1. List qualities of stool and identify signs and symptoms about stool to report Define the following term: defecation the act of passing feces from the.

1. List qualities of stool and identify signs and symptoms about stool to report
Define the following term: defecation the act of passing feces from the large intestine out of the body through the anus.

1. List qualities of stool and identify signs and symptoms about stool to report
NAs should observe and report these signs and symptoms about stool: Whitish, black, or red stools Diarrhea Constipation Flatulence/gas Pain when having a bowel movement Blood, pus, mucus, or discharge in stool Fecal incontinence

2. List factors affecting bowel elimination
Define the following term: peristalsis involuntary contractions that move food through the gastrointestinal system.

Transparency 17-1: Factors Affecting Bowel Elimination
• Normal changes of aging - Peristalsis slows. - Digestion takes longer and is less efficient. - Possible tooth loss and less saliva affect digestion. - Medication use and dulled sense of taste may result in poor appetite. • Psychological factors - Stress, anger, and fear increase peristalsis. - Depression decreases peristalsis. - A lack of privacy can greatly affect elimination. • Food and fluids - Fiber improves elimination. - Animal fats and low-fiber foods can cause constipation. - Some foods cause gas, which can help with elimination. - Proper fluid intake helps elimination.

Transparency 17-1: Factors Affecting Bowel Elimination (cont’d)
• Physical activity - Regular activity helps elimination. - Immobility weakens muscles and may slow elimination. • Personal habits - Time of day varies, but it usually occurs after meals. - Supine position causes most trouble for bowel elimination. - Best position for elimination is squatting and leaning forward. • Medications - Laxatives help elimination. - Pain relievers can slow elimination. - Antibiotics may cause diarrhea.

3. Describe common diseases and disorders of the gastrointestinal system
NAs should know these facts about constipation: Occurs when feces moves too slowly through the intestine Can result from decreased fluid, poor diet, inactivity, medications, aging, certain diseases, or ignoring urge to eliminate Symptoms are abdominal swelling, gas, irritability, and record of no recent bowel movement Treatment involves increasing fiber in diet and increasing activity, as well as medication (enemas and suppositories may be ordered to help). Documentation of bowel movements is important.

NAs should know these facts about fecal impaction: Results from unrelieved constipation Symptoms include no stool for several days, oozing of liquid stool, cramping, abdominal swelling, and rectal pain Treatment is doctor or nurse breaking the mass into fragments Prevention involves high-fiber diet, increased fluids and activity, and, possibly, medication.

NAs should know these facts about hemorrhoids: Results from straining during bowel movements, chronic constipation, obesity, pregnancy, and sitting for long periods of time on the toilet Symptoms include rectal itching, burning, pain, and bleeding. Treatment may include medications, compresses, sitz baths, and possibly surgery. NAs should be careful to avoid causing pain while cleaning anal area.

NAs should know these facts about diarrhea: Results from bacterial and viral infections, microorganisms in food and water, irritating foods, and medications Treatment involves medication, increase in certain fluids, and change of diet.

NAs should know these facts about fecal incontinence: Causes are constipation, muscle and nerve damage, loss of storage capacity in the rectum, and diarrhea. Treatment includes a change in diet, medication, bowel training, or surgery.

NAs should know these facts about flatulence: Causes include swallowing air while eating, eating high-fiber foods, eating foods that a person cannot tolerate (eating dairy products if a person has lactose intolerance, for example), antibiotics, colitis, or malabsorption Treatment includes change of diet, medication, and reducing the amount of air swallowed.

NAs should know these facts about gastroesophageal reflux disease (GERD): Heartburn is most common symptom. Treatment involves medication; serving the evening meal three to four hours before bedtime; not lying down until two to three hours after eating; using extra pillows to keep the body more upright during sleep; serving the largest meal of the day at lunchtime; eating smaller meals throughout the day; reducing fast foods, fatty foods, and spicy foods; stopping smoking; not drinking alcohol; and wearing loose clothing.

NAs should know these facts about peptic ulcers: Caused by excessive acid production Symptoms include pain after eating, belching, and vomiting. Treatment involves medications, avoiding smoking, alcoholic drinks, and caffeine, and change of diet.

NAs should know these facts about ulcerative colitis and colitis: Symptoms include cramping, diarrhea, pain occurring on one side of the lower abdomen, rectal bleeding, and loss of appetite. Treatment includes medications and surgical treatment (a colostomy). Colitis, or irritable bowel syndrome, is milder and is controlled by diet and/or medication.

NAs should know these facts about colorectal cancer: Symptoms include changes in normal bowel patterns, cramps, abdominal pain, and rectal bleeding. Treatment is surgery

Handout 17-1: Procedure: Giving a Rectal Suppository
Giving a Rectal Suppository Equipment: gloves, suppository, lubricant, bath blanket, toilet paper 1. Identify yourself by name. Identify the resident by name. 2. Wash your hands. 3. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. 4. Provide for resident’s privacy with curtain, screen, or door. 5. Adjust bed to a safe level, usually waist high. Lock bed wheels. 6. Help resident into left-sided Sims’ position. Cover with a bath blanket. 7. Uncover resident enough to expose buttocks only. 8. Unwrap the suppository. 9. Put on gloves. 10. Lubricate suppository as needed. 11. Spread buttocks to expose anal area. 12. Insert the suppository, using your index finger. Place the suppository past the rectal sphincter against the wall of the colon. 13. Ask the resident to take deep breaths, as it will help him or her relax and retain the suppository. 14. Withdraw the finger and briefly hold toilet paper against the anus. 15. Remove and discard gloves.

Handout 17-1: Procedure: Giving a Rectal Suppository (cont’d)
16. Wash your hands. 17. Remove bath blanket and cover the resident. Ask the resident to retain the suppository as long as possible. Make resident comfortable. 18. Provide a bedpan or assistance to the bathroom when needed. 19. Return bed to lowest position. Remove privacy measures. 20. Place call light within resident’s reach. 21. Report any changes in resident to the nurse. 22. Document procedure using facility guidelines.

4. Discuss how enemas are given
There are several different types of enemas: Tap water enema Soapsuds enema Saline enema Commercially-prepared enema

NAs should follow these guidelines when assisting with an enema: Keep bedpan nearby or make sure bathroom is vacant before assisting with enema. Resident will be placed in Sims’ position. Enema solution should be warm. Enema bag should not be raised above the height listed in the care plan. Tip of tubing should be lubricated. Unclamp tube and allow a small amount of solution to run through, then reclamp. This removes air that could cause cramping.

Guidelines when assisting with an enema (cont’d): Solution should flow in slowly. Hold tubing in place while giving the enema. Stop immediately if the resident has pain or you feel resistance. Report to the nurse. Resident should take slow, deep breaths. Report any of the following to the nurse: Resident could not tolerate enema due to cramping. Enema had no results. Amount of stool was very small. Stool was hard, streaked with red, very dark, or black.

Giving a cleansing enema
Equipment: bath blanket, IV pole, enema solution, tubing and clamp, protective pad, bedpan, lubricating jelly, bath thermometer, tape measure, toilet paper, disposable wipes, robe, non-skid footwear, towel, supplies for perineal care, paper towel, 2 pair of gloves 1. Identify yourself by name. Identify the resident by name. 2. Wash your hands.

3. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. 4. Provide for resident’s privacy with curtain, screen, or door. 5. Adjust bed to a safe level, usually waist high. Lock bed wheels. 6. Help resident into left side-lying Sims’ position. Cover with a bath blanket. 7. Place the IV pole beside the bed.

8. Clamp the enema tube. Prepare the enema solution. Fill bag with mL of warm water (105°F), and mix the solution. Check water temperature with bath thermometer. 9. Unclamp the tube. Let a small amount of solution run through the tubing. Re-clamp the tube. 10. Hang the bag on IV pole. Using the tape measure, make sure the bottom of the enema bag is not more than 12 inches above the resident’s anus.

11. Put on gloves. 12. Place protective pad under resident. Ask resident to remove undergarments or help him do so. Place bedpan close to resident’s body. 13. Lubricate tip of tubing with lubricating jelly. 14. Ask the resident to breathe deeply. This relieves cramps during procedure.

Place one hand on the upper buttock. Lift to expose the anus. Ask the resident to take a deep breath and exhale. Using other hand, gently insert the tip of the tubing two to four inches into the rectum. Stop immediately if you feel resistance or if the resident complains of pain. If this happens, clamp the tubing. Tell the nurse immediately.

16. Unclamp the tubing. Allow the solution to flow slowly into the rectum. Ask resident to take slow, deep breaths. If resident complains of cramping, clamp the tubing and stop for a couple of minutes. Encourage him to take as much of the solution as possible.

17. Clamp the tubing before the bag is empty when the solution is almost gone. Gently remove the tip from the rectum. Place the tip into the enema bag. Do not contaminate yourself, the resident, or the bed linens. 18. Ask the resident to hold the solution inside as long as possible.

19. Help resident to use bedpan, commode, or get to the bathroom. If the resident uses a commode or toilet, put on robe and non-skid footwear. Lower the bed to its lowest position before the resident gets up. 20. Remove and discard gloves. Wash your hands.

21. Place toilet paper and disposable wipes within resident’s reach. Ask the resident to clean his hands with the hand wipe when finished if he is able. If the resident is using the toilet, ask him not to flush it when finished. 22. Place the call light within resident’s reach. Ask resident to signal when done. Leave the room and close the door. 23. When called by the resident, return and put on clean gloves.

24. Lower the head of the bed. Make sure resident is still covered. 25. Remove bedpan carefully and cover bedpan. 26. Provide perineal care if help is needed. Wipe female residents from front to back. Dry the perineal area with a towel. Help the resident put on undergarment. Cover the resident and remove the bath blanket. 27. Place the towel and bath blanket in a hamper or bag, and discard disposable supplies.

28. Take bedpan to the bathroom. Call the nurse to observe the enema results. Empty the contents of bedpan carefully into the toilet. 29. Turn the faucet on with a paper towel. Rinse the bedpan with cold water and empty it into the toilet. Flush the toilet. Place bedpan in proper area for cleaning or clean it according to facility policy. 30. Remove and discard gloves. 31. Wash your hands.

32. Make resident comfortable. 33. Return bed to lowest position. Remove privacy measures. 34. Place call light within resident’s reach. 35. Report any changes in resident to the nurse. 36. Document procedure using facility guidelines.

Giving a commercial enema
Equipment: bath blanket, standard or oil retention commercial enema kit, protective pad, bedpan, lubricating jelly, toilet paper, disposable wipes, robe, non- skid footwear, towel, supplies for perineal care, 2 pair of gloves 1. Identify yourself by name. Identify the resident by name. 2. Wash your hands. 3. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.

4. Provide for resident’s privacy with curtain, screen, or door. 5. Adjust bed to a safe level, usually waist high. Lock bed wheels. 6. Help resident into left- sided Sims’ position. Cover with a bath blanket. 7. Put on gloves. 8. Place protective pad under resident. Ask resident to remove undergarments or help him do so. Place bedpan close to resident’s body.

9. Uncover resident enough to expose anus only. 10. Lubricate tip of bottle with lubricating jelly. 11. Ask resident to breathe deeply to relieve cramps during procedure. 12. Place one hand on the upper buttock. Lift to expose the anus. Ask the resident to take a deep breath and exhale. Using other hand, gently insert the tip of the tubing about one and a half inches into the rectum. Stop if you feel resistance or if the resident complains of pain. Tell the nurse immediately.

13. Slowly squeeze and roll the enema container so that the solution runs inside the resident. Stop when the container is almost empty. 14. Gently remove the tip from the rectum, and place the bottle inside the box upside down. 15. Ask the resident to hold the solution inside as long as possible.

Help resident use bedpan or commode, or get to the bathroom. If the resident uses a commode or toilet, put on robe and non-skid footwear. Lower the bed to its lowest position before the resident gets up. 17. Remove and discard gloves. Wash your hands.

18. Place toilet paper and disposable wipes within resident’s reach. Ask the resident to clean his hands with the hand wipe when finished if he is able. If the resident is using the toilet, ask him not to flush it when finished. 19. Place the call light within resident’s reach. Ask resident to signal when done. Leave the room and close the door. 20. When called by the resident, return and put on clean gloves.

21. Lower the head of the bed. Make sure resident is still covered. 22. Remove bedpan carefully and cover bedpan. 23. Provide perineal care if help is needed. Wipe female residents from front to back. Dry the perineal area with a towel. Help the resident put on undergarment. Cover the resident and remove the bath blanket. 24. Place the towel and bath blanket in a hamper or bag, and discard disposable supplies.

25. Take bedpan to the bathroom. Call the nurse to observe the enema results. Empty the contents of bedpan carefully into the toilet. 26. Turn the faucet on with a paper towel. Rinse the bedpan with cold water and empty it into the toilet. Flush the toilet. Place bedpan in proper area for cleaning or clean it according to facility policy. 27. Remove and discard gloves. 28. Wash your hands.

29. Make resident comfortable. 30. Return bed to lowest position. Remove privacy measures. 31. Place call light within resident’s reach. 32. Report any changes in resident to the nurse. 33. Document procedure using facility guidelines.

5. Demonstrate how to collect a stool specimen
NAs should remember these points about stool specimens: Stool is tested for blood, pathogens, and other things. Stool must be warm if being tested for ova and parasites. Urine or tissue in a stool sample can ruin the sample.

Collecting a stool specimen
Equipment: specimen container with completed label (labeled with resident’s name, date of birth, room number, date, and time) and lid, specimen bag, 2 pairs of gloves, 2 tongue blades, bedpan (if resident cannot use portable commode or toilet), hat for toilet (if resident uses portable commode or toilet), plastic bag, toilet paper, disposable wipes, paper towels, supplies for perineal care, lab slip 1. Identify yourself by name. Identify the resident by name. 2. Wash your hands.

3. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. 4. Provide for resident’s privacy with curtain, screen, or door. 5. Put on gloves. 6. Fit hat to toilet or commode, or provide resident with bedpan.

7. When the resident is ready to move bowels, ask him not to urinate at the same time and not to put toilet paper in with the sample. Provide a plastic bag to discard toilet paper separately. 8. Place toilet paper and disposable wipes within resident’s reach. Ask resident to clean his hands with a wipe when finished if he is able. 9. Remove and discard gloves. Wash your hands.

10. Place the call light within resident’s reach. Ask resident to signal when done. Leave the room and close the door. 11. When called by the resident, return and put on clean gloves. Provide perineal care if help is needed. 12. Using the two tongue blades, take about two tablespoons of stool and put it in the container. Without touching the inside of the container, cover it tightly. Apply label and place container in a clean specimen bag.

13. Wrap the tongue blades in toilet paper and put them in plastic bag with used toilet paper. Discard bag in proper container. 14. Empty the bedpan or container into the toilet. Turn the faucet on with a paper towel. Rinse the bedpan with cold water and empty it into the toilet. Flush the toilet. Place equipment in proper area for cleaning or clean it according to facility policy. 15. Remove and discard gloves.

16. Wash your hands. 17. Remove privacy measures. 18. Place call light within resident’s reach. 19. Report any changes in resident to the nurse. 20. Take specimen and lab slip to proper area. Document procedure using facility guidelines. Note amount and characteristics of stool.

6. Explain occult blood testing
Define the following term: occult hidden; difficult to see or observe.

6. Explain occult blood testing
REMEMBER: Blood in the stool may be a sign of a serious problem, such as cancer. There are different tests that can be used to check for occult blood.

Testing a stool specimen for occult blood
Equipment: labeled stool specimen, occult blood test kit (Fig. 17-8), 2 tongue blades, plastic bag, gloves 1. Wash your hands. 2. Put on gloves. 3. Open the test card. 4. Pick up a tongue blade. Get small amount of stool from the specimen container.

5. Using a tongue blade, smear a small amount of stool onto Box A of test card. 6. Flip tongue blade (or use a new tongue blade). Get some stool from another part of specimen. Smear small amount of stool onto Box B of test card. 7. Close the test card. Turn over to other side. 8. Open the flap. 9. Open the developer. Apply developer to each box. Follow manufacturer’s instructions.

10. Wait the amount of time listed in instructions, usually between 10 and 60 seconds. 11. Watch the squares for any color changes. Record color changes. Follow instructions. 12. Place tongue blade and test packet in plastic bag, and dispose of plastic bag properly. 13. Remove and discard gloves. 14. Wash your hands. 15. Document procedure using facility guidelines.

7. Define the term ostomy and list care guidelines
Define the following terms: ostomy a surgically-created opening from an area inside the body to the outside. ureterostomy a surgically-created opening from an ureter to the abdomen for urine to be eliminated. colostomy surgically-created opening through the abdomen into the large intestine to allow feces to be expelled. ileostomy a surgically-created opening into the end of the small intestine to allow stool to be expelled.

REMEMBER: There are several different types of ostomy appliances and equipment sold. Different types are appropriate for certain ostomies.

NAs should remember these guidelines when caring for a resident with an ostomy: Make sure resident receives careful skin care. Empty and clean or replace the ostomy bag whenever stool is eliminated. Always wear gloves and wash hands carefully. Follow Standard Precautions. Teach proper handwashing techniques to residents with ostomies. Skin barriers protect skin around stoma from irritation.

Guidelines for caring for a resident with an ostomy (cont’d): Residents with an ileostomy may experience food blockage, in which a large amount of undigested food collects in the small intestine and blocks passage of stool. Follow diet instructions in the care plan and the nurse’s instructions for assisting with feeding. Encourage fluids and proper diet. Be sensitive and supportive when working with residents with ostomies. Always provide privacy for ostomy care. Report odors to the nurse.

Guidelines for caring for a resident with an ostomy (cont’d): Observe and report any emotional or physical problems the resident has adjusting to the ostomy. Report any of the following to the nurse: Changes in color, amount, frequency, or odor of stool. Any skin change at stoma site Leaking stool Absence of stool Watery stool with green, stringy material Abdominal cramps Vomiting

1. Identify yourself by name. Identify the resident by name.
Caring for an ostomy Equipment: protective pad, bath blanket, clean ostomy drainage bag and belt, disposable wipes, basin of warm water, soap, washcloth, skin cream as ordered, 2 towels, plastic disposable bag, gloves 1. Identify yourself by name. Identify the resident by name. 2. Wash your hands. 3. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.

4. Provide for resident’s privacy with curtain, screen, or door.
Caring for an ostomy 4. Provide for resident’s privacy with curtain, screen, or door. 5. Adjust bed to a safe level, usually waist high. Lock bed wheels. 6. Put on gloves. 7. Place protective pad under resident. Cover resident with a bath blanket. Pull down the top sheet and blankets. Expose only the ostomy site. Offer resident a towel to keep clothing dry.

Caring for an ostomy 8. Remove ostomy bag carefully. Place it in plastic bag. Note the color, odor, consistency, and amount of stool in the bag. 9. Wipe the area around the stoma with disposable wipes. Discard wipes in plastic bag. 10. Using a washcloth and warm, soapy water, wash the area in one direction, away from the stoma. Rinse. Pat dry with another towel. Apply skin cream as ordered.

13. Remove and discard gloves. 14. Wash your hands.
Caring for an ostomy 11. Place the clean ostomy drainage bag on resident. Hold in place and seal securely. Make sure the bottom of the bag is clamped. 12. Remove protective pad and discard. Place soiled linens in proper container. Discard plastic bag properly. 13. Remove and discard gloves. 14. Wash your hands. 15. Make resident comfortable.

16. Return bed to lowest position. Remove privacy measures.
Caring for an ostomy 16. Return bed to lowest position. Remove privacy measures. 17. Place call light within resident’s reach. 18. Report any changes in resident to the nurse. Note any changes to the stoma and surrounding area. A normal stoma is red and moist and looks like the lining of the mouth. Call the nurse if the stoma appears very red or blue or if swelling or bleeding is present. 19. Document procedure using facility guidelines.

8. Explain guidelines for assisting with bowel retraining
When assisting a resident with bowel retraining, an NA should remember these guidelines: Follow Standard Precautions. Wear gloves. Explain the schedule to the resident. Follow the schedule. Keep a record of bowel habits. Encourage plenty of fluids. Encourage foods that are high in fiber. Answer call lights promptly. Provide privacy.

Guidelines for bowel retraining (cont’d): Never rush resident. Assist with careful perineal care. Discard wastes properly. Discard clothing protectors and incontinence briefs properly. Follow Standard Precautions when handling washable bed pads or briefs. Keep an accurate record of elimination. Offer positive reinforcement but do not talk to residents as if they were children. Never show frustration or anger.

REMEMBER: It is important that NAs consider how they would feel in the place of a resident going through bowel retraining. NAs must maintain a positive attitude and help the resident maintain a sense of dignity.

Exam Multiple Choice. Choose the correct answer.
How should stool normally appear? (A) Brown and soft (B) Black and hard (C) Brown and loose (D) Red and formed Foods high in ______ improve bowel elimination. (A) Refined sugar (B) Animal fats (C) Fiber (D) Dairy products

Exam Signs of constipation include (A) Frequent stools
(B) Rapid heart rate (C) Fecal incontinence (D) Irritability A disorder that causes frequent, liquid feces and is generally treated with a change of diet is (A) Diarrhea (B) Constipation (C) Peptic ulcers (D) Hepatitis

Exam What is the most common symptom of gastroesophageal reflux disease (GERD)? (A) Diarrhea (B) Lactose intolerance (C) Heartburn (D) Constipation Which of the following care guidelines is true for gastroesophageal reflux disease (GERD)? (A) The last meal of the day should be served as close to bedtime as possible. (B) Increasing intake of fatty and spicy foods may help reduce reflux. (C) The resident should remain upright two to three hours after eating. (D) Serving three large meals a day helps promote comfort.

Exam The best position for bowel elimination is
(A) Lying flat on the bed (B) Squatting and leaning forward (C) Lying on the stomach (D) Sitting with the back straight and feet flat on the floor During an enema, a resident will be in the _______ position. (A) Lateral (B) Supine (C) Sims’ (D) Fowler’s

Exam When giving a cleansing enema, how far should the bottom of the enema bag be above the anus? (A) Not more than 20 inches (B) Not more than 12 inches (C) Not more than 10 inches (D) Not more than 8 inches What can ruin a stool specimen if it is included? (A) Liquid stool (B) Urine (C) Hard stool (D) Too large a quantity of stool

Exam Occult blood means that the blood is (A) Visible (B) Hidden
(C) Cancerous (D) Added to a stool sample after it is collected The opening in the abdomen in a resident with an ostomy is called a(n) (A) Stoma (B) Stool (C) Bag (D) Appliance

Exam Which of the following statements is true of ostomies?
(A) Ostomies require no special care. (B) People with ostomies are rarely embarrassed by the ostomy. (C) NAs do not need to worry about privacy when providing ostomy care. (D) Many people manage the ostomy appliance by themselves. Which of the following is a guideline for nursing assistants who are assisting with bowel retraining? (A) NAs should encourage residents to drink plenty of fluids. (B) NAs do not need to wear gloves when handling body wastes. (C) NAs do not need to provide privacy during elimination if residents are in bed. (D) NAs should let residents know when they are taking too long to have a bowel movement.

CHAPTER 17 1. What can ruin a stool specimen if it is included? (A) Liquid stool (B) Urine (C) Hard stool (D) Too large a quantity of stool 2. Which of the following statements is true of ostomies? (A) Ostomies require no special care. (B) People with ostomies are rarely embarrassed by the ostomy. (C) NAs do not need to worry about privacy when providing ostomy care. (D) Many people manage the ostomy appliance by themselves. 3. Occult blood means that the blood is (A) visible (B) hidden (C) cancerous (D) Added to a stool sample after it is collected 4. How should stool normally appear? (A) Brown and soft (B) Black and hard (C) Brown and loose (D) Red and formed

CHAPTER 17 PRACTICE ANSWERS
B- URINE D- MANY PEOPLE MANAGE THE OSTOMY APPLIANCE BY THEMSELVES B- HIDDEN A- BROWN AND SOFT

1. List qualities of stool and identify signs and symptoms about stool to report Define the following term: defecation the act of passing feces from the.

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1. List qualities of stool and identify signs and symptoms about stool to report Define the following term: defecation the act of passing feces from the.

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