GRCC PN132 Constipation & intestinal obstruction
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| Hard, dry infrequent stools, difficult to pass | Constipation
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| Decreased fluid intake, low fiber intake, medications (opiates) ignoring the urge | Causes of constipation
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| Abdominal surgery, brain and spinal cord conditions, and colon problems | Medical conditions related to constipation
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| Diverticulitis | person with this condition may lack fiber
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| Abdominal distention | Clinical manifestation of constipation.
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| Fatigue | Clinical manifestation of constipation.
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| Decreased appetite | Clinical manifestation of constipation.
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| Hard, Dry stool | Clinical manifestation of constipation.
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| Abdominal pain | Clinical manifestation of constipation.
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| Incomplete emptying | Clinical manifestation of constipation.
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| Complain of headaches | Clinical manifestation of constipation.
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| Hemorrhoids straining lead to rectal bleeding | Clinical manifestation of constipation.
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| Lack of exercises of fluids | Clinical manifestation of constipation.
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| Diet | Assessment cause of constipation
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| Current medications - opiates causes | Assessment cause of constipation
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| travel | Assessment cause of constipation
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| Normal defecation | Assessment cause of constipation
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| Stool color and consistency | Assessment cause of constipation
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| Onset and duration - is it short term or long term | Assessment cause of constipation
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| Constipation | Nursing Diagnosis
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| Knowledge deficit | Nursing Diagnosis
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| Anxiety related to not pooping | Nursing Diagnosis
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| Pain | Nursing Diagnosis
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| Two or fewer BM's per week. | Constipation
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| 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
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| An organic cause such as a tumor or partial bowel obstruction. | Acute constipation
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| Ignoring the urge to defecate or being rigid as to stick to a schedule | Lifestyle and psychogenic factors that may cause constipation.
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| Habitual use of laxatives can cause constipation when they are with drawn are common in which age group? | The older adult
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| Nursing care for clients with constipation | Barium enema
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| 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.
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| When should laxatives NOT be administered? | When pt has a bowel obstruction.
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| Bowel preparation cathartics | these laxatives are commonly used as bowel prep prior to colon x-ray studies or colonscopy.
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| 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
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| bulk forming agent that draws water into small intestine, softening the stool mass. | laxatives
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| this stimulant draws water into stool and form an emulsion of fat and water, softening the stool. | Stool Softners (docusate)
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| 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
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| These laxatives stimulate intestinal motility and secretions | Irritant/stimulate laxatives - i.e bisacoydl, senna
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| Mineral oil forms an oily coat around feces | Lubricants (mineral oil)
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| Saline Enema | Least irritating to the bowel- use 500 to 2000 ml of warmed normal saline solution.
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| Tap-water enemas | 500 to 1000 ml of water to soften feces.
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| Soap sud enemas | Tap water plus soap is added as a further irritant
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| Phosphate enemas (fleet) | Hypertonic saline solution to draw fluid into the bowel and irritate the mucosa, leading to a BM
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| 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.
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| Excess enemas | Can impair bowel function and cause fluid and electrolyte imbalance.
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| Assess intake and output- including pattern, time of day, and stool consistency | Nursing intervention
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| Encourage increase fluid intake - at least 2500 ml per day. | Nursing interventions
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| Ambulation | Nursing intervention- this stimulates peristalsis and strengthens ab muscles, facilitating elimination.
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| Education | Nursing intervention
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| colace- Dulcosate | medications used as nursing interventions
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| Peri-Colace - stool softener (dolcusate) + laxative (senna) - Initiates and helps peristalsis. | medication used as nursing intervention.
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| Ducolax | Medication that helps with gas and loosens stools.
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| Miralax | Whole bottle given prior to colonscopy for suppository work- allow 20 minutes to work.
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| Non- mechanical intestinal bowel obstruction: non-mechanical | When the bowel is obstructed, gas and fluid accumulate to the obstructed bowel causing distention.
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| Distention of bowel and vomiting may lead to? | Loss of electrolytes.
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| complications of constipation | Increase blood pressure
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| obstipation | prolonged constipation; Intestinal obstruction; severe constipation.
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| Pathophysiology; types of obstructions | Mechanical and non mechanical.
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| paralytic ileus | lack of peristalsis- Most common non mechanical obstruction after abdominal surgery - no reason for it.
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| Good to fart | It means the bowel may be clearing up from obstruction.
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| Obstructions in large colon. | Are rare,obstructions are mainly found in small intestines.
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| Mechanical obstruction: adhesions | scar tissue caused from surgery.
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| Mechanical obstruction: tumors | Cause narrowing area (i.e. block large colon)
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| Mechanical obstruction:hernias | protrusion through muscle areas.
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| Mechanical obstruction | Foreign bodies
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| Mechanical obstruction: stricture | Narrowing (i.e. form radiation which cause adhesions, burns, strictures in intestine)
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| 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.
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| Cuts off the blood supply to the part of the intestine that's affected and is common in children | Mechanical Obstruction: Intussusception
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| Mechanical Obstruction: Vovulus | Abnormal twisting of the intestines (usually in the area of the ileum or sigmoid colon) resulting in intestinal obstruction
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| This condition may resolve on its own- if not, then surgery can be done. | Mechanical Obstruction: Vovulus
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| Non -Mechanical Obstruction: Paralytic Ileus | Obstruction of the intestine due to paralysis of the intestinal muscles- from surgery, inflammation, spinal injuries, or drugs,
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| Motility disorder characteristized by alternating periods of constipation and diarrhea | Irritable Bowel Syndrome
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| Hospital wants pt to poop within how many days? | Three
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| Most common non-mechanical obstruction? | Paralytic ileus-lack of peristalsis - this obstruction happens usually following abd surgery.
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| Obstipation | An obstruction caused by prolonged constipation
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| What is a complication of constipation? | Increased blood pressure.
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| What happens to an obstructed bowel? | Gas and fluid accumulate to the obstruction causing distention.
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| Distension and vomiting lead to this | Loss of electrolytes as a result of obstructed bowel.
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| 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.
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| Gradual onset, cramping and ab pain, vomiting is rare, ab distention is increased, and absolute constipation. | Clinical manifestations of large bowel obstructions.
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| Describe vomit consistency if obstruction is below the ileum? | It smells like stool.
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| Describe vomit consistency if obstruction is above the ileum? | Watery bile, light green in color.
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| Ab pain, constipation, distended stomach | Manifestations of obstruction.
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| Blood and or drainage may be passed rectally? T or F | True- this indicates probable bowel obstruction.
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| What type of laxatives can be given long term? | Bulk forming laxatives such as methylcellulose.
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| 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.
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| 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.
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| Damage to the bowel and eventually lead to perforation. | administering laxatives or cathartics when the bowel is obstructed.
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| Pain and nausea | Assess for obstruction symptoms
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| Ask client about last BM | Assess for obstruction symptoms
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| Onset and progession of symptoms | Assess for obstruction symptoms
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| Assess vital signs | Assess for obstruction symptoms
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| Inspect ab for distention | Assess for obstruction symptoms
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| Ausculate for High pitched bowel sounds | Assess for obstruction symptoms
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| Acute ab pain- sharp and bowel is perforated. | Nursing dgx for obstruction.
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| Fluid volume deficiency due to hypovulimia | Nursing dgx for obstruction.
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| Anxiety | Nursing dgx for obstruction.
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| risk for infection | Nursing dgx for obstruction.
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| Ineffective breathing patterns | Nursing dgx for obstruction.
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| Ineffective tissue perfusion/gastrointestinal (i.e. hernia that becomes gangrenous) | Nursing dgx for obstruction.
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| Analgesics as ordered/assess effectiveness | Interventions of obstruction
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| Monitor vitals | Interventions of obstruction
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| Monitor intake and output | Interventions of obstruction
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| Administer oxygen as ordered | Interventions of obstruction
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| Elevate HOB | Interventions of obstruction
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| Give simple explanations of care | Interventions of obstruction
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| Maintain patency of NG tube | Interventions of obstruction
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| Start with conservative treatment with patient suffering from this condition. | Interventions of obstruction
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| Conservative approach to treating obstructed bowel. | NG tube, NPO, Bedrest, everything out of stomach allow it to rest, and relieves pt from nausea.
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| If obstruction persists, and conservative approach was ineffective. | explore surgery to identify problem.
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| Potential cause of hemoroids and tissue damage. | Straining to have a bowel movement can lead to these conditions.
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