Interventions such as _____ may affect
bowel elimination
surgery
immobility
medications
therapeutic diets
_____ is defined as bowel movements that are infrequent, hard or dry, and difficult to pass.
Constipation
_____ is defined as an increased number of loose, liquid stools.
Diarrhea
_____ are collected both for screening and for diagnostic tests, such as for the detection of occult blood, bacteria, or parasites.
Stool specimens
Collect stool specimens for serial fecal occult blood (guaiac) testing _____ times from _____ different defecations. Stool samples should come from fresh stools that are not contaminated with water or urine.
three
three
Bowel diversions through _____ are temporary or permanent openings (stomas) in the abdominal wall to allow fecal matter to pass.
ostomies
_____ are a result of colorectal cancer or some types of bowel disease. Colostomies
end in the colon, and ileostomies end in the ileum.
End stomas
_____ are performed as a medical emergency and are temporary.
Loop colostomies
______ consist of two abdominal stomas - one proximal and one distal.
Double-barrel colostomies
Visualization of the bowel
Colonoscopy
the large colon and sometimes a portion of the lower small bowel are visualized and may be biopsied.
Visualization of the bowel
Sigmoidoscopy
the sigmoid colon and rectum are visualized and may be
biopsied.
Bedpans
? Fracture pan - for supine clients and clients in body casts or leg casts
? Regular pan - for seated clients
For clients using a fracture pan, raise the
head of the bed to ______.
30�
If a client cannot lift his hips to get the
bedpan under him:
roll him onto one side, position the bedpan over his buttocks, and roll the client back onto the bedpan.
Fecal occult blood testing is done using a _____.
guaiac test
Cleansing enema - The height of the bag above the rectum determines the _____ of
cleansing.
depth
Enema solutions and additives:
Tap water or hypotonic solution
? Stimulates evacuation
? Never repeated due to potential water toxicity
Enema solutions and additives:
Soapsuds
? Pure castile soap in tap water or normal saline
? Acts as an irritant to promote bowel peristalsis
Enema solutions and additives:
Normal saline
? Safest due to equal osmotic pressure
? Volume stimulates peristalsis
Enema solutions and additives:
Low-volume hypertonic
? Good for clients who cannot tolerate high-volume enemas
? Fleet� - a commercially prepared hypertonic enema
Enema solutions and additives:
Oil retention
lubricates the rectum and colon for easier passage of stool
Enema solutions and additives:
Medicated enemas
contains medications to be retained
Complications:
Constipation
? Bowel pattern difficult.
? Infrequent evacuation of hard dry feces.
? May be the result of improper diet, decreased fluid intake, lack of exercise, or side effects of certain medications.
? Increase fiber and water consumption before treating constipati
Complications:
Impaction
? Stool that is wedged into the rectum with diarrhea fluid leaking around impacted stool
? Digital removal of the stool is done using a gloved and lubricated finger.
? The stool is loosened around the edges and then removed in small pieces, allowing the
c
Complications:
Diarrhea
? Frequent, liquid stools caused by various disorders.
? The cause must be determined and treated.
? Medications to slow peristalsis may also be prescribed.
? Provide good perineal care after each stool and apply a moisture barrier if indicated.
? The cli
Complications:
Fecal Incontinence
? The inability to control defecation, often caused by diarrhea
? Assess the client for causes, such as medications, infections, or impaction.
? Provide perineal care after each stool and apply a moisture barrier if indicated.
Complications:
Flatulence
? Signs and symptoms - the distention of the bowel from gas accumulation (may cause cramping or a feeling of fullness)
? Assess the client for abdominal distention and the ability to pass gas through the anus.
? If mobile, encourage the client to ambulate
Complications:
Hemorrhoids
? Engorged, dilated blood vessels in the rectal wall caused by difficult defecation, pregnancy, liver disease, and heart failure
? May be itchy, painful, and bloody after defecation.
? When cleansing the perianal area, moist wipes may be more comfortable.
Causes of constipation include:
? Frequent use of laxatives.
? Advanced age.
? Inadequate fluid intake.
? Inadequate fiber intake.
? Immobilization due to injury.
? A sedentary lifestyle.
Causes of diarrhea include:
? Viral gastroenteritis.
? Bacterial gastroenteritis.
? Overuse of laxatives.
? Use of certain antibiotics.
? Inflammatory bowel disease.
? Irritable bowel syndrome.
? Food-borne pathogens.
Monitor for signs and symptoms of constipation:
Abdominal bloating
Abdominal cramping
Straining at defecation
Monitor for signs and symptoms of diarrhea:
Signs and symptoms of dehydration
Frequent loose stools
Abdominal cramping
Fecal occult blood test:
a fecal sample is obtained using medical asepsis while
wearing disposable gloves. Some foods (red meat, fish, poultry, raw vegetables) and medications can cause false positive results. Bleeding can be a sign of cancer, which
can be a contributing factor f
Digital rectal examination for impaction:
the client should be positioned on the left side with the knees flexed. The examiner inserts a gloved, lubricated index finger gently into the rectum. During the procedure, the client's vital signs and response should be monitored.
Specimens for stool cultures:
these are obtained using medical asepsis while wearing disposable gloves. The specimen should be labeled and promptly sent to the laboratory. Intestinal bacteria can be a contributing factor for diarrhea.
Complications of constipation include:
? Fecal impaction.
? Development of hemorrhoids or rectal fissures.
? Bradycardia, hypotension, and syncope associated with the Valsalva maneuver
Complications of diarrhea include:
? Signs and symptoms of dehydration and fluid and electrolyte disturbances (metabolic acidosis caused by excessive loss of bicarbonate).
? Skin breakdown around the anal area.
Meeting the Needs of Older Adults
? Older adult clients are more susceptible to developing constipation as bowel tone decreases with age, and they are more at risk for developing fecal impaction.
? Adequate fluid and fiber intake and exercise are very important.
? Older adult clients are
occult
Hidden blood in the stool that is not visible.
guaiac
chemical from the wood of trees
paralytic ileus
Usually temporary paralysis of intestinal wall that may occur after abdominal surgery or peritoneal injury and that causes cessation of peristalsis; leads to abdominal distention and symptoms of obstruction.
carthartics
promote peristalsis
magnesium citrate or sorbitol 70%.
syncope
Passing out", loss of consciousness or fainting