1. Bowel Elimination Care
PN 1 Nursing Skill Labs

2. 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

3. 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

4. always inspect, auscultate, and palpate in that order WHY??
should hear high pitched gurgles
normally bowel sounds per minute
document amount, frequency, consistency, colour, odour, etc.

5. 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 mL of stool

6. 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

7. 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

8. 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!!!!!!

9. 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

10. 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!!!!

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

12. 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

13. Rectal Tubes
helps gas escape by stimulating peristalsis and providing a passageway
may be a post op patients best friend!!!
usually size 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