Term
|
Definition
Decreased peristalsis
Lose muscle tone in perineal floor and anal sphincter
Often have difficulty controlling bowel
elimination with an intact external sphincter
Become less aware of need to defecate
Bowel consciousness |
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Term
|
Definition
provides bulk of fecal matter
Need 20-35 grams of fiber/day
Risk for polyps with no fiber in diet |
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Term
| Diet (Bulk forming foods) |
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Definition
help flush fats and wastes
from body
Whole grains, fresh fruits and vegetables |
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Term
|
Definition
| Bowel walls stretch, creating peristalsis and initiate defecation reflex |
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Term
|
Definition
1100-1400 mL fluid daily
Fluids and fruit juice soften stool and 5 peristalsis
Risk for constipation with diminished fluid intake |
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Term
|
Definition
Promotes peristalsis
Weakened abdominal and pelvic floor muscles impair ability to increase intraabdominal pressure and to control the external sphincter
Encourage early ambulation |
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Term
|
Definition
Stress increases
peristalsis
Diarrhea
Gaseous distention |
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Term
|
Definition
Maintain privacy
Prefer own toilet
Embarrassment
ignore urge
Convenient time
Busy work schedule
ignore urge |
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Term
| Position During Defecation |
|
Definition
Leaning forward
Intraabdominal pressure
Contract thigh muscles
Bedridden
client…raise HOB 30º
or more while on
bedpan |
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Term
|
Definition
Hemorrhoids
Rectal surgery
Rectal fistulas
Abdominal surgery
Suppress urge to defecate
Develop constipation |
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Term
|
Definition
General anesthesia
Temporarily stop peristalsis
Local or regional anesthesia
Minimally or does not affect bowel activity
Direct manipulation of bowel temporarily stops peristalsis (paralytic ileus) for 24 to 48 hours |
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Term
|
Definition
Infrequent bowel movements- < every 3 days
Inability to defecate at will
Difficulty passing stools
Excessive straining
Hard feces |
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Term
| Health hazards from straining |
|
Definition
Increased intracranial pressure
Increased intraocular pressure with possible fainting
Bradycardia (Valsalva maneuver)
Suture and wound separation |
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Term
| CONSTIPATION COMMON CAUSES |
|
Definition
Ignoring urge to defecate
Low fiber diet
Low fluid intake
Anxiety, depression or cognitive impairment
Lack of regular exercise
Laxative misuse
Medications
Opioid analgesics
Diuretics |
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Term
|
Definition
| Results from ongoing constipation |
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Term
| Fecal Impaction (Signs and symptoms) |
|
Definition
Inability to pass hardened stool for several days despite repeated urge with intestinal obstruction
Continuous oozing of diarrhea stool around impaction
Loss of appetite
Nausea and/or vomiting
Abdominal distention and cramping
Rectal pain
Can extend into sigmoid colon |
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Term
|
Definition
| Inability to control passage of feces and gas from anus due to imparment of anal sphincter control. |
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Term
| Promoting normal defecation |
|
Definition
Sitting position
Positioning on bedpan – raise HOB 30 degrees or greater after bedpan placement unless contraindicated
Privacy |
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Term
| Normal Fecal Characteristics |
|
Definition
Color –brown
Odor – Pungent; affected by food type
Consistency – soft, formed
Frequency – 2-3 times per week
Shape – resembles diameter of rectum
Constituents – undigested food, dead bacteria, fat, bile pigments, cells lining intestinal mucosa, water |
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Term
| Stool Specimen Collection |
|
Definition
Gather supplies
Explain reason for specimen collection
Wear gloves
Ask to void before stool collection
Have defecate in a clean bedpan, bed side commode or hat in toilet
Teach to not contaminate specimen with urine or menstrual discharge
Teach to not place tissue in bedpan, commode or hat
Use clean tongue depressor to transfer specimen (sterile if for bacteria/viral study)
1 inch formed stool or 15-30 mL of liquid diarrhea stool for most tests
Some specimens are temperature sensitive and must be sent to lab immediately |
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Term
| Performing a Hemoccult/Guaiac test on stool for occult blood (microscopic amounts of blood)preparation |
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Definition
| Preparation: No red meat, any blood containing food, cantaloupe, uncooked broccoli, turnip, radish or horseradish 3 days before test |
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Term
| Performing a Hemoccult/Guaiac test on stool for occult blood (microscopic amounts of blood) |
|
Definition
Requires 3 consecutive samples
If directed by MD stop taking meds that interfere with test –vit C, aspirin, NSAID, steroids, iron, anticoagulants that irritate gastric mucosa & cause bleeding
Label card on front with patient identifying info
Thin smear from 2 portions of the stool
Close cover flap & turn over
Wait 3-5 minutes. Open flap. Apply 2 drops of developing solution on each smear. Interpret within 60 seconds. Blue is positive & no color is negative |
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Term
| OVA & Parasite Test on stool |
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Definition
Transport immediately to lab while warm
3 stool specimens over a period of days |
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Term
|
Definition
3-5 day collection of stool
Save all of the stool for this test |
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Term
|
Definition
Purposes:
Temporary relief of constipation
Removal of impacted feces
Empty bowel before diagnostic tests or surgery
Beginning a program of bowel training |
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Term
|
Definition
Low volume hypertonic solutions.
120-180 ml solution.
Pull fluid out of interstitial spaces into the intestine and stimulate peristalsis.
Contraindicated for hydrated clients. |
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Term
| Cleansing Enemas (Tap Water) |
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Definition
Stimulates defecation
Water moves from intestines into interstitial spaces
Risk of circulatory overload if repeated – avoid this |
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Term
| Cleansing Enemas (Normal Saline) |
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Definition
Safest solution
Stimulates defecation without movement into interstitial spaces |
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Term
| Cleansing Enemas (Soapsuds) |
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Definition
Use pure castile soap (comes in kit)
Intestinal irritation to stimulate peristalsis
Use cautiously in elderly – damage intestinal mucosa; fluid and electrolyte imbalance |
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Term
| Cleansing Enemas (Oil Retention) |
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Definition
Lubricates rectum and colon
Softens stool
Usually retained for 30 minutes up to several hours if possible |
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Term
| Cleansing Enemas (Carminative(to relieve gas) |
|
Definition
MGW solution – 30 mL magnesium, 60 mL glycerin & 90 mL water
Medicated
Kayexalate (for clients with high potassium)
Neomycin solution – to reduce bacteria in colon before bowel surgery |
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Term
| Digital removal for impacted stool (per MD order)…it is the nurse’s responsibilities!! |
|
Definition
Provide for privacy
Assist to left side lying position with knees flexed and back toward nurse
Place bed pad below buttocks, and bedpan nearby for stool
Nurse wears clean gloves with index finger well lubricated
Gently insert gloved index finger along the length of the rectum
Loosen and dislodge stool by gently massaging around it. Break up the stool and remove in small pieces
Assess throughout for facial pallor, diaphoresis or change in pulse rate
Assist onto bedpan or commode
Document responses & results |
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Term
| Enema Administration Key Points When Using Solution Administration Bag |
|
Definition
Water proof pad under client
Position client onto left side lying (Sims) position with right knee flexed
Use warm solution
Raise solution bag above anus on hanging pole
12-18 inches for high enema – for entire colon
12 inches for regular enema
3 inches for low enema – for rectum and sigmoid areas
Insert lubricated tip in direction of clients umbilicus 3-4 inches
Open regulating clamp and allow solution to enter slowly
Clamp tubing for cramping or fluid leakage around rectal tube
After enema infused turn from left lateral to dorsal recumbent to right lateral to reach entire colon for high enema |
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Term
| Prepackaged Bottle Disposable Container |
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Definition
Once inserted roll up container to instill the solution
Retain solution until urge to defecate (2-5 minutes)
Exception: mineral oil |
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Term
|
Definition
| Increase in the number of stools and passage of liquid, unformed feces |
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Term
|
Definition
Antibiotic use and other causes of over of clostridium difficule (c.difficilie)
Enteral nutrition
Food allergies and intolerance |
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Term
| Overgrowth of Clostridium difficile (Causes) (C. difficile) |
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Definition
Antibiotics – cephalosporins, ampicillan, amoxicillin, clindamycin
Chemotherapy
Invasive bowel procedures |
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Term
| Prevention of C. difficule |
|
Definition
Good hand washing
Probiotics e.g. culturell
Stool specimens for c. difficile |
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Term
| Enteral nutrition (prevention of diarrhea) |
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Definition
Canned formulas at room temp
Strict sanitation during preparation
Initial feedings at half strength and gradually increase volume
Increase rate slowly and at rate tolerated by client
Dietician for assistance |
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Term
| Enteral nutrition (Food-borne pathogens prevention) |
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Definition
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Term
|
Definition
Usual elimination pattern (frequency & time of day)
Description of usual stool characteristics
Routines to promote normal elimination
-drinking hot liquids
-eating specific foods
- taking time to defecate
Use of artificial aids
-enemas, laxatives &
bulk forming additives
Presence of bowel diversion (ostomy)
Changes in appetite
Diet history
Description of daily fluid intake
Surgeries or illnesses affecting GI tract
Medication history (laxatives, antacids, iron supplements, analgesics)
Emotional state
Exercise
Pain or discomfort
Living arrangements
Mobility and dexterity |
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Term
| Physical Assessment (Diarrhea) |
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Definition
• Mouth
Abdomen
Rectum
Characteristics of feces |
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Term
| Acute Care: Client Goals(Diarrhea) |
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Definition
Restore normal elimination
Restore normal stool consistency
Prevent associated Risks
-Fluid Balance & Electrolyte
imbalances
-Skin Breakdown
-Abdominal Distention
-Pain |
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Term
Acute Care: Nursing Order & Implementation
(Diarrhea) |
|
Definition
Assess for causative factors
Assess for fecal impaction
Eliminate causative factors
Maintain hydration & fluid/electrolyte balance
Avoid caffeine, high fiber or spicy foods
Maintain skin integrity
Promote wellness |
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Term
| Nursing History (Constipation) |
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Definition
• Usual elimination pattern (frequency & time of day)
• Description of usual stool characteristics
• Routines to promote normal elimination
-drinking hot liquids
-eating specific foods
- taking time to defecate
• Use of artificial aids
-enemas, laxatives &
bulk forming additives
• Presence of bowel diversion (ostomy)
• Changes in appetite
• Diet history
• Description of daily fluid intake
• Surgeries or illnesses affecting GI tract
• Medication history (laxatives, antacids, iron supplements, analgesics)
• Emotional state
• Exercise
• Pain or discomfort
• Living arrangements
• Mobility and dexterity |
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Term
| Physical Assessment (Constipation) |
|
Definition
Mouth
Abdomen
Rectum
Characteristics of feces |
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Term
| Acute Care: Client Goals (Constipation) |
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Definition
Restore normal elimination
Restore normal stool consistency
Prevent associated Risks
-Abdominal distention
-Pain |
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Term
| Acute Care: Nursing Order & Implementation (Constipation) |
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Definition
Provide privacy & uninterrupted time
Timing – when urge is recognized, after breakfast
Positioning- lean forward on toilet.
Discourage straining.
Diet – high fiber & fluids
Exercise |
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Term
| Fecal Impaction (Acute Care) |
|
Definition
Enemas
Cleansing promote complete evaluation (tap water, normal saline, soapsuds, low vol hypertonic solution)
Oil retention
Other |
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Term
|
Definition
promote defecation by softening stool & promoting peristalsis
laxatives
*cathartics
*chronic -use-lg intestines loses muscle tone & less responsive to stimulation by laxatives
control diarrhea |
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