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GRCC - PN 132 test1

GRCC PN132 Constipation & intestinal obstruction

QuestionAnswer
Hard, dry infrequent stools, difficult to pass Constipation
Decreased fluid intake, low fiber intake, medications (opiates) ignoring the urge Causes of constipation
Abdominal surgery, brain and spinal cord conditions, and colon problems Medical conditions related to constipation
Diverticulitis person with this condition may lack fiber
Abdominal distention Clinical manifestation of constipation.
Fatigue Clinical manifestation of constipation.
Decreased appetite Clinical manifestation of constipation.
Hard, Dry stool Clinical manifestation of constipation.
Abdominal pain Clinical manifestation of constipation.
Incomplete emptying Clinical manifestation of constipation.
Complain of headaches Clinical manifestation of constipation.
Hemorrhoids straining lead to rectal bleeding Clinical manifestation of constipation.
Lack of exercises of fluids Clinical manifestation of constipation.
Diet Assessment cause of constipation
Current medications - opiates causes Assessment cause of constipation
travel Assessment cause of constipation
Normal defecation Assessment cause of constipation
Stool color and consistency Assessment cause of constipation
Onset and duration - is it short term or long term Assessment cause of constipation
Constipation Nursing Diagnosis
Knowledge deficit Nursing Diagnosis
Anxiety related to not pooping Nursing Diagnosis
Pain Nursing Diagnosis
Two or fewer BM's per week. Constipation
Older people are affected by constipation more than younger people because significant factors General health, diet, medications, and activity levels all factor into preventing constipation. Elderly usually takes a lot of meds, limited activity level, etc
An organic cause such as a tumor or partial bowel obstruction. Acute constipation
Ignoring the urge to defecate or being rigid as to stick to a schedule Lifestyle and psychogenic factors that may cause constipation.
Habitual use of laxatives can cause constipation when they are with drawn are common in which age group? The older adult
Nursing care for clients with constipation Barium enema
Methylcellulose Bulk forming agents should only be used as long term treatment. the Feces increase in bulk and draw water into the bowel to soften it.
When should laxatives NOT be administered? When pt has a bowel obstruction.
Bowel preparation cathartics these laxatives are commonly used as bowel prep prior to colon x-ray studies or colonscopy.
A stimulant that draws fluid into the bowel, and as fluid accumalates it distends the colon and stimulates peristalsis- sometimes electrolytes are added to avoid imbalance. Bowel Preparation cathartics
bulk forming agent that draws water into small intestine, softening the stool mass. laxatives
this stimulant draws water into stool and form an emulsion of fat and water, softening the stool. Stool Softners (docusate)
These laxatives contain poorly absorbed salts or carbs that draw water into the intestine to increase stool volume;should only be used for acute conditions. Osmotic or Saline laxatives
These laxatives stimulate intestinal motility and secretions Irritant/stimulate laxatives - i.e bisacoydl, senna
Mineral oil forms an oily coat around feces Lubricants (mineral oil)
Saline Enema Least irritating to the bowel- use 500 to 2000 ml of warmed normal saline solution.
Tap-water enemas 500 to 1000 ml of water to soften feces.
Soap sud enemas Tap water plus soap is added as a further irritant
Phosphate enemas (fleet) Hypertonic saline solution to draw fluid into the bowel and irritate the mucosa, leading to a BM
Oil-retention enemas Instill mineral or vegetable oil ino the bowel to soften the fecal mass- this may take several hours or overnight to work.
Excess enemas Can impair bowel function and cause fluid and electrolyte imbalance.
Assess intake and output- including pattern, time of day, and stool consistency Nursing intervention
Encourage increase fluid intake - at least 2500 ml per day. Nursing interventions
Ambulation Nursing intervention- this stimulates peristalsis and strengthens ab muscles, facilitating elimination.
Education Nursing intervention
colace- Dulcosate medications used as nursing interventions
Peri-Colace - stool softener (dolcusate) + laxative (senna) - Initiates and helps peristalsis. medication used as nursing intervention.
Ducolax Medication that helps with gas and loosens stools.
Miralax Whole bottle given prior to colonscopy for suppository work- allow 20 minutes to work.
Non- mechanical intestinal bowel obstruction: non-mechanical When the bowel is obstructed, gas and fluid accumulate to the obstructed bowel causing distention.
Distention of bowel and vomiting may lead to? Loss of electrolytes.
complications of constipation Increase blood pressure
obstipation prolonged constipation; Intestinal obstruction; severe constipation.
Pathophysiology; types of obstructions Mechanical and non mechanical.
paralytic ileus lack of peristalsis- Most common non mechanical obstruction after abdominal surgery - no reason for it.
Good to fart It means the bowel may be clearing up from obstruction.
Obstructions in large colon. Are rare,obstructions are mainly found in small intestines.
Mechanical obstruction: adhesions scar tissue caused from surgery.
Mechanical obstruction: tumors Cause narrowing area (i.e. block large colon)
Mechanical obstruction:hernias protrusion through muscle areas.
Mechanical obstruction Foreign bodies
Mechanical obstruction: stricture Narrowing (i.e. form radiation which cause adhesions, burns, strictures in intestine)
Mechanical Obstruction: Intussusception Rare but serious disorder in which part of the intestine (small intestine or colon) slides into another part of the intestine. "telescoping" often blocks the intestine, preventing food or fluid from passing thru.
Cuts off the blood supply to the part of the intestine that's affected and is common in children Mechanical Obstruction: Intussusception
Mechanical Obstruction: Vovulus Abnormal twisting of the intestines (usually in the area of the ileum or sigmoid colon) resulting in intestinal obstruction
This condition may resolve on its own- if not, then surgery can be done. Mechanical Obstruction: Vovulus
Non -Mechanical Obstruction: Paralytic Ileus Obstruction of the intestine due to paralysis of the intestinal muscles- from surgery, inflammation, spinal injuries, or drugs,
Motility disorder characteristized by alternating periods of constipation and diarrhea Irritable Bowel Syndrome
Hospital wants pt to poop within how many days? Three
Most common non-mechanical obstruction? Paralytic ileus-lack of peristalsis - this obstruction happens usually following abd surgery.
Obstipation An obstruction caused by prolonged constipation
What is a complication of constipation? Increased blood pressure.
What happens to an obstructed bowel? Gas and fluid accumulate to the obstruction causing distention.
Distension and vomiting lead to this Loss of electrolytes as a result of obstructed bowel.
Rapid onset, colicky and intermittent pain, frequent and copious vomiting, greatly increased ab distention and BM's happen in short time Manifestation of small bowel obstruction.
Gradual onset, cramping and ab pain, vomiting is rare, ab distention is increased, and absolute constipation. Clinical manifestations of large bowel obstructions.
Describe vomit consistency if obstruction is below the ileum? It smells like stool.
Describe vomit consistency if obstruction is above the ileum? Watery bile, light green in color.
Ab pain, constipation, distended stomach Manifestations of obstruction.
Blood and or drainage may be passed rectally? T or F True- this indicates probable bowel obstruction.
What type of laxatives can be given long term? Bulk forming laxatives such as methylcellulose.
Methylcellulose Increases the bulk of feces and draws water into the bowel to soften it. At least 6-8 glasses of water should be consumed daily when using these laxatives.
Can pt be given laxatives for bowel obstruction or ab pain? No. Never give laxatives for bowel obstructions or impaction is suspected, not to people with ab pain of unknown cause.
Damage to the bowel and eventually lead to perforation. administering laxatives or cathartics when the bowel is obstructed.
Pain and nausea Assess for obstruction symptoms
Ask client about last BM Assess for obstruction symptoms
Onset and progession of symptoms Assess for obstruction symptoms
Assess vital signs Assess for obstruction symptoms
Inspect ab for distention Assess for obstruction symptoms
Ausculate for High pitched bowel sounds Assess for obstruction symptoms
Acute ab pain- sharp and bowel is perforated. Nursing dgx for obstruction.
Fluid volume deficiency due to hypovulimia Nursing dgx for obstruction.
Anxiety Nursing dgx for obstruction.
risk for infection Nursing dgx for obstruction.
Ineffective breathing patterns Nursing dgx for obstruction.
Ineffective tissue perfusion/gastrointestinal (i.e. hernia that becomes gangrenous) Nursing dgx for obstruction.
Analgesics as ordered/assess effectiveness Interventions of obstruction
Monitor vitals Interventions of obstruction
Monitor intake and output Interventions of obstruction
Administer oxygen as ordered Interventions of obstruction
Elevate HOB Interventions of obstruction
Give simple explanations of care Interventions of obstruction
Maintain patency of NG tube Interventions of obstruction
Start with conservative treatment with patient suffering from this condition. Interventions of obstruction
Conservative approach to treating obstructed bowel. NG tube, NPO, Bedrest, everything out of stomach allow it to rest, and relieves pt from nausea.
If obstruction persists, and conservative approach was ineffective. explore surgery to identify problem.
Potential cause of hemoroids and tissue damage. Straining to have a bowel movement can lead to these conditions.
Created by: Wends1984