Ch 47: Bowel Elimination - SP Alterations

Question 1

Define Diarrhea

Answer 1

• Abnormal frequency and fluidity of fecal evacuations. It is characterized by:
  
  • Hyperactive bowel sounds
  • Urgency
  • Abdominal pain and cramping
• Caused by
  
  • Very quick movement of ingested material through the intestine.
  • Enough water is not absorbed, leaving the stool loose and watery.

Question 2

Contributing factors that cause diarrhea include:

Answer 2

• Food intolerance/pathogens
• Medication side effect
• Antibiotics use
• Enteral nutrition
• Excessive laxative use
• Diseases of the colon
• Psychological stress

Question 3

Clostridium difficile, or c-diff, is a common cause of…

Answer 3

frequent, foul-smelling diarrhea after receiving antibiotic therapy.

Question 4

What are two considerations of lifespan on bowel elimination patterns?

Answer 4

1. Children cannot control defecation until about the age of two years.
2. Older adults are at increased risk for developing constipation.

Question 5

How do disabilities play into bowel elimination?

Answer 5

• Patients with physical and cognitive impairments may experience difficulty with constipation and incontinence.
• Patients with neurological conditions, spinal cord injury or low LOC may lack recognition of the urge to defecate or have lost control of the muscles that control defecation

Question 6

How does diet effect bowel elimination?

Answer 6

High-fiber diet adds bulk to the stool, which maintains peristalsis and regular elimination patterns.

Question 7

What types of food are good for healthy stool?

Answer 7

grains, fresh fruits, and vegetables.

Question 8

How much fluid should be taken in for an adult to maintain regular bowel elimination patterns?

Answer 8

64-plus ounces per day

Question 9

What are some food intolerances that should be avoided to maintain regular elimination patterns?

Answer 9

• lactose,
• gluten,
• wheat, and
• spicy food

Question 10

Diseases associated with stress that effect bowel elimination include:

Answer 10

• Colitis
• Crohn’s disease
• Ulcers
• Irritable bowel syndrome

Question 11

How can bowel elminations be effected by patients with psychological depression?

Answer 11

Depression can slow peristalsis, resulting in constipation.

Question 12

What are two surgery related factors that can effect bowel elimination?

Answer 12

• General anesthesia decreases or stops peristalsis by blocking parasympathetic stimulation to the muscles of the colon.
• If the intestines are manipulated during surgery, intestinal movement stops, causing a paralytic ileus.

Question 13

What kind of medications increase the likelihood of diarrhea?

Answer 13

• Antibiotics
• Laxatives
• Cathartics
• Stool softeners

Question 14

What kind of medications increase the likelihood of constipation?

Answer 14

• Opioids
• Anticholinergics
• Histamine antagonists
• Antacids
• Calcium supplements
• Iron supplements

Question 15

What are the six types of colostomies?

Answer 15

1. Ascending
2. Transverse
3. Descending
4. Sigmoid
5. Double-barrel
6. Loop

Question 16

Location and stool characteristics of an Ascending colostomy.

Answer 16

• Location: First (ascending) segment of the colon; stoma located on the right side of the abdomen
• Stool characteristics: drainage similar to ileostomies—liquid and cannot be regulated; has an odor due to digestive enzymes
• Rarest type

Question 17

Location, stool characteristics and use of Transverse colostomy.

Answer 17

• Location:
  
  • Transverse segment of the colon;
  • stoma located in the upper, middle to right side of the abdomen
• Stool characteristics:
  
  • Drainage is semi-formed liquid and cannot be regulated; malodorous
• Often used in emergencies such as intestinal obstruction or perforation, as it can be created quickly

Question 18

What versions of colostomies can generally be found for Transverse colostomies?

Answer 18

• One opening (single-barrel),
• two openings (double-barrel), or
• loop

Question 19

Location, stool and other characteristics for Descending and Sigmoid colostomies?

Answer 19

• Location:
  
  • Final (descending or sigmoid) segment of the colon;
  • stoma usually located in lower left quadrant of abdomen;
  • descending colostomy stoma is located higher on the abdomen than the sigmoid stoma.
• Stool characteristics:
  
  • Well-formed stool that can be regulated; mild odor
• Does not require the patient to wear an appliance at all times.
• Most common type of ostomy

Question 20

Characteristics of the double-barrel colostomy:

Answer 20

• Brings two ends of bowel out onto the abdominal wall
• Results in two distinct stomas—functional proximal end and nonfunctional distal end
• Proximal one, closest to the small intestine, drains feces; distal one drains mucus
• Bowel between stomas is surgically severed

Question 21

Characteristics of the Loop colostomy:

Answer 21

• Temporary colostomy, usually created in an emergency
• Location:
  
  • On the right abdomen/transverse colon
• Involves bringing a loop of the bowel out onto the abdominal wall
• Has one stoma with two openings: the proximal end of the stoma discharges stool; the distal end may discharge mucus
• Results in a large stoma that may be difficult to manage because of its size and inability to be covered with available ostomy products

Question 22

An ileostomy is

Answer 22

a surgically created opening in the small intestine, usually at the end of the ileum that is brought through the abdominal wall to form a stoma.

Question 23

Characteristics of the ileostomy include:

Answer 23

• Can be temporary or permanent
• Involves removal of all or part of the colon, bypassing the large intestine
• Stool characteristics:
  
  • Liquid consistency and contains digestive enzymes and a high volume of water and electrolytes; minimal odor

Question 24

What are special considerations for the ileostomy?

Answer 24

• Drainage is not regulated, so it is important that patients wear an appliance continuously.
• Special precautions are needed to prevent skin breakdown from digestive enzymes.
• Fluids and electrolyte need monitoring.

Question 25

What are two alternatives to the ileostomy?

Answer 25

1. Ileonanal Pouch
2. Kock Pouch

Question 26

Describe the Ileoanal Pouch procedure.

Answer 26

• Removing the colon and most of the rectum
• Forming an internal pouch out of the terminal portion of the ileus
• Attaching the pouch to the anus so that the existing anal sphincter can be used for continence
• After the initial pouch creation, the patient has a temporary ileostomy to allow the anastomosis to heal

Question 27

Describe the Kock Pouch procedure.

Answer 27

• Connecting the terminal portion of the ileum to a reservoir pouch inside the abdomen
• Constructing a valve in the pouch and bringing out the stoma through the abdominal wall
• Accessing the pouch using a catheter several times a day to drain feces from the pouch

Question 28

Bowel alterations manifest as:

Answer 28

• diarrhea,
• incontinence,
• constipation, and
• impaction.

Question 29

Common factors that affect bowel elimination include…

Answer 29

• Age,
• disability,
• morphology,
• cultural, ethnic, and religious considerations.