Nursing Principles & Skills II

Bowel Sounds

Constipation

Fecal Impaction

Bowel Sounds

Definition-

the 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,

2006 by Mosby, Inc., an

imprint of Elsevier Inc.

All rights reserved.

12

Skills for Gastrointestinal

Disorders cont’d

• Ostomies

– Colostomy

• 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,

2006 by Mosby, Inc., an

imprint of Elsevier Inc.

All rights reserved.

13

Skills for Gastrointestinal

Disorders cont’d

• Ostomies

– Ileostomy

• 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

All items and derived

items © 2015, 2011,

2006 by Mosby, Inc., an

imprint of Elsevier Inc.

All rights reserved.

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”