Gastrointestinal tract
Mouth, esophagus, stomach, small intestine, large intestine, rectum, anus, defecation
Factors effecting bowel elimination
-Age
-Diet/Fluid intake
-Physical activity
-Psychological factors
-Personal habits
-Surgery/anesthesia
-Position while defecating
-Pain
-Pregnancy
-Medications
-Diagnostic tests (colonoscopy, FOCB-looks for early signs of bowel cancer(warns no meats, veal
Age effects of bowel elimination
With increasing age, absorption and emptying decreases. Mastication also becomes less efficient.
Paralytic ileus
complete absence of peristaltic movement that may follow abdominal surgery or complete bowel obstruction, 24-48 hours
Common problems
-Constipation (can be related to decreased peristalsis if immobile)
-Impaction
-Diarrhea
-Incontinence (loss of bowel control)
-Flatulence ("farting," especially when excessive)
-Hemorrhoids (swollen veins in rectum or anus)
Ostomies
Surgically formed opening from the inside of an organ to the outside. Ileostomy allows liquid fecal content from the ileum of the small intestine to be eliminated through the stoma. A colostomy permits formed feces in the color to exit through the stoma.
Types of colostomies
End colostomy-If parts of large bowel (colon) or rectum have been removed, the remaining large bowel is brought to the surface of the abdomen to form a stoma. Can be temporary or permanent. The temporary solution is relevant in situations where the diseas
Ostomy care
Irrigation:A way to regulate bowel movements (fecal continence and control) by flushing and emptying the colon at a selected time. Water is inserted into the colostomy and water and feces are expelled from the colostomy into the irrigation sleeve and then
Assessment of history
-Elimination patterns
-Characteristics of stool
-Routines
-Use of medication or enemas
-Presence of bowel diversion
-Changes in appetite
-Diet and fluid-intake (bulk forming foods, ex. whole grains)
-Prior history and use of medications
-Emotional state
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Nursing diagnosis
-Bowel incontinence
-Constipation
-Diarrhea
-Impaired skin integrity
When planning
Set goals and outcomes, set priorities, continuity of care
Implementation
-Position: Sitting upright on a toilet or commode if possible. May need support. Using a small step stool to raise feet. Avoid using bed pain, if needed elevate head of the bed to as close of a sitting position as possible.
-Privacy:Give when possible
Common causes of constipation
Irregular bowel habits, chronic or organic illness, low fiber diet, lack of exercise or mobility, heavy laxative use, age, neurological conditions and stress
Enemas
Tap water: 500-1000mL, 15 minutes, can lead to fluid and electrolyte imbalance, should not be used in children
Normal saline:500-1000mL, 15 minutes, safest
Soap:500-1000mL, 10-15 minutes, must only use castile soap
Hypertonic:70-130mL, 5-10 minutes, avoid
Digital removal of stool
Use if enemas fail to remove an impaction. Last resort in managing severe constipation. Insert gloved, lubricated finger into fecal mass. Slowly and gently using finger to break up some of the hardened mass. Break off a section of the impaction. Remove a
Nasogastric tube
Used for uncontrollable diarrhea, passed through the nasopharync into the stomach, allows for the removal of gastric secretions and instillation of solutions such as medications or feedings into the stomach. Tube placement must be verified.
Placement: Hig
Restoritive Care
-Bowel training
-Maintenance of proper fluid and food intake
-Promote regular exercise
-Hemorrhoid care
-Maintenance of skin integrity
Differences between NG tubes
Levine: Tube feedings only, single lumen, may have guideware, usually soft and pliable, cannot be used for suction
Salem:Can be used for feedings or suction, has 2+ lumens, has an airport, salem sucks
Suppositories
solid, cone-shaped, medicated substances inserted into a body cavity, stimulate the bowel
Diarrhea
At least 3 loose, liquid stools per day, increased frequency, urgency, hyperactive bowel sounds, report of abdominal pain and cramping
Developmental considerations
Infants: Breastfed typically have more frequent stools (2-10 per day), yellow to golden in color, loose, and have little odor usually, Formula fed typically have 1-2 stools daily, yellow to brown color, stronger odor. Both may have curds or mucus.
Toddler
A nurse is assessing the abdomen of a patient who is experiencing frequent diarrhea. The nurse first observes the contour of the abdomen, noticing any masses, scars, or areas of distention. What action would the nurse perform next?
Auscultate the abdomen using an orderly clockwise approach in all abdominal quadrants. (Auscultation should always be done before palpation or percussion in the abdomen because it may disturb normal peristalsis, Deep palpation and percussion can only be p
A nurse is administering a large-volume cleansing enema to a patient prior to surgery. Once the enema is introduced, the patient reports severe cramping. What nursing intervention would the nurse perform next based on patient reaction?
Lower the solution contained and check temperature and flow rate. (If the solution is too cold or flow rate is too fast, severe cramping may occur)
A nurse working in a hospital includes abdominal assessment as part of patient assessment. In which patients would a nurse expect to find decreased or absent bowel sounds after listening for 5 minutes?
A patient diagnosed with peritonitis, a patient who is on prolonged bed rest, a patient who has paralytic ileus caused by surgery
A nurse assesses stool of patients who are experiencing gastrointestinal problems. In which patients would diarrhea be a possible finding?
A patient who is taking metformin for type 2 diabetes, a patient who is taking amoxicillin for an infection, a patient taking over-the-counter antacids
A patient has fecal impaction. Which nursing action is correctly performed when administering an oil-retention enema for this patient?
The nurse instructs the patient to retain the enema for at least 30 minutes.
A nurse prepares to assist a patient with a newly created ileostomy. Which recommended patient teaching points should the nurse stress?
The stool from an ileostomy is normally liquid," "You should eat dark-green vegetables to control the odor of the stool," "You may have a tendency to develop food blockages
A nurse is preparing a hospitalized patients for a colonoscopy. Which nursing action is the recommended preparation for this test?
Have the patient follow a low-fiber diet several days before the test.
A nurse is performing digital removal of stool on a patient with a fecal impaction. During the procedure, the patient reports feeling dizzy and nauseated and then vomits. What should be the nurse's next action?
Stop the procedure, assess vital signs, and notify the primary care provider
A nurse is scheduling tests for a patient who has been experiencing epigastric pain. The health care provider ordered the following tests a)barium enema, b)fecal occult blood test, c)endoscopic studies, and d)upper gastrointestinal series. Which is the co
B, A, D, C
A nurse is caring for a patient who has an NG tube in place for gastric decompression. Which nursing actions are appropriate when irrigating an NG tube connected to suction.
Draw up 30 mL of saline solution into syringe, Place the tip of the syringe in the tube to gently inset saline solution, after instilling irrigant hold the end of the NG tube over an irrigation tray, observe for return flow of NG drainage into available c
A nurse is planning a bowel-training program for a patient with frequent constipation. What is a recommended intervention?
Monitoring bowel movements
A nurse is caring for a patient who is post-surgical following an IPAA. For which adverse effect would the nurse monitor in this patient?
Incontinence
For which patient would a nurse expect the primary care provider to order colostomy irrigation?
A patient with a left-sided end colostomy in the sigmoid colon.
A nurse is assisting a patient to empty and change an ostomy appliance. When the procedure is finished, the nurse notes the stoma is protruding into the bag. What would the nurse's first action be in this situation?
Have the patient rest for 30 minutes to see if the prolapse resolves.
A nurse is caring for an older adult who has constipation. Which laxative would be contraindicated for this patient?
A saline osmotic laxative. These can lead to fluid and electrolyte imbalances and should not be used in older adults or those with cardiac/kidney diseases.