Bowel Elimination Flashcards
Structures of the Small intestine:
the duodenum, jejunum & ileum
Structures of the Large intestine:
cecum, colon, rectum & anus
Structures of the colon
Ascending, transverse & descending & sigmoid colon
Function of the intestines
Motility
Absorption
Defecation
A forced expiration against a closed glottis, may be used when needed to initiate a bowel movement.
The Valsalva maneuver
Two types of motility:
Segmentation
Peristalsis
Daily fiber needs for a woman
24-25 grams
Daily fiber needs for a man
35-38 grams
Length of small intestine
20ft long
Length of large intestine
6ft long
The anus has how many sphincters?
Two
What type of response does the internal anal sphincter have?
Involuntary
What type of response does the external anal sphincter have?
Voluntary
A sphincter muscle valve that separates the small intestine and the large intestine
Ileocecal valve
Type of people that have problems with gut transit
Older adults
Intestinal motility is controlled by
The autonomic nervous system
Absorption takes place in the
Small intestine
Motility that propels/ pushes feces through
peristalsis
Contraction of intestinal circular smooth muscles that mixes chyme is called
Segmentation
Process of digestion, in which food, gastric acid and pepsin are turned from mush into a semi-digested acidic liquid called
Chyme
Contracting (pinching) and relaxing of intestinal muscles
Segmentation
Autonomic nervous system innervation:
Sympathetic
Parasympathetic
Sympathetic-
Slows down
Parasympathetic-
Speeds up
Partially digested food (chyme), empties from the stomach to the _________ for __________
Small intestine for absorption
Where most nutrients an electrolyte absorption occurs
Duodenum & jejunum
Absorbs some vitamins, iron & fluids.
Ileum
Final absorption of nutrients especially fluid & electrolytes
Large Intestine
The process begins when peristalsis propels feces into the rectum causing rectal distention.
Defecation
___________________ are stimulated causing contraction of the descending & sigmoid colon, rectum, anus & the relaxation of the internal & external sphincter
Parasympathetic nerve fibers
The external anal sphincter can remain closed until the person decides
To defecate
Speed of passage affects __________
Absorption. The slower the better.
Normal feces consist of ___% water & ___% solids
75% water & 25% solids
Solids within normal feces includes:
Bacteria, undigested fiber, fat, inorganic matter & some protein
The major undigested fiber of feces
Cellulose
The color in feces comes from
Bilirubin
Bilirubin comes from
The liver
White stool has low
Bilirubin caused by gallbladder condition
Feces has an aromatic, pungent odor due to
Bacterial breakdown of proteins
Yellow or green feces is an indicator of
A virus
Normal feces color should be
Yellowish brown
Factors affecting elimination
Nutrition- fiber gives bulk, ( fruits, vegetables &grains)
Food intolerances
Fluid intake- 2000ml per day
Activity & exercise-promotes muscle tone & peristalsis
Body position
Ignoring the Urge to Defecate
Best body position for elimination
Sitting or squatting
Ignoring the urge to defecate can lead to
Constipation
Steatorrhea
Greasy stool
Lifestyle factors affecting elimination
Individual pattern any changes in ADLS or emotions such as stress or traveler’s diarrhea or constipation
Pregnancy factors affecting elimination
Hormonal changes, fetus, iron supplements can cause constipation or frequent smaller stools
Medication factors affecting elimination
Can cause constipation or diarrhea
Ex. antibiotics cause diarrhea
Narcotics constipation
Diagnostic procedure factors affecting elimination
Barium is binding and can cause problems with elimination
Patients should start on a _____ diet right after surgery
light diet
An inflammation of the peritoneum that is usually due to a bacterial or fungal infection.
Peritonitis
A silk-like membrane that lines your inner abdominal wall and covers the organs within your abdomen
Peritoneum
A stoma through the small intestine
ileostomy
A stoma through the colon
Colonostomy
The portion of the intestine that is brought through the abdominal wall
Stoma
Reasons for fecal diversion
Colitis, Trauma, chronic disease or diverticulitis
Proper position of a stoma
Above the skin or level with skin (flat)
Ostomy at end descending colon may not need
A bag because they have more control
Patients with a ileostomy may not have
a large intestine
Patients with an ileostomy have liquidly stool which causes
fluid and electrolyte imbalances
Two stomas on ab wall
Double barrel colostomy
Double barrel colostomy:
Stoma that evacuates stool
Proximal stoma
Double barrel colostomy:
Stoma that evacuates mucus
Distal stoma
Double barrel colostomy:
Stoma that does not need a bag
Distal stoma
Double barrel colostomy:
Stoma that needs a bag
Proximal stoma
Can a double barrel colostomy be reversed?
Yes
Reason for double barrel colostomy
Tumor removal
Loop of bowel with two openings
Loop colostomy
Temporary colostomy where a pin is used to keep a loop of bowel above the skin, then removed after a couple of weeks
Loop colostomy
Is a loop colostomy permanent?
No it is temporary
Internal pouch where a catheter is needed for bowel elimination
Koch pouch or “K pouch”
Patient with this kind of pouch does not have a rectum or anus (possibly because of disease)
K Pouch
Is a Koch pouch permanent?
Yes
Type of pouch needed to be drained 4-5 times a day and patient does not feel fullness
Koch pouch
Type of internal pouch where the patient can feel pressure and fullness
J pouch
Type of pouch where the patient has an anus but no rectum or large intestine
J pouch
Type of pouch where a valve at the anus is opened to go
J pouch
Type of pouch where the patient has kidneys but no bladder
Ileal conduit
Type of pouch where the ureters are attached to the ileum to drain urine
Ileal conduit
Is the ileal conduit a sterile system?
Yes
Continent ileostomy
Kock pouch
Ileoanal reservoir
J pouch
Type of altered bowel function that can lead to impaction
Constipation
Type of altered bowel function that is very dry at the end
Slow transit constipation
Antibiotics disrupt gut flora for
3 months
Shoes should be bleached after leaving this patient’s room
C-Diff
This type of problem is a risk for cardiac patients with constipation
Vasovagal problem
CDAD a type of antibiotic associated diarrhea
Clostridium Difficile Associated Diarrhea
Constipation problem caused by poor nursing
Impaction
Best body position for manual disimpaction
Left side lying
Stool that is green in color and very contagious
C-diff
Flatulence is caused by
Foods or talking too much
Excessive amounts of gas, liquids, or intestinal contents
Abdominal distention
An intestinal blockage without an actual physical obstruction
Paralytic ileus
Blockage that can occur 72 hours after abdominal surgery
Paralytic ileus
Risks for altered bowel function
Patients who are immobile, poor fluid or diet, or on pain meds
How to assess for abdomen
Look for contour, listen, and palpate
Pain after palpating
rebound pain
Measure of abdominal girth is
doc ordered and done first thing in the morning
Exam to look for hardened stool, hemorrhoid’s, or bleeding
Perirectal exam
Abrasion or tearing of skin
Excoriation
Diagnostic tests
Stool culture must not be contaminated with
Urine or toilet paper
Diagnostic tests
Preliminary results within __ hr
24 hours
Diagnostic tests
Final results given after __ hr
48 hours
Diagnostic tests
Length of time needed to know if antibiotics are needed
48 hours
Hidden blood in stool
Occult blood
Diagnostic tests
Stool for ova or parasites must be
Warm and go direct to lab
Diagnostic tests
For salmonella, shigella, or c-diff
stool culture
FOBT
Fecal Occult Blood Test
A procedure that uses a guaiac paper slide test to detect fecal occult blood.
Hemoccult test
When is the hemoccult test done?
Samples are taken from three bowel movements on three different days
Guaiac test paper turns this color if there is blood present in stool
Blue
Things that can cause a false positive in FOBT testing and should be stopped at least 3 days prior to testing
ASA (aspirin), Nsaids, steroids, and rare meats
This can inhibit color reaction and cause a false negative in FOBT testing
250mg/day of Vit C
Radiologic exam of the upper GI
UGI
Radiologic exam where the radiologist follows barium from the esophagus through the ileum.
GI with small bowel
Type of enema needed for visualization of the lower tract
Barium
Patients may need this to pass the barium out of body
Laxatives
These two radiologic tests are sometimes done together
GI with small bowel and barium enema
Type of exams done under conscious sedation
Endoscopic Examinations
20 minutes exam done with a flex scope through the mouth up to the duodenum, gas discomfort is expected after
EGD - Esophagogastroduodenoscopy
Type of diagnostic test done under complete sedation
colonscopy
Type of diagnostic test that visualizes the colon to ileocecal valve. Prep is done the day before
Colonoscopy
Diagnostic tests to visualize the sigmoid colon & rectum
Sigmoidoscopy
Type of diagnostic tests where the patient is conscious but may be given valium and enema prior
Sigmoidoscopy
Helps to reestablish normal bowel movements in persons who suffer from constipation, diarrhea, incontinence, or irregularity
Bowel training
Fluids needed for health
1500 – 2000 ml a day
Saline laxative that contains Magnesium
Milk of magnesia
Medication that can be habit forming and cause electrolyte imbalance
Laxatives
Medication given when there is slow bowel motility- contra indicated when viral or bacterial agents cause diarrhea
Antidiarrheal
Type of medication given to patients with colitis or Chron’s
Antidiarrheal
Simethicone
Antiflatulence-gas relief ( no eating for 20 minutes)
When healthy feces is transplanted in a sick patient to treat c.diff
FMT - Fecal Microbiota Transplant
It is the cleansing of a portion of the large bowel by the insertion of fluid rectally.
Enema
Small volume enema that draws water into the colon to promote peristalsis
Hypertonic (fleet)
Small volume enema using mineral oil- good for fecal impaction and softens stool
Oil Retention
Time it takes for small volume enema to act
5-10 minutes
Large volume enemas can only be given ___ times due to risk of electrolyte imbalance
Three times
Procedure for large volume enema
750-1000ml, can be tap water, soapsuds or saline.
Luke warm – 105-110 degrees F
Pt. Must be on LT side with knees flexed
Prime tubing- no air
Container – 18 in. above anus
Lubricate 2-3 in of tubing & insert tip in rectum ( adult 3-4 in) towards the umbilicus.
Run slowly- helps prevent cramping & allows for retention
Have client hold as long as possible
Cleansing enemas can only repeat 3x.
Type of enema used to treat flatus (gas)
Return-flow Enema ( Harris Flush)
This is 10 inches long and used for gas relief
Rectal tube
A bag used with adhesive to collect a sample
Fecal collection during incontinence
Involves the passage of a tube (such as an Ewald tube) via the mouth or nose down into the stomach followed by sequential administration and removal of small volumes of liquid. Used during overdoses
Gastric lavage
Is the introduction of nourishment into the stomach by means of a tube passed through the nose or mouth
Gastric gavage or feeding
Draining the stomach contents
Gastric decompression
A double-lumen nasogastric tube used for suction and irrigation of the stomach
Salem sump
If there is no drainage coming from a Salem sump this should be done
Move tube to unblock or get doc ordered irrigation
intermittent suction is done to prevent
trauma
Suction set to suction every ___
60 sec
NG should not be used when there is
nausea or vomiting present
Nursing Considerations for NG tube
Maintaining suction
Maintaining patency
Ensuring accurate placement
Tube where end tip is weighted
Nasointestinal tube
