Altered Bowel Elimination
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What lives in the bowels?
Bacteria ONLY...NO Enzymes!!
What makes gas?
breakdown of bacteria
What happens when you suppress the urge to defecate?
Constipation-cuz poop sits in lg intestine longer so more water is reabsorbed. Hardens
What causes diarrhea?
- increase bowel transit time (less time from mouth to anus)
Subjective assessment data pertinent to bowel elimination
Tell me what your normal BM practice is like? Diet? Exercise? Weight history? Narcotics? Gas? Pain, amount, shape and color of BM? Pruritis? Hemmorhoids? Pyrosis (heartburn)? odynophagia (painful swallowing) Travel history?
Objective assessment data pertinent to bowel elimination
- What I see, hear, touch or smell.
- Pt. height and weight
- Oral cavity, condition, sores, thrush, halitosis
- Inspect and measure abdominal girth, stool observation, AUSCULATE, PERCUSS
If I dont hear bowel sounds what do I do?
spend 5 min. at each quadrant
Where will I find largest fecal mass?
Labs for stools
- Occult Blood
- Ova and Parasite
Barium Swallow and Small bowel series...
What does it look at?
- pt. drinks white chalky substance
- pics taken of pharynx, esophagus, stomach, duodenum.
Prep and Post care for Barium Swallow and Small Bowel series
- NPO 8-12 hours before
- Post care....lots of liquids to prevent constipation
Lower GI Series or Barium Enema look at...
Looks at large intestine
Prep and Post care for Lower GI Series and Barium Enema
- Post-Laxatives and a ride home
CT scan Prep and Post
- Pre-drink a litre of water
- Post-check BUN & Creatinine
Direct visualization diagnostic studies
Endoscopy looks for
Looks for bleeding, inflammation, masses and polyps
Prep and Post for Endo
- Prep NPO for 8 hrs. before
- Post NPO till gag reflex returns
EGD looks at
Looks at the stomach, duodenum and upper GI problems
ERCP looks at...
Looks at the gallbladder, liver, pancrease, stones in GB
Nursing care after endoscopy
NPO till gag reflex returns
Why do babies have a hard time with bowel elimination?
lack of development of nervous system so cant control the sphincter
Why do the elderly have problems with bowel movements?
- Decreased motility so slower peristalsis
- Dryer feces cuz drink less water
- More water absorbed cuz of slower peristalsis
- Decreased abd tone so harder to bear down
- Decreased anal sphincter tone
What are cultural issues with bowel elimination?
- Muslims eat with their right hand and wipe with their left
- African Americans/Asians are lactose intolerant
infrequent bowel movements that are hard to pass
perceived constipation is
think constipated cuz have BM's every other day or 3 days. But it is soft and not hard to pass, so it isnt constipation.
What dont you give a person with any sort of a perforation?
Bulk forming laxative does what....
- increases absorption of water in to stool
- Doesnt require RX
- Examples: Metamucil, Citrucel
- Bran and Prunes
Emollient/Fecal Softeners does what....
Lower surface tension of feces allowing water to be absorbed by fecal mass make a soft stool
Examples: Docusate Sodium, Colace
Osmotic Cathartics do what...
Increase fluid bulk in feces by pulling H2O thru the intestinal wall by osmosis
Example: Milk of Magnesia, Miralax, Fleet Enema
Stimulants do what....
Increase peristalsis by chemical irritation to the bowel nerve endings
Examples: Castor oil, Dulcolax, Ex Lax
Complications of altered bowel elimination
- fecal impaction
- anal fissures
- mega colon
Complications of diarrhea
- Fluid volume deficit
- risk for injury
- impaired skin integrity
What causes diarrhea
high fiber foods, spicy foods, sugar and sugar substitutes, food poisoning, allergies and antibiotics, and bacteria
What causes constipation
- lean meat
- decrease in fluids
- sedentary life style
What is Gastrocolic and Duodenocolic Reflex?
Bowel evacuation that is stimulated by peristalsis in the colon. Usually happens after the first meal of the day.
Humming or swishing sound heard with the stethoscope. Turbulance
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