Ch 30 bowel Flashcards by Taylor McMahan

The bacteria interact with the chyme, which produces a gas called

Flatus

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____ 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

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Infants will normally have bowel movements ____

Daily

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Children will accomplish voluntary control of elimination between the ages ___ and ___ years after their neuromuscular structures developed

2 and 3

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Peristalsis decreases as the individual ages making the elderly individuals more prone to ____ or hard stools that are difficult to pass

Constipation

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You must make certain your patient has had a bowel movement at least every ___ says to prevent constipation

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____ is the process of bowel elimination

Defecation

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The urge to defecate typically occurs around ____ minutes to ___ hour(s) after eating

30 min- 1Hr

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Newborns typically have black shiny sticky stools called ____

Meconium

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Several liquid or watery stools per day are classified as

Diarrhea

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A change in bowel habits can indicate

Cancer

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To determine the presence of occult blood a _____ year must be performed via stool sample

Guaiac test

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Documentation of bowel elimination should always include
1.
2.

Color

Amount

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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

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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

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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

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_____ blood is visible to the eye

Frank blood

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____ blood is hidden or not visible

Occult blood

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When doing a focused assessment to determine objective signs what do you do first

Assess the shape of abdomen

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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

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Name the bowel sound

Soft gurgles, irregular clicks, between 5 and 30 per minute

Normal bowel function

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Name the bowel sound

Fewer than 5 per minute

Hypoactive

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Name the bowel sound

More than 30 per min or continuous

Hyperactive

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Name the bowel sound

Excessively loud gurgling may be high pitched and tinkling in one quad and absent or decreased in the LLQ

Borborgymi

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_____ 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

1. Decreased activity level 2. Changes in food intake 3. Decreased fluid intake 4. Medication side effects 5. Surgery 6. Pregnancy 7. Depression 8. Aging 9. Laxative overuse 10. 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

1. Increase activity 2. Increase fluid and fiber intake 3. Provide privacy 4. Assist with positioning 5. Admin medications 6. 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

____ 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

1. Lactose intolerance 2. Med side effects 3. Anxiety and stress 4. Diverticulosis 5. Inflammatory processes 6. 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

1. When the patient arises each day 2. After each meal 3. 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

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

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