handle, goes just under the upper thighs.
Term
Should a person be supine or fowler's when on a bedpan?
Definition
Fowler's
Term
How do you position an immobilized patient on a bedpan?
Definition
Lower the head of the bed flat, and help the patient roll onto one side, backside toward the nurse.
2. Apply a small amount of powder to back and buttocks, or cover bedpan edge with tissue to prevent skin from sticking to the pan.
3. Place the bedpan firmly against the buttocks, down into the mattress, with the open rim toward the patient’s feet.
4. Keeping one hand against the bedpan, place the other around the patient’s fore hip. Ask the patient to roll back onto the pan, flat in the bed. Do not shove the pan under the patient.
5. With the patient positioned comfortably, raise the head of the bed 30 degrees.
6. Place a rolled towel or a small pillow under the lumbar curve of the patient’s back for added comfort.
7. Raise the knee gatch or ask the patient to bend the knees to assume a squatting position. Do not raise the knee gatch if contraindicated.
Term
What are the medications associated with elimination problems?
Definition
Cathartics and laxatives
Oral, tablet, powder, and suppository forms
Excessive use increases risks for diarrhea and abnormal elimination.
Antidiarrheal agents
Over the counter
Opiates used with caution
Term
What does ongoing use of cathartics laxatives etc. cause?
Definition
Ongoing use of cathartics, laxatives, and enemas affects and delays normal defecation reflexes.
Term
What are the 4 types of cleansing enemas?
Definition
Tap water
Normal saline (infants and children)
Hypertonic solutions
Soapsuds
Term
What is a cleansing enema?
Definition
promote the complete evacuation of feces from the colon. They act by stimulating peristalsis through infusion of a large volume of solution or through local irritation of the mucosa of the colon.
Term
What is a normal saline enema?
Definition
Infants and children receive only normal saline because they are at risk for fluid imbalance
Term
What is a tap water enema?
Definition
hypotonic and exerts an osmotic pressure lower than fluid in interstitial spaces. After infusion into the colon, tap water escapes from the bowel lumen into interstitial spaces. The net movement of water is low. The infused volume stimulates defecation before large amounts of water leave the bowel. Do not repeat tap water enemas because water toxicity or circulatory overload develops if the body absorbs large amounts of water.
Term
What is a physiologically normal saline enema?
Definition
safest solution to use because it exerts the same osmotic pressure as fluids in interstitial spaces surrounding the bowel. The volume of infused saline stimulates peristalsis. Giving saline enemas does not create the danger of excess fluid absorption.
Term
What is a hypertonic enema?
Definition
exert osmotic pressure that pulls fluids out of interstitial spaces. The colon fills with fluid, and the resultant distention promotes defecation. Patients unable to tolerate large volumes of fluid benefit most from this type of enema, which is by design low volume. This type of enema is contraindicated for patients who are dehydrated and for young infants. A hypertonic solution of 120 to 180 mL (4 to 6 oz) is usually effective. The commercially prepared Fleet enema is the most common.
Term
What is soapsuds?
Definition
Add soapsuds to tap water or saline to create the effect of intestinal irritation to stimulate peristalsis. Use only pure castile soap that comes in liquid form and is included in most soapsuds enema kits. Use soapsuds enemas with caution in pregnant women and older adults because they cause electrolyte imbalance or damage to the intestinal mucosa.
Term
What is an oil retention enema?
Definition
lubricate the rectum and colon. The feces absorb the oil and become softer and easier to pass. To enhance the action of the oil, the patient retains the enema for several hours if possible.
Term
What is a carminitive enema?
Definition
provide relief from gaseous distention.
Term
What is a medicated enema?
Definition
contain drugs. An example is sodium polystyrene sulfonate (Kayexalate), which is used to treat patients with dangerously high serum potassium levels.
Term
How do you administer an enema>
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
How do you remove stool with digits?
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.
Term
What is the purpose of an NG tube?
Definition
Decompression, enteral feeding, compression, and lavage
Term
What can an NG tube cause sometimes?
Definition
The NG tube sometimes causes distention. Its presence causes many patients to swallow large volumes of air. Channels of gastric secretions form along the walls of the stomach and bypass the suction holes. Turning the patient regularly helps to collapse the channels and promotes emptying of stomach contents.
Term
What's important when inserting and maintaining an NG tube?
Definition
Clean technique
Maintaining patency
Term
. To maintain normal elimination patterns in the hospitalized patient, you should instruct the patient to defecate 1 hour after meals because
Definition
Mass colonic peristalsis occurs at this time.
Term
How do you care for an ostomy?
Definition
Irrigate it
Term
What does an effective pouching ostomy do?
Definition
An effective pouching system protects the skin, contains fecal material, remains odor free, and is comfortable and inconspicuous.
Term
What are nutritional considerations for restorative care?
Definition
Consume low fiber for the first weeks.
Eat slowly and chew food completely.
Drink 10 to 12 glasses of water daily.
Patient may choose to avoid gassy foods.
Term
What is apart of bowel training?
Definition
Training program
Diet
Promotion of regular exercise
Management of hemorrhoids
Skin integrity
Term
What is a training program?
Definition
The training program involves setting up a daily routine. By attempting to defecate at the same time each day and using measures that promote defecation, the patient gains control of bowel reflexes. The program requires time, patience, and consistency. The health care provider determines the patient’s physical readiness and ability to benefit from bowel training.
Term
What ?'s should you ask to evaluate effectiveness?
Definition
Do you use medications such as laxatives or enemas to help you defecate?
What barriers are preventing you from eating a diet high in fiber and participating in regular exercise?
How much fluid do you drink in a typical day? What types of fluids do you normally drink?
What challenges do you encounter when you change your ostomy pouch?
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