Bowel Care, Constipation, and Diarrhea
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
|
|
||||
|---|---|---|---|---|---|
| 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
🗑
|
Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Created by:
Ladystorm