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NUR151-BowelCare
Bowel Care, Constipation, and Diarrhea
| Question | Answer |
|---|---|
| Temporary large stoma in the transverse colon | loop colostomy |
| Safest solution to use for an enema | normal saline |
| Surgical creation of two distinct stomas | double-barrel colostomy |
| Type of enema that lubricates the rectum and colon | oil retention |
| Stool discharged from an ostomy | Effluent |
| Agents that irritate the intestinal mucosa to increase motility | cathartics |
| High-fiber substances that increase intestinal bulk | bulk-forming agents |
| Agent used when pouching an ostomy | skin barrier |
| The small intestine (specifically the duodenum and jejunum) absorb | most of the nutrients and electrolytes. |
| The ileum absorbs | certain vitamins, iron, and bile salts. |
| The colon absorbs | water, sodium, and chloride from the digested food that has passed from the small intestine. |
| The esophagus moves food | from the mouth to the stomach. |
| Routine screening for colon cancer includes | fecal occult blood testing. |
| The maximum volume of enema to be administered to an adult is | 750 to 1000 ml. |
| A nurse trained to care for ostomy clients is | A wound-ostomy-continence nurse (WOCN) is a nurse with special training in caring for ostomy clients. |
| Hot and cold foods stimulate | peristalsis, which can cause abdominal cramping and further diarrhea. Thus room-temperature liquids are better tolerated. |
| What drugs increase chance of gastrointestinal bleeding? | Aspirin and NSAIDs may cause gastrointestinal bleeding. |
| Antidiarrheal opiate agents slow | the motility in the gastrointestinal tract. |
| Cathartics increase | gastrointestinal tract motility |
| What foods increase gas? | beans, onions, and cauliflower |
| Nausea, liquid stool, and continuous bowel sounds are all symptoms of | an impaction. |
| Fish and some raw vegetables can produce false-positive results in what? | fecal occult blood test - if consumed during the collection of stool for occult blood testing. |
| Put patient in what position while doing enema? | Left Sims Position when - should be inserted apx 3 in - hold it in as long as possible – 30 – 45 minutes is idea –Never give while on toilet. |
| 3 tasks stomach performs | storing swallowed food & liquid, mixing, and emptying contents into sm. Intestine – secrets HCL, mucus, pepsin, and intrinsic factor. |
| Pepsin and HCL facilitate digestion of | protein |
| Intrinsic factor essential for? | vit B12 absorption |
| Sm. Intestine has 3 sections | duodenum (8-11 in), jejunum (8ft) and ileum (12ft). |
| 3 functions of colon | absorption, secretion, elimination |
| Lg intestine divided into what 3 parts | cecum, colon, and rectum |
| __ is primary organ of bowel elimination | lg intestine |
| Where does chyme enter lg intestine? | ileocecal valve |
| Lg intestine absorbs what? | water, sodieum, and choloride |
| Healthy adult absorbs more than __ water every 4 hours | a gallon |
| If peristalsis is abnormally fast, what will happen? | watery stools because less time to absorb water. |
| If peristaltic contractions slow down, what will happen? | hard stools and constipation |
| What is secreted in the colon? | bicarbonate is secreted in exchange for chloride – also potassium (4 – 9 mEq) is secreted daily |
| What is the main stimulus for peristaltic contrations? | intestinal content – mass movements usually only 3 – 4 times daily & strongest 1 hr after mealtime |
| Normal defecation begins where? | movement in left colon, moving stool toward anus. |
| Bulk foods promote | peristalsis |
| Constipation is due to decreased | peristalsis |
| Rectum | Final portion of lg intestine - Usually empty prior to defecation - Contains both vertical and transverse folds of tissue |
| Anus | expels both flatus & feces through contraction & relaxation of internal & external sphincters |
| Sphincters innervated by | sympathetic and parasympathetic systems |
| Digestive process is affected how during stress? | accelerated and peristalsis is increased - diarrhea and gaseous distention – colitis, irritable bowel syndrome, ulcers, and Crohn’s disease. |
| Digestive process is affected how during depression? | anutonomic NS slows impulses & peristalsis decreases – constipation |
| In what position is it impossible to contract muscles used during defication? | supine position. |
| Inhaled anesthetic agents do what to intestinal musculature? | block parasympathetic impulses and slows waves. |
| Paralytic ileus | usually lasts about 24 – 48 hrs –temporarily stopped peristalsis – usually after direct manipulation of bowel. |
| Laxatives and cathartics do what? | soften stool and promote peristalsis |
| Chronic use of cathartic cause lg intestine to | lose muscle tone and become less responsive to stimulation |
| Mineral oil lax can have what neg effect? | decreases fat-soluble vitamin absorption and influence efficacy of other meds by altering transit time |
| What can cause constipation? | improper diet, dehydration, lack of exercise, meds, parkinsons, MS, rheumatoid arthritis, diabetic neuropathy, ED, electrolyte imbal. |
| How does aspirin affect GI system? | prostaglandin inhibitor – interferes with formation of protective mucus and causes GI bleeding |
| Factors Affection Bowel Function | Age – peristalsis slows, Diet - fiber, gas-producing foods, lactose intolerance; Fluid intake, NG; Activity, Weak muscle tone (illness or neurological disease), stress, Personal habits, Med, Post-op |
| Diarrhea - passage of liquid, unformed feces - Caused by | disorders of digestion, absorption, antibiotic use, enteral feedings, food allergies, pathogens |
| In diarrhea Contents pass too quickly to allow | absorption of water & nutrients |
| NANDA’s regarding bowels | Bowel Incontinence, Constipation, Risk for; Perceived, Diarrhea, Impaired Skin Integrity, Self-care Deficit, toileting |
| Bowel Retraining: Goal | To achieve normal bowel control in patients w/ fecal incontinence who have neuromuscular control |
| How to bowel retrain | Assess pt. normal pattern & time of incontinence, Stool softener qd, cathartic suppository ½ hour before desired time of defecation, Offer hot drink or fruit juice (prune juice) to stimulate peristalsis |
| Physical assessment of abdomen for distention, bowel sounds | aucultate for 5 minutes if you don’t hear bowl sounds. |
| Assess fecal characteristics | usually darkish brown, red streaks indicate blood, black = old blood |
| Dicyclomine HCL (Bentyl) | suppress peristalsis and decreases gastric emptying |
| Opiod analgesics | slow persitalsis and segmental contractions – constipation |
| Anticholinergic drugs such as atropine or glycopyrrolate (Robinul) | Inhibit gastric acid secretion and depress GI motility – usful in treating hyperactive bowel disorders – constipation |
| Fluoroguinolones | antibiotic – produce diarrhea by disrupting normal bacterial flora |
| Nonsteroidal anti-inflammatory drugs | causes GI irritation – increases bleeding |
| Histamine2 (H2) antagonists | suppress secretion of HCL and interferes w/digestion of some foods |
| Iron | causes discoloration of stool (black), nausea, vomiting, constipation and ab craps |
| Fecal occult blood or guiac testing | FOBT, or guaiac test, measures microscopic amounts of blood in feces - diagnostic screening tool for colon cancer |
| Normal bowel sounds occur every | 5 to 15 seconds and last a second to several seconds. |
| You hear __with abdominal distention. | an increase in pitch or a tinkling sound |
| Absent (no auscultated bowel sounds) or hypoactive sounds (less than five/min) occur with | paralytic ileus, such as after abdominal surgery. |
| High-pitched and hyperactive bowel sounds (35 or more/min) occur with | sm intestine obstruction and inflammatory disorders. |
| What is normal frequency of bowel movements? | Once a day to every 3 days |
| Signs of constipation usually include | infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feces |
| Although similar, laxatives are milder in action than | cathartics. |
| BCOC | bowel care of choice – like colace, mag citrate, fleet enema |
| Vagal stimulation | slows the heart rate, occurs during straining while defecating, taking rectal temperatures, enemas, and digital removal of impacted stool |
| ileostomy bypasses the entire | large intestine - stools are frequent and liquid - same for a colostomy of the ascending colon. |
| A colostomy of the transverse colon generally results in | more solid, formed stool. |
| The sigmoid colostomy releases | near-normal stool. |
| Three types of colostomy construction | loop colostomy, end colostomy, and double-barrel colostomy |
| Loop colostomy is usually performed in an emergency when health care providers anticipate | closure of the colostomy - usually temp large stomas constructed in transverse colon - loop of bowel onto abdomen |
| End colostomy consists of one stoma formed from | proximal end of bowel w/distal portion either removed or sewn closed (called Hartmann's pouch) & left in the abdominal cavity |
| Unlike the loop colostomy, the bowel is surgically severed in a ___, and the two ends are brought out onto the abdomen | double-barrel colostomy |
| Bulk-forming lax | e.g. Metamucil – OTC – laxative - absorb water & increase bulk in bowel - Stretch intestinal wall to stimulate peristalsis |
| With bulk-forming lax, you must mix | at least 1c. water (240 mL) or juice & swallow quickly or may cause obstruction. Follow with additional water |
| Emollient (stool softeners) E.g. docusate sodium (Colace) | Lower surface tension of feces, so more water & fat can penetrate - detergents that lower surface tension of feces, increase secretion of water by intestine. |
| Short term use to prevent straining after surgery, MI, pregnancy | emollient stool softneres - Also for chronic opioid use or prone to constipation |
| Enemas | instillation of a solution into the rectum and sigmoid colon. |
| The primary reason for an enema is to promote defecation by | stimulating peristalsis - volume of fluid instilled breaks up the fecal mass, stretches the rectal wall, and initiates the defecation reflex. |
| Cleansing Enemas | stim peristalsis through the infusion of lg vol of solution or local irritation of colon's mucosa. |
| Cleansing enemas include | tap water, normal saline, soapsuds solution, and low-volume hypertonic saline. |
| Tap Water enema | hypotonic & exerts lower osmotic press than fluid in interstitial spaces - stims defecation before lg amounts of water leave bowel - water tox danger if bod absorbs lg amounts of water. |
| Saline laxatives – Magnesium citrate, MOM, Fleet phosphosoda, Fleet enema | used a lot for bowel prep - Increases osmotic pressure in sml intest by inhibiting water absorption & increases water & electrolyte secretions from bowel wall. |
| Saline laxs do what? | Promotes peristalsis, lubricate feces. |
| Don’t use __ lax on renal pts. or those on fluid restriction | saline |
| Safest enema to use? | physiologically normal saline because it is isotonic to fluids in interstitial spaces surrounding bowel. |
| Saline enemas does not create the danger of | excess fluid absorption. |
| Hypertonic Solutions | exert osmotic pressure that pulls fluids out of interstitial spaces - colon fills w/fluid & distention promotes defecation - contraindicated in pt who are dehydrated &young infants. |
| Soapsuds enema | create effect of intestinal irritation to stimulate peristalsis - only pure castile soap is safe |
| The terms high and low enema refer to | the height from which, and hence the pressure with which, the fluid is delivered. |
| High enemas cleanse | the entire colon. |
| After high enema infused, ask the client to turn from the left lateral to the | dorsal recumbent, over to the right lateral position - ensures fluid reaches lrg intestine. |
| A low enema cleanses | only the rectum and sigmoid colon. |
| Carminative enemas provide relief from | gaseous distention - improve ability to pass flatus |
| Medicated enemas contain drugs | sodium polystyrene sulfonate (Kayexalate) used to treat clients with dangerously high serum potassium levels. |
| Another medicated enema is neomycin solution | an antibiotic used to reduce bacteria in the colon before bowel surgery |
| Stimulant Cathartics – e.g. bisacodyl (Dulcolax) | Irritate intestinal mucosa to increase motility - decrease absorption in small bowel & colon - May cause severe abdominal cramping - prep bowel for diagnostic procedures |
| If taken w/ emollients or mineral oil, increases risk of fat emboli or aspiration pneumonia in which lax? | Lubricants – Haley’s M-O |
| Lomotil (diphenoxylate) | opiate Rx. – habit forming – educate them and take only when necessary - ACTION: Decrease intestinal muscle tone to slow passage of feces |
| Opiates inhibit | peristaltic waves, but increase segmental contractions to increase water absorption |
| Loperamide | Immodium A-D – synthetic antidiarrheal – inhibits peristalsis, opiate without the effects |
Created by:
Ladystorm