ACTIVE LEARNING TEMPLATE: Nursing Skill
.
STUDENT NAME _____________________________________
Nursing care for Bowel Elimination
SKILL NAME____________________________________________________________________________ 38
REVIEW MODULE CHAPTER ___________
Description of Skill
Describe how you will:
Assess bowel elimination and function in your patient
Promote normal bowel elimination
Provide ostomy care
Indications CONSIDERATIONS
Pt paralyzed and bowel motility in question.
Nursing Interventions (pre, intra, post)
Pre: reviewed chart and confirmed order for ostomy care. Also attempted to review when
last BM was documented. Knock/gel-in/introduce/provide privacy. Confirmed with pt last
known BM (and texture/consistency/color). Explained that I need to evaluate ostomy and
possibly administer enema. Pt consented.
Intra: Washed hands and donned gloves. Removed dressing to evaluate stoma; clean
and red, moist, and fleshy appearance, no apparent blockage appreciated. Discussed
with provider who approved intra-stoma isotonic enema. Prepared materials, cleansed
area using saline-soaked gauze. Inserting 14fr red rubber into stoma, administered
~500mL warmed (not hot) isotonic saline slowly. Allowed to sit for several minutes,
removed red rubber, confirmed comfort level w/ pt (0/10, not concerned). Cleaned stoma
well but gently, covered, re-attached ostomy collection bag, and allowed to fill with
material; some fecal matter and saline produced. Notified pt would confirm more material
was produced and that it should be evaluated as to potential cause of blockage.
Post: Cleaned materials, washed hands, confirmed comfort level, gel/out, documented.
Set timer to check on pt in 30 minutes.
Outcomes/Evaluation
Client Education
Assess ostomy site/collection system and
administer enema as ordered by provider Discussed with pt continued need to care for
ostomy site and what to look for (normal vs.
abnormal tissues). Also recommended pt
keep a detailed calendar of BMs to ensure
patency of GI. Rec pt contact should any
concerns arise asap.
Potential Complications Nursing Interventions
- Stoma blocked/unhealth - Evaluate stoma and assess blockage; if unable to easily relieve
gently, notify provider. Should stoma appear unhealthy (white,
- Fecal obstruction not affected by enema blue, or black), notify provider immediately and document. Educate
- Pt not adjusting well to ostomy and isn't pt on proper stoma care.
- If GI obstruction is resistant to isotonic enema effects, discuss
caring properly for it with provider utilizing a more effective enema such as oil or fleet.
Administer as instructed; consider radiographs should obstruction
persist.
- Consider offering therapeutic resources for adjusting to the new
and negatively taboo lifestyle change. Discuss the importance of
why having a healthy and cared for stoma is critical (not in a
judgmental way of course). Provide love and understanding as this
is a challenging adjustment for anyone.
ACTIVE LEARNING TEMPLATES
.
STUDENT NAME _____________________________________
Nursing care for Bowel Elimination
SKILL NAME____________________________________________________________________________ 38
REVIEW MODULE CHAPTER ___________
Description of Skill
Describe how you will:
Assess bowel elimination and function in your patient
Promote normal bowel elimination
Provide ostomy care
Indications CONSIDERATIONS
Pt paralyzed and bowel motility in question.
Nursing Interventions (pre, intra, post)
Pre: reviewed chart and confirmed order for ostomy care. Also attempted to review when
last BM was documented. Knock/gel-in/introduce/provide privacy. Confirmed with pt last
known BM (and texture/consistency/color). Explained that I need to evaluate ostomy and
possibly administer enema. Pt consented.
Intra: Washed hands and donned gloves. Removed dressing to evaluate stoma; clean
and red, moist, and fleshy appearance, no apparent blockage appreciated. Discussed
with provider who approved intra-stoma isotonic enema. Prepared materials, cleansed
area using saline-soaked gauze. Inserting 14fr red rubber into stoma, administered
~500mL warmed (not hot) isotonic saline slowly. Allowed to sit for several minutes,
removed red rubber, confirmed comfort level w/ pt (0/10, not concerned). Cleaned stoma
well but gently, covered, re-attached ostomy collection bag, and allowed to fill with
material; some fecal matter and saline produced. Notified pt would confirm more material
was produced and that it should be evaluated as to potential cause of blockage.
Post: Cleaned materials, washed hands, confirmed comfort level, gel/out, documented.
Set timer to check on pt in 30 minutes.
Outcomes/Evaluation
Client Education
Assess ostomy site/collection system and
administer enema as ordered by provider Discussed with pt continued need to care for
ostomy site and what to look for (normal vs.
abnormal tissues). Also recommended pt
keep a detailed calendar of BMs to ensure
patency of GI. Rec pt contact should any
concerns arise asap.
Potential Complications Nursing Interventions
- Stoma blocked/unhealth - Evaluate stoma and assess blockage; if unable to easily relieve
gently, notify provider. Should stoma appear unhealthy (white,
- Fecal obstruction not affected by enema blue, or black), notify provider immediately and document. Educate
- Pt not adjusting well to ostomy and isn't pt on proper stoma care.
- If GI obstruction is resistant to isotonic enema effects, discuss
caring properly for it with provider utilizing a more effective enema such as oil or fleet.
Administer as instructed; consider radiographs should obstruction
persist.
- Consider offering therapeutic resources for adjusting to the new
and negatively taboo lifestyle change. Discuss the importance of
why having a healthy and cared for stoma is critical (not in a
judgmental way of course). Provide love and understanding as this
is a challenging adjustment for anyone.
ACTIVE LEARNING TEMPLATES
