bowel elimination Flashcards
describe the large intestine
-primary organ of bowel elimination
-extends from the ileocecal valve to the anus
what are some functions of the large intestine
-absorption of water (aprox. 1000ml/day)
-formation of feces
-expulsion of feces from body
describe the small intestine
-secretes enzyme aiding in protein and and carb digstion
-3 parts: duodenum, jejunum, ileum
-connects to large intestine
what the functions of the small intestine
-receive liver and pancreases juices for digestion
-food digestion and nutrient absorption in the bloodstream
what are some variables influencing bowel elimination
-developmental considerations
-food and fluid
-meds
-daily patterns
-activity and muscle tone
-lifestyle
-psychological variables
-pathologic conditions
-diagostic studies
-surgery and anesthesia
developmental considerations
infants
-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
developmental considerations
toddler
physiologic maturity is the first priority for bowel training/voluntary bowel control between 22-36months
developmental considerations
child/adolescent/adult
defacation patterns vary in quantity, frequency, and rhythmicity. 1-2/day to 1 every 2-3days
developmental considerations
older adult
constipation is often a chronic problem; diarrhea and fecal incontinence may result from physiologic or lifestyle changes resulting in a decrease in motility
name some constipating foods
cheese, lean meat, eggs, pasta
name some foods with laxative effects
fruits and veggies, bran, chocolate, alcohol, coffee
name some gas producing foods
onions, cabbage, beans, cauliflower
how does aspirin and anticoagulants effect shit
pink to red to black shit
how do iron salts effect shit
black stool (pts need accurate assessment of nuber of BM with stool softener elimination when taking iron tx bc it can cause constipation)
how do antacids effect shit
white discoloration or speckling in stool
how do antibiotics effect shit
green-grey color
describe the physical assessment of the anus and rectum
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
describe stool collection
-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
what are you testing for when you collect stool
-occult blood
-culture and sensitivity
-pus
-ova and parasites
what are the instructions/how-to for stool collection
-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
describe occult blood testing
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
describe esophagogastroduodenoscopy (EGD)
-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
describe colonoscopy
-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
describe sigmoidoscopy
-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
describe wireless capsule endoscopy
-campsule with cam in it
-good to visualize small intestine
-helpful to identify cancers, erosion, inflammatory diseases, ulcers
KUB
-kidney, ureter, bladder
-term for abdominal xray -> looking at abdominal cavity below level of diaphragm
-no prep needed, may be done standing or sitting
upper GI/small bowel series
-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
describe barium enema
-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
abdominal ultrasound
-looks at soft tissue, including organs of stomach, liver, gallbladder and pancrease
-looks for dilation of sections of organs or fluid collection
describe magnetic resonance imaging (MRI)
-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
abdominal CT scan
shows the body in planes
MRIs and abdominal CT scans are…
more expensive and emit more radiation
noninvasive procedures…
take precedence over invasive procedures
what are some patient outcomes for normal bowel elimination
-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
whats some shit that goes into promoting regular bowel habits
-timing
-positioning
-privacy
-nutrition/hydration
-exercise (abdominal, thigh strengthening, postural muscles)
what individuals are at high risk for constipation
-bedrest taking constipating meds
-reduced fluids or bulk in their diet
-depressed
-CNS disease or local lesions that cause pain while defecating
what are some nursing measure for a pt with diarrhea
-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
what are some nursing measures foe a pt with fecal incontinence
-target toileting
-pericare with barrier cream
-keep skin and linens clean
-frquent skin assessments
-rectal tubes/incontinence devices
describe a rectal tube
-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
describe preventing food poisoning
-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
describe enemas
-instill fluid through the tube into the large intestine
-helps expel any contents in large intestine
describe rectal suppositories
gelatinous med placed directly in rectum and is absorbed -> causes expulsion of feces
describe oral intestinal lavage
-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
describe digital removal of stool
-used for severe impaction
-requires physicians order
-use gloved hands and lubricate to help break up shit impaction so pt can pass it
name some different types of enemas
-cleansing
-rentention
-large volume
-small volume
what is a cleansing enema used for
elimination
describe retention enemas
-provide lubrication to help expel shit
can be:
-oil
-carminative
-medicated
-anthelmintic
describe a large volume enema
-need IV pole
-should be warm - reduces cramping
-500-1000ml
describe administrationof a large volume enema
-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
describe oil rentention enema
lubricate th stool and intestinal mucosa, easing defecation
describe carminative enema
help expel flatus from the rectum
describe medicated enemas
provide meds absorbed through the rectal mucosa
describe anthelmintic enemas
destroy intestinal parasites
what are bowel training programs
-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
describe NG tubes
-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
name some different types of ostomies
-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
describe colostomy
-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
describe ileostomy
-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)
what quadrant would an ileostomy be located in
RL
what quadrant would a sigmoid colostomy be located in
LL
describe uterostomy
permanent fistula for drainage of a ueter though the abdominal wall (usually done when bladder has been removed)
describe ileoloop or ileoconduit
-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
how often do you assess a post operative stoma
-every 2hrs for 24hrs
-every 4hrs for 28-72hrs
-every 4-8hrs routinely prn
describe a healthy stoma appearance
-highly vascular
-beefy red/pink in appearance
-smooth surface
what are you looking for with a stoma assessment
-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)
describe how to document stoma drainage
-amount
-color
-consistency
-application of a cline pouch or dressing
-client participation
describe colostomy care
-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
what do interostomal therapist or wound ostomy continence nurses do
-excellent resource for clients and healthcare personnel concerning colostomy care
-teach clients to perform ostomy self care
describe pt teaching for colostomies
-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
describe comfort measures for ostomies
-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
