Fundamentals of Nursing: Bowel elimination Flashcards

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bowel elimination can affect

fluid and electrolyte balance, hydration, nutritional status, skin integrity, comfort and self concept.


the large intestine is

the primary organ of bowel elimination

extends from the ileocecal valve to the anus


functions of the large intestine

absorption of water, formation of feces, expulsion of feces from the body


the GI tract is from where to where?

mouth to anus


peristalsis is

involuntary constriction and relaxation of the muscles of the intestine


peristalsis is under control of...?

the nervous system


How much food waste is excreted in stool in 24 hours?

one third to one half


waste products are stopped from exiting the body by

anal sphincters


anal sphincters control

the discharge of feces and intestinal gas


When the person bears down to defecate it can cause

the heartrate to slow and may result in syncope


Valsalva maneuver is

the intense bearing down that can be contraindicated in people with cardiovascular problems and other illnesses


developmental considerations influencing bowel elimination

  • Infants: Characteristics of stool and frequency depend on formula or breast feedings
  • Toddler: Physiologic maturity is the first priority for bowel training
  • Child, adolescent, adult: Defecation patterns vary in quantity, frequency, and rhythmicity
  • Older adult: Constipation is often a chronic problem; diarrhea and fecal incontinence may result from physiologic or lifestyle changes

daily patterns influencing bowel elimination

people have their own patterns for frequency, time, place and any interruption can affect their elimination


food and fluids influencing bowel elimination

high fiber and hydration are key factors in healthy bowels


how activity and muscle tone influence bowels

regular exercise improves GI motility inactivity decreases GI motility


can medications affect bowel elimination

yes, diarrhea and constipation are caused by many medications



passage of 3 or more loose stools a day


fecal impaction

prolonged retention of fecal matter that forms a hard mass in the rectum



dry, hard stool and difficult passage of stool


fecal incontinence

the involuntary or inappropriate passing of stool


intestinal obstruction

when a blockage prevents the normal flow of intestinal contents through the intestinal tract


what is C. diff.?

inflammation of the colon caused by the bacteria clostridium difficile


A patient receiving broad- spectrum antibiotics has

a disruption in their normal intestinal flora which allows C. diff. to grow.


C. diff causes

intestinal mucosal damage and inflammation, diarrhea, and abdominal cramping


c. diff is resistant to

disinfectants and can be easily spread


what precautions should be used for c. diff.?

contact precautions


postoperative paralytic ileus

direct manipulation of the bowel during surgery inhibits peristalis causing this postop condition


if peristalis persists ______________ can occur

distension and obstruction


_____________ can also inhibit peristalsis

inhaled general anesthesia


Physical assessment for abdomen involves _________

inspection: observe contour, any masses, scars or distension

auscultation: listen for bowel sounds in all quadrants

not frequency and character, audible clicks and flatus

describe bowel sounds as hypoactive, hyperactive, absent


Physical assessment for anus & rectum involves

  • Inspection – Superficial examination
  • Lesions, ulcers, fissures (linear break on the margin of the anus), inflammation, and external hemorrhoids
  • Ask the patient to bear down as though having a bowel movement, assess for the appearance of hemorrhoids or fissures and fecal masses
  • Inspect perineal area for skin irritation secondary to diarrhea or fecal incontinence
  • Note information or characteristics of patient’s stool

Collecting a specimen consists of

  • Medical aseptic technique is imperative
  • Hand hygiene, before and after glove use, is essential
  • Wear disposable gloves
  • Do not contaminate outside of container with stool
  • Do not place toilet tissue in the container with the specimen
  • Obtain stool and package, label, and transport according to agency policy

Why should the characteristics of the stool be assessed?

because the patient could have a change that we need to know about and the stool can tell us those changes.


conditions that can place the patient at high risk for intestinal bleeding

ulcer disease, inflammatory bowel disorders, and colon cancer


black stools may indicate

upper gi bleed


bright-red stools may indicate

a lower gi bleed or may be from hemorrhoids or a polyp


certain foods or medications can cause

black or reddish stools


__________ can be detected with screening tests

occult blood (blood hidden in the specimen)


specimen can be tested for

bacteria, lymphocytes, blood, c.diff


common diagnostic procedures include

  • Endoscopy
  • Esophagogastroduodenoscopy (EGD)
  • Colonoscopy
  • Sigmoidoscopy
  • Upper Gastrointestinal and Small-Bowel Series
  • Barium Enema
  • MRI
  • Abdominal CT Scan
  • Abdominal Ultrasound

Which of the following direct visualization tests uses a long, flexible, fiberoptic–lighted scope to visualize the rectum, colon, and distal small bowel?

  1. Esophagogastroduodenoscopy
  2. Colonoscopy
  3. Sigmoidoscopy
  4. UGI series



Normal bowel elimination

  • Patient has a soft, formed bowel movement every 1 to 3 days without discomfort
  • There is a strong relationship between bowel elimination and diet, fluid, and exercise
  • Patients should seek medical evaluation if changes in stool color or consistency persist
  • Promote proper positioning and privacy

Patients at high risk for constipation include

those on bedrest taking constipating medicines

with reduced fluids or bulk in their diet

with CNS disease or local lesions that cause pain while defecating


Nursing interventions for patient with constipation

drink more fluid

educate about proper nutrition, exercise, medication and hydration

Give laxatives or meds that induce gastric emptying

overuse of laxatives can cause constipation


Nursing interventions for diarrhea

  • Answer call bells immediately to assist patients in a timely manner
  • Remove the cause of diarrhea whenever possible
  • If there is impaction, obtain physician order for rectal examination
  • Provide hygiene care to promote skin integrity
  • Replace lost fluids and treat symptoms

What might some clinical findings be for a patient who has had diarrhea for 3 or 4 days?

risk for fluid volume deficit, may have low bp, poor skin turgor, elevated HR, elevated temp. if body is unable to cool itself through perspiration. Diarrhea for that long can be caused by medication or diet.


What is an enema?

  • Introduction of a solution into the large intestine, usually to remove feces or administer medications

types of enemas



large volume

small volume


What technique should be used for administration?

aseptic technique


What is a safe and effective distance for the nurse to insert an enema into the patients rectum?

3 - 4 inches


What can a nasogastric tube be used for?

  • Inserted to decompress or drain the stomach of fluid or unwanted stomach contents
  • Used to allow the gastrointestinal tract to rest before or after abdominal surgery to promote healing
  • Inserted to monitor gastrointestinal bleeding
  • Feeding

If a patient has a NG tube in place that is hooked to low intermittent suction, why might they have IV fluids ordered?

the patient will be NPO and fluids and electrolytes may need to be replaced that were lost during suctioning


Fecal management system

  • Indwelling rectal catheter
  • Protects perianal skin from repeated episodes of incontinence
  • Liquid stool collects in the drainage bag
  • Require regular assessment and documentation of skin condition
  • Disadvantages include leaking and skin damage at the insertion site, injury to the rectal mucosa
  • May be contraindicated for a patient with severe hemorrhoids, recent bowel, rectal, or anal surgery or injury, rectal or anal tumors
  • Monitor for rectal bleeding

Bowel diversions

  • Sigmoid colostomy
  • Descending colostomy
  • Transverse colostomy
  • Ascending colostomy
  • Ileostomy


  • Allows liquid fecal content from the ileum of the small intestine to be eliminated through the stoma
  • right lower quadrant is the typical site for this type

Colostomy and Ileostomy care

  • Patients need physical and psychological support, ongoing education
  • Empty an ostomy appliance when it is about 1/3 full, reduces the risk of leakage or odor
  • Remove or change non-drainable pouches when they are ½ full
  • Inspect the stoma regularly, it should be dark pink to red and moist
  • Keep the skin around the stoma clean and dry
  • Patients will ileostomies need to ensure adequate fluid intake to

avoid dehydration and electrolyte imbalances


Dietary Considerations for Ileostomy/ Colostomy

  • Foods that may cause stomal blockage
  • Foods that may cause gas
  • Foods that may help control diarrhea
  • Foods that produce odor
  • Foods that are natural intestinal deodorizers

if ostomy is pale it could be



if ostomy is dark or blue

decreased circulation or anemia


if the stoma is any color besides the dark pink or red that it should be what should you do?

notify the provider or surgeon


patient teaching for ostomies

  • Explain the reason for bowel diversion and the rationale for treatment
  • Demonstrate self-care behaviors that effectively manage the ostomy
  • Describe follow-up care and existing support resources
  • Report where supplies may be obtained in the community
  • Verbalize related fears and concerns
  • Demonstrate a positive body image