Ch 30 bowel Flashcards
The bacteria interact with the chyme, which produces a gas called
Flatus
____ or stretching out the intestinal walls and making them appear inflated stimulates the walls stretch receptors and sends impulses to the central nervous system which turn on signals to the muscular walls of the sigmoid colon causing the rectum to contract
Distention
Infants will normally have bowel movements ____
Daily
Children will accomplish voluntary control of elimination between the ages ___ and ___ years after their neuromuscular structures developed
2 and 3
Peristalsis decreases as the individual ages making the elderly individuals more prone to ____ or hard stools that are difficult to pass
Constipation
You must make certain your patient has had a bowel movement at least every ___ says to prevent constipation
3
____ is the process of bowel elimination
Defecation
The urge to defecate typically occurs around ____ minutes to ___ hour(s) after eating
30 min- 1Hr
Newborns typically have black shiny sticky stools called ____
Meconium
Several liquid or watery stools per day are classified as
Diarrhea
A change in bowel habits can indicate
Cancer
To determine the presence of occult blood a _____ year must be performed via stool sample
Guaiac test
Documentation of bowel elimination should always include
1.
2.
Color
Amount
Stool that appears fluffy, floats on water, and has a foil odor due to an abnormally high content of undigested fat and is called
Steatorrhea
Stool that is pale or clay colored indicated a lack of bile in the intestine which may be due to liver or gallbladder disease. Can also cause stool to be white
Know
Small amounts of bright red blood will indicate bleeding or hemorrhage of the colon
Larger amounts of bright red blood will indicate bleeding or hemorrhage of the colon
Large amounts of maroon colored blood indicates bleeding from small intestine
Stool that is black and tarry with a foul odor indicates bleeding from the stomach, blood has been partially digested giving it a black tarry appearance called Malena
Know
_____ blood is visible to the eye
Frank blood
____ blood is hidden or not visible
Occult blood
When doing a focused assessment to determine objective signs what do you do first
Assess the shape of abdomen
After checking the abdominal shape what do you do next during an assessment
Auscultate the Bowel sounds using the diaphragm surface and listen in all 4 quads and should be assessed once per shift
Name the bowel sound
Soft gurgles, irregular clicks, between 5 and 30 per minute
Normal bowel function
Name the bowel sound
Fewer than 5 per minute
Hypoactive
Name the bowel sound
More than 30 per min or continuous
Hyperactive
Name the bowel sound
Excessively loud gurgling may be high pitched and tinkling in one quad and absent or decreased in the LLQ
Borborgymi
_____ sounds May indicate hunger or if not hungry can indicate bowel obstruction
Borborgymi
____ May he heard when patient has diarrhea
Hyperactive
____ May indicate constipation
Hypoactive
An absence of bowel sounds indicated a problem and should be reported to
The health care provider
Avoid palpating the abdomen until you have assessed the bowel sounds because palpation may stimulate bowel sounds that we’re not there naturally
Know
A patient with severe constipation may complain of loss of appetite known as
Anorexia
Elderly people who are not physically active are prone to
Constipation
What are some factors that contribute to constipation
- Decreased activity level
- Changes in food intake
- Decreased fluid intake
- Medication side effects
- Surgery
- Pregnancy
- Depression
- Aging
- Laxative overuse
- Nerve damage or impairment
Which part of the stool do you obtain a sample from
Middle
How much fiber should you have daily
25-35 g of fiber qd
Nursing interventions for constipation
- Increase activity
- Increase fluid and fiber intake
- Provide privacy
- Assist with positioning
- Admin medications
- Admin enemas
Fluid intake should be maintained between ____ and ____ mL per day
1,500 to 2,500 mL
Stool softeners and those that add bulk are safer than using laxatives that stimulate peristalsis
Know
How many days should you change a face plate or wafer of ostomy
3-5 days
What is the temp for water when doing enema
105-110 F
How full should a colostomy bag be when you change it
1/3-1/2 full
Large volume enema is ___-____ amount of water
500-1000 ML
Continent ileostomy has to be changed every ____-___ hours
4-6 hours
What position do you put the patient in before performing enema
Left lateral sims
How long should you hold the enema before elimination
5-15 mins
When the vagus nerve is stimulated it can drop the heart rate as low as 30 to 40 bpm and cause constriction of the bronchioles of the lungs
Know
Signs and symptoms of vagus nerve stimulation
Sxs Chest pain Chest heaviness SOB or inability to breathe Dizziness Feeling like going to faint Nausea
Signs
Pallor
Clammy skin
Pulse rate under 60
Stop admin enema or removing impaction
If patient has any signs or symptoms of vagus nerve stimulation you should
Stop the enema Remove tube from rectum Place patient in supine position Assess pulse rate, skin color, and whether or not the patient is diaphporetic Call for assistance but don’t leave pt If pulse is below 60 place the patient in the shock position with head lower than feet Asses BP Supply oxygen if needed
How far should you insert an enema
4-6 inches
An ____ is a blockage of the movement of feces through the intestine by a mass of very hard stool. May occur in rectum, sigmoid flexure, or any part of large colon
Impaction
What is a common cause of constipation-impaction In elderly adults
Abuse of laxatives
Sometimes small amounts of diarrhea is a indication of
Impaction
Small amounts of liquid stool seepage or just smears in the underwear are more indicative of
Fecal impaction
If an impaction is not relieved an obstruction or perforation of the bowel wall can occur
Know
When your patient has a fecal impaction it typically requires a digital removal before a cleansing enema
Know
To make the procedure of fecal impaction removal less painful it is helpful to instill an oil retention enema ____ hr prior to digital removal
1
____ is a persistent desire to empty the bowel when no feces are present causing ineffective straining efforts
Tenesmus
What three age groups dehydrate quicker than young or middle aged adults so
Elderly; infants; and small children
____ that occurs frequently or lasts a long time can lead to fluid and electrolyte loss
Diarrhea
Factors contributing to diarrhea
- Lactose intolerance
- Med side effects
- Anxiety and stress
- Diverticulosis
- Inflammatory processes
- Food allergies
What can occur if a barium enema is not passed
Fecal impaction
____ is the destention of the abdomen or intestines Bc of gas
Typanites
____ means burp/belch
Eructation
____ and ____ is used to identify microorganisms infecting the stool and the antibiotics that will kill the microorganisms
Culture and sensitivity
___ and ___ test for presence of parasites and worms and their eggs
Ova and parasites
You should obtain a clear liquid diet during the first 24 hours of diarrhea caused by infection and inflammation
During the first 24 hours avoid serving extremely hot or cold liquids as they increase peristalsis
If diarrhea lasts longer 24-36 hours, full liquids along with any type of cooked fruits and veggies such as apple sauce and carrots can be given
Know
___ ___ is a common treatment for diarrhea
Apple pectin
Why do we check maconium stool on newborns
For drug test
____ ____ is where the voluntary control is lost
Fecal incontinence
Times to assist the patient with the bed pan
- When the patient arises each day
- After each meal
- Anytime the patient says that his or her bowels have to move
It is recommended to train the bowels to move within ___ hour after breakfast. The first meal of the day stimulates peristalsis
1 hour
____ is expelled intestinal gas
Flatus
____ is excessive has in the GI tract
Flatulance
What can cause flatulance
Laughing, chewing gum, yeast bread
A new stoma should be pink to red, shiny and moist.
Pallor or cyanosis or a dusky color indicates impaired blood supply, black depicts necrosis
Know
The correct size will fit around around the stoma and allow only a ___ to ___ inch of periostomal skin
1/16 to 1/8
Colostomies May be irrigated to evacuate stool due to contipation or irrigation may be used postoperatively for stoma locates In descending or sigmoid colon
Know
The goal when irrigating a descending or sigmoid colostomy, evacuate at the same time each day.
Know
Most common medicated enema is
Kayexalak enema
What is the function of return flow enema
Remove gas
What enema softens hard stool. Wait 30 mins before elimination
Oil retention enema
How high should the enema bag be above the patient
12-18 inches above hip level
Hold the rectal tube in place for ___
20 sec
The cleansing enema for small children is
100-250 mL
The amount for a cleansing enema for school age children is
250-500 mL
What’s the amount for a small vol enema
120 mL
Tap water enema
3
Rectal tube
22-32
Insert the enema ___-___ into the rectum
3-4 inches
If the patient complains of cramping during enema clamp the tubing for ___-___ seconds instruct the patient to take deep slow, breathes pursed lips or lower the container to decrease flow
15-30
Cover the patient and instruct them to hold the enema solutions for approx __-___ min to improve effectiveness of enema
5-15 min
Raise the bed 80-90 degrees making certain that toilet tissue and call light is within reach
Know
When admin. Prepackaged enema encourage the patient to hold the solution for ___ to ___ min
5-10 min
For oil retention enema the patient should be instructed to hold the oil for at least ___ min
30
When obtaining a stool specimen for culture and ova and parasites obtain ___ to ___ inches of formed stool
1-2 inch
What position should you use when removing a fecal impaction
Left lateral sims
When removing a fecal impaction you should generously lubricate your ___ finger to reduce discomfort
Index finger
When doing a fecal impaction removal flex the fiber toward the center of fecal mass, allowing you to break up the mass so it can be removed
Know
When changing a patients ostomy appliance, if patient is unable to use toilet what position should you place patient in
Low semi Fowler’s
