GI System & Bowel Elimination Flashcards
Book Ch. 29 ATI Ch. 43 (26 cards)
What are some factors affecting bowel elimination?
Hint there are 10 in total
- Developmental Stage
- Personal Factors (privacy, positioning, pain)
- Sociocultural Factors
- Nutrition & Hydration
- Physical Activity
- Medications
- Procedures
- Pregnancy
- Pathological Conditions
- Bowel Diversions (ileostomy & colostomy)
What do we want to look for when assessing a patient’s bowel?
- Abdominal size & shape
- Bowel habits
- Color
- Consistency
- Pain
- Bowel sounds
What are 2 common diagnostic tests in diagnosing & treatment?
- Direct Visualization
- Colonoscopy
- Sigmoidoscopy - Radiographic Views
- Flat plat of the abdomen
What are some laboratory tests for assessing the bowel?
- Stool for Hemoccult Test (occult blood)
- Stool for Fecal Fat
- Stool for Ova & Parasites
The nurse knows that the results of a fecal occult blood test can be inaccurate if?
A. The client has had an excessive intake of red meat
B. The female client is menstruating
C. The client takes high doses of Vitamin C
D. All of the above
D. All of the above.
- Excessive intake of red meat causes a false positive of hGB in the stool.
- Menstruating can cause contamination of the specimen.
- Vitamin C can cause a false negative.
What are some potential causes of bowel incontinence?
- Developmental abilities
- Cognitive function
- Physical dysfunction from neurological issues
- Other issues
What is our main concern with incontinence?
Protecting the skin
- We can use a barrier cream to protect the skin.
Describe a bowel management system.
- Used for patients who are incontinent, bed ridden, with very loose or liquid stool.
- A long, flexible tube that inserts into the rectum w/ a balloon on the end that is inflated to hold tube in place.
- Tube is connected to drainage bag & stool drains from rectum into drainage bag.
- Keeps the perineal area clean.
Describe flatulence.
- People pass gas anywhere from 5-15 times a day.
- Assess abdominal distention & pain
- If a client develops gas pain, there are non pharm measures we can use:
- Encourage them to ambulate.
- Lying on their side with knees pulled up into a fetal position.
- Applying a heating pad to the abdomen.
What are hemorrhoids?
Cause?
Treatment?
Education?
- Dilated blood vessels in the rectum.
- Painful, itchy, bloody,swollen
- Caused by: an increase in pressure in the rectum (pregnancy, constipation, heart failure & liver disease)
- Can treat with moist wipes, medications, or a sitz bath.
- Educate on prevention to increase fluid intake, eat meals on regular schedules, & consume appropriate amount of fiber.
Define ostomies.
Bowel Diversions
- Surgically created temporary or permanent opening of the bowel for elimination rather than the rectum.
What are the 2 types of ostomies?
- Colostomy - opening from the colon; allows more to be absorbed.
- Ileostomy - opening fro the ileum
How should we care for ostomies?
- Perform regularly to avoid skin breakdown.
- Monitor effluent.
- Be professional!
The nurse is assisting the client in caring for her ostomy. The client states, “Oh, this is so disgusting. I’ll never be able to touch this thing.” The nurse’s best response is:
A. “I’m sure you’ll get used to taking care of it eventually.”
B. “Yes, it is pretty messy, so I’ll take care of it for you today.”
C. “It sounds like you are really upset.”
D. “You sound very angry. Should I call the chaplain for you?”
C. “It sounds like you are really upset.”
- Uses therapeutic communication by acknowledging the patient’s feeling without sounding judgemental or agreeing with the negative aspect of the statement.
Describe constipation.
Cause?
Types?
- Infrequent bowel elimination; typically hard, dry feces.
- Causes: pregnancy, poor intake of fluid & fiber, opioids, immobility.
- Paralytic Ileus - obstruction due to poor bowel motility.
- Fecal Impaction - hard fecal mass in rectum
How can we intervene for constipation?
- Increase fluid intake
- Increase fiber intake
- Encourage mobility & exercise
- Digital rectum exam
- Enema
- Bowel training program
- Encourage patient not to ignore the urge to defecate
How can we promote regular defecation?
- Privacy
- Correct position (seated upright)
- Timing (often occurs after meals * some clients may need assistance)
- Fluid intake
- Proper diet (fresh fruits, veggies, whole grain, fiber)
- Exercise (3-5 times per week, ROM for clients on bedrest)
How can we establish a bowel training program?
- Plan program with client
- Increase fiber in diet gradually
- Increase fluid intake to 8 glasses of water per day
- Establish designated time for defecation
- Provide privacy
- Treatment plan should be staged
- Treatment may include a stool softener
- Plan should be modified based on client results
Describe diarrhea.
- Frequent, loose or liquids stools
- Cased by: viral, bacterial, medication like antibiotic therapy, IBS, inflammatory bowel disease.
Nursing interventions for diarrhea.
- Monitor stool
- Teach hand hygiene
- I & O
- Monitor electrolyte & fluid levels
- Skin care
- Medication as prescribed (avoid antidiarrheal meds for acute diarrhea)
- Diet:
- Encourage fluids
- Reduce fiber
- Avoid caffeine
- Take probiotics as appropriate
Mrs. Addies is 70 years old. While the nurse is gathering admission assessment data, the patient states, “I’ve taken a tablespoon of milk of magnesia everyday for 3 years.” Which nursing diagnosis is most appropriate for the nurse to use in the plan of care?
A. Diarrhea
B. Constipation
C. Risk for ineffective therapeutic regimen
D. Perceived constipation
D. Perceived constipation
- Daily laxative used by patient might suggest that she thinks she is constipated & the nurse should gather more info related to client’s bowel patterns.
- There is not enough data to determine that she actually has constipation.
A nurse is caring for a client who will perform fecal occult blood testing at home. Which of the following information should be included when explaining the procedure to the client?
A. Eating more protein is optimal prior to testing.
B. One stool specimen is sufficient for testing.
C. A red color change indicates a positive test.
D. The specimen cannot be contaminated with urine.
D. The specimen cannot be contaminated with urine.
- For fecal occult blood testing, instruct the client not to contaminate the stool specimens with water or urine.
A nurse is providing dietary teaching for a client who reports constipation. Which of the following foods should the nurse recommend?
A. Macaroni & cheese
B. One medium apple with skin
C. One cup of plain yogurt
D. Roast chicken and white rice
B. One medium apple with skin
- Best food source to recommend b/c it contain 4.4 grams of fiber.
A nurse is assessing a client who has had diarrhea for 4 days. Which of the following findings should the nurse expect? (Select All That Apply.)
A. Bradycardia B. Hypotension C. Elevated Temperature D. Poor Skin Turgor E. Peripheral Edema
B. Hypotension
- Prolonged diarrhea leads to dehydration. Except the client to have a decrease in BP.
C. Elevated Temperature
- Prolonged diarrhea leads to dehydration. Expect the client to have an elevated temperature.
D. Poor Skin Turgor
- Prolonged diarrhea leads to dehydration. Expect the client to have poor skin turgor.
A. Bradycardia
- Incorrect: expect the client who has prolonged diarrhea to have tachycardia due to dehydration.
E. Peripheral Edema
- Incorrect: Expect the client who has prolonged diarrhea to have weakened peripheral pulses due to dehydration. Peripheral edema results from fluid overload.
