Transcript PN1lab notes\Bowel Elimination Care

Bowel Elimination Care
PN 1 Nursing Skill Labs
Factors affecting elimination
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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