What are the 11 Parts to the Anatomy of Bowel Elimination?
1. Small Intestine
2. Large Intestine
Absorbs nutrients & _______
Absorbs nutrients & WATER
What does the Colon/Large Intestine Reabsorb?
What is the term for the bowel moving through the intestine?
(Moving Content Forward)
What is the purpose of the Mucoid (Mucous) Protection?
To protect from stomach acid and hold feces together.
If you get a disease in the intestine's, there might be a problem doing what?
When waste products are in the lower GI for extended period of time what happens?
More Water is removed
Hard, Dry Stools
What are the characteristics of NORMAL feces?
Brown in Color
Have fecal odor from normal flora (Bacteria)
Small amounts of fat
Soft and formed
How many times a day/week is considered
Several Times a Day
2-3 Times Per Week
(Remember, Norms are different for everyone, Look for variation in their NORMS)
What can Cause BLACK TARRY STOOLS?
Upper GI Bleed
Increase in Iron
What causes Hard, dry stools?
What can cause watery stools?
What would cause Ribbon-Like, Narrowed Stools?
Obstruction of Rectum
What can cause pieces of undigested food in stool?
What can cause shreds of mucous?
What is large amounts of fat in stools called?
What is the definition of Constipation?
Hard, infrequent stools that may be painful
What are some causes of constipation?
Lack of fiber
Lack of adequate water intake
Poor habits - no regularity, no time, avoiding urge
Overuse/Dependent on laxatives
Medications - Narcotics, antacids, statins, iron, Anticholinergic
Neurological - Stroke (CVA) Spinal Cord Damage
Certain Foods - Cheese, Eggs, Milk
What causes Hemorrhoids (Enlarged Vein)?
What are anal fissures?
Tear in lining of anus
What is Fecal Impation?
Large or hard fecal mass
Results from Prolonged retention and accumulation of fecal material. (Poor defecation habit)
Will Experience the passage of liquid fecal seepage (Diarrhea) and no normal stool.
What are some Constipation Interventions?
Increase fluid to 2000-3000ml/Day if not contraindicated
Offer warm fluids especially after breakfast (Increases Parastolosis)
Avoid highly refined foods like fast food, sweetners & Flours
LAST RESORT - Laxatives
What is gas or air in colon passed through the anal canal called?
What can cause Flatus?
Action of bacteria on chyme
Gas forming foods- IE Cabbage, Onion
(Usually absorbed into the bloodstream)
What are some Flatus Interventions?
Avoid Gas-producing foods
Provide low fat meals
Warm blanket or pad to abdomen (Increases blood flow)
Correct positioning for meals
Obtain order for rectal tube
Avoid chewing gum or drinking with a straw
What is liquid, unformed stools with increased frequency of defication?
What is a result of Diarrhea?
Serious Fluid and Electrolyte Imbalance
Especially in Very young and older adults
What are some causes of Diarrhea?
Medication Side Effects
Drug or Food Allergies
Digestive Diseases (Crohn's)
What are some Diarrhea Interventions?
Provide liquid diet and advance as tolerated
(Allow bowel to rest andn Rehydrate them)
Monitor and Record amount, Consistency, and Frequency of stools, monitor skin for breakdown, and monitor for dehydration
Give meds as appropriate including PRN anal ointments/barriers & antidiarrheals
Teach to avoid ETOH(Alcohol) and Caffeine if chronic
What are Fecal Impaction Interventions?
Manual Rectal Exam PRN
Assess Abdominal Distention
Enemas as Ordered
What is the loss of voluntary control of stools?
What causes Fecal Incontinence?
Impaired sphincter muscle control
Impaired Nerve Supply
What are some Fecal Incontinence Interventions?
(Place on toilet every hour)
Provide METICULOUS skin care
Use mild dilute soap & water
Provide clean linens
Use adult incontinence aids
Provide Emotional Support
What is the ULTIMATE goal for bowel movements?
Client has soft, Formed brown stool by certain time
To reach Ultimate Goal what is the main thing you want to encourage?
GOOD BATHROOM HABITS
Going to bathroom same time each day
Don't sit longer than 5 min (Can cause you to pass out because of nerve)
Don't supress the urge
Don't rely on laxatives/enemas
What are some System Specific Assessments for Bowels?
Abdonminal Assessment is PRIORITY - ESP bowel sounds
Characteristics of stool
Regular Defication Pattern
What do the following Color Bowel Movements Mean:
Light Brown/Pale =
Clay = Absence of Bial
Black = Upper GI Bleed, Diet high in red meat, Dark green Veggies, Excess Iron, Pepto
Light Brown/Pale = Malabsorption of Fats, diet high in milks, low in meats
Red = Bleeding in lower GI, beets
Yellow = bile, may be seen in diarrhea
Green = Intestinal infection, food dyes
What are some labs you would run during your assessment of Bowels?
Stool Culture - Obtain culture BEFORE antibiotics
Ova and Parasites
Occult blood (Hemocult)
Barium enema vs upper GO
True or False:
You cannot delegate getting stool specimen to aide
Bowels do not take priority over ABC. You always auscultate BEFORE Palpate (LISTEN 1st). If their abdomen is ______ or _______ it needs to be assessed QUICKLY.
Bowels do not take priority over ABC. You always auscultate BEFORE Palpate (LISTEN 1st). If their abdomen is RIGID & HARD it needs to be assessed QUICKLY.
What medication is used tto help client pass painful gas?
What is used to treat or prevent constipation or to prepare the bowel for radiologic or endoscopic procedures?
Excessive or prolonged use of laxatives can lead to _____________
Excessive or prolonged use of laxatives can lead to DEPENDENCE
What are the different types of laxatives?
Saline Laxatives (Magnesium Salts and Phosphates)
Stool Softeners (Colace)
Bulk-Forming Agents (Citrucel)
Osmotic Cathartics (Miralax)
What are Anti-Diarrheals?
They are used to control/relieve acute or chronic diarrhea
They slow intestinal motility (Imodium)
They can change the fluid content of the stool (Pepto)
What is an opioid used to treat diarrhea?
What are the 2 MAIN things you do when dealing with stools?
When a patient has C-Diff what is MUST DO when entering or leaving room?
Wash hands with soap and water
FOAM DOESN'T WORK
How many grams of fiber a day do you need to add bulk to stool and to develop regular bowel?
20-35 grams of fiber a day
What are some natural bowel remedies you should know?
Fiber - Apples, bananas, bran cereal, dates, Prunes
Natural Laxatives - Prune Juice, honey, Coffee/tea, warm drinks
Colon clensings and Juice Fastings
What are the 5 anatomical components of urine elimination?
Regulates fluid & Electrolyte blance
Connects Kidney to Bladder
Resevoir (holds urine)
Extends from bladder to opening (Urinary meatus)
How many ml of blood circulates through the kidney's every minute?
Normal urine output is equal to fluid ______
Normal urine output is equal to fluid INPUT
Average adult daily output is _____-_____ ml/Day
Average adult daily output is 1200-1500 ml/Day
The average bladder holds 500-1000ml. But you "feel the urge" around _____ ml.
The average bladder holds 500-1000ml. But you "feel the urge" around 200ml.
When urine output is less than 30ml/Hour it may indicate _____ _____ _____ or _______ _______ and MUST be reported!!!
When urine output is less than 30ml/Hour it may indicate Low Blood Volume or Kidney Malfunction and MUST be reported!!!
What is it when a client does not preceive bladder fullness and is unable to control the urinary sphincters?
What are some interventions you would do for urinary retention?
Observe and palpate for bladder distension
Utilize normal voiding position
Monitor I & O
Offer Sitz Bath
Place urinary catheter (LAST RESORT)
Urinary incontinence is defined as _______ _______
Urinary incontinence is defined as Involuntary Urination
What are some of the types of urinary incontinence?
Couging, sneezing, laughing etc.
Associated with overactive bladder
Cognitive Disorders (Able to but don't)
Spinal Cord Damage
Stress & Urge
What can cause a UTI?
Stasis of Urine
What are some UTI Interentions you can do as a nurse?
Give Anti-Infectives as ordered
Increase fluid intake to 2000 ml
Follow up UA
Offer Sitz bath
Drink (8) 8oz glasses of water daily
What are some interventions you can have the client do for UTI's?
Void immediately after intercourse
Avoid bubble baths/Harsh soaps
Avoid tight fitting clothes
Wear cotton underwear
Females wipe front to back
Increase acidity of urine
(Vit C, Cranberry Juice)
What is the most important thing to do when assessing urine elimination?
(Might even do hourly)
What is the accumulation of urine in the bladder and inability of the bladder to empty itself?
What is a temporary or permanent inability of the external sphincter muscles to control the flow of urine from the bladder?
What is the process of emptying the bladder?
Urination (micturition, voiding)
What is the failure of the kidneys to produce urin, resulting in a total lack of urination or output of less than 100ml/day in adults?
What is painful or difficult voiding?
What is the production of abnormally small amounts of urine by the kidney's?
What is it called when you void two or more times per night?
What is the involuntary passing of urine in children after bladder control is acheived (Bed-wetting)?
What is the presence in the urine of abnormally large quantities of protein, usually albumin?
What is the production of large amounts of urine by the kidney's without an increased fluid intake?
What is a decrease in the force of the stream of urine, often with difficulty in beginning the flow ?
What is the presence of an excessive number of white blood cells in the urine, typically more than four leukocytes per high-power field count (Sign of UTI)?
What is the feeling that one must urinate?
What is the abnormal presence of blood in the urine?
What is the excretion of an abnormally large quantity of urine?
True or False:
You can delegate Urine Specimen to aide
True or False:
You can delegate foley irrigation or insertion to LPN
What kind of medicine is administered for UTI's?
Ex: Bactrim, Septra, Levaquin, Cipro
MUST GIVE FULL COURSE TO PREVENT RESISTENCE
What medication is used to increase the formation and secretion of urine?
Give potassium with it to prevent electrolyte imbalance because you will urinate off potassium with Lasix.
What are the norms for Urine:
Blood - Not present
Ketone Bodies - Not present
Color - Straw, Amber, Transparent
Odor - Faint aromatic
pH - 1.010-1.025
Glucose - Not present
What medication is given to help with urinary Retention?
What medication is given to help with impact elimination?
Ex: Detrol, Atropine, scopolamine
Urinary retention or hesitency, decreased GI secretions, can cause ileus(twitch in bowel)
What medicine can change your urine blue/Green?
What medication can turn your urine blue?
What medication can turn your urine orange?
What infection control items do you need to do when dealing with urine?
Use sterile technique when inserting foley catheter
You need to teach ______ exercises for females to strengthen perineal muscles.
What is important to do when evaluating a clients home when dealing with urinary issues?
Assess to toilet facilities
No barriers, not too far away
Grab bars, elevated toilet seats
Clothing easily removed for toileting
What are some bladder UTI remedies that you should know?
Cranberry Juice - 10oz/Day
Blueberries - 1-2 servings/Day
Why are the elderly at an increased risk for elimination problems?