220-bowel elimination Flashcards
factor influencing bowel elimination
age
daily patterns
diet anf fuld intake
activity and exercise
medications
psychological factors
surgery and anesthesia
diagnostic test
diagnosis
how does age effect bowl elimination?
older you are more trouble you have
how does diet and fluid intake effect bowl elimination?
can improve it or make it worse
need 20-30g of fiber daily
2-3L of water daily
how does medication effect bowel elimination?
Narcotics slow it down, constipation is very common with narcotics
how does surgery and anesthesia effect bowel elimination?
everything stops
what kind of diagnosis effects bowel elimination?
Peripheral neuropathy in bowels
what is involved in a GI assessment?
inspect abdomen
auscultate bowel sounds
palpate abdomen
inspect anus and stool
See if the abdomen is soft and non tender
If your patient is on Nasal Gastric suction, turn the suction off to auscultate the BS
We are inspecting the anus for hemorrhoids
what is considered when assessing stool?
Occurrence
volume
color
oder
consistency.
shape
how much stool is needed for a culture and sensitivity?
1in or 15-30 mL
what is occult blood/guaiac?
a test that can be used to dent blood that cannot be seen
what is considered direct visualization?
colonoscopy
sigmoidoscopy
wireless capsule
what is considered indirect visualization?
barium enema
barium swallow
CT
ultrasound
constipation
Constipation is dry, hard stool
impaction
Impaction is hard immovable mass of stool in the rectum or higher.
***remember that absence of stool in the rectum does not rule out impaction. Fecal impaction causes increased pressure in the colon resulting in necrosis of the wall and eventually ulceration and perforation. The distal colon has a relatively poor blood supply making it more susceptible to necrosis from stool impaction
diarrhea
Diarrhea is liquid stool from food passing through the intestines rapidly before water is absorbed
incontinence
Incontinence is an inability to control bowel sphincters or an inability to tell if they have to have a bowel movement
hemorrhoids
Hemorrhoids are distended veins in the rectal folds/internal or external
small bowel obstruction
Small bowl obstruction a stoppage of peristalsis that can last days
bulk forming
form bulk within the lumen of colon, creates pressure and causes contractions
stool softener
These mild laxatives soften dry, hard stool with water that they pull into the stool from the intestine, making it easier to push out the stool.
Lubricant
These oily laxatives coat the surface of the stool to retain stool fluid and make it easier to push out the stool.
stimulant
Stimulant laxatives trigger the intestines to contract and push out the stool.
saline osmotic laxative
Osmotic laxatives draw water into the bowel from the surrounding tissues to soften stools and increase bowel movement frequency.
fecal impaction
compacted immoveable mass of feces
(the absence of stool in the rectum does not rule out impaction)
treatment for impaction
digital disimpaction
enemas
digital impaction
patient in left lateral position
double glove
lubrication
break up the mass with finger and remove chunks
(do not use on cardiac patients)
tap water enema
500-1000 mL (instill slowly)
distends intestine, increases peristalsis, softens stool
normal saline enema
500-1000 mL
distends intestine, increases peristalsis, softens stool
soap subs enema
500-1000 mL
distends intestine, irritates intestinal mucosa, softens stool
Fleets hypertonic
70-130 mL
distends intestine, irritates intestinal mucosa
oil retention
150-200 mL
lubricates stool and intestinal mucosa
key points to an enema
left lateral position
lubrication of tube
assess for bowel perforation after
bowel perforation signs
acute abdominal pain
rectal pain and bleeding
back pain
fever
bowel perforation facts
often fatal
patient die of peritonitis/sepsis
two causes of bowel peroration
fecal impaction and enemas
treatment of diarrhea
get a culture to determine the cause and find things that could contribute to the cause
drugs that decrease GI mobility
atropine
Imodium
paregoric
lomotil
absorbent drugs
kaopectate
Antimicrobial drugs
peto-bismol
what to do if pathogen comes back?
hydrate and let to run it’s course. you do not want to change anything.
fecal incontinence treatment
bowel training programs
retal tubes
external appliances
bowel training programs
pelvic floor training
diet (fluid, fiber, mobility)
rectal tubes are used for
runny stool
external appliances for fecal incontinence
skin protection
peri wash
per shield ointment
bowel diversions
colostomy
ileostomy
ileostomy
ileostomy redirects part of the small intestine to a stoma
colostomy
colostomy redirects the large intestine (colon) to a stoma
formation of stool with bag placement
depending colon placement the should be. more formed compared to small intestine or ascending colon placement should be more runny
Stoma care
assessment
skin care
appliance
application
dietary teaching
dietary teaching for stoma care
No pops, beer, smelly foods like eggs, nuts will cause blockage.
Probiotics are good deodorizer
colon rectal caner signs
often no signs
changes in bowel habits
blood in stool
constant need to void
weakness and fatigue
cramping and abdominal pain
unintended weight loss
how often for colon rectal caner screening?
10 years unless high risk then 3-5 years
starting at age 45
colon rectal caner risk factors
smoking
genetics
diets high in red meats
