SUFFOLK COUNTY COMMUNITY COLLEGE
SCHOOL OF NURSING
NUR101 LAB #14
Bowel Elimination
Urinary and Bowel diversions
INSTRUCTIONS TO STUDENTS:
 Please complete lab handout, assigned readings, and review appropriate ATI DVD in advance of lab
classes.
 Students who are unprepared for lab are negatively affecting their grades and more importantly, their
ability to make the most from the learning opportunities in the lab.
I. Bowel Elimination Assessment:
1.
What is the proper sequence for an abdominal physical assessment?
2.
Subjective factors to assess:
 Usual patterns of elimination
 Recent changes in bowel elimination – changes in stool, blood in stool, difference in
appearance, mucus, shape
 Aids used in elimination: natural
pharmacologic
enemas
II. Enema Administration: An MD order is needed to give any enema.
1.
Types of cleansing enemas:
For each of the following types of enemas describe their purpose, how the patient is positioned
and how much volume is given for each:
a.
b.
c.
d.
2.
Tap water (TWE)
Soapsuds (SSE)
Fleets enema (hypertonic)
Oil retention
Explain the best position to place a client in for an enema?
Length of tube insertion and height of bag if applicable.
III. Elimination Aids:
1.
Describe how the following elimination aids are used and their purpose:
1 – Harris flush
2 – Rectal tube
NUR101 Lab #14
3 – Disimpaction – Digital removal of stool
Critical Thinking:
Can the procedure for disimpaction be delegated to assistive personnel? Defend your answer.
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
Can enema administration be delegated to assistive personnel? Defend your answer.
__________________________________________________________________________________
IV.
Stool Specimen Collection:
1.
List the steps and equipment you would need for the following:
1- routine stool specimen
2- Fecal occult blood test (FOBT) AKA stool for OB or guaiac test
3- Stool for Ova & Parasites (O&P)
V.
Bowel Diversions: can be temporary or permanent
1.
Types of ostomies:
Ileostomy – bypasses entire large intestine
Colostomy – bypasses a portion of the large intestine. (loop, end, double barrel) refer to
pictures
Describe the differences in each type of ostomy listed below and the expected effluent:
Ileostomy ___________________________________________________________________________
Transverse (loop) Colostomy ____________________________________________________________
Descending Colostomy (and/or sigmoid)____________________________________________________
2.
Describe assessment of the ostomy:
3.
Pouching an Ostomy:
2
NUR101 Lab #14
List the equipment needed for changing a ostomy appliance:
Review the procedure for measuring and changing an ostomy appliance.
When is an appropriate time to change the colostomy appliance?
Documentation:
Urinary diversions
Urostomy:
bladder is removed and ureters are brought to skin surface. Outflow is continuous
so the challenge is to keep device secure and skin free from irritation, infection
and breakdown.
Ileal loop or conduit: portion of ileum (colon) is resected and becomes drainage chamber. Bladder is
removed and ureters are attached to resected ileum. Same challenges as
urostomy.
* can be fashioned into a continent storage pouch.
Nephrostomy: tube placed directly into one or both kidneys.
REV: rmk 06/10
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