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NSG 1135 > bowel elimination > Flashcards

bowel elimination Flashcards

1
Q

alterations in regular bowel elimination are early signs of

A

problems in the gastrointestinal tract or other body systems

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2
Q

parts of digestive system

A 
mouth
esophagus
stomach
small intestine
large intestine (colon)
anus
defecation
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3
Q

the human mouth, esophagus, stomach, small intestine, colon, and rectum contain

A

millions of non harmful bacteria

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4
Q

are GI tract procedures we perform as nurses sterile

A

no

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5
Q

mouth

A

digestion begins with mastication (chewing)

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6
Q

esophagus

A

peristalsis moves food into the stomach

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7
Q

stomach

A

stores food, mixes food, liquid, and digestive juices, moves food into small intestines

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8
Q

small intestine

A

duodenum
jejunum
ileum

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9
Q

large intestine

A

primary organ of bowel elimination

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10
Q

anus

A

expels feces and flatus from the rectum

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11
Q

digestion

A

begins in the mouth and ends in the small and large intestines
mechanical breakdown that results from chewing, churning, and mixing with fluid and chemical reactions in which food reduces to its simplest form

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12
Q

absorption

A

intestine is the primary area of absorption, then metabolism and storage of nutrients
the small intestine is lined with fingerlike projections called villi
absorption of carbs, protein, minerals, and water soluble vitamins occurs in the small intestine

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13
Q

metabolism

A

all biochemical reactions within the cells of the body

anabolic vs catabolic

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14
Q

elimination

A

chyme is moved through peristalsis and is changed into feces
chyme moves by peristaltic action through the ileocecal valve into the large intestine, where it becomes feces
water absorbs in the mucosa as feces move toward the rectum

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15
Q

peristalsis

A

series of involuntary wave-like muscle contractions which move food along the digestive tract

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16
Q

what increases and decreases peristalsis

A

stress and anxiety increase

surgery and anesthesia decrease

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17
Q

factors influencing bowel elimination

A 
age
diet
fluid intake
physical activity
psychological factors
personal habits
position during defecation
pain
surgery and anesthesia
medications
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18
Q

what drug can cause constipation

A

opioids

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19
Q

constipation

A

symptom, not a disease; infrequent stool and/or hard, dry, small stools that are difficult to eliminate

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20
Q

impaction

A

results from unrelieved constipation; a collection of hardened feces wedged in the rectum that a person cannot expel

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21
Q

diarrhea

A

an increase in the number of stools and the passage of liquid, unformed feces

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22
Q

incontinence

A

inability to control passages of feces and gas to the anus

23
Q

flatulence

A

accumulation of gas in the intestines causing the walls to stretch

24
Q

hemorrhoids

A

dilated, engorged veins in the lining of the rectum

25
Q

bowel diversions

A

temporary or permanent artificial opening in the abdominal wall (stoma)
surgical opening in the ileum or colon
ileostomy or colostomy
location of an ostomy determines stool consistency

26
Q

ileostomy stool consistency

A

thin to thick liquid

27
Q

large intestine ostomy

A

ascending - thick liquid
transverse - thick liquid to soft
descending -soft to formed
sigmoid - more formed

28
Q

three types of ostomies

A

colostomy
ileostomy
urostomy

29
Q

colostomy types

A

ascending
transverse
descending
sigmoid

30
Q

what characteristics should the stoma have if patient has a bowel diversion

A

beefy bright red, moist

blue or purple means decreased blood flow and is an emergency

31
Q

effective pouching system for ostomies

A

protects skin, contains fecal material, remains odor free, and is comfortable and inconspicuous

32
Q

nutritional considerations for ostomies

A

consume low fiber for the first few weeks
eat slowly and chew food completely
drink 10-12 glasses of water daily
eat food slowly and chew food completely so food breaks down easier
patient may choose to avoid gassy foods

33
Q

psychological considerations with ostomies

A

serious body changes/self image
intimacy needs
odor

34
Q

assessment for ostomies

A 
nursing history
physical assessment
mouth 
abdomen
identifying normal and abnormal patterns, habits, and the patient's perception of normal and abnormal with regard to bowel elimination 
not everyone eliminates feces everyday - after 3 days, we worry
laboratory tests
fecal specimens
test stool for blood, parasites, etc
diagnostic examinations
35
Q

review box 47.3

A

47.3

36
Q

collection of a stool sample

A

hat or collect stool from brief
wear gloves while collecting
use tongue depressor or a spoon to pick up stool and place
collect in a dry, clean, leak-proof container
usually don’t need much
make sure there’s no urine or water
seal specimen well
place specimen in a biohazard bag for transport
look for parasites, ovum, blood, black/tarry stool, in sample
notice color and consistency
send stool to lab
don’t let it go into the toilet

37
Q

promotion of normal defecation

A 
sitting position 
positioning on bedpan
develop and promote routine
privacy 
safety
38
Q

bedpan use

A

if patient is immobile or it is unsafe to allow them to raise their hips, they remain flat and roll onto the bedpan

39
Q

standard bedpan position

A

wide side up

40
Q

fracture bedpan position

A

wide side down

41
Q

cathartics and laxatives

A

medications that initiate and facilitate stool passage
empty the bowel
cathartics have a stronger and more rapid effect on the intestines than laxatives
laxatives can be administered via oral route or suppository route
suppositories may act more quickly than oral medications (stimulate rectal mucosa)

42
Q

antidiarrheal agents

A

decrease intestinal muscle tone to slow passage of feces

43
Q

enemas

A

instillation of a liquid solution into the rectum and sigmoid colon
promote defecation by stimulating peristalsis
fluid breaks up fecal mass, stretches rectal wall and initiates the defecation reflex
can also give medications via enema route

44
Q

rectal suppository admin

A

sterile technique not necessary
explain procedure
position the patient laying left lateral sims
hand hygiene and apply gloves
lubricate finger and medication
insert approx one inch or once you feel medication bypass sphincter
place on wall of rectum - not stool
med will melt when it reaches body temp and will be absorbed

45
Q

common meds given suppository route

A

acetaminophen

dulcolax

46
Q

enema admin

A

sterile technique is unnecessary
wear gloves
explain procedure, positioning, precautions to avoid discomfort, length of time necessary to retain solution before defecation
administer slowly
cramping is likely
position patient on left lying position with top leg bent upwards - sim’s position

47
Q

digital removal of stool

A

provider or nurse removing stool with fingers
when fecal mass is too difficult for patient to pass
las resort in managing severe constipation due to discomfort and risks involved
already tried other measures and they failed
order is necessary

48
Q

purpose of digital removal of stool

A

break up fecal mass and remove it so patient can voluntarily pass stool on their own

49
Q

what needs to be assessed before digitally removing stool

A

heart rate

50
Q

digital removal of stool process

A

position patient side lying, educate, hand hygiene, gloves
lube finger, insert into rectum slowly
gently loosen fecal mass by massaging around it and remove all pieces slowly
what are characteristics of initial stool pieces being removed
what are characteristics of stool after hard fecal mass has been removed
patient should be able to have a bowel movement after

51
Q

risks/complications of digital removal of stool

A

irritation to mucosa, bleeding

possible stimulation of vagus nerve (causes bradycardia); if this happens, nurse must stop procedure

52
Q

bowel training

A

performed with patients who have chronic constipation or fecal incontinence secondary to cognitive impairment

53
Q

implementing bowel training

A

routine - keep patient on a schedule with bowel movements
diet - increase fluids to decrease constipation and fecal impaction
promote regular exercise - improves peristalsis
management of hemorrhoids - patient will avoid a bowel movement due to pain with hemorrhoids
skin integrity - fecal incontinence will cause skin breakdown
assess skin frequently, keep area clean, use barrier ointment to protect the skin

NSG 1135 (3 decks)

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