Bowel Elimination Flashcards
Functions of GI Tract
- Prepare food for absorption & use
- Absorb nutrients and fluid
- Temporary storage of waste
- Electrolyte balancing
- Remove secretions [gallbladder, pancreas]
GI Tract Parts
- Mouth
- Esophagus
- Stomach
- Small Intestine (Duodenum, Jejunum, Ileum)
- Large Intestine
- Anus
Mouth: Function and Essential Elements
Function: mechanical and chemical breakdown
Essential Elements: Saliva, teeth, tongue, swallowing
Esophagus: Function and Essential Elements
Function: to stomach, airway protection
Essential Elements: 2 sphincters- upper and lower prevent reflux
Stomach: Function and Essential Elements
Function: storage, mixing, emptying
Essential Elements: HCL, pepsin (protein breakdown), mucous (protection, intrinsic factor (B12)
Small Intestine: Function and Essential Elements
Function: digestion and absorption of most nutrients
Essential Elements:
1. Duodenum (10”) processes chyme
2. Jejunum (8”) absorbs carbs, protein
3. Ileum (12”) absorbs H2O, fat, salts, vitamins, iron
Alterations in Small Intestine
- malabsorption
- nutrient deficiency
- electrolyte imbalance
Large Intestine: Function and Essential Elements
Function: organ of elimination Essential Elements: 1. Absorption of H2O depends on SPEED 2. Bicarb exchanged for chloride, K+ excreted 3. Essential bacteria
Anus: function and Essential Elements
Function: Sphincters
Essential Element: CNS Control
Elimination relies on:
- GI function
- CNS Control
- Sensation
- Moderate Peristalsis
Factors Affecting Elimination
- Age & Development
- Diet
- Fluid [1,500-2,000 ml/day for normal stool]
- Activity: promotes peristalsis and tone
- Psychosocial
- Position [bedbound], pain or pregnancy
- Surgery, anesthesia causes decrease in peristalsis, ileus
- Medications affecting elimination, elimination also affects medications.
Factors Affecting Elimination by Age & Development
Infant- small capacity, increase speed, no control
Older adult- low efficiency/motility/sensation
low absorption, protein synthesis, constipation
Factors Affecting Elimination by Diet
- fiber, gas-producing foods increase motility
- lack of enzyme leads to food intolerance (lactose, gluten)
Factors Affecting Elimination by Psychosocial Factors
Stress, depression, access
Privacy, cleanliness and impaired ability may lead to ignoring urge, constipation.
Embarrassment may cause delay in seeking help.
Factors Affecting Elimination by Medications
Analgesics- opioids slow peristalsis
Include: NSAIDS and ASA (irritation, bleeding, low protective mucous)
Antibiotics- disrupt flora which lead to diarrhea
How Elimination Affects Medication
Motility may affect absorption, excretion; which affects timing & effectiveness, side effects
Alterations in Elimination
- Constipation
- Impaction
- Diarrhea
- Incontinence
- Flatulence
- Hemorrhoids
- Neurogenic Bowel- lack of innervation
Surgical Alterations
- G-tubes & J-tubes for feeding
- Ostomies for elimination
- name refers to site; ileostomy, colostomy
- site determines consistency of effluent, nutritional deficiencies likely
- may be reversed or permanent
Nursing Diagnosis for Elimination
- Altered Elimination: constipation/Diarrhea
- Self-Care deficit
- Knowledge deficit
- [Risk for or Actual] Fluid/ Electrolyte Imbalance
- Pain
- Nutrition: less than body requirements r/t altered digestion, elimination, absorption
Nursing Assessment
- diet and intake
- elimination pattern “usual” and new
- bowel sounds, palpation & observation
- medications
- activity
- age
- appearance of stool:
- tarry/bright red smear- blood
- pale/clay- mucous, fatty
Goals for Elimination: Overall
Return to normal elimination pattern
-patient reports passing soft, formed stool daily w/o pain
Goals for Elimination: Short Term
Short term goals support modifiable factors
- patient will increase fluid intake to 1,500ml/day
- patient will walk to end of hall and back 3x today
Goals for Altered Patterns
- pt will correctly demonstrate ostomy care by end of week
- pt will independently perform catheter care after breakfast today
- pt will choose a nutritionally balanced diet incorporating gluten-free foods from a list
Nursing Interventions
- Promote normal elimination when possible
- position, privacy, pain management, safety - Advancing diets: clear, soft, regular
- Special diets: lactose free, gluten free, high fiber, and fluid restriction
- Activity
- Medications: laxatives, softeners, fiber, cathartics, anti-diarrheals
- Enemas
- Ostomy Care
- assessment, irrigation, change bag, skin care - NG tubes: for decompression, removal of gas/secretions, feeding, taking meds
- Bowel Training
- Education: Pt and family
- vagal response [cardiac], fluid restriction, meds, diet, new Dx, post-op, when to call M.D
Nursing Evaluation
- was goal met?
- Goal Met: Patient passed soft formed brown stool w/o pain today. continue with plan of care.
- Advance education as patient progresses in ability and comfort, general health
What could cause alterations in elimination that reflect problems in the GI tract or elsewhere?
Neuro, cancer, GI tract problems, liver, kidneys
“normal” elimination
Different for each person
Where does absorption of nurtrients begin?
The small intestine
Feces- 75%, 25%
75% water, 25% solids (bacteria, fiber, fat, inorganic matter, protein)
What is the antibiotic for C. Dif?
Flagyl. C.Dif is very contagious. example from class- can be transmitted by touching a door knob
What is chyme?
Undigested food
How long does it take for food to reach the large intestine?
3 hours
Anus spinchters (CNS control)
Tells us when to push food out
Hyperkalcemia PT
Will be given meds (kayexalate) to poop
When do new borns usually have a bowl movement?
24-28 hours after birth
Who usually abuses laxatives?
Elderly, eating disorders
How much fluid intake is needed for normal stools?
1.5-2 liters (changes depending on condition)
What age group may ignore an urge to go potty?
Toddlers
Are caffeinated beverages included in normal fluid intake?
no
Why would pregnancy affect bowl elimination?
Hemorrhoids because of pressure
ASA
Aspirin
What are black tarry stools indicative of?
Upper GI issues
What are bright red stools indicative of?
Lower GI issues
What is Imodium?
Drug used to treat diarrhea
What is a side effect of anesthesia from surgery?
Decreased motility
Where are G tubes placed?
The stomach
Where are J tubes?
The jejunum
Steatorrhea
Fatty stools
What could mucus in the stools be indicative of?
Ulcer colitis, parasites
What could pain after a fatty meal be indicative of?
Gall bladder inflammation
Five F’s
Fat, Female, Forties, Flatulent, Fertile
What is the overall goal for elimination?
To return to normal elimination pattern
What sign is used to test for an inflamed appendix?
Murpheys sign- rebound tenderness
