Bowel Elimination Flashcards
Mouth
Esophagus
Mouth: Digestion begins especially with the breakdown of carbohydrates through the secretion of amylase.
Esophagus: Collapsible tube, connecting the pharynx to the stomach
Stomach
mixes food and digestive juices (chyme) and hydrochloric acid causing a mechanical breakdown of food stuff before entering the small intestine.
Duodenum
Secretory functions consisting of hormones and triggers the release of pancreatic juice and bile.
protects the intestine by secreting chemicals that neutralize the acidity of the chyme
Jejunum
controls carbohydrate and protein absorption
Ileum
absorbs fats, bile salts, and water
After passing through the small intestine, undigested food stuff will pass and empty into the ________ quadrant of the abdomen.
Lower right
Large Intestine
absorption, secretion, and elimination
Peristalsis
mechanism of progressive contraction and relaxation of the walls of the intestine
Bowel sounds:
Normoactive
Hyperactive
Hypoactive
Absent
Normoactive: irregular, high-pitched, and gurgling sounds that occur every 5 to 15 seconds
Hyperactive: loud, high-pitched, and rushing most commonly associated with diarrhea or inflammatory disorders
Hypoactive: slow and sluggish, with occurrence of less than five sounds per minute.
Absent: may be a sign of obstruction or paralytic ileus.
listen for 5 full minutes before documenting the absence of bowel sounds
What is flatulence
How is it expelled?
Mixture of gases in the intestine, by-products of the digestive process
May be expelled by the mouth (belching)
May be expelled by the anus (flatus)
How does diet affect bowel elimination?
* Gas producing foods
* Food intolerance
*Fluid intake
* Spicy foods
* High fiber foods
Gas-producing foods-cause the intestinal walls to become distended, increasing the colon motility. Such foods are onions, cauliflower, and beans
Food intolerance- digestive upset, and in some instances, cause watery stools, cramps, or flatulence.
Fluid intake or loss- Increased water intake eases the passage of feces, while poor fluid intake increases the risk of constipation
Spicy foods- Diarrhea and flatus
Constipating-producing foods
High fiber foods- foods improves the likelihood of a normal elimination pattern such as whole grains, fresh fruits and vegetables
How does physical activity affect Bowel elimination?
Exercise: promotes peristalsis and facilitates movement of chyme through the colon
Regular Activity: maintains the tone of pelvic and abdominal floor muscles.
Immobility: Weakens the the tone of pelvic and abdominal floor muscles.
How does emotional stress affect bowel elimination?
How does depression affect bowel elimination?
Emotional stress accelerates the digestive process, and peristalsis is increased resulting in diarrhea, nausea and gastric distention.
Depression may slow peristalsis resulting in constipation.
How does pregnancy affect bowel elimination
As the fetus grows, pressure is exerted on the rectum, impairing the passage of stool.
Straining during delivery may result in hemorrhoids.
Prenatal vitamins high in iron may increase the risk of constipation.
Normal posture for bowel elimination is
Normal posture is squatting
How does anesthesia affect bowel elimination
Anesthesia blocks the parasympathetic stimulation to the muscles of the colon and causes peristalsis to slow or cease.
paralytic ileus
temporary cessation of intestinal movement.
Narcotics also contribute to development of ______
constipation
Hemorrhoids
swollen and inflamed veins in the anus or lower rectum
Laxatives
ease defecation often by stimulating bowel activity.
Carthatics
strong laxatives that stimulate evacuation of the bowel by causing a change in GI transit time.
Antibiotics
contribute to diarrhea by interfering with the normal bacterial flora in the GI tract.
Anticholinergics
inhibit gastric acid secretion and depress GI motility
Histamine anatgonists
suppress secretion of hydrochloric acid and interfere with digestion of some foods.
Calcium supplements and opioids
Slow colonic actions
NSAIDS
may cause red or black stools depending where the bleeding is occurring.
Iron suppliments
may cause constipation and may cause the stool to be black in appearance.
Antacids
whitish discoloration or white specks to appear in feces.
Prescribed bowel preparations
ensure emptying of the bowel are given to facilitate visualization at endoscopic, radiographic, or other examinations
gas and loose stools, may persist
Diarrhea
abnormal frequency and fluidity of bowel movements
hyperactive bowel sounds
Associated with disorders that affect digestion, absorption and secretion in GI tract
May be caused by allergies or intolerances to food, fluids, or certain medications
C-diff
foul-smelling, watery diarrhea three or more times a day for 2 or more days, accompanied by mild abdominal cramping and tenderness.
Incontinence
loss of voluntary control of fecal and gaseous discharge via anus
Constipation
Due to increased water absorption in the colon, constipation leads to difficulty passing stool, excessive straining at defecation, the inability to defecate at will, hard feces, and rectal pain.
Straining during defecation can
induce elevations in intraocular pressure, increased intracranial pressure, changes in cardiac rhythms, and hemorrhoids.
Valsalva maneuver consists of
“bearing down” while holding the breath. The person thus is exerting force against a closed windpipe, creating increased intrathoracic pressure.
Impaction
The presence of hard fecal mass in the rectum or colon which the patient is unable to expel
Symptoms are loss of appetite, nausea, vomiting, distention, cramping, and rectal pain.
Other causes are Barium used in radiologic examinations contributes to the risk of impaction.
Diagnosis of impaction is through digital examination and palpation of fecal mass.
Symptoms of gastroentitis
Nausea
Vomiting
Fever
Abdominal cramping
Gastroenteritis
Most common cause
Inflammation of the mucosa of the stomach and small intestine
Viruses are the most common cause
Colorectal Cancer
_____leading cause of cancer-related deaths
More common in _____ than ____
3rd leading cause of cancer-related deaths
More common in men than women
Clinical manifestations of colorectal cancer
Early disease: None or no specific findings (fatigue, weight loss)
More advanced disease: Abdominal tenderness, palpable abdominal mass, hepatomegaly, and ascites
Bleeding can occur with both right and left-sided colorectal cancer
Complications include obstruction, bleeding, perforation, peritonitis, and fistula formation
Pencil-thin stools due to possible obstruction causing narrowing of colon for stool to pass
Ileostomy
It bypasses the
Ileostomy-Surgically created opening in the small intestine, usually at the end of the ileum.
colon
What is a Colostomy
The surgical opening is the remaining colon after a portion of the colon or the rectum has been removed.
Features of ileostomy
Temporary or permanent
Stools are frequent and liquid
Ileoanal pouch is most common
With ileoanal pouch, there is no stoma
Ileoanal pouch also referred to as a pull- through, endorectal-pull-through, pelvic pouch, and J-pouch procedure
Kock pouch
Features of colostomy
Temporary or permanent
Stools vary in consistency
Sigmoid and descending colostomies
Transverse colostomy
Ascending colostomy
Loop colostomy
Double-barrel colostomy
first fecal material passed by the newborn
______ is ——– consistency
. Meconium
It is black, thick, and tarry in consistency
Infants have ——– stomachs, ———secretion of enzymes, and a——— transit of food through the GI tract.
Infants have small stomachs, less secretion of enzymes, and a fast transit of food through the GI tract.
Constipation may be an issue with a school-aged child due to
lack of privacy
risk for bullying
limited access
dirty bathrooms.
Older adults are More susceptible to developing fecal impaction
Decreased bowel tone
Decreased fluid intake
Decreased activity
Teach older adults about
Adequate fiber intake including fruits, vegetables, and breakfast cereal such as bran and oatmeal
Adequate fluid intake of at least 2 liters of water or juice daily
Assess for these among older adults
Diarrhea or diarrhea-associated complications such as
Electrolytes imbalances
Dehydration
Skin breakdown
Highest incidence of colorectal cancer
Black Americans
Eastern European Jewish
Start auscultating at the——— quadrant then——- quadrant. Then move to the——–quadrant then move to the——–quadrant last.
Right lower
Right upper
Left upper
Left lower
Stool culture
For culture, parasites, or ova,
To detect and for diagnosis of C. diff
To detect presence of microorganisms responsible for food-borne illness or contaminated foods
To determine causative factors of patient complaints of diarrhea for several days
Fecal occult blood test
blood in feces. Blood may be associated with benign or malignant growths or polyps in the colon, hemorrhoids, anal fissures, intestinal infections, ulcerative colitis, Crohn disease, diverticular disease, and abnormalities of the blood vessels
Foods that affect Fecal occult blood test
beets, broccoli, red food coloring, red meats, horseradish, fish, cantaloupe, carrots, poultry
Stool culture: food-borne illnesses caused by
ingesting raw eggs, raw hamburger, etc. for salmonella, E. coli, and listeria, etc.
Upper Gastrointestinal Series is also known as
It defines the anatomy of
Assists in the diagnosis of
Barium swallow
upper digestive tract including the esophagus, stomach, and duodenum
ulcers, tumors, hiatal hernias, scarring, blockages, and GI tissue abnormalities
Teachings for barium swallow
Side effects
Nothing by mouth for 4 to 8 hours
Major side effect is constipation
Stool may be gray or white in appearance
Patients are encouraged to drink extra fluids after test
Side effects are same as barium enema
Lower Gastrointestinal Series is also known as
Barium enema
Defines the anatomy of the
Assists in diagnosis of
lower GI tract including the rectum, colon, and lower portion of the small intestine
abnormal growths, ulcers, polyps, diverticula, and colon cancer
Preparation for barium enema
Restricted diet for a few days beforehand, generally a liquid diet for 2 days prior to test
Clear liquids only for 24 hours before test
Laxative or enema just before test
Colonoscopy
Visualizes
Procedure identifies
Procedure diagnoses
Inflamed tissue, ulcers, and abnormal growths in the anus, rectum and colon
Procedure identifies early signs of colorectal cancer Unexplained changes in bowel habits, abdominal pain, bleeding from the anus, and weight loss
Preparation for colonoscopy
Clear liquid diet for 1 to 3 days prior to test
Patients must abstain from eating foods and drinking beverages that contain purple or red dye
A laxative or an enema may be required the night before the test
Patient must inform prescriber of all medications, vitamins, or supplements taken daily including aspirin, arthritis medication, anticoagulants, diabetic mediations, and iron supplements
Nothing by mouth for several hours prior to test
As a nurse, inform prescriber if patient refuses or is unable to complete bowel prep for this test
Side effects of colonoscopy
Cramping and bloating may occur during first hour following test
Driving is not permitted for 12 hours following test
Endoscopy
What does it consist of
Esophagoscopy to view the esophagus
Gastroscopy to view the inside of the stomach
Duodenoscopy to view the inside of the duodenum
Consists of a small camera that passes through the mouth, down the throat, and into the stomach for pictures of GI tract
Prescribed for patients with swallowing problems, vomiting, bleeding, gastric reflux, abdominal pain, and chest pain
Biopsy may be obtained during test
Preparation of endoscopy
Stomach must be empty
Nothing by mouth for at least 8 hours prior to test
Patient receives medication for sedation and relaxation during test
Throat is numbed with a numbing spray prior to introducing scope
Side effects of endoscopy
Patient not permitted to drive for 12 hours following the test
Nurse assesses for swallowing and presence of gag reflex
Bulk forming laxatives (Psyllium)
Temporary treatment of constipation
decrease diarrhea in clients with diverticulosis and IBS.
Control stool for clients who have an ileostomy or colostomy.
Surfactant laxatives (Docusate sodium)
Treatment of constipation. Softening of fecal impaction.
Stimulant laxatives (Bisacodyl, senna)
Bowel preparation prior to surgery or diagnostic tests including colonoscopy. Short-term treatment of constipation caused by high-dose opioid use or slow intestinal transit.
Osmotic laxatives (Magnesium hydroxide, lactulose)
Draw water into the intestine to increase the mass of stool, stretching musculature, which results in peristalsis.
Low dose: prevents painful elimination
High dose: Client preparation prior to surgery or diagnostic tests
Adverse effects of laxatives
Gi irritation, rectal burning sensation, toxic magnesium levels, fluid retention, dehydration, and obstruction
Client Teaching/
Nursing Actions on laxatives
- Do not crush or chew enteric-coated tablets
- do not use bisacodyl suppositories on a regular basis,
- nurses to monitor intake and output, nurse to assess for dehydration
- instruct client to drink at least 8 to 10 glasses of water daily
Antidiarrheals
Diphenoxylate
Treat underlying cause of diarrhea.
Nurse to administer initial dose 5 mg and monitor client response, administering further medication as needed. Maximum dose 8 tabs/day. Instruct client to drink small amounts of clear liquids or commercial oral electrolyte solution to maintain electrolyte balance. Avoid drinking plain water and avoid caffeine.
Antidirrheal: Loperamide
To minimize manifestations of diarrhea
Instruct client to drink small amounts of clear liquids or commercial oral electrolyte solution to maintain electrolyte balance. Avoid drinking plain water and avoid caffeine.
Position for enema
Left side lying sim’s position
Foods contraindicated for colonoscopy
soup, milk and cream, coffee, red food coloring
large intestine in elimination structures
Cecum, ascending, transverse, descending, sigmoid, and rectum
clients is at greatest risk for serious complications when using the
Valsalva maneuver to expel feces
Clients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical
wound are at greater risk, such as cardiac irregularities and elevated blood pressure,
