ExamFinch.com My Study

Study guide

6.5 Bowel Elimination and Ostomy Care

Practice this exam

NCLEX-RN Registered Nurse

Track your progress as you read

Finished sections get a check mark.

1 Introduction

About the NCLEX-RN Exam Next Generation NCLEX (NGN) Clinical Judgment Measurement Model (NCJMM) How to Use This Course

2 Chapter 2: Management of Care

2.1 Legal Rights and Responsibilities 2.2 Advance Directives and Self-Determination 2.3 Informed Consent Protocols 2.4 Client Advocacy and Rights (HIPAA) 2.5 Assignment, Delegation, and Supervision 2.6 Five Rights of Delegation 2.7 Scope of Practice (RN vs LPN vs UAP) 2.8 Ethical Practice Principles

3 Chapter 3: Safety and Infection Prevention and Control

3.1 Standard Precautions and Hand Hygiene 3.2 Transmission-Based Precautions (Contact, Droplet, Airborne) 3.3 PPE Donning and Doffing Sequences 3.4 Fall Prevention and Restraints 3.5 Fire Safety (RACE/PASS) 3.6 Disaster Triage and Emergency Response

4 Chapter 4: Health Promotion and Maintenance

4.1 Growth and Development (Erikson/Piaget) 4.2 Developmental Stages: Infancy through Older Adult 4.3 Maternal and Newborn Care (Antepartum) 4.4 Intrapartum Care and Fetal Monitoring 4.5 Postpartum Care (BUBBLE-HE) 4.6 Health Screening Guidelines 4.7 Immunization Schedules

5 Chapter 5: Psychosocial Integrity

5.1 Therapeutic Communication Techniques 5.2 Non-Therapeutic Communication (What to Avoid) 5.3 Anxiety Disorders and Mental Health Concepts 5.4 Schizophrenia: Hallucinations and Delusions 5.5 Depression and Suicide Assessment 5.6 Substance Misuse and Withdrawal 5.7 Grief and End-of-Life Care

6 Chapter 6: Basic Care and Comfort

6.1 Mobility and Hazards of Immobility 6.2 Assistive Devices (Crutches, Canes, Walkers) 6.3 Nutrition and Diet Therapy 6.4 Enteral Nutrition (Tube Feeding) 6.5 Bowel Elimination and Ostomy Care 6.6 Urinary Elimination and Catheter Care

7 Chapter 7: Pharmacological and Parenteral Therapies

7.1 Medication Administration Rights 7.2 Medication Calculations 7.3 High-Alert Medications: Insulins 7.4 High-Alert Medications: Anticoagulants 7.5 High-Alert Medications: Opioids 7.6 High-Alert Medications: Digoxin and Electrolytes 7.7 IV Therapy and Complications 7.8 Blood Product Administration 7.9 Total Parenteral Nutrition (TPN)

8 Chapter 8: Reduction of Risk Potential

8.1 Laboratory Values: Hematology (CBC) 8.2 Laboratory Values: Metabolic Panel (BMP) 8.3 Laboratory Values: Coagulation Studies 8.4 Vital Signs and Trend Recognition 8.5 Perioperative Care (Pre-Op and Post-Op) 8.6 Nasogastric Tubes and Therapeutic Procedures

9 Chapter 9: Physiological Adaptation

9.1 Fluid Imbalances (Hypovolemia and Hypervolemia) 9.2 Arterial Blood Gases (ABGs) and Acid-Base Balance 9.3 Medical Emergencies: Stroke (CVA) 9.4 Medical Emergencies: Myocardial Infarction (MONA) 9.5 Diabetic Emergencies (Hypoglycemia and DKA) 9.6 Respiratory Conditions (COPD, Pneumonia) 9.7 Cardiac Conditions (Heart Failure) 9.8 Neurological Conditions (Seizures)

6.5 Bowel Elimination and Ostomy Care

Key Takeaways Explain This Topic AI

A healthy stoma is pink/red and moist; a pale, dusky, or black stoma indicates ischemia and requires immediate surgical consultation

Ileostomies produce liquid stool and increase risk for dehydration and electrolyte imbalances; colostomies produce more formed stool

Constipation prevention: increase fiber (25-30g/day), fluids (2-3L/day), and physical activity

Colostomy location affects output: ascending = liquid, transverse = semi-formed, descending/sigmoid = formed

  • Ostomy pouches should be emptied when 1/3 to 1/2 full and changed every 3-7 days or when seal loosens
  • Last updated: January 2026

Bowel elimination is a fundamental human need. The nurse must understand normal patterns, common problems, and the specialized care required for patients with ostomies.

Normal Bowel Function

Normal bowel pattern varies widely—from three times daily to three times weekly. The key is what's normal for the individual patient.

Characteristics of Normal Stool

  • Characteristic Normal Abnormal
  • Color Brown Black (melena), red (hematochezia), clay-colored (biliary obstruction)
  • Consistency Soft, formed Hard (constipation), liquid (diarrhea), mucus-filled
  • Frequency 3x/day to 3x/week Significant change from baseline
  • Odor Characteristic fecal odor Extremely foul (C. diff, GI bleed)
  • Constipation

Constipation is infrequent, difficult passage of hard, dry stool.

Causes

  • Category Examples
  • Dietary Low fiber, inadequate fluids
  • Activity Immobility, sedentary lifestyle
  • Medications Opioids, anticholinergics, iron supplements, calcium
  • Conditions Hypothyroidism, neurological disorders, obstruction
  • Behavioral Ignoring urge to defecate, lack of privacy
  • Nursing Interventions
  • Intervention Rationale
  • Increase fiber intake (25-30 g/day) Adds bulk to stool, promotes peristalsis
  • Increase fluid intake (2-3 L/day) Softens stool
  • Encourage physical activity Stimulates peristalsis
  • Establish regular toileting routine Uses gastrocolic reflex (30 min after meals)
  • Provide privacy Promotes relaxation of sphincter
  • Position on toilet/commode Sitting position uses gravity
  • Laxatives and Stool Softeners
  • Type Examples Mechanism Onset
  • Bulk-forming Psyllium (Metamucil) Absorbs water, increases bulk 12-72 hours
  • Stool softener Docusate (Colace) Allows water into stool 24-72 hours
  • Osmotic Polyethylene glycol (MiraLAX) Draws water into bowel 24-48 hours
  • Stimulant Bisacodyl (Dulcolax), Senna Irritates bowel, increases motility 6-12 hours
  • Enema Fleet, tap water Mechanical stimulation Minutes
  • Diarrhea

Diarrhea is frequent passage of loose, watery stool.

  • Causes
  • Infection: Viral, bacterial (C. difficile, Salmonella), parasitic
  • Medications: Antibiotics, laxatives, chemotherapy
  • Diet: Food intolerance, excessive fiber
  • Disease: Inflammatory bowel disease, malabsorption
  • Tube feeding: Rate too fast, contamination
  • Nursing Interventions
  • Assess for dehydration (vital signs, skin turgor, urine output)
  • Replace fluids and electrolytes
  • Monitor and record frequency and characteristics
  • Protect perianal skin (barrier cream, gentle cleansing)
  • Identify and treat cause (stool culture, C. diff testing)
  • Contact precautions if infectious cause suspected
  • C. difficile Precautions

C. difficile requires contact precautions and hand washing with soap and water (alcohol-based sanitizers do not kill spores).

Ostomies

An ostomy is a surgically created opening from an internal organ to the body surface. Bowel ostomies divert stool to an external pouch.

Types of Intestinal Ostomies

Type Location Stool Consistency Key Concerns

Ileostomy Ileum (small intestine) Liquid, continuous High-volume output, dehydration, electrolyte loss, skin breakdown

  • Ascending colostomy Right colon Liquid to semi-liquid Similar to ileostomy
  • Transverse colostomy Mid-colon Semi-formed Moderate output
  • Descending colostomy Left colon Semi-formed to formed More predictable
  • Sigmoid colostomy Sigmoid colon Formed Most predictable, may achieve regularity
  • Stoma Assessment

A healthy stoma should be:

  • Pink to brick red in color
  • Moist and shiny
  • Slightly raised above skin level

ABNORMAL FINDINGS requiring immediate action:

  • Finding Indicates Action
  • Pale or dusky Ischemia Notify surgeon immediately
  • Black/necrotic Tissue death Emergency—surgical consultation
  • Dry, dull Dehydration Assess fluid status
  • Bleeding (more than slight) Trauma, complication Assess cause, may need intervention
  • Prolapse Stoma protruding excessively Notify provider
  • Retraction Stoma sinking below skin May need revision
  • Ostomy Pouch Care
  • Emptying the Pouch
  • Empty when 1/3 to 1/2 full to prevent leakage and weight pulling at seal
  • For ileostomy: May need to empty frequently (liquid output)
  • For colostomy: Less frequent (formed stool)
  • Changing the Pouch System
  • Component Change Frequency
  • Pouch (drainable) Every 3-7 days
  • Skin barrier (wafer) Every 3-7 days or when seal loosens
  • One-piece system Every 3-5 days
  • Steps for Pouch Change
  • Gather supplies
  • Remove old pouch gently (adhesive remover helps)
  • Clean peristomal skin with warm water (no soap with oils)
  • Pat dry completely
  • Assess stoma and peristomal skin
  • Measure stoma and cut opening 1/8 inch larger than stoma
  • Apply skin barrier if using two-piece system
  • Apply pouch, press firmly for 30 seconds
  • Ensure secure seal
  • Skin Protection

The effluent (output) from an ileostomy is highly caustic and can cause severe skin breakdown. Protect skin with:

  • Properly fitted pouch (opening just slightly larger than stoma)
  • Skin barrier paste to fill irregular areas
  • Pectin-based powder for denuded skin
  • Change pouch promptly when seal leaks
  • Patient Education: Ostomy Living
  • Dietary Considerations

Ileostomy:

  • Avoid high-fiber foods initially (may cause obstruction)
  • Chew food thoroughly
  • Stay well-hydrated (risk of dehydration)
  • Avoid excessive gas-producing foods

Colostomy:

  • Fiber intake may help regulate output
  • Identify foods that cause gas or odor
  • Stay hydrated
  • Foods That May Cause Issues
  • Effect Foods
  • Gas Beans, cabbage, broccoli, carbonated beverages
  • Odor Fish, eggs, asparagus, garlic, onions
  • Blockage (ileostomy) Popcorn, nuts, mushrooms, raw vegetables, corn
  • Lifestyle Considerations
  • Bathing: Can bathe/shower with or without pouch
  • Activity: Most activities are safe; avoid contact sports (protect stoma)
  • Clothing: Regular clothing; avoid tight waistbands over stoma
  • Intimacy: Possible and encouraged; empty pouch beforehand
  • Travel: Carry extra supplies; TSA notification cards available
  • On the Exam

NCLEX tests:

  • Stoma assessment: Know normal (pink/red, moist) vs. abnormal (pale, dusky, black = ischemia)
  • Output by ostomy type: Ileostomy = liquid; sigmoid colostomy = formed
  • Complications: Dehydration with ileostomy, skin breakdown, obstruction
  • Patient teaching: Pouch care, dietary modifications, when to seek help
  • Key Takeaways
  • Healthy stoma: Pink/red, moist; ischemic stoma: Pale, dusky, black—notify surgeon immediately
  • Ileostomy: Liquid output, high dehydration risk
  • Colostomy: Output consistency depends on location (ascending = liquid → sigmoid = formed)
  • Constipation prevention: Fiber, fluids, activity
  • Empty pouch when 1/3 to 1/2 full; change pouch every 3-7 days