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bowel elimination Flashcards

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1
Q

describe the large intestine

A

-primary organ of bowel elimination
-extends from the ileocecal valve to the anus

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2
Q

what are some functions of the large intestine

A

-absorption of water (aprox. 1000ml/day)
-formation of feces
-expulsion of feces from body

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3
Q

describe the small intestine

A

-secretes enzyme aiding in protein and and carb digstion
-3 parts: duodenum, jejunum, ileum
-connects to large intestine

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4
Q

what the functions of the small intestine

A

-receive liver and pancreases juices for digestion
-food digestion and nutrient absorption in the bloodstream

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5
Q

what are some variables influencing bowel elimination

A

-developmental considerations
-food and fluid
-meds
-daily patterns
-activity and muscle tone
-lifestyle
-psychological variables
-pathologic conditions
-diagostic studies
-surgery and anesthesia

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6
Q

developmental considerations

infants

A

-characteristics of stool and frequency depend on formula or breast feedings
-breast fed babies have bowel eliminations more frquently, more yellow and creamy
-formula fed babies have less freuent and darker shits

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7
Q

developmental considerations

toddler

A

physiologic maturity is the first priority for bowel training/voluntary bowel control between 22-36months

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8
Q

developmental considerations

child/adolescent/adult

A

defacation patterns vary in quantity, frequency, and rhythmicity. 1-2/day to 1 every 2-3days

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9
Q

developmental considerations

older adult

A

constipation is often a chronic problem; diarrhea and fecal incontinence may result from physiologic or lifestyle changes resulting in a decrease in motility

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10
Q

name some constipating foods

A

cheese, lean meat, eggs, pasta

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11
Q

name some foods with laxative effects

A

fruits and veggies, bran, chocolate, alcohol, coffee

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12
Q

name some gas producing foods

A

onions, cabbage, beans, cauliflower

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13
Q

how does aspirin and anticoagulants effect shit

A

pink to red to black shit

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14
Q

how do iron salts effect shit

A

black stool (pts need accurate assessment of nuber of BM with stool softener elimination when taking iron tx bc it can cause constipation)

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15
Q

how do antacids effect shit

A

white discoloration or speckling in stool

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16
Q

how do antibiotics effect shit

A

green-grey color

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17
Q

describe the physical assessment of the anus and rectum

A

inspection and palpation
-lesions, ulcers, fissures (linear break on the margin of the anus), inflammation, and external hemorrhoids
-ask pt to bear down as though having a bowel movement. assess for the appearance of internal hemorrhoids or fissure and fecal masses
-inspect perineal area for skin irritation secondary to diarrhea or fecal incontinence

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18
Q

describe stool collection

A

-medical aseptic technique is imperative
-hand hygiene, before and after glove use is essential
-wear disposable gloves
-do not contaminate outside of container with stool

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19
Q

what are you testing for when you collect stool

A

-occult blood
-culture and sensitivity
-pus
-ova and parasites

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20
Q

what are the instructions/how-to for stool collection

A

-void first so that urine is not in stool sample
-shit into the container rather than the toilet bowl
-do not place toilet tissue in the bedpan or specimen container
-notify nurse when specimen is available

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21
Q

describe occult blood testing

A

used to test stool sample for presence of hidden blood
-uses solution of guaiac to test for presence of blood
-using small wooden blade smear small amount of shit on the testing slide to test for presence of occult blood

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22
Q

describe esophagogastroduodenoscopy (EGD)

A

-looks at lining of esophagus, stomach, and down to the duodenum
-uses concsious sedation to stop gag reflex and local anesthetic in the throat
-NPO beforehand to prevent aspiration
-needs a driver afterwards, cant eat or drink until after local anesthetic wears off

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23
Q

describe colonoscopy

A

-passage of cam through anus, rectum, and large intestine
-NPO beforehand
-conscious sedation
-complete a series of bowel prep to make sure they have eliminated as much material from large intestine as possible

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24
Q

describe sigmoidoscopy

A

-similar to colonoscopy
-cam goes through anus, rectum, sigmoid colon, but not whole length of large intestine
-indicates diverticulitis or certain types of cancers or inflammatory diseases

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25
Q

describe wireless capsule endoscopy

A

-campsule with cam in it
-good to visualize small intestine
-helpful to identify cancers, erosion, inflammatory diseases, ulcers

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26
Q

KUB

A

-kidney, ureter, bladder
-term for abdominal xray -> looking at abdominal cavity below level of diaphragm
-no prep needed, may be done standing or sitting

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27
Q

upper GI/small bowel series

A

-pt ingests oral contrast then xrays are taken to observe how everything moves through the body
-can show hernias, leaks, irregular shape, or dilation
-usualyl NPO prior to UGI or clear liqs

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28
Q

describe barium enema

A

-similar to UGI but for lower digestive track
-bowel prep and clear liq diet
-administer barium directly into rectum to illuminate lining of large intestine

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29
Q

abdominal ultrasound

A

-looks at soft tissue, including organs of stomach, liver, gallbladder and pancrease
-looks for dilation of sections of organs or fluid collection

30
Q

describe magnetic resonance imaging (MRI)

A

-most specific radiologic procedure
-very clearly identify blood vessels, nerves, soft tissues, bones
-not done very frequently bc its expensive and time consuming
-also claustrophobic and may require sedation

31
Q

abdominal CT scan

A

shows the body in planes

32
Q

MRIs and abdominal CT scans are…

A

more expensive and emit more radiation

33
Q

noninvasive procedures…

A

take precedence over invasive procedures

34
Q

what are some patient outcomes for normal bowel elimination

A

-pt has a soft, formed bowel movement every 1-3 days without discomfort
-the relationship between bowel elimination, diet, fluid, and exercise is explained
-pt should seek medical evaluation if changes in stool color or consistency persist

35
Q

whats some shit that goes into promoting regular bowel habits

A

-timing
-positioning
-privacy
-nutrition/hydration
-exercise (abdominal, thigh strengthening, postural muscles)

36
Q

what individuals are at high risk for constipation

A

-bedrest taking constipating meds
-reduced fluids or bulk in their diet
-depressed
-CNS disease or local lesions that cause pain while defecating

37
Q

what are some nursing measure for a pt with diarrhea

A

-answer call bells immediately to prevent falls
-remove the cause of diarrhea whenever possible
-if there is impaction, obtain physician order for rectal examination
-give special care to the region around the anus

38
Q

what are some nursing measures foe a pt with fecal incontinence

A

-target toileting
-pericare with barrier cream
-keep skin and linens clean
-frquent skin assessments
-rectal tubes/incontinence devices

39
Q

describe a rectal tube

A

-require physician orders
-only helpful for pts experiencing incontinence with diarrhea
-usually reserved for pts with severe skin breakdown or who are critically ill and cannot tolerate turning in bed

40
Q

describe preventing food poisoning

A

-never buy food with damaged packaging
-take items requiring refrigeration home imediately
-wash hands and surfaces often
-use separate cutting boards for foods
-thoroughly wash all fruits and veggies before eating
-do not wash meat, poultry, or eggs to prevent spreading miscroorganisms to sink and other kitchen surfaces
-never use raw eggs in any form
-do not eat seafood raw if it has an unpleasant odor

41
Q

describe enemas

A

-instill fluid through the tube into the large intestine
-helps expel any contents in large intestine

42
Q

describe rectal suppositories

A

gelatinous med placed directly in rectum and is absorbed -> causes expulsion of feces

43
Q

describe oral intestinal lavage

A

-bowel prep
-fill bottle with water and mix it up then consume 4-6oz every 15mins and continue drinking until whats coming out is clear

44
Q

describe digital removal of stool

A

-used for severe impaction
-requires physicians order
-use gloved hands and lubricate to help break up shit impaction so pt can pass it

45
Q

name some different types of enemas

A

-cleansing
-rentention
-large volume
-small volume

46
Q

what is a cleansing enema used for

A

elimination

47
Q

describe retention enemas

A

-provide lubrication to help expel shit
can be:
-oil
-carminative
-medicated
-anthelmintic

48
Q

describe a large volume enema

A

-need IV pole
-should be warm - reduces cramping
-500-1000ml

49
Q

describe administrationof a large volume enema

A

-pt should be on left side
-acquire enema as prescribed
-use lube
-have clear plan and path to bathroom
-lube 2-3inches of tube and shove it in the rectum
-undo clamp on tubing and allow fluid to move into pt
-cramping is normal (can lower or clamp tubing to allow cramping to pass)
-remove tubing
-encourage pt to hold on to fluid for as long as possible (longer inside= more effective)
-have pt tell you whe they go to the bathroom

50
Q

describe oil rentention enema

A

lubricate th stool and intestinal mucosa, easing defecation

51
Q

describe carminative enema

A

help expel flatus from the rectum

52
Q

describe medicated enemas

A

provide meds absorbed through the rectal mucosa

53
Q

describe anthelmintic enemas

A

destroy intestinal parasites

54
Q

what are bowel training programs

A

-manipulate factors within the patients control
-food and fluid intake, exercise, and time for defecation
-eliminate soft, formed shit at regular intervals without laxatives
-when achieved, continue to offer assistance with toileting at the auccessful time

55
Q

describe NG tubes

A

-inserted to decompress or drain the stomach of fluid or unwanted stomach contents
-used to allow the GI tract to rest before or after abdominal surgery to promote healing
-inserted to monitor GI bleeding

56
Q

name some different types of ostomies

A

-sigmoid colostomy
-descending colostomy
-transverse colostomy
-ascending colostomy
-ileostomy
-ureterostomies may be temporary or permanent

ostomies are surgically created bowel diversions, can be temporary or permanent

57
Q

describe colostomy

A

-located anywhere along the length of the large intestine
-the further along the digestive tract the more solid the stool
-reusable or disposable pouch worn
-stomadhesive is cut and placed around stoma to protect the skin from urine and stool

58
Q

describe ileostomy

A

-empties from the end of the small intestines
-water is not absorbed (high volume and prone to dehydration)
-stool is liquid
-may not be irrigated
-drainage pouch is worn at all times (could require high volume pouch)

59
Q

what quadrant would an ileostomy be located in

A

RL

60
Q

what quadrant would a sigmoid colostomy be located in

A

LL

61
Q

describe uterostomy

A

permanent fistula for drainage of a ueter though the abdominal wall (usually done when bladder has been removed)

62
Q

describe ileoloop or ileoconduit

A

-ureter drains into a portion of the ilium which forms a pseudo bladder with an artificial opening into the abdominal wall. a straight catheter can be placed for drainage
-avoids the need for external pouch
-can be voluntary, as valve to empty urine

63
Q

how often do you assess a post operative stoma

A

-every 2hrs for 24hrs
-every 4hrs for 28-72hrs
-every 4-8hrs routinely prn

64
Q

describe a healthy stoma appearance

A

-highly vascular
-beefy red/pink in appearance
-smooth surface

65
Q

what are you looking for with a stoma assessment

A

-assess stoma for prolapse or retraction
-abnormal findings would include color being blue, purple, or grey
-assess for irritation (there are no nerve endingd so the stoma may be irritated without client’s awareness)
-skin irritations should be reported and documented (dermatitis, rash, pimples, bluish discoloration)

66
Q

describe how to document stoma drainage

A

-amount
-color
-consistency
-application of a cline pouch or dressing
-client participation

67
Q

describe colostomy care

A

-privacy and reassurance
-use clean technique adn clean gloves
-keep patient as free of odors as possible, empty when 1/4 to 1/3 full
-inspect stoma regularly (note size which should stabilize in 6-8wks, keep skin around site clean and dry)
-measure the pts fluid intake and output
-explain each aspect of care to the patient and self care role
-encourage pt to care for and look at ostomy

68
Q

what do interostomal therapist or wound ostomy continence nurses do

A

-excellent resource for clients and healthcare personnel concerning colostomy care
-teach clients to perform ostomy self care

69
Q

describe pt teaching for colostomies

A

-explain reason for bowel diversiona dnrationale for treatment
-demonstrate self care behaviors that effectively manage the ostomy
-describe follow up care and existing support resources
-report where supplies may be obtained in the community
-verbalize related fears and concerns
-demonstrate a positive body image

70
Q

describe comfort measures for ostomies

A

-encourage recommended diet and exercise
-use meds only as needed
-apply ointments or astringent (witch hazel)
-use suppositories that contain anesthetics
-specialty ostomy sets designed by wound care nurses

nursing 20030 (31 decks)

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