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P&A II final > Bowel elimination > Flashcards

Bowel elimination Flashcards

1
Q

Where do mechanical and chemical digestion start?

A

Mouth

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2
Q

What is the mouth’s role in digestion?

A

Mastication

Saliva to break dilute/soften food

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3
Q

How long does it take for food to travel from the top of the esophagus to the bottom?

A

15 seconds

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4
Q

What is located at the bottom of the esophagus?

A

Cardiac sphincter (LES)

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5
Q

What is the stomach’s role in digestion?

A

Temporary storage

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6
Q

What does the stomach secrete?

A

HCL - stomach acidity
Intrinsic factor - B12 absorption/normal RBC formation
Pepsin - digests proteins
Mucus - protect lining

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7
Q

What happens in a lack of B12?

A

Pernicious anemia

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8
Q

How long is the small intestine?

A

20 feet

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9
Q

What 3 sections make up the small intestine?

A

Duodenum, jejunum, ileum

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10
Q

Where does digestion end?

A

In the small intestine

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11
Q

What does the small intestine do?

A

Enzymes here break down fats, proteins, and carbs

Nutrients, vitamins, minerals are absorbed

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12
Q

How long is the duodenum?

A

8-11in

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13
Q

How long is the jejunum?

A

8ft

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14
Q

How long is the ileum?

A

12ft

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15
Q

Where does the absorption of nutrients primarily happen?

A

Duodenum

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16
Q

What happens in the large intestine?

A

Chyme is transformed into fecal matter
Absorption of water
Secretion of bicarb
Elimination of wastes and gas (flatus)

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17
Q

What are the sections of the LI?

A

Cecum
Colon (ascending, transverse, descending, sigmoid)
Rectum

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18
Q

Which has a wider diameter: small or large intestine?

A

Large

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19
Q

How much water and salt can a healthy person absorb from the LI?

A

1 gallon of water

1 oz of salt

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20
Q

What happens when peristalsis is abnormally fast?

A

Less time for absorption of water - diarrhea

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21
Q

What happens when peristalsis is abnormally slow?

A

More water absorption - constipation

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22
Q

What factors affect elimination?

A 
Age
Diet
Fluid Intake
Physical Activity
Psychological Factors
Personal Habits
Position during Defecation
Pain
Pregnancy
Surgery and Anesthesia
Medications
Diagnostic Tests
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23
Q

How does breastfeeding affect BM?

A

Stools will be bright yellow, soft, unformed

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24
Q

How does formula-feeding affect BM?

A

Darker yellow/tan, slightly more formed

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25
Q

At what age does voluntary BM happen?

A

2-3 years

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26
Q

When is a BM routine established

A

Adulthood

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27
Q

Do healthy adults normally develop constipation

A

Not necessarily

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28
Q

When is peristalsis strongest?

A

1 hr after eating

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29
Q

Why is fiber good for BM?

A

Efficient elimination

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30
Q

How do gas producing foods affect peristalsis?

A

Increase it

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31
Q

How does fluid intake affect BM?

A

Affects consistency of feces

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32
Q

How much should someone drink daily for normal BM?

A

1100-1400 mL daily

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33
Q

How does physical activity affect BM?

A

Promotes peristalsis
Prevents constipation
Maintain skeletal muscles (core) used during defecation

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34
Q

How do psychological factors affect BM?

A

Emotional stress - diarrhea

Depression – may result in constipation

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35
Q

What is the normal position for BM?

A

Squatting - harder to contract ab muscles when supine

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36
Q

What can cause pain during BM?

A 
Hemorrhoids
Rectal surgery
Rectal fistulas
Abdominal surgery
Following childbirth
37
Q

How do surgery/anesthesia affect BM?

A

Anesthesia slows peristalsis

38
Q

What is paralytic ileus and how long does it usually last?

A

Bowel section has fallen asleep.

Pt cannot be fed until bowel sounds have returned or there’s risk for vomiting undigested contents

39
Q

How is an NGT tube put in?

A

Water-soluble lubricating gel for the tip
Clean gloves
Emesis basin nearby

40
Q

What type of tube should be used to NGT tubes?

A

Large-bore

14 or 16 french NG tube (Salem sump)

41
Q

How do medications affect BM?

A

Can increase BM problems

42
Q

What medications cause constipation?

A

Opioids
Anticholinergics
Iron supplements

43
Q

What medications cause diarrhea?

A

Antibiotics

Allow proliferation of C. diff

44
Q

What type of antacid will cause diarrhea?

A

Mg based

45
Q

What type of antacid will cause constipation?

A

Al based

46
Q

When does annual guaiac testing begin?

A

Age 50

47
Q

What should be avoided before guaiac testing?

A

Avoid red meat, iron, ASA 72 hours prior to the test

48
Q

What color indicates blood in a BM sample?

A

Blue

49
Q

How often are colonoscopies?

A

5-10 years starting age 50

50
Q

What is a stool culture used for?

A

Looking for atypical infectious agent, ova, and parasite

51
Q

What is an endoscopic exam used for?

A

Looking at upper GI tract with scope

52
Q

What is x-ray imaging used for?

A

Looking at upper or lower GI tract

Can used barium swallow or enema as marker

53
Q

What is a sigmoidoscopy used for?

A

Lighted scope inserted to look at sigmoid colon

54
Q

What is constipation?

A

Decreased frequency of BMs from what is normal for the individual

55
Q

What are characteristics of constipated BM?

A

Hard, dry stool – difficult to pass

Incomplete emptying of the bowel

56
Q

What is the etiology of constipation?

A

Inadequate bulk in the diet
Decreased activity
Decreased sensitivity to urge to defecate
Emotions – depression

57
Q

What foods contribute to constipation?

A

Refined carbohydrates
Cheese
Bananas
Rice

58
Q

How does constipation manifest?

A 
Abdominal distention
Bloating
Flatulence
Rectal pressure
Hemorrhoids from straining
59
Q

What is fecal impaction?

A

Unrelieved constipation followed by the passage of liquid stool

60
Q

What is the etiology of fecal impaction?

A

Opioids, neurological conditions

61
Q

How is fecal impaction diagnosed?

A

Presence of hard mass in the rectum

62
Q

How does fecal impaction present?

A

Complaints of abdominal or rectal fullness/bloating
Urge to defecate but unable
Oozing of liquid feces around mass

63
Q

Who is at risk for fecal impaction?

A

Confused, unconscious, opioid, otherwise impaired

64
Q

What are interventions for constipation?

A

Increase fiber
Increase fluid intake (2-3L)
Regular exercise
Bowel routine

65
Q

What can straining lead to?

A

Hemorrhoids

Increased intrathoracic -> vagus nerve stimulation -> bradycardia

66
Q

What are pharmacologic interventions for constipation?

A 
Bulk laxatives
- Act in 24 hours
Stool softeners
- Act in 72 hours
Saline laxatives
- Act 15 min-overnight
Stimulant laxatives
- Act in 12 hours
67
Q

How do stool softeners work?

A

Decrease surface tension of stool, allowing water to more readily enter the stool

68
Q

What are saline laxatives?

A

Hyperosmolar solution

69
Q

How do saline laxatives work?

A

They draw fluid into the GI tract, softening stool

70
Q

How do laxatives work?

A

Irritate colon wall, stimulate muscle contraction

71
Q

Why should chronic laxative use be avoided?

A

Can cause electrolyte imbalances

72
Q

What is an enema?

A

Instillation of a solution into the rectum and sigmoid colon

73
Q

What are small volume enemas?

A

Hypertonic solution to draw water from mucosa

Causes distension of rectum to trigger defecation

74
Q

What is a large volume enema?

A

1000 mL enema

75
Q

How do you insert an enema?

A

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

76
Q

What types of solution can be found in large volume enemas?

A

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

77
Q

What causes diarrhea?

A 
Viral - 48 hours
Bacterial
- Rotavirus
- C. diff
Parasitic
- Giardia 
Food poisoning (toxins)
- S. aureus food poisoning causes abdominal cramping within 1-3 hours
78
Q

Why should one avoid an antidiarrheal unless instructed by PCP?

A

By inhibiting diarrhea, you’re impeding body of ridding itself of infection

79
Q

What causes non-infectious diarrhea?

A 
Sugar-free sweeteners Lactose intolerance
Medications
Radiation therapy
Inflammatory colitis
Crohn’s disease
80
Q

How do you treat non-infectious diarrhea?

A

Decrease peristalsis - Immodium or Lomotil (Loperamide)

81
Q

What is the BRAT diet?

A

Bananas
Rice
Applesauce
Toast

82
Q

What is a bowel diversion?

A

Temporary or permanent artificial opening in the abdominal wall (stoma)
Ileum: ileostomy
Colon: colostomy

83
Q

What is effluent from an ileostomy like and why?

A

Liquidy with fluid and electrolyte losses because colon is not reached to absorb Na and water

84
Q

What is effluent from a colostomy like and why?

A

Ascending colon - liquid
Transverse colon - semi-formed
Sigmoid colon - normal

85
Q

What are nutritional considerations for ostomy appliances?

A

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

86
Q

How do you care for a patient with an ostomy?

A

Assess stoma
- Should appear moist, shiny and reddish-pink.
Assess peri-stomal skin
Report characteristics and volume of ostomy output

87
Q

Can pouching established ostomies be delegated to CNAs?

A

Yes

88
Q

How do you pouch an ostomy?

A

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

P&A II final (6 decks)

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