Bowel elimination Flashcards
Where do mechanical and chemical digestion start?
Mouth
What is the mouth’s role in digestion?
Mastication
Saliva to break dilute/soften food
How long does it take for food to travel from the top of the esophagus to the bottom?
15 seconds
What is located at the bottom of the esophagus?
Cardiac sphincter (LES)
What is the stomach’s role in digestion?
Temporary storage
What does the stomach secrete?
HCL - stomach acidity
Intrinsic factor - B12 absorption/normal RBC formation
Pepsin - digests proteins
Mucus - protect lining
What happens in a lack of B12?
Pernicious anemia
How long is the small intestine?
20 feet
What 3 sections make up the small intestine?
Duodenum, jejunum, ileum
Where does digestion end?
In the small intestine
What does the small intestine do?
Enzymes here break down fats, proteins, and carbs
Nutrients, vitamins, minerals are absorbed
How long is the duodenum?
8-11in
How long is the jejunum?
8ft
How long is the ileum?
12ft
Where does the absorption of nutrients primarily happen?
Duodenum
What happens in the large intestine?
Chyme is transformed into fecal matter
Absorption of water
Secretion of bicarb
Elimination of wastes and gas (flatus)
What are the sections of the LI?
Cecum
Colon (ascending, transverse, descending, sigmoid)
Rectum
Which has a wider diameter: small or large intestine?
Large
How much water and salt can a healthy person absorb from the LI?
1 gallon of water
1 oz of salt
What happens when peristalsis is abnormally fast?
Less time for absorption of water - diarrhea
What happens when peristalsis is abnormally slow?
More water absorption - constipation
What factors affect elimination?
Age Diet Fluid Intake Physical Activity Psychological Factors Personal Habits Position during Defecation Pain Pregnancy Surgery and Anesthesia Medications Diagnostic Tests
How does breastfeeding affect BM?
Stools will be bright yellow, soft, unformed
How does formula-feeding affect BM?
Darker yellow/tan, slightly more formed
At what age does voluntary BM happen?
2-3 years
When is a BM routine established
Adulthood
Do healthy adults normally develop constipation
Not necessarily
When is peristalsis strongest?
1 hr after eating
Why is fiber good for BM?
Efficient elimination
How do gas producing foods affect peristalsis?
Increase it
How does fluid intake affect BM?
Affects consistency of feces
How much should someone drink daily for normal BM?
1100-1400 mL daily
How does physical activity affect BM?
Promotes peristalsis
Prevents constipation
Maintain skeletal muscles (core) used during defecation
How do psychological factors affect BM?
Emotional stress - diarrhea
Depression – may result in constipation
What is the normal position for BM?
Squatting - harder to contract ab muscles when supine
What can cause pain during BM?
Hemorrhoids Rectal surgery Rectal fistulas Abdominal surgery Following childbirth
How do surgery/anesthesia affect BM?
Anesthesia slows peristalsis
What is paralytic ileus and how long does it usually last?
Bowel section has fallen asleep.
Pt cannot be fed until bowel sounds have returned or there’s risk for vomiting undigested contents
How is an NGT tube put in?
Water-soluble lubricating gel for the tip
Clean gloves
Emesis basin nearby
What type of tube should be used to NGT tubes?
Large-bore
14 or 16 french NG tube (Salem sump)
How do medications affect BM?
Can increase BM problems
What medications cause constipation?
Opioids
Anticholinergics
Iron supplements
What medications cause diarrhea?
Antibiotics
Allow proliferation of C. diff
What type of antacid will cause diarrhea?
Mg based
What type of antacid will cause constipation?
Al based
When does annual guaiac testing begin?
Age 50
What should be avoided before guaiac testing?
Avoid red meat, iron, ASA 72 hours prior to the test
What color indicates blood in a BM sample?
Blue
How often are colonoscopies?
5-10 years starting age 50
What is a stool culture used for?
Looking for atypical infectious agent, ova, and parasite
What is an endoscopic exam used for?
Looking at upper GI tract with scope
What is x-ray imaging used for?
Looking at upper or lower GI tract
Can used barium swallow or enema as marker
What is a sigmoidoscopy used for?
Lighted scope inserted to look at sigmoid colon
What is constipation?
Decreased frequency of BMs from what is normal for the individual
What are characteristics of constipated BM?
Hard, dry stool – difficult to pass
Incomplete emptying of the bowel
What is the etiology of constipation?
Inadequate bulk in the diet
Decreased activity
Decreased sensitivity to urge to defecate
Emotions – depression
What foods contribute to constipation?
Refined carbohydrates
Cheese
Bananas
Rice
How does constipation manifest?
Abdominal distention Bloating Flatulence Rectal pressure Hemorrhoids from straining
What is fecal impaction?
Unrelieved constipation followed by the passage of liquid stool
What is the etiology of fecal impaction?
Opioids, neurological conditions
How is fecal impaction diagnosed?
Presence of hard mass in the rectum
How does fecal impaction present?
Complaints of abdominal or rectal fullness/bloating
Urge to defecate but unable
Oozing of liquid feces around mass
Who is at risk for fecal impaction?
Confused, unconscious, opioid, otherwise impaired
What are interventions for constipation?
Increase fiber
Increase fluid intake (2-3L)
Regular exercise
Bowel routine
What can straining lead to?
Hemorrhoids
Increased intrathoracic -> vagus nerve stimulation -> bradycardia
What are pharmacologic interventions for constipation?
Bulk laxatives - Act in 24 hours Stool softeners - Act in 72 hours Saline laxatives - Act 15 min-overnight Stimulant laxatives - Act in 12 hours
How do stool softeners work?
Decrease surface tension of stool, allowing water to more readily enter the stool
What are saline laxatives?
Hyperosmolar solution
How do saline laxatives work?
They draw fluid into the GI tract, softening stool
How do laxatives work?
Irritate colon wall, stimulate muscle contraction
Why should chronic laxative use be avoided?
Can cause electrolyte imbalances
What is an enema?
Instillation of a solution into the rectum and sigmoid colon
What are small volume enemas?
Hypertonic solution to draw water from mucosa
Causes distension of rectum to trigger defecation
What is a large volume enema?
1000 mL enema
How do you insert an enema?
Position pt in Sims
Lubricate tip of enema tubing with water soluble lubricant
Insert tip in direction of umbilicus.
Adults – 4 inches, child 2-3 inches
What types of solution can be found in large volume enemas?
Normal saline
Tap water (hypotonic) - solution absorbed into interstitial space
Hypertonic solution - pull fluid from interstitial space
Soapsuds - irritate wall and promote peristalsis
Oil retention - loosen stool and promote evacuation
What causes diarrhea?
Viral - 48 hours Bacterial - Rotavirus - C. diff Parasitic - Giardia Food poisoning (toxins) - S. aureus food poisoning causes abdominal cramping within 1-3 hours
Why should one avoid an antidiarrheal unless instructed by PCP?
By inhibiting diarrhea, you’re impeding body of ridding itself of infection
What causes non-infectious diarrhea?
Sugar-free sweeteners Lactose intolerance Medications Radiation therapy Inflammatory colitis Crohn’s disease
How do you treat non-infectious diarrhea?
Decrease peristalsis - Immodium or Lomotil (Loperamide)
What is the BRAT diet?
Bananas
Rice
Applesauce
Toast
What is a bowel diversion?
Temporary or permanent artificial opening in the abdominal wall (stoma)
Ileum: ileostomy
Colon: colostomy
What is effluent from an ileostomy like and why?
Liquidy with fluid and electrolyte losses because colon is not reached to absorb Na and water
What is effluent from a colostomy like and why?
Ascending colon - liquid
Transverse colon - semi-formed
Sigmoid colon - normal
What are nutritional considerations for ostomy appliances?
Initially only clear liquids low in simple sugars
Low fiber diets
Advanced based on tolerance
A near-regular diet resumes in 6-8 weeks
Obtaining adequate fluid and electrolytes is a concern
May benefit from avoiding foods that cause gas and odor
How do you care for a patient with an ostomy?
Assess stoma
- Should appear moist, shiny and reddish-pink.
Assess peri-stomal skin
Report characteristics and volume of ostomy output
Can pouching established ostomies be delegated to CNAs?
Yes
How do you pouch an ostomy?
Pouch and skin barrier
Intact skin barriers may remain in place 3-7 days
Opening should be no more than 1/16 inch larger than the stoma
Check existing bag for gas accumulation
