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NURS 106 Exam 2

Bowel Elimination (W & VL)

What are the main functions of the GI tract? digest and absorb nutrients and eliminate food waste
What are the structures of the GI tract? mouth, esophagus, stomach, sm. intestine, lg intestine, rectum, anus
What is the main purpose of the jejunum? to absorb carbs and protein
What is the main purpose of the ileum? absorption of fat, bile salts, some vitamins, minerals and water
Where does the majority of absorption occur in the digestive system? duodenum and jejunum
What is the large intestine also known as? the colon
Name structures of the large intestine? ascending colon, hepatic flexure, transverse colon, splenic flexure, descending colon
Approximately what % of fluid enters the colon is reabsorbed along its passage? 80%
gastrocolic reflex triggered by food entering the stomach and sm intestine... causes most of the propulsions of the contents into the transverse and sigmoid colon
hemorrhoids distended blood vessels within or protruding from the anus
Defecation the process by which bowel eliminates waste
Valsalva Maneuver Contraction of the abdominal muscles while maintaining a closed airway to increase the pressure to expel feces
Who should not use the valsalva maneuver? Why? people with heart disease, glaucoma, increased intracranial pressure or new surgical wounds as it may increase blood pressure, increase pressure in the abdominal cavity and is associated with cardiac arrhythmias
What is a normal frequency for BMs? Anywhere from couple times a day to once a week
How do you know when your BMs are normal? If the person passes stool without excessive urgency (needing to rush to the toilet) and with minimal effort and no straining without blood loss and without the use of laxatives
Meconium green black tarry and sticky substance that new borns pass due to swallowed amniotic fluid.
What color stools do breastfed babies pass? golden yellow stools
What color stools do formula babies pass? tan stools
When does the ability to control defecation develop? 2 to 3 years of age
What is the primary risk factor for irritable bowel syndrome? Stress
What is irritable bowel syndrome? disorder with bloating, pain and altered bowel function
What does calcium supplements cause? constipation
What does magnesium cause in the digestive system? loosen stool
What does vitamin C do to stool? softens it and can cause diarrhea in sensitive patients or if over consumed
How many glasses should a person drink to promote healthful bowel function? Min of 6-8 glasses
What do antacids do? neutralizes stomach acids but may slow peristalsis
Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen do what to the digestive system? irritate the stomach and if used a lot lead to ulceration of the stomach or duodenum
What mineral supplement is notorious for causing constipation? Iron
Paralytic ileus a cessation of bowel peristalsis but the bowel still makes secretions causing distention and discomfort
Food allergy a true immune system reaction promopted by the presence in the body of an allergenic such as constipation, diarrhea, rashes, anaphylatic shock, bloating, intestinal bleeding
Food intolerance not a food allergy - it produces symptoms like GI discomfort, pain, gas, bloating, diarrhea or constipation that is NOT CAUSED BY A IMMUNE RESPONSE
Diverticulosis A balloon out between the muscles of the colon that forms pouches in which fecal material is trapped.
Diverticulitis When the diverticulosis becomes infected
Bowel diversion surgically created opening for elimination of digestive waste products
effluent output
stoma or ostomy a surgically created opening in the abdominal wall
What kind of output or effluent would a bowel diversion have that was located close to the ileocecal valve (between the sm and lg intestines)? liquid effluent
Reanastomosis reconnection of the bowel
ileostomy brings a portion of the ileum through a surgical opening in the abdomen bypassing the large intestine
Kock pouch continent ileostomy, creates an internal pouch the patient inserts a tube through the external stoma into the pouch so the pt is free of an ostomy appliance
total colectomy ileaoanal reserve removes the colon, creates a pouch from the ileum and connects the ileum to the rectum
colostomy brings a portion of the colon through a surgical opening in the abdomen, can be located anywhere on the colon (lg intestines)
What kind of drainage would be produced from a colostomy close to the sigmoid colon? solid feces
Double barreled colostomy 2 separate stomas that externalize the bowel on both sides of the portion that has been removed one side drains fecal material and one side drains mucus (distal stoma)
Loop colostomy segment of bowel brought out the abdominal wall with a plastic rod wedged under the bowel to keep it from slipping back into the abdomen.
What should be part of your assessment when learning about a pt's digestive system? normal bowel patterns, appearance of stool, changes in bowel habits/stool appearance, history of elimination problems, use of bowel elimination aids including diet, exercise, meds and remedies
What do you examine when doing a physical assessment for bowel elimination? abdomen, rectum, anus look at the size, shape, contour of abdomen, listen to bowel sounds and u can palpate the anus and rectum for the presence of stool or masses
What do normal bowel sounds like? high pitched with approx 5-35 gurgles every minute
What do hyperactive bowel sounds like? very high pitched
What do hypoactive bowel sounds like? low pitched and quiet
What does it mean if after 3-5 minutes you hear no bowel sounds? absent bowel sounds
Normal quantity of stool produced a day? 100-400g
What does narrow pencil shaped stool indicate? intestinal obstruction or constriction or rapid peristalsis
What do hard stools indicate? constipation
Liquid stool indicate? rapid peristalsis (i.e. from infection)
Normal pH of stool? neutral or slightly alkaline
What do stools with strong foul odors indicate? blood in the stool, especially in the upper GI tract or infection
What are indirect visualization studies? radiographic views of the lower GI tract
Why are stool specimen analyzed? detect blood, infection or parasite infestation
To obtain a stool specimen what must the client first do? Void and then defecate in a clean dry bedpan/bedside commode or special container (half hat)
How much stool do you need for a stool specimen? 20 or 30 mL of liquid stool
Occult? Hidden
What does the fecal occult blood test, test? for blood hidden in the stool
What does the fecal occult blood test require? special reagent that detects the presence of peroxidase ( an enzyme present in hemoglobin)
What is peroxidase an enzyme in hemoglobin
What food should be restricted when a fecal occult test is required? red meat, chicken, fish, horseradish, some raw fruits, vegies as they may cause false positives
What meds should a pt avoid if a fecal occult test is required? salicylates (aspirin), steroids, iron preparations, or anticoagulants as they cause false positives
What supplement should a pt avoid if a fecal occult test is required? vitamin C as it can produce a false negative
How many days should the pt not eat contraindicated meds before the fecal occult test? 7 days
How many days should the pt avoid contraindicated foods before a fecal occult test? 3 days
What color is a positive fecal occult result Blue
How long should a pt hold the solution of an enema? 5-15 minutes depending on the type of enema
Prior to removing stool digitally what should you do? obtain a baseline vital signs and determine whether the pt has a history of cardiac problems or other contraindications
Why are baseline vital signs obtain prior to removing stool digitally? because the digits may stimulate the vagus nerve
How often should the ostomy pouch should be changed? 3-5 days
What are common nursing diagnosis related to bowel elimination? bowel incontinence, constipation, risk for constipation, perceived constipation, diarrhea, toileting self care deficit
Constipation decrease frequency of bowel movement resulting in hard dry stool
Subjective characteristics of constipation abdominal pain, feeling of rectal fullness, straining or pain with defecation
fecal impaction hard dry stool is lodged in the rectum and cannot be passed
risk for constipation can be caused by bedrest, meds such as opioids or surgery
Perceived constipation for clients who make a self diagnosis of constipation and uses laxatives, suppositories or enemas to ensure daily bowel movement
Toileting self care deficit impaired ability to preform or complete own toileting activities examples include: those who can't carryout proper toilet hygiene, flush the toilet, get to the toilet
Is toileting self care deficit a bowel problem? no
How can a nurse promote normal or regular defecation? privacy, positioning, timing of defecation, fluids and nutrition, exercise
How much should nurses encourage pt to intake of fiber? 25-30 grams
What is a BRAT diet bananas,rice (white), applesauce, toast
What are bulking agents? fiber in a nonfood source
What are the preferred medications for treating constipation? bulking agents
What occurs with habitual laxative use (not including bulking agents) lead to further constipation
What is the fecal impaction cycle? impaction blocks the normal stool and then more stool is hardened
How do you treat fecal impaction enemas or digital removal of stool
What is an enema? the introduction of a solution into the rectum to soften feces, distend the colon and stimulate peristalsis and the evacuation of feces
What kind of enemas are there? cleansing, retention or return flow
cleansing enema? promote removal of feces from the colon
Retention enemas? introduces a solution into the colon that is meant to be retained for a prolonged period
What are carminative enemas? used to help expel flatus and relieve bloating and distention
Medicated enemas? used to instill antibiotics to treat infections in the rectum or anus or to introduce anthelminthic agents for treatment of intestinal worms or parasites
nutritive enemas administer fluid and nutrition for pt's that are dehydrated and frail
What are return flow enemas? used to help patient expel flatus and relieve abdominal distention
hypertonic enemas are ______ to the intestinal mucosa? irritating and cause rapid evacuation
where should a solution container for an enema be placed? no higher than 30 cm or 12 inches above the rectum for an adult or 7.5 cm or 3 inches for children
What is digital removal? breaking up the hardened mass into pieces and manually extracting the pieces with your fingers
What occurs when the vagus nerve is stimulated? heart rate slows
flatulence when gas is excessive or leads to complaints of abdominal distention, cramping or discomfort
In severe flatulence what can a nurse do? insert a rectal tube to aid in elimination
bowel incontinence inability to control discharge of feces and flatulence
When should the fecal pouch be changed? when it is 1/3 to 1/2 full
What clients should go through bowel training? people with chronic constipation, impaction or bowel incontinence
What is bowel training? gradually increase fiber, increase fluids, initiate a designated uninterrupted time for pooping, provide privacy, develop a staged treatment plan
What is the goal of ostomy care? for the patient to assume self care
Healthy stoma should be: PMS Pink, Moist, Shinny
What does a black stoma mean necrosis
What does a blue stoma mean? ischemia
Can stomas in the descending colon be controlled? No, as they are liquid
Can stomas in the descending or sigmoid colon be controlled? Yes, and colostomy irrigation is a means to control evacuation and possibly eliminate the need to wear a ostomy pouch
colostomy irrigation similar to an enema, a tube is put into the stoma and evaluate poop
Created by: lydia.koo