NSG 3112 : FUNDAMENTALS OF NURSING STUDY
GUIDE (2024/2025)
Textbook chapters 38, 46, 30, 32, 34,35, 39, 27, & 36
ATI Chapters 43,35,41,42,55,38,39,15, & 53 (ALL ANSWERS AT THE END OF THE SG)
Chapter 38: Bowel
- The Large Intestine:
o Functions
▪ Absorption of water, formation of feces, expulsion of feces from the body
- Process of Peristalsis:
o Peristalsis is under control of the nervous system.
o Contractions occur every 3 to 12 minutes.
o Mass peristalsis sweeps occur one to four times each 24-hour period.
o One-third to one-half of food waste is excreted in stool within 24 hours.
o NOTE: Typically, only a 3rd of half of what we consume comes back out
- Defecation: the act of having a BM
o Variables influencing bowel elimination:
▪ Developmental considerations: really old, really young
▪ Daily patterns
▪ Food and fluid
▪ Activity and muscle tone:
❖ If client is active, then they will have a bowel movement more often
than someone who isn’t active
▪ Lifestyle
▪ Psychological variables
▪ Pathologic conditions
▪ Medications
▪ Diagnostic studies
▪ Surgery and anesthesia
- Clostridium Difficile:
o Health care–acquired infection (HAI): best way to prevent it is handwashing with soap
and water!!!
o S/S: Diarrhea and abdominal cramping.
o Spread on the hands of health care providers
o Treatment with broad-spectrum antibiotics, leads to a disruption in the normal intestinal
flora, allowing the microorganism to flourish within the intestine
o C. difficile spores are shed in feces and are resistant to disinfectants
o Contact precautions for infected patients
- Developmental considerations:
o Infants: Characteristics of stool and frequency depend on formula or breast feedings.
, o Toddler: Physiologic maturity is the priority for bowel training.
o Child, adolescent, adult: Defecation patterns vary in quantity, frequency, and
rhythmicity.
o Older adult: Constipation is often a chronic problem; diarrhea and fecal incontinence
may result from physiologic or lifestyle changes.
- Foods Affecting Bowel Elimination:
o Constipating foods: cheese, lean meat, eggs, pasta
o Foods with laxative effect: fruits and vegetables, bran, chocolate, alcohol, coffee
o Gas-producing foods: onions, cabbage, beans, cauliflower
- Effect of Medications on Stool:
o Aspirin anticoagulants: pink to red to black stool
o Iron salts: black stool
▪ Bismuth subsalicylate used to treat diarrhea can also cause black stools
o Antacids: white discoloration or speckling in stool
o Antibiotics: green-gray stool
- Physical Assessment of the Abdomen:
o The sequence for abdominal assessment proceeds from inspection, auscultation, and
percussion to palpation.
o Inspection: observe contour, any masses, scars, or distention
o Auscultation: listen for bowel sounds in all quadrants
▪ Describe as hypoactive, hyperactive, absent, or infrequent.
o Percussion and palpations: performed by advanced practice professionals
- Physical Assessment of the Anus and Rectum:
o Inspection and palpation-
▪ Lesions, ulcers, fissures (linear break on the margin of the anus), inflammation,
and external hemorrhoids
- Stool collection:
o Medical aseptic technique is imperative
o Do not contaminate outside of container with stool
- Pt Guidelines for Stool Collection:
o Void: Void first so that urine is not in stool sample.
o Defecate: Defecate into the container rather than toilet bowl.
o Do not place: Do not place toilet tissue in the bedpan or specimen container.
o Avoid: Avoid contact with soaps, detergents, and disinfectants as these may affect test
results.
o Notify: Notify nurse when specimen is available.
- Direct Visualization Studies:
o Esophagogastroduodenoscopy: goes from upper to lower; usually a lighted camera; pt is
comfortable
o Colonoscopy: from lower to upper; 2-day prep (change diet and go lightly to clean out
colon); starts at 50 yrs old and then every 10 yrs after that
o Sigmoidoscopy: looks inside the colon right at the sigmoid
, o Wireless capsule endoscopy: wires on chest; swallow tiny camera that looks through out
the GI system.
- Indirect Visualization Studies:
o Upper gastrointestinal (UGI)
o Small bowel series
o Barium enema
o Abdominal ultrasound
o Magnetic resonance imaging (MRI)
o Abdominal CT scan
- Scheduling Diagnostic Tests:
o 1: fecal occult blood tests (usually done in groups of three)
▪ They don’t usually work with nosebleeds, menstruation, or bleed hemorrhoids
bc they will give a false positive for blood in stool
o 2: barium studies (should precede UGI): pt will get constipated if they don’t drink
enough fluid
o 3: endoscopic examinations
o NOTE: start with the least invasive FIRST
o Black blood: peptic ulcer or GI bleed– upper
o Bright red blood: hemorrhoids (it’s a vein) or polyp—lower
- Pt Outcomes for Normal Bowel Elimination:
o Patient has a soft, formed bowel movement every 1 to 3 days without discomfort.
o The relationship between bowel elimination and diet, fluid, and exercise is explained.
o Patient should seek medical evaluation if changes in stool color or consistency persist.
- Promoting Regular Bowel Habits:
o Timing: big deal; pt in the hospital will struggle to go bc they don’t have enough time to
go.
o Positioning: sit pt up on a bedpan
o Privacy
o Nutrition
o Exercise:
▪ Abdominal settings
▪ Thigh strengthening
- Individuals at High Risk for Constipation:
o Pts on bedrest taking constipation medications
o Pts with reduced fluids or bulk in their diet
o Pts who are depressed
o Pts with CNS diseases or local lesions that cause pain while defecating
- Nursing Measures for the Pt with Diarrhea:
o Answer call bells ASAP
o Remove the cause of diarrhea whenever possible and try to help with food
o Obtain a physician order for rectal examination if there is impaction
o Give special care to the region around the anus
, - Preventing Food Poisoning:
o Buy: Never buy food with damaged packaging.
o Take: Take items requiring refrigeration home immediately
o Wash: Wash hands and surfaces often and thoroughly wash all fruits and vegetables
before eating.
o Use: use separate cutting boards for foods and never use raw eggs in any form
o Do not wash: Do not wash meat, poultry, or eggs to prevent spreading microorganisms
to sink and other kitchen surfaces
o Do not eat: Do not eat seafood raw or if it has an unpleasant odor
- Methods of Emptying the Colon of Feces:
o Enemas:
▪ Cleansing: trying to remove stool and relieve constipation; clean out for surgery
▪ Large volume: hypotonic (tap water) or isotonic (normal saline)
▪ Small volume: hypertonic solution (70-100 mL); they’re full of sodium and have
a lot of phosphate
❖ Pts with Chronic kidney failure or CHF cannot have these
▪ NOTE:
❖ if you raise the bag, the faster it is; and if you lower the bag, the slower
it is
❖ put them on their lef t side—or sims
o Rectal suppositories
o Oral intestinal lavage (ex. Go lightly)
o Digital removal of stool (NEED AN ORDER)
- Retention Enemas:
o Lubricate:
▪ Oil-retention: lubricate the stool and intestinal mucosa, easing defecation
o Help:
▪ Carminative: help expel flatus from the rectum
o Provide:
▪ Medicated: provide medications absorbed through the rectal mucosa
o Destroy:
▪ Anthelmintic: destroy intestinal parasites
- Nasogastric (NG) Tubes:
o Inserted to decompress or drain the stomach of fluid or unwanted stomach contents
o Used to allow the gastrointestinal tract to rest before or after abdominal surgery to
promote healing
o Inserted to monitor gastrointestinal bleeding
o To check placement: GET A CHEST XRAY (gold standard)
▪ BUT if you have to give meds you might not be able to get a xray, so now you’ll
pull out stomach contents and test w pH paper.
▪ ALWAYS CHECK PLACEMENT BEFORE YOU GIVE MEDICATIONS
GUIDE (2024/2025)
Textbook chapters 38, 46, 30, 32, 34,35, 39, 27, & 36
ATI Chapters 43,35,41,42,55,38,39,15, & 53 (ALL ANSWERS AT THE END OF THE SG)
Chapter 38: Bowel
- The Large Intestine:
o Functions
▪ Absorption of water, formation of feces, expulsion of feces from the body
- Process of Peristalsis:
o Peristalsis is under control of the nervous system.
o Contractions occur every 3 to 12 minutes.
o Mass peristalsis sweeps occur one to four times each 24-hour period.
o One-third to one-half of food waste is excreted in stool within 24 hours.
o NOTE: Typically, only a 3rd of half of what we consume comes back out
- Defecation: the act of having a BM
o Variables influencing bowel elimination:
▪ Developmental considerations: really old, really young
▪ Daily patterns
▪ Food and fluid
▪ Activity and muscle tone:
❖ If client is active, then they will have a bowel movement more often
than someone who isn’t active
▪ Lifestyle
▪ Psychological variables
▪ Pathologic conditions
▪ Medications
▪ Diagnostic studies
▪ Surgery and anesthesia
- Clostridium Difficile:
o Health care–acquired infection (HAI): best way to prevent it is handwashing with soap
and water!!!
o S/S: Diarrhea and abdominal cramping.
o Spread on the hands of health care providers
o Treatment with broad-spectrum antibiotics, leads to a disruption in the normal intestinal
flora, allowing the microorganism to flourish within the intestine
o C. difficile spores are shed in feces and are resistant to disinfectants
o Contact precautions for infected patients
- Developmental considerations:
o Infants: Characteristics of stool and frequency depend on formula or breast feedings.
, o Toddler: Physiologic maturity is the priority for bowel training.
o Child, adolescent, adult: Defecation patterns vary in quantity, frequency, and
rhythmicity.
o Older adult: Constipation is often a chronic problem; diarrhea and fecal incontinence
may result from physiologic or lifestyle changes.
- Foods Affecting Bowel Elimination:
o Constipating foods: cheese, lean meat, eggs, pasta
o Foods with laxative effect: fruits and vegetables, bran, chocolate, alcohol, coffee
o Gas-producing foods: onions, cabbage, beans, cauliflower
- Effect of Medications on Stool:
o Aspirin anticoagulants: pink to red to black stool
o Iron salts: black stool
▪ Bismuth subsalicylate used to treat diarrhea can also cause black stools
o Antacids: white discoloration or speckling in stool
o Antibiotics: green-gray stool
- Physical Assessment of the Abdomen:
o The sequence for abdominal assessment proceeds from inspection, auscultation, and
percussion to palpation.
o Inspection: observe contour, any masses, scars, or distention
o Auscultation: listen for bowel sounds in all quadrants
▪ Describe as hypoactive, hyperactive, absent, or infrequent.
o Percussion and palpations: performed by advanced practice professionals
- Physical Assessment of the Anus and Rectum:
o Inspection and palpation-
▪ Lesions, ulcers, fissures (linear break on the margin of the anus), inflammation,
and external hemorrhoids
- Stool collection:
o Medical aseptic technique is imperative
o Do not contaminate outside of container with stool
- Pt Guidelines for Stool Collection:
o Void: Void first so that urine is not in stool sample.
o Defecate: Defecate into the container rather than toilet bowl.
o Do not place: Do not place toilet tissue in the bedpan or specimen container.
o Avoid: Avoid contact with soaps, detergents, and disinfectants as these may affect test
results.
o Notify: Notify nurse when specimen is available.
- Direct Visualization Studies:
o Esophagogastroduodenoscopy: goes from upper to lower; usually a lighted camera; pt is
comfortable
o Colonoscopy: from lower to upper; 2-day prep (change diet and go lightly to clean out
colon); starts at 50 yrs old and then every 10 yrs after that
o Sigmoidoscopy: looks inside the colon right at the sigmoid
, o Wireless capsule endoscopy: wires on chest; swallow tiny camera that looks through out
the GI system.
- Indirect Visualization Studies:
o Upper gastrointestinal (UGI)
o Small bowel series
o Barium enema
o Abdominal ultrasound
o Magnetic resonance imaging (MRI)
o Abdominal CT scan
- Scheduling Diagnostic Tests:
o 1: fecal occult blood tests (usually done in groups of three)
▪ They don’t usually work with nosebleeds, menstruation, or bleed hemorrhoids
bc they will give a false positive for blood in stool
o 2: barium studies (should precede UGI): pt will get constipated if they don’t drink
enough fluid
o 3: endoscopic examinations
o NOTE: start with the least invasive FIRST
o Black blood: peptic ulcer or GI bleed– upper
o Bright red blood: hemorrhoids (it’s a vein) or polyp—lower
- Pt Outcomes for Normal Bowel Elimination:
o Patient has a soft, formed bowel movement every 1 to 3 days without discomfort.
o The relationship between bowel elimination and diet, fluid, and exercise is explained.
o Patient should seek medical evaluation if changes in stool color or consistency persist.
- Promoting Regular Bowel Habits:
o Timing: big deal; pt in the hospital will struggle to go bc they don’t have enough time to
go.
o Positioning: sit pt up on a bedpan
o Privacy
o Nutrition
o Exercise:
▪ Abdominal settings
▪ Thigh strengthening
- Individuals at High Risk for Constipation:
o Pts on bedrest taking constipation medications
o Pts with reduced fluids or bulk in their diet
o Pts who are depressed
o Pts with CNS diseases or local lesions that cause pain while defecating
- Nursing Measures for the Pt with Diarrhea:
o Answer call bells ASAP
o Remove the cause of diarrhea whenever possible and try to help with food
o Obtain a physician order for rectal examination if there is impaction
o Give special care to the region around the anus
, - Preventing Food Poisoning:
o Buy: Never buy food with damaged packaging.
o Take: Take items requiring refrigeration home immediately
o Wash: Wash hands and surfaces often and thoroughly wash all fruits and vegetables
before eating.
o Use: use separate cutting boards for foods and never use raw eggs in any form
o Do not wash: Do not wash meat, poultry, or eggs to prevent spreading microorganisms
to sink and other kitchen surfaces
o Do not eat: Do not eat seafood raw or if it has an unpleasant odor
- Methods of Emptying the Colon of Feces:
o Enemas:
▪ Cleansing: trying to remove stool and relieve constipation; clean out for surgery
▪ Large volume: hypotonic (tap water) or isotonic (normal saline)
▪ Small volume: hypertonic solution (70-100 mL); they’re full of sodium and have
a lot of phosphate
❖ Pts with Chronic kidney failure or CHF cannot have these
▪ NOTE:
❖ if you raise the bag, the faster it is; and if you lower the bag, the slower
it is
❖ put them on their lef t side—or sims
o Rectal suppositories
o Oral intestinal lavage (ex. Go lightly)
o Digital removal of stool (NEED AN ORDER)
- Retention Enemas:
o Lubricate:
▪ Oil-retention: lubricate the stool and intestinal mucosa, easing defecation
o Help:
▪ Carminative: help expel flatus from the rectum
o Provide:
▪ Medicated: provide medications absorbed through the rectal mucosa
o Destroy:
▪ Anthelmintic: destroy intestinal parasites
- Nasogastric (NG) Tubes:
o Inserted to decompress or drain the stomach of fluid or unwanted stomach contents
o Used to allow the gastrointestinal tract to rest before or after abdominal surgery to
promote healing
o Inserted to monitor gastrointestinal bleeding
o To check placement: GET A CHEST XRAY (gold standard)
▪ BUT if you have to give meds you might not be able to get a xray, so now you’ll
pull out stomach contents and test w pH paper.
▪ ALWAYS CHECK PLACEMENT BEFORE YOU GIVE MEDICATIONS
