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Nursing

Bowel Elimination

QuestionAnswer
Bowel Function Motility (segmentation-digesting, churning, "chime", peristalsis- moves chime through bowel). Absorption, defecation (pushes stool into rectum)
Normal feces 75% H2O, 25% solid-bacteria, undigested fibers, fat, protein, Brown due to bilirubin. Soft and cylindrical.
Where does most absorption occur In duodem & dejudem. Small intestine. Large intestine responsible for reabsorption of fluids and electrolytes.
Lifespan considerations: Infant Frequent BMs often after each feeding. Metonium- blackish tar. Infants first bowel movement.
Toddlers voluntary bowel control between 22-36 months of age
School age and adolescents More towards adult bowel patterns
Adults Have a typical pattern of bowel movement of 1-2/day to 1 every 2-3 days
Older adults decrease in motility can lead to constipation
Factors affecting elimination Age, nutrition, fluid intake, physical activity, psychological factors, personable habits, fecal diversions (ostomy), position during defecation, pain, pregnancy, surgery, anesthesia (decreases motility), medication, diagnostic tests
Common problems Constipation, impaction (stool in rectum, but can't pass), diarrhea, fecal incontinence, flatulence, hemorrhoids, abdominal distension (bloating, paralytic illius, pain, loss of bowel sounds.)
Assessment Physical assessment, elimination pattern, characteristics of stool, routines, use of medications or enemas, presence of bowel diversion, change in appetite, diet and fluid intake, current medications, exercise patterns, presence of discomfort, mobility
Stool specimen collection For culture and sensitivity, pus, ova, and parasites. Transport all specimens in a plastic biohazard/resealable bag. Specimen should be transported prior to cooling. O&P/Culture: Place in a small plastic container.
How to test stool sample for presence of hidden blood Hemoccult or fecal occult blood test. Uses a solution of guaiac to test for presence of blood. Using small wooden blade smear small amount of stool on testing slide to test for presence of occult blood.
Diagnostic and Radiologic Tests Upper GI/Barium swallow, upper endoscopy, lower GI barium enema, ultrasound, colonoscopy, flexible sigmoidoscopy, computerized tomography, MRI, enteroclysis
Barium Nursing Considerations Liquid when digested, but becomes solid after sitting in stomach. Can cause obstruction. Pt needs to drink plenty of fluids.
Nursing Diagnosis Bowel incontinence, constipation, diarrhea, impaired skin integrity, body image disturbance*
Health promotion Diet high in fiber, increase fluid intake, activity and exercise, regular screenings
Nursing interventions Medication: cathartics and laxatives, antidiarrheal agents. Enemas: tap water (moves gas out of bowel), saline, hypertonic (pulls fluid from bowel), soapsuds, oil retention
Enema Administration Heat enema solution to 100-105oF. Assess VS prior to administration. Place waterproof pad under buttock. Position client on LEFT side (sims). Drape client for privacy. Lubricate installation tip. Insert tip 3-4 inches into the rectum.
Enema Administration cont Instill fluid slowly to avoid cramping (speed is controlled by the height of the bag. If c/o of severe cramping temporarily stop the instillation and then resume). Encourage client to retain a fluid as long as possible. Provide for a safe path to toilet
Types of ostomies Ostomies may be temporary or permanent. Ureterostomy (urine)
Nursing considerations for ostomies skin integrity very important, cut paper 1/8" bigger than measured hole.
Ileostomy Empties from the end of the small intestines. Water is not absorbed. Stool is liquid. May not be irrigated. Drainage pouch is worn at all times.
Healthy stoma Moist, beefy red. Pale indicates anemia. Dark indicates problem with circulation.
Colostomy Located anywhere along the length of the large intestine. The further along the intestinal tract the more solid the stool. Reusable or disposable pouch worn. Stomadhesive is cut and placed around the stoma to protect the skin from urine or stool.
Ureterostomy Permanent fistula for drainage of a ureter through the abdominal wall
Ileoloop or Illeoconduit Ureter drains into a portion of the ileum which forms a pseudo bladder with an artificial opening into the abdominal wall. A straight catheter can be placed for drainage. Avoids the need for an external pouch.
Postoperative Stoma Assessment Every 2 hours for 24 hours. Every 4 hours for 28-72 hours. Every 4-8 hours routinely or PRN. Assess stoma for prolapse or retraction
Stoma Assessment Assess for irritation: there are no nerve endings so the stoma may be irritated without the client's awareness. Skin irritations should be reported and documented: dermatitis, rash, pimples, bluish discoloration.
Stoma documentation Drainage: amount, color, consistency, application or a cline pouch or dressing, client participation
Colostomy care Use clean technique, clean gloves, empty pouch when 1/4-1/3 full, rinse pouch with warm tap water, schedule regular daily care, change appliance every 4 days or PRN, Specimen should be taken directly from the stoma, not the pouch
Enterostomal Therapist Excellent resource person for clients and healthcare personnel concerning colostomy care. Teach clients to perform ostomy self-care.
Created by: senmark