Bowel Elimination (W & VL)
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| What are the main functions of the GI tract? | digest and absorb nutrients and eliminate food waste
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| What are the structures of the GI tract? | mouth, esophagus, stomach, sm. intestine, lg intestine, rectum, anus
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| What is the main purpose of the jejunum? | to absorb carbs and protein
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| What is the main purpose of the ileum? | absorption of fat, bile salts, some vitamins, minerals and water
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| Where does the majority of absorption occur in the digestive system? | duodenum and jejunum
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| What is the large intestine also known as? | the colon
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| Name structures of the large intestine? | ascending colon, hepatic flexure, transverse colon, splenic flexure, descending colon
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| Approximately what % of fluid enters the colon is reabsorbed along its passage? | 80%
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| 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
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| hemorrhoids | distended blood vessels within or protruding from the anus
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| Defecation | the process by which bowel eliminates waste
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| Valsalva Maneuver | Contraction of the abdominal muscles while maintaining a closed airway to increase the pressure to expel feces
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| 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
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| What is a normal frequency for BMs? | Anywhere from couple times a day to once a week
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| 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
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| Meconium | green black tarry and sticky substance that new borns pass due to swallowed amniotic fluid.
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| What color stools do breastfed babies pass? | golden yellow stools
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| What color stools do formula babies pass? | tan stools
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| When does the ability to control defecation develop? | 2 to 3 years of age
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| What is the primary risk factor for irritable bowel syndrome? | Stress
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| What is irritable bowel syndrome? | disorder with bloating, pain and altered bowel function
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| What does calcium supplements cause? | constipation
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| What does magnesium cause in the digestive system? | loosen stool
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| What does vitamin C do to stool? | softens it and can cause diarrhea in sensitive patients or if over consumed
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| How many glasses should a person drink to promote healthful bowel function? | Min of 6-8 glasses
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| What do antacids do? | neutralizes stomach acids but may slow peristalsis
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| 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
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| What mineral supplement is notorious for causing constipation? | Iron
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| Paralytic ileus | a cessation of bowel peristalsis but the bowel still makes secretions causing distention and discomfort
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| 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
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| 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
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| Diverticulosis | A balloon out between the muscles of the colon that forms pouches in which fecal material is trapped.
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| Diverticulitis | When the diverticulosis becomes infected
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| Bowel diversion | surgically created opening for elimination of digestive waste products
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| effluent | output
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| stoma or ostomy | a surgically created opening in the abdominal wall
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| 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
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| Reanastomosis | reconnection of the bowel
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| ileostomy | brings a portion of the ileum through a surgical opening in the abdomen bypassing the large intestine
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| 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
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| total colectomy ileaoanal reserve | removes the colon, creates a pouch from the ileum and connects the ileum to the rectum
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| colostomy | brings a portion of the colon through a surgical opening in the abdomen, can be located anywhere on the colon (lg intestines)
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| What kind of drainage would be produced from a colostomy close to the sigmoid colon? | solid feces
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| 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)
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| 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.
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| 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
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| 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
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| What do normal bowel sounds like? | high pitched with approx 5-35 gurgles every minute
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| What do hyperactive bowel sounds like? | very high pitched
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| What do hypoactive bowel sounds like? | low pitched and quiet
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| What does it mean if after 3-5 minutes you hear no bowel sounds? | absent bowel sounds
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| Normal quantity of stool produced a day? | 100-400g
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| What does narrow pencil shaped stool indicate? | intestinal obstruction or constriction or rapid peristalsis
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| What do hard stools indicate? | constipation
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| Liquid stool indicate? | rapid peristalsis (i.e. from infection)
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| Normal pH of stool? | neutral or slightly alkaline
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| What do stools with strong foul odors indicate? | blood in the stool, especially in the upper GI tract or infection
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| What are indirect visualization studies? | radiographic views of the lower GI tract
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| Why are stool specimen analyzed? | detect blood, infection or parasite infestation
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| 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)
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| How much stool do you need for a stool specimen? | 20 or 30 mL of liquid stool
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| Occult? | Hidden
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| What does the fecal occult blood test, test? | for blood hidden in the stool
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| What does the fecal occult blood test require? | special reagent that detects the presence of peroxidase ( an enzyme present in hemoglobin)
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| What is peroxidase | an enzyme in hemoglobin
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| 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
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| 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
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| What supplement should a pt avoid if a fecal occult test is required? | vitamin C as it can produce a false negative
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| How many days should the pt not eat contraindicated meds before the fecal occult test? | 7 days
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| How many days should the pt avoid contraindicated foods before a fecal occult test? | 3 days
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| What color is a positive fecal occult result | Blue
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| How long should a pt hold the solution of an enema? | 5-15 minutes depending on the type of enema
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| 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
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| Why are baseline vital signs obtain prior to removing stool digitally? | because the digits may stimulate the vagus nerve
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| How often should the ostomy pouch should be changed? | 3-5 days
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| What are common nursing diagnosis related to bowel elimination? | bowel incontinence, constipation, risk for constipation, perceived constipation, diarrhea, toileting self care deficit
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| Constipation | decrease frequency of bowel movement resulting in hard dry stool
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| Subjective characteristics of constipation | abdominal pain, feeling of rectal fullness, straining or pain with defecation
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| fecal impaction | hard dry stool is lodged in the rectum and cannot be passed
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| risk for constipation can be caused by | bedrest, meds such as opioids or surgery
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| Perceived constipation | for clients who make a self diagnosis of constipation and uses laxatives, suppositories or enemas to ensure daily bowel movement
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| 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
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| Is toileting self care deficit a bowel problem? | no
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| How can a nurse promote normal or regular defecation? | privacy, positioning, timing of defecation, fluids and nutrition, exercise
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| How much should nurses encourage pt to intake of fiber? | 25-30 grams
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| What is a BRAT diet | bananas,rice (white), applesauce, toast
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| What are bulking agents? | fiber in a nonfood source
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| What are the preferred medications for treating constipation? | bulking agents
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| What occurs with habitual laxative use (not including bulking agents) | lead to further constipation
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| What is the fecal impaction cycle? | impaction blocks the normal stool and then more stool is hardened
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| How do you treat fecal impaction | enemas or digital removal of stool
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| 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
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| What kind of enemas are there? | cleansing, retention or return flow
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| cleansing enema? | promote removal of feces from the colon
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| Retention enemas? | introduces a solution into the colon that is meant to be retained for a prolonged period
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| What are carminative enemas? | used to help expel flatus and relieve bloating and distention
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| 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
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| nutritive enemas | administer fluid and nutrition for pt's that are dehydrated and frail
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| What are return flow enemas? | used to help patient expel flatus and relieve abdominal distention
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| hypertonic enemas are ______ to the intestinal mucosa? | irritating and cause rapid evacuation
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| 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
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| What is digital removal? | breaking up the hardened mass into pieces and manually extracting the pieces with your fingers
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| What occurs when the vagus nerve is stimulated? | heart rate slows
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| flatulence | when gas is excessive or leads to complaints of abdominal distention, cramping or discomfort
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| In severe flatulence what can a nurse do? | insert a rectal tube to aid in elimination
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| bowel incontinence | inability to control discharge of feces and flatulence
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| When should the fecal pouch be changed? | when it is 1/3 to 1/2 full
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| What clients should go through bowel training? | people with chronic constipation, impaction or bowel incontinence
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| What is bowel training? | gradually increase fiber, increase fluids, initiate a designated uninterrupted time for pooping, provide privacy, develop a staged treatment plan
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| What is the goal of ostomy care? | for the patient to assume self care
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| Healthy stoma should be: | PMS Pink, Moist, Shinny
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| What does a black stoma mean | necrosis
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| What does a blue stoma mean? | ischemia
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| Can stomas in the descending colon be controlled? | No, as they are liquid
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| 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
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| colostomy irrigation | similar to an enema, a tube is put into the stoma and evaluate poop
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