1. Factors affecting bowel elimination
    • Water
    • Diet
    • Nutrition
    • Medication
    • Exercise
    • Age
  2. Bowel routine is important so...
    • Daily time clock
    • Hot drinks (sometimes with lemon)
    • Stool softeners
    • Privacy
    • Position and abdominal pressure
    • Bearing down
    • What else?
  3. Promoting regularity
    • Encourage fluids – fiber pill without water = cement blockage in the intestine
    • Proper diet – fresh fruits, vegetables, whole grains, fiber
    • Exercise – 3-5 times a week; range of motion for clients on bed rest
    • What can the nurse do to facilitate? – this would be the intervention portion of your Nursing Care Plan
  4. Bowel Assessment
    • What are some questions you would ask?
    • Subjective versus Objective
    • What are the assessments you would do?
    • What patient education would you provide?
  5. Managing diarrhea
    • Monitor stools to quantify diarrhea
    • Assess and monitor for fluid imbalance – how?
    • Monitor for alterations in perineal skin integrity – why?
    • Increase fiber intake.
    • BRAT diet: Bananas, Rice, Apple sauce, Toast.
    • Increase exercise
  6. Managing constipation
    • Increase intake of high-fiber foods – like what and why?
    • Increase fluid intake
    • Increase activity/exercise
    • Provide privacy
    • Help client in a position that facilitates defecation
    • Allow uninterrupted time
    • Laxatives when lifestyle changes are ineffective
  7. Managing fecal impaciton
    • Prevention is the best treatment
    • Determine presence: digital examination (finger exam)
    • Enemas
    • Manual/digital removal: disimpacting (work it out with your fingers. Yay.)
    • Establish bowel program to prevent recurrence
  8. Enemas
    • Main purpose is the promotion of defecation, stimulate peristalsis
    • Fluid breaks up fecal mass, stretches the rectal wall and initiates defecation reflex
    • Position patient in left lateral position because fluid flow is best in this position.
  9. Enema procedure
    • Physician order
    • Equipment: Protect the bed.
    • Have client lie on left side.
    • Warm the solution to 105 – 110 degrees
    • Insert tube, lubricated, gently, 3-4 inches. Hold 12–18 inches above client – the average adult can accommodate 350-500mL.
    • Listen to your patient and encourage to hold 15-20 min.
    • Monitor for adverse affects
    • Document results!
Card Set
Bowel elimination and enemas