Nursing Principles & Skills II Bowel Sounds Constipation Fecal Impaction
Bowel Sounds Definitionthe noise or sounds made by the peristaltic waves of the intestinal muscle contracting and relaxing
Bowel Sounds Sounds are normally heard in each of the four abdominal quadrants. Always auscultate bowel sounds before palpating the abdomen. Normal rate for sounds is 4-32/minute.
Bowel Sounds Procedure: patient should be lying down use the diaphragm of the stethoscope listen for one full minute in each quadrant
Absent or Decreased Bowel Sounds Absence of sounds may be indicative of paralytic ileus especially following general anesthesia in intestinal obstruction Decreased, hard to hear sounds with lower lobe pneumonia in electrolyte imbalances
Increased Bowel Sounds Occurs with increased bowel activity Gastroenteritis Diarrhea Flatulance, gas Beginning bowel obstruction Stenosis of bowel
Palpate abdomen Always listen to abdomen before palpating abdomen Assess for firmness, distention and tenderness
Constipation Definition Infrequent evacuation of feces Symptoms dry hard stools, headache, feeling full, elevated temp, feels bad all over
Interventions for constipation Increase fluids Increase activity Increase fiber Stool softeners, laxatives, suppository, enemas (if no BM in 3 day), fleets, soapsuds, warm water enema
Fecal Impaction Definition blockage of the rectum or sigmoid colon with hard, dry stool Symptoms no BM for more than 3 days, leaking small amount of liquid stool, hypoactive bowel sounds
Interventions for fecal impaction Oil retention enema Manually check and remove impacted stool
Skills for Gastrointestinal Disorders cont d Administering an enema Instillation of a solution into the rectum and sigmoid colon Primary reason is promotion of defecation Volume and type of fluid instilled can lubricate or break up the fecal mass, stretch the rectal wall, and initiate the defecation reflex Should not rely on enemas to maintain bowel regularity Frequent enemas disrupt normal defecation reflexes, resulting in dependency All items and derived items 2015, 2011, 12
Ostomies Skills for Gastrointestinal Colostomy Disorders cont d Surgical artificial anus on the abdominal wall formed by incising the colon and bringing it out to form a stoma on the abdominal surface Performed for patients with cancer of the colon, intestinal obstructions, intestinal trauma, or inflammatory diseases of the colon May be permanent or temporary until intestinal healing occurs All items and derived items 2015, 2011, 13
Ostomies Skills for Gastrointestinal Ileostomy All items and derived items 2015, 2011, Disorders cont d Surgical opening of the ileum onto the surface of the abdomen through which fecal matter is emptied Performed for patients with inflammatory bowel conditions and cancer of the large intestine Stoma looks like a colostomy, but it is smaller and located lower on the abdomen Patient wears a pouch to collect the semiliquid fecal matter 14
Collecting a stool specimen Reasons to collect: to determine presence of infection, bleeding or hemorrhage, identify parasites, ova, and bacteria Inform patient, may collect from colostomy or ileostomy
NURSING PRINCIPLES & SKILLS II E. Stool for Hemoccult 1. Purpose: to test for hidden or occult blood in the stool (bleeding from somewhere in the GI tract upper?) 2. May also be called GUAIAC, SEROCCULT, STOOL FOR O.B. 3. The reaction that occurs: peroxidase in the reagent reacts with any hemoglobin present in the stool to cause a color change to BLUE 4. Specimens may be sent to the lab or they may be done on the nursing unit; they are regulated by the LAB
Stool for Hemoccult
Stool for Hemoccult Apply a THIN smear of Stool in Box A&B Add developer drops Read in 60 seconds
NURSING PRINCIPLES & SKILLS II F. Stool for Ova and Parasites (O & P) 1. Purpose: to check the stool for microorganisms that have been shed into the stool 2. Specimen must be warm, so it needs to be sent immediately to the lab (they are looking for live organisms) 3. Multiple specimens may be ordered to check for irregularly shed microorganisms
Meet the Famous Parasite: C. Diff Under the Microscope In person