bowel elimination Flashcards
What are hemorrhoids?
when the veins in the anal canal become abnormally distended
When is the rectum empty?
Immediatly before and after defecation
how much Chyme enters the large intestines daily?
1500 mL
how much water is absorbed in the large intestines?
800-1000 mL a day
how often does peristalsis take place?
mass sweeps?
every 3-12 minutes
one to 4 times in 24 hours
how much food is normally excreted in stool withing 24 hours?
about one third to one half
if someone has a heart condition, what should they be concerned about during defacation?
Bearing down too much can decrease blood flood to the atria and ventricles,
called the valasalva maneuver
what is an average count of BMs in a day for breast fed infants?
Bottle fed?
After they are one year old?
2-10
1 or 2
1 or 2
when does toddler bowel training become possible? when does it usually happen?
18-24 months
30 months
how much fluid is needed to facilitate good BM
2000-3000 mL
what are some constipating foods?
cheese, lean meat, eggs, pasta
what are some foods that have a laxative effect?
fruits and veggies, bran, chocolate, alcohol, coffee
what are some gas producing foods?
onions, cabbage, beans, cauliflower
what color would you expect to see the stool if a pt was taking aspirin or anticoagulants?
Iron salts?
antacids?
antibiotics?
pink to red to black stools
black
white discoloration or speckling in stool
green-grey color
what causes mechanical obstructions?
what are some?
pressure on the intestinal walls
tumors, stenosis, adhesions, hernias, and strictures
what causes functional obstructions?
what are some?
inability of the intestinal musculature to move the contents through the bowel
muscular systrophy, Parkinson’s, diabetes, and manipulation of the bowel during surgery
what is it called when the bowels stop moving because they were manipulated during surgery?
what considerations have to be made?
paralytic ileus
food and fluids are withheld for 24-28 hours
what influences the volume of stool?
what is normal?
special considerations?
the amount, type, and nature of the diet
varies
more roughage = more stool
consisant large diarrheal stools suggest problem with in small bowel or proximal colon
small frequent stools with urgeny suggest a disorder of the left colon or rectum
what is the normal color for stool?
what can influence this?
infant = yellow to bronw adult = brown
red meat and spinach = black absence of bile = white or clay colored medications bleeding (high in the tract is black low is fresh blood) standing too long darkens the stool
what is the normal odor of stool?
what can alter this?
pungent
affected by foods that are ingested
pH value (normal is neutral or slightly alkaline)
excessive putrefacation
presence of blood in stool
what is the normal consistency of stool?
what can effect this?
soft, semi solid and formed
food and fluid intake, and gastric motility
less time in = more liquid
longer time in = harder
what is the normal shape of stool and what can influence this ?
tubular, around 1 inch diameter
a obstruction can produce narrower stool, pencil shaped
rapid peristalisis thins stool
increased time in can result in a hard, marble like mass
what are the normal constituents of stool?
what can alter this?
bile, intestinal secretions, epithelial cells, bacteria, inorganic material, seeds, meat fibers, fat
internal bleeding, infetion, inflammation, and other pathological conditions
What foods can trigger a false positive for fecal occult blood?
what medications?
What can produce a false negative
red meat, liver, kidneys, fish, tomatoes, cauliflower, horseradish, turnips, melon, bananas, and soybeans.
salicylate of more than 325 mg, steroids, iron, anticoagulants
Vitamin C can produce a false negative even in the presence of bleeding
what is a common symptom of pinworms?
perianal itching
how should diagnostic tests be scheduled? give an example?
from least invasive to most invasive
fecal occult blood, barium studies, then endoscopic examinations
What is the name of a bulk forming laxative?
How does it work?
onset time?
Contraindications?
Metamucil
causes stool to absorb water and swell
within 24 hours
can interfere with calcium and iron and some meds
dont give to peoplewho are bedridden or have intestinal strictures
can be expensive
what is the name of a stool softener?
how does it work?
advantage
contraindications”?
Colace
agents with detergent that allow water and fat to penetrate and lubricate stool
Recommended for those who must refrain from straining
lubricant can interfere with fat soluable absorption
What is the name of an emollient?
how does it work
advantages
contraindications?
mineral oil
lubricates the intestinal tract and stops colonic absorption of water
effective within 8 hours
can interfere with fat soluable absorbtion and can be aspirated
what is the name of a stimulant laxative?
how does it work?
advantages?
contraindications?
Dulcolax
promotes peristalsis by irritating the intestinal mucosa or stimulating nerve endings
works faster than bulking agents
most abused causes lazy bowel syndrome can affect vitamin D and calcium absorption not recommended for elderly alters electrolyte transport
what is the name of a saline-osmotic laxative?
How does it work?
advantages?
contraindications?
MOM
draws water into intestines and stimulates peristalsis
used when rapid clearing is desired
no elderly
can produce dehydration
not recommended in patients with kidney disease or heart failure
what category does Paregoric belong to?
how does it work?
what are some cautions?
antidiarrheal, works on the smooth muscle
increases smooth muscle tone
decreases GI motility
Diminishes GI secretions
may be addictive ( opium)
May cause drowsiness and lightheadedness
discontinue after diarrhea subsides
how does Diphenoxylate and atropine work against diarrhea? (lomotil)
what are some cautions?
slows gastric motility through local effect on GI wall
is chemically related to morphine, can be addictive in high doses
can cause drowsiness
How does loperimide work against diarrhea?
advantages?
cautions?
inhibits peristalsis via direct effect on GI wall
not addictive, works longer than Lomotil
may cause drowsiness
must be discontinued of no improvemtn in 48 hours with acute cases
How doe Kaolin-pectin (Kaopectate) work to stop diarrhea?
what is an advantage?
cautions?
absorbs and soothes
Nondrowsy
can interfere with oral medications absorption and nutrient absorption
How does Bismuth-subsalicylate (Pepto) work to stop diarrhea?
advantages?
Cautions?
decreases GI secretions and has a antimicrobial action against bacterial and viral pathogens
no drowsiness
contains salicylate so check with physician before giving to children or administering asprin
may decrease absorption of medications
For a tap water enema ( hypotonic)
How much?
How does it work?
Onset?
adverse effects?
500-1000mL
distends intestines, increases peristalsis, softens stool
15 mins
fluid and electrolye imbalances and water intoxication
For a Normal Saline enema (isotonic)
How much?
How does it work?
Onset?
adverse effects?
500-1000 mL
distends intestines, increases peristalsis, softens stool.
15 mins
fluid and electrolyte imbalances, sodium retention
For a soap enema
How much?
How does it work?
Onset?
adverse effects?
500-1000mL (concentrate is 3-5mL/1000mL)
Distends intestines, irritates the intestinal mucosa, softens stool
10-15 minutes
rectal mucosa irritation or damage
For a hypertonic enemea
How much?
How does it work?
Onset?
adverse effects?
70-130 mL
distends intestines, irritates intestinal mucosa
5-10 minutes
sodium retention
For an oil enema
How much?
How does it work?
Onset?
adverse effects?
150-200 mL
lubricates stool and intestinal mucosa
30 mins
none
What are the types of retention enemas and what are they for?
oil retention - lubrication
carminiative - expel flatus (milk and molassas enema)
Medicated - absorb mediation through the rectal mucosa
Anthelmintic - destroy pathogens
