Case Studies for Bowel Elimination:

1. C.B. is a 72 year old female who complains of abdominal fullness and pain in her LLQ. C.B. has not
had a bowel movement for 6 days, and she states that this is not her normal bowel regimen. She
lives in an extended care facility, and has history of HTN, PVD, Parkinsons disease, and arthritis. He
is currently taking carbamazipine to control her Parkinsons disease. She is non ambulatory,
however is able to sit in a Cadillac chair with assistance. C.B. admits to a loss of interest in food,
and doesnt like the taste of the water provided.
Questions:
a. Identify the risk factors that lead to the development of the problem.
b. Give at least five nursing intervention to promote bowel elimination.
2. Mrs. Emma Brown is a 78-year-old widow of 9 months. She lives alone in a low-income housing
complex for elders. Her two children live with their families in a city approximately 150 miles away.
She has always enjoyed cooking for her family; however, now that she is alone, she does not cook
for herself. As a result, she has developed irregular eating patterns and tends to prepare soup-andtoast meals. She gets little exercise and has had bouts of insomnia since her husbands death. For
the past month, Mrs. Brown has been having a problem with constipation. She states she has a
bowel movement about every 3 to 4 days and her stools are hard and painful to excrete. Mrs.
Brown decides to attend the health fair sponsored by the housing complex and seeks assistance
from the county public health nurse.
Physical Examination
Height: 162 cm (54)
Weight: 65 kg (143 lb)
Temperature: 36.2C (97.2F)
Pulse: 82 BPM
Respirations: 20/minute
Blood pressure: 128/74 mm Hg
Active bowel sounds, abdomen slightly distended
Diagnostic Data
CBC: Hgb 10.8
Urinalysis negative
Questions:
a. Identify risk factors that lead to the development of the problem.
b. Give at least five nursing interventions to promote bowel elimination.
3. Mrs. M is a 30-year-old woman who sustained a complete spinal cord injury of the seventh cervical
vertebra 2 years before this hospital admission. She currently manages her bowels by enemas
every 5 to 7 days when she notes pressure and distension of her abdomen. She has frequent
episodes of fecal incontinence, described as passage of moderate amounts of black, watery stool.
She manages these episodes by administering one or two enemas, followed by passage of a large
volume of odorous, dark feces. Before her spinal injury she denied problems with her bowel control.
She states that she moved her bowels every other day, typically after breakfast. Currently, she
reports fluid intake of 3 to 4 glasses per day. She eats primarily meats, white breads, some pastas,
and one portion of vegetables per day. She does not routinely eat cereals or fruits or supplement
her diet with bulk laxatives.
Questions:
a. Identify the risk factors that lead to the development of the condition.
b. Give at least five nursing intervention to promote bowel elimination.
4. A 43 year old male was admitted in the medical ward due to severe constipation. The problem was
associated with pain during defecation for only twice since the last two week. Base on the history,
the patient was diagnosed of bone cancer 3 months ago. The patient is taking morphine for severe
cancer paom. That patient had amputation on the left leg 2 year ago and most of the time is
confined to bed and rarely ambulate. His dietary history revealed red meat 3 to 5 times per week
and one to two servings of fruit. He used to have 4 glasses of water every day. His sleeping pattern
is 5-7 hours. He is a smoker consuming 1 pack per day for the last 15 years. Advised to quit by
unable to do so.
Questions:
a. Identify the risk factors that lead to the development of the condition.
b. Give at least five nursing intervention to promote bowel elimination.

5. Mr. Y, a 31 year old male was rushed to the ER due passage of watery stool 8 time for the last 24
hours. According to him, it is full liquid and no particles with it. No abnormal odor was noted and
the color appears yellowish in a moderate amount. In the nursing history, you noted that patient
had his dinner in the fast food last night with fried chicken and gravy. He expressed that the water
served to him has a taste which he considered to be strange. He is unable to explain it further. He
had fruits and vegetables with milk this morning as part of his usual breakfast. Despite of the
condition, still had a walk as his morning exercise. After such, he noted that the problem was
worsen. In the physical exam, it was noted that his skin turgor is 4 seconds with dryness in his
buccal mucosa. His bowel sound is also hyperactive. Slight dehydration was noted to the patient.
Stool exam appears normal.
Questions:
a. Identify the risk factors the practices that contributed to the condition?
b. Five possible nursing intervention and health teaching to the patient.
II. Individual Work
1. Veronica 78 years old, admitted with severe constipation. While interviewing Veronica, she
states she has managed her constipation in the past with laxatives and that she restricts her
fluid intake because she suffers with urinary incontinence. She has not been mobile since her
last left knee replacement 1 month ago. What key changes can you suggest to Veronica to
maintain regular bowel elimination program?
2. As elderly client was admitted with history of 3 days diarrhea. What are the possible causes of
diarrhea? What is your primary concern for the client? What key informations should you tell to
the elderly client?
3. A 24-year-old client with a history of good health is admitted to you unit because of vehicular
accident. He will rest in bed for the next two weeks. What type of plan would you design to
prevent him from becoming constipated during this period of immobility?