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bowel elimination


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use laxatives cautiously with patients who are
pregnancy, breast feeding, anemia or after sugery on anus or perineum.
safest least irritating laxative
bulk forming laxative
agent used for chronic constipation and to relieve mild watery diarrhea, in ibs, diverticular disease
bulk forming laxative
can cause esophageal or bowell obstruction if not mixed with at leaset 240cc's of water or juice and swallowed quickly.
bulk forming laxatives
types of bulk forming laxatives include
Psyliium ( metamucil, naturacil)
methlcellulose (cologel, hydrolose)
polycarbophil calcium (mitrolan)
Laxative that can not be mixed through a tube because it forms a gelatin
bulk forming laxative
Lower surface tension of feces, allowing water and fat to penetrate' also increase secretion of water by intestine
stool softner
when are stool softners used
short term therapy to relieve stranin on defecation (hemmorioids perianal or prostate surgery pregnancy)
names of stool softners
colace docusate Na
surfak docusate Ca
dialose docusate K+
Emollient or fecal mositening agent is also know as
Stool softners
dilute stool softners with
milk or fruit juice to decrease throat irritation
used to empty bowel for endoscopic exam, suspected poisoning, stool specimen
Saline cathartics
Contraindicated in clients with kidney dysfunction
saline cathartics
contain salt prepartion not absorbed by intestines that creates an osmotic effect that draws water into intestinal luman producing fluid distention leading to peristalsis.
saline cathartics
saline cathartics include
milk of magnesia, fleet enema
on contact with mucosa of colon, irritates mucosa to increase motility. Decreases absorption in small bowel and colon.
Stimulant cathartics.
what Cathartic is used for acute constipation, preparation of radiologic exam?
stimulant cathartic
Side effects of stimulant cathartics.
nausea, cramping loose stools, fluid and electrolyte imbalance, rectal irritation.
Not to be taken with milk or antacids because it dissolves the tabs coating.
stimulant cathartics.
kinds of stimulant cathartics are
and when not to take them
doxidan, correctol, exlax,
at bed time. the take 2-6 hours to work.
penetrates and coats fecal mass and prevets excessive absorption of water
lubricant laxatives
Down side of lubricant laxatives
can leak and seep from rectum causing anal pruritis.
colonic bacteria metabolized galactose and fructose to organic acids.
increased fluid accumulation distion peristalisis with in 24 to 72 hours.
decreased blood ammonia level in chronic liver disease
side effects of lactulose
gas cramps belching flatulence.
mix lactulose with
water juice or milk
cleans bowls for colonscopy with low incidence of N,m V or bloating
polyethylene glycol
isotonic solution so fluids and electrolytes are neikther absorbed nor secreted in gi tract.
polyethylene glycol
defining characteristics of constipation
dry hard stool, straining, painful defecation, abd distention, palpable abd mass rectal pain.
causes of constipation
low fiber diet. hi animal fats and refind sugars
irregular bowel habits, ignoring urge
fluid intake less than 1500cc
assessments for constipation
monitor bowel elimination
asculate bowel sounds
palpate abdomen
diagnostic tests for constipation
Stool for occult blood, guiac
things not to do before occult blood test that give false +
no rare red meat. horsradish, iron anticoagulants, asa, nsaid 3 days before can give false +
things that give a false neg to occult blood test
vitamine c 24h before, do not mix stook and urine.
Tests UGI series is NPO when
After 12am and MOM after test to ecacuate barium.
exercise, activity
1500cc2000cc fluids
high fiber diet use RR after eating when duodenocolic reflex works best
Enema types 5
soap suds
tap water
oil retention
enema that is made from hypertonic solution
enema that is the safest. 2 tsp salt in 500 ccs water
Emema that irritates bowel mucosa
5ml of castile soap in 1L water
Soap Suds
enema that is hypotonic with potential for water intoxication so never give to children , alters cardica or renal funcion patients
Tap water
Enema that Softens feces, caots rectal mucosa to facilitate expulsion and specifically given for impaction
Oil Retention
bowel traning includes
stool softners, buling agent, suppositorys, rehab for spinal coard injury, planned time for using rr
client leans forward. massaging stomach
inability to evacuate stool voluntarily
fecal impaction
evidence of fecal impaction
no stool for 3-5 days, followed by liquid stool. may be incontinent and not perceive urge.
Risk of fecal impaction is greater with people who are
cognitive impaired, immobilized
Fecal impactions defining characteristics are
rectal/abd fullness, bloating, urge to defecate but no stool, n,v
interventions for fecal impaction are
oil enemas
digital removal
change in bowel habits
review meds, add buling agent
frequent evacuation of water stools with loss of fluid and electrolytes increased mucus.
Defining characteristics of diarrhea
abd cramps
urge to evacuate
increased stools
change in color
increased BS 30per min
burning at anus due to irritation
causes of diarrhea
emotional stress
intestinal infection
food allergies
greasy spicey food
tube feeding with inadequate water
antibiotics, magnesium antacids, laxatives
colitis chrons disease gastrectomy, colon resection
interventions for diarrhea
balanced electrolyte/glucose solutions
if diarrhea 3-4 days no milk
no spicey fatty foods
antidiarrheal meds given for longer then 2 days.
over the counter meds for diarrhea
pepto bismol
kaopectate magnesium
immodium (loperamide)
does what? side effect? dose
-opiod that decreases gi motility by stopping movements in the gut.
side effects are dizzy, dry mouth , skin rash.
no more then 8mg with 2-3 mg as inital.
kaopectate (attopulgite) does what?
Gi absorbent and protective agent
pepto bismol does what?
enhances what?
inhibits gi secretions and syntheses of prostaglandin that produces intestinal inflamation and hypermotility. supresses growth of helicobactor pylori that causes ulcers.
Dose is 30 ccs or 2 tbsp. q30-60min
enhances effect of anticoagulant.
prescription antidiarrheals are
synthetic opiods
antidiarrheal opids work by
lowering bowel motility.
reduce pain and rectal spasms
increase reabsorption of water
synthetic opiods for diarrhea are
lomotil (diphenoxylate & atropine)
inhibits intestinal propulsive motility thus decreasing transit time
S.E. drowsiness, dizy rash dry mouth abd distress
take up or attach to another substance and coats wall of gi tract.
absorbs bacteria or toxins and passes them out with stool.
questran (cholestyramine) absorbs bile acids to reat increased cholestrol and also used to treat diarrhea
involuntary elimination of bowel contents associated with neurologic mental or emotional impairments
fecal incontinence
causes of fecal incontinence
cerevral cortx or scaral cord injury or disease.
tube feeding/diet changes
fecal impaction
gi disorgers
infectious disease
interventions for fecal incontinence
bowel management programs
bulk forming agents to normalize stool
andidiarrheal agent if ordered
maintain hydration
treat infectious disease if cause
precent impaction.
accumulation of gas in GI tract
causes for flatulence
swolling air
smoking, carbonated bevs.gum chewing
rapid food ingestion or drink ingestion
colonic irritationi
hi fber goods. onions cabbage lugumes
interventions for flatulence
increase activity
alter diet
rectal dube
return flow enema
abdominal distention is from
accumulation of excessive amounts of flatus or liquid or solid intestinal contents
causes for abdominal distention
inactivity, constipation, fecal impactioin, tumors
interventions for abd distention
activity, give reglan, ng decopression for ileus
Colostomy is a
diversion of the colon
ileostomy is a
diversion of the ileum that produces liquid stool
Stomas should be?
beefy red, not being serous red
be above skin level
not tucked inward
if stoma is tucked inward or is syanotic, what do you do
call surgeon immediatly

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