Editing Fundamentals of Nursing (section)

=== Bowel elimination ===

Normal frequency varies widely, from three times daily to three times weekly. Any change from the patient's own baseline is more meaningful than the absolute number.

* '''Constipation:''' hard, dry, difficult stool. Interventions include increased fluid, dietary fiber, activity, a regular toileting routine that takes advantage of the gastrocolic reflex after meals, and prescribed stool softeners or laxatives.
* '''Fecal impaction:''' a hardened mass in the rectum. A classic and easily missed sign is the passage of liquid stool around the impaction, which can be mistaken for diarrhea. Digital removal may be prescribed but carries a risk of vagal stimulation and bradycardia.
* '''Diarrhea:''' risks are dehydration, electrolyte loss, and perineal skin breakdown. Assess for infection, including ''Clostridioides difficile''.
* '''Flatulence and distention:''' ambulation and left side lying may help.

'''Enema administration:''' place the patient in the left lateral Sims position, lubricate the tip, insert about 7.5 to 10 cm (3 to 4 inches) in an adult, directing the tip toward the umbilicus, and instill slowly. Solution containers for a cleansing enema are typically held about 30 to 45 cm (12 to 18 inches) above the anus; the higher the container, the faster and more forceful the flow. Stop and reassess if the patient reports cramping, dizziness, or palpitations. Never force the tubing against resistance.

'''Ostomy care:''' assess the stoma, which should be pink to red, moist, and slightly raised. A dusky, purple, or black stoma indicates compromised circulation and is an emergency to report. The peristomal skin should be intact. Cut the barrier opening no more than about one eighth inch larger than the stoma, empty the pouch when it is one third to one half full, and expect an ileostomy to drain liquid to pasty stool continuously while a descending or sigmoid colostomy produces more formed stool. Ileostomy patients are at particular risk for dehydration and electrolyte imbalance.