Bowel Elimination Flashcards
The small intestine hooks to the large intestine at the:
cecum
Main cause of rectal bleeding?
Hemorroids
Defecation:
bowel movement
A reflex affecting internal anal sphincter:
involuntary
Control comes from the external anal sphincter:
Voluntary
Act of defecation:
deep breath
contract abdominal muscles
contract pelvic floor muscles
Newborns and Infants:
meconium- 1st fecal material (black, tarry, odorless, sticky)
Toddlers:
begin to have some control between 18 or 24 months
School Age:
constipation may become an issue
Aging Adult:
Old people are obsessed with bowel movements = may become laxative dependent
Normal amount of fiber per day:
20-35 grams
Gas producing foods:
onions
cauliflower
beans
cabbage
Laxative causing foods:
bran prunes figs chocolate alcohol
Constipation causing foods:
cheese
pasta
eggs
lean meats
Peristalsis:
involuntary constriction and relaxation of the muscles of the intestine, creating wavelike movements that push the contents of the canal forward
Pregnancy:
as the fetus grows, pressure is exerted on the rectum, impairing passage of feces.
Surgery:
paralytic ileus, anesthesia blocks stimulation of muscles.
Paralytic Ileus:
(stoppage of peristalsis which lasts 24-48 hours) early activity and frequent assessment of bowel sounds are important during this time
Non-modiflabe
cannot change
Modiflabe
can change
Non-modiflabe
age
race
family history
Modiflabe
smoking
poor diet
lack of exercise
Symptoms of colorectal cancer:
change in bowel habits feeling of incomplete evacuation rectal bleeding or blood in stool abdominal pain unintentional weight loss
Flatus:
gas- adult forms 7-10 liters per day
Diarrhea:
characterized by an abnormal frequency and fluidity of fecal evacuations
How to prevent excessive flatulence:
limit carbonated drinks
don’t use straws
limit chewing gum
avoid gas forming foods
Cause of diarrhea:
stress medications allergies colon diseases antibiotics iron food intolerance surgery
Why do you need to make sure a patient is clean and dry after cleaning stool?
because stool is very acidic and can cause skin breakdown
Constipation:
having infrequent or difficult bowel movements
Causes of constipation:
low fiber low fluid intake change in routine chronic use of laxative diseases/disorders neurological disorders decreased activity irregular toileting habits lack of privacy
Main cause of constipation:
feces stays in the colon too long and all the water is reabsorbed.
Fecal Impaction:
collection of hardened feces in the rectum
Symptoms of fecal impaction:
anorexia
distended abdomen
nausea and vomiting
Causes of C. Diff:
antibiotics
surgery
chemotherapy
acquired from healthcare workers
Diagnostics for C.Diff:
enzyme linked immunoassay (ELIZA)
With C.Diff you must wash your hands with:
soap and water
With Subjective History, review of factors influencing elimination:
use of aids diet medications exercise fluid stress
Why do you need to chart intake/output?
because the patient is loosing fluid
Collection of stool specimen procedure:
void first defecate into containers do not place toilet paper in container free pf barium and edema solution use gloves
Occult blood testing:
checks for hidden blood in the stool
Occult blood test requires:
3 different specimens on 3 different days
Privacy:
alone if possible and safe
Timing:
after meals
Nutrition and Fluid:
fiber and water
Exercise:
early ambulation, bedside exercises
Positioning:
sitting, commode extension
If you can’t fix constipation naturally what do you do?
move to the pharmacologic methods
Suppository:
solid which melts at room temperature and patient holds.
Removal of impaction:
digital removal
Rectal Catheter:
flatus and distention relief
Can fleet enemas be delegated?
yes, they can be delegated
Hypertonic Enema:
draws water into the colon works in 5-10 minutes contains 90-120 mL of fluid adverse effect=retention of sodium example: fleet enema
Are enemas a sterile procedure?
no, they are not considered a sterile procedure.
How do you give a big enema?
give it slowly
Hypotonic enema:
distends colon, stimulates peristalsis and softens feces
takes 15-20 minutes to work
contains 500- 1000 mL of tap water
adverse effect: fluid, electrolyte imbalance, water intoxication
contraindicated: CHF, renal conditions
example: tap water
Isotonic enema:
distends colon, stimulates peristalsis and softens feces
takes 15-20 minutes to work
contains 500-1000 mL of saline
adverse effect- possible sodium retention
Soapsuds enema:
irritates mucosa, distends colon
works in 10-15 minutes
contains 500-1000 mL of water
irritates and may damage colonic mucosa
Oil enema:
lubricates the feces and colonic mucosa
works in 1/2 to 3 hours
contains 90-120 mL of oil
How to administer an enema:
explain procedure wash hands, don gloves provide privacy lubricate about 2.5-3 inches prime the tubing assist patient into Left Lateral Sims position ask patient to take a deep breath inset the enema tube (3-inches)
When removing fecal impaction:
may cause vagal stimulation and always check cardiac status. (use xylocaine because it is painful)
If the bowel diversion is on the left side:
the stool is solid
If the bowel diversion is on the right side:
the stool is liquid
