Bowel Elimination Care

PN 1 Nursing Skill Labs

Factors affecting elimination change in daily routine ignoring urge because not convenient not allowed out of bed - use of bedpan privacy issues change in diet - vacationers lack of exercise stress medications

Assessing the Abdomen

have client void position supine with knees flexed warm diaphragm of stethoscope and hands use diaphragm of stethoscope not bell start in RLQ >RUQ>LUQ>LLQ listen for 1-5 mins in each quadrant listen for 5 mins before declaring no BS

always inspect, auscultate, and palpate in that order WHY??

should hear high pitched gurgles normally 5 - 30 bowel sounds per minute document amount, frequency,

consistency, colour, odour, etc.

Collecting Stool Specimens

have patient void first use a clean or sterile bed pan depending

on type of specimen tell the patient not to put toilet paper in

with specimen do not take specimen from toilet bowel need 15 - 30 mL of stool

bring requisition, plastic bag, stool container to bedside

fresh specimen produces best results note on requisition if female patient who

is menstruating or any patient who has visible hemorrhoids

Treatments and Procedures

Rectal Suppositories check doctors order check for patient allergies 5 rights - patient, drug, route, time, dose 3 checks - off shelf, before dispensing,

prior to putting container away often kept in fridge

insert past anal sphincter - 4-10 cm have patient breath in and out deeply to

relax sphincter wear gloves lubricate suppository well extra care with hemorrhoids MAKE SURE YOU UNWRAP IT!!!!!!

Enemas

introduction of solution into the large intestine to remove feces

work by distending or irritating the colon which increases peristalsis

different types give large volume enemas over 5-10

mins and smaller volume ones over 1-2 mins

pt. should be in left sims position lubricate tubing and insert 7-10cm be very gentle if hemorrhoids present container should be 45cm above bed have patient take deep breaths to relax if cramping, lower container or clamp off clamp tubing before removing PAD PATIENT WELL!!!!

1. Cleansing enema large volume of fluid used (500 - 1000 mL) hypotonic = tap water isotonic = NS irritant = soap suds hypertonic = fleet enema (smaller volume) give large volume enemas

2. Retention Enemas held in the bowel longer oil retention enema used to lubricate

stool and intestinal mucosa making defecation easier

carminative enema used to help expel flatus and relieve abdominal distension - black and white

Rectal Tubes

helps gas escape by stimulating peristalsis and providing a passageway

may be a post op patients best friend!!! usually size 22-34 French position patient on left side AND PAD WELL lubricate and insert tube about 10cm DO NOT LEAVE IN LONGER THAN 20

MINS - MAY REPEAT Q 2-3 HOURS