Diet
Jim just ate an entire pint of chocolate ice cream (he was having a rough day and needed to eat his favorite food). Unfortunately, he is lactose intolerant. What do you expect his next few hours to look like, in regard to his bowel pattern?
diarrhea
Jeff is admitted with a fractured hip. He reports his pain to be 10 out of 10, so the doctor prescribes IV hydromorphone [Dilaudid] 1 mg q3hr as needed for pain. Additionally, he is prescribed PO hydrocodone-acetaminophen [Norco] 10-325 mg q6hr as needed for pain. Jeff is requiring both medications around the clock. Jeff is now reporting abdominal discomfort. What do you suspect is occurring?
constipation (narcotics depress the CNS and cause slowed peristalsis)
Ileostomies and ostomies are diversions of intestinal contents. The specific name for the stool output is called _____. What is the consistency of ileostomy and colostomy output?
effluent; ileostomy: liquid, colostomy: more formed
What should a healthy stoma look like?
pink or red (“beefy” red)
Jaime has a colostomy, and she is still learning about how different foods affect the consistency and odor of the stool. She shares with you what she eats on an average day. She is reporting that her stool has an extra smelly odor, and she is wondering how to decrease the strong odor. Identify the foods that are causing this.
Breakfast: Oatmeal, one egg, banana, one cup of coffee with cream and sugar
Lunch: Ham sandwich with spinach and onions, three bean salad, potato chips, and a chocolate chip cookie
Dinner: Salmon, steamed broccoli, white rice, and one can of beer
egg, coffee, onions, three bean salad, salmon, broccoli, beer
Your patient is prescribed a bulk-forming laxative once daily. Name one of these medications. What key teaching point should you tell your patient?
Polycarbophil [FiberCon], Psyllium [Metamucil], Methylcelluose [Citrucel]; drink a large amount of fluid to prevent constipation and fecal impaction
You are teaching your patient with a new ostomy how to cut the appliance to fit over the stoma. She cuts the faceplate approximately 3/4 inch larger than the stoma. What is your next action?
intervene, as 3/4 inch is too far to the stoma and allows an opening for stool to irritate the exposed skin. The opening of the faceplate should be ¼ inch larger than the stoma.
Molly is receiving IV Vancomycin and IV Zosyn (antibiotics) for pneumonia. What food do you recommend for her to eat to prevent diarrhea? Why do you tell her this?
yogurt (or a probiotic) to replace the healthy gut bacteria. This minimizes the risk of developing diarrhea.
Edna is 82 years old. She has difficulty walking, so she is confined to her bed or chair for most of the day. She doesn’t drink much water because it is difficult for her to walk to the bathroom, so less water intake, less trips to the bathroom, is her rationale. Her diet consists of microwave meals, as she has difficulty in preparing her meals. As a result, she suffers from constipation. What are three recommendations can you make for Edna to relieve her constipation?
Increase water intake (eight 8-oz glasses per day)
Increase activity (i.e. walking)
Increase intake of fruits, vegetables, whole grains (fiber)
Establish bowel pattern (defecate at the same time every day)
Drink hot coffee, hot water & lemon juice, prune juice
Your patient is scheduled for a colonoscopy tomorrow. The doctor prescribed magnesium citrate 300 mL PO at 17:00. What is the mechanism of action of this medication?
hyperosmotic laxative, draws water from surrounding body tissues, used for rapid emptying of lower intestine/bowel, not used long-term
You are assessing your patient’s stoma. In shift report, you were told that the stoma appeared dark purple/black, but “that’s how it was before.” You see that the stoma is dark purple/black upon your assessment. What is your next action?
report this to the provider immediately. A dark, pale, or dusky stoma indicate compromised blood flow to the bowel and is an emergency!
What is the Valsalva Maneuver?
when a person holds their breath, closes the glottis, and tightens the abdominal muscles
Daniel loves his McDonalds. Big Mac, McChicken, Filet-o-fish, you name it, he loves it. On one particular day, he had McDonalds for all three meals. What do you suspect his stool to look like?
steatorrhea (oily, foul-smelling, floating)
Mary has overactive bladder, so she takes Oxybutynin [Ditropan]. Name two dietary and one lifestyle recommendation to manage the GI side effect of Oxybutynin.
Oxybutynin is an anticholinergic, and this drug class can cause constipation.
Recommendations on page 585
Why are patients with ileostomies more at risk for becoming dehydrated?
Because the patient’s stool is not traveling through the large intestine (which is where the majority of fluid/electrolytes are absorbed), the stool/water content is expelled from the ileostomy, thus placing the patient at an increased risk of dehydration and electrolyte imbalance.
Your patient is post-operative day #3 for her exploratory laparotomy. You auscultate her abdomen and do not hear any bowel sounds. Her abdomen is distended. She is also reporting nausea. What do you suspect is occurring? What is your immediate action?
paralytic ileus; notify the doctor, anticipate orders for NPO
Create a meal that contains at least 25 grams of fiber. State the foods and associated fiber content with each food.
see page 473
You are receiving report for a patient from the night shift nurse. He tells you that the patient had three loose stools overnight. You review the medication list and notice that the patient has Senna [Senakot] scheduled to be given at 0800. What are your actions?
Notify the doctor and ask if you can hold the Senna. Giving the Senna will cause worsening of the loose stools, as Senna is an irritant/stimulant laxative.
Name three indications of why a patient would require an ostomy.
Crohn’s disease, ulcerative colitis, cancer, abdominal trauma
Your patient has a bowel movement, and it appears dark, formed. Here is assessment data you have gathered:
Current medications: Ferrous sulfate (iron) 100 mg PO q12hr
Labs:
today: Hgb 6.0 g/dl yesterday: Hgb 8.0 g/dl
What is your next intervention?
Notify the doctor. The patient might be bleeding in the GI tract as evidenced by the dark stool. The cause of bleeding may not be the GI tract (as iron can also make the stool dark), but we must rule this out as a source of bleeding. Either way, the patient probably needs a blood transfusion as his hemoglobin is low (target for hemoglobin is at least 7 g/dl).