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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