ch 47 potter bowel elimination Flashcards
1
Q
is a single tube that extends from the mouth to the anus and includes the mouth, esophagus, stomach, and intestines
A
alimentary canal
2
Q
of the alimentary canal and its accessory organs
A
GI tract consists
3
Q
are the teeth, tongue, salivary glands, liver, pancreas, and gallbladder
A
accessory organs
4
Q
absorbs high volumes of fluids, making fluid and electrolyte balance a key function of the GI system.
A
GI tract absorbs
5
Q
from the gallbladder and pancreas.
A
GI tract also receives secretions
6
Q
chew food, breaking it down into a size suitable for swallowing
A
teeth
7
Q
produced by the salivary glands in the mouth, dilutes and softens the food in the mouth for easier swallowing
A
Saliva
8
Q
, a circular muscle that prevents air from entering the esophagus and food from refluxing into the throat.
A
upper esophageal sphincter
9
Q
travels down the esophagus with the aid of peristalsis, which is a contraction that propels food through the length of the GI tract.
A
bolus of food
10
Q
which lies between the esophagus and the upper end of the stomach
A
cardiac sphincter,
11
Q
prevents reflux of stomach contents back into the esophagus.
A
sphincter
12
Q
storage of swallowed food and liquid, mixing of food with digestive juices into a substance called chyme, and regulated emptying of its contents into the small intestine.
A
stomach performs 3 tasks:
13
Q
hydrochloric acid (HCl), mucus, the enzyme pepsin, and intrinsic factor
A
stomach produces and secretes
14
Q
help to digest protein.
A
Pepsin and HCl
15
Q
protects the stomach mucosa from acidity and enzyme activity.
A
Mucus
16
Q
is essential in the absorption of vitamin B12.
A
Intrinsic factor (protein)
17
Q
facilitates both digestion and absorption
A
Movement within the small intestine, occurring by peristalsis,
18
Q
the duodenum, the jejunum, and the ileum.
A
small intestine is divided into 3 sections
19
Q
carbohydrates and proteins.
A
jejunum (2nd part of intestines)
20
Q
absorb most nutrients and electrolytes in the small intestine.
A
duodenum and jejunum
21
Q
is approximately 3.7 m (12 feet) long and absorbs water, fats, and bile salts, vitamins, iron
A
ileum
22
Q
enter the small intestine from the pancreas and the liver to further break down nutrients into a form usable by the body.
A
Digestive enzymes and bile
23
Q
lower GI tract is called the large intestine or colon because it is larger in diameter than the small intestine.
A
large intestine or colon
24
Q
the cecum, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum.
A
large intestine is divided into
25
large intestine is the
primary organ of bowel elimination.
26
waves of peristalsis through the ileocecal valve (i.e., a circular muscle layer that prevents regurgitation back into the small intestine)
Digestive fluid enters the large intestine by
27
allows it to accommodate and eliminate large quantities of waste and gas (flatus).
muscular tissue of the colon a
28
absorption, secretion, and elimination.
colon has 3 functions:
29
resorbs a large volume of water (up to 1.5 L) and significant amounts of sodium and chloride daily
colon resorbs
30
peristalsis is abnormally fast, there is less time for water to be absorbed, and
the stool will be watery.
31
peristaltic contractions slow down, water continues to be absorbed,
hard mass of stool forms, resulting in constipation .
32
pushes undigested food toward the rectum
Mass peristalsis
33
contains vertical and transverse folds of tissue that help to control expulsion of fecal contents during defecation
rectum
34
Each fold contains veins that can become distended from pressure during straining. This distention results in
hemorrhoid formation.
35
contains a rich supply of sensory nerves that allow people to tell when there is solid, liquid, or gas that needs to be expelled and aids in maintaining continence.
anal canal
36
have a smaller stomach capacity, less secretion of digestive enzymes, and more rapid intestinal peristalsis
Infants
37
experience rapid growth and increased metabolic rate
Adolescents
38
may have decreased chewing ability. Partially chewed food is not digested as easily.
- Peristalsis declines, and esophageal emptying slows.
- Muscle tone in the perineal floor and anal sphincter weakens, which sometimes causes difficulty in controlling defecation
Older adults
39
the digestive process is accelerated, and peristalsis is increased. Side effects of increased peristalsis include diarrhea and gaseous distention.
emotional stress impacts bowel elimination
40
the autonomic nervous system may slow impulses that decrease peristalsis, resulting in constipation.
depressed impacts bowel elimination
41
Slowing of peristalsis during the third trimester often leads to constipation.
third trimester (pregnancy)
42
block parasympathetic impulses to the intestinal musculature
Inhaled anesthetic agents
43
Any surgery that involves direct manipulation of the bowel temporarily stops peristalsis. This condition, called an ileus, usually lasts about 24 to 48 hours.
ileus
44
often resulting in constipation
opioid analgesics slow peristalsis and contractions
45
in diarrhea
antibiotics decrease intestinal bacterial flora, often resulting
46
objective measure of stool characteristics
Bristol Stool Form Scale
47
that alter defecation or fecal characteristics.
laxatives, antacids, iron supplements, and analgesics
48
Observable peristalsis is often
a sign of intestinal obstruction
49
occur with small intestine obstruction and inflammatory disorders.
High-pitched and hyperactive bowel sounds
50
with an ileus such as after abdominal surgery but may also mean that you did not capture the bowel sounds when you were assessing them.
Absent (no auscultated bowel sounds) or hypoactive sounds occur
51
identifies underlying abdominal structures and detects lesions, fluid, or gas within the abdomen.
-Masses, tumors, and fluid are dull to percussion.
Percussion on abdomen
52
Gas or flatulence creates a
tympanic note
53
is to have soft-formed, painless bowel movements
Normal hemorrhoids should be
54
Proper diet, fluids, and regular exercise improve the likelihood of stools being soft
improve stools by
55
, passage of hard stools causes bleeding and irritation
signs for constipation
56
ice pack or a warm sitz bath provides temporary relief of swollen hemorrhoids
-physician can prescribe topical medication for pain & swelling
relief for hemorrhoids
57
help determine whether anemia from GI bleeding is present
hemoglobin and hematocrit (usually no laboratory test can be done for GI disorders)
58
serum amylase, and serum lipase, which are used to assess for hepatobiliary diseases and pancreatitis.
liver function tests (by HCP)
59
infant: yellow;
adult: brown
fecal colors (normal)
60
infant 4 to 6 times daily (breastfed) or
| 1 to 3 times daily (bottle-fed);
infant fecal frequency
61
adult twice daily to 3 times a week
adult fecal frequency
62
Iron ingestion or gastrointestinal (GI) bleeding
Black or tarry (melena)
63
GI bleeding, hemorrhoids, ingestion of beets
Red fecal
64
Malabsorption of fat
pale and oily
65
Blood in feces or infection
Noxious change
66
Diarrhea, reduced absorption
liquid fecal (consistency)
67
Constipation
Hard (consistency)
68
Infant more than 6 times daily (Hypermotility)
| or less than once every 1 to 2 days; (hypomotility)
Hypermotility or hypomotility (abnormal infant fecal)
69
Narrow, pencil shaped
Obstruction, increased peristalsis (fecal shape)
70
Internal bleeding, infection, swallowed objects, irritation, inflammation, infestation of parasites
Blood, pus, foreign bodies, mucus, worms (stuff seen with fecal meaning)
71
Malabsorption syndrome, enteritis, pancreatic disease, surgical resection of intestine
Oily stool (Constituents)/things seen in fecal
72
Intestinal irritation, inflammation, infection, or injury
Mucus(Constituents)/things seen in fecal
73
require the stool to be warm.
tests such as measurement for ova and parasites
74
Collect about a 3-cm (1-inch) mass of formed stool or 15 to 30 mL of liquid stool.
- Tests for measuring the output of fecal fat require a 3- to 5-day collection of stool
test amount needed to be collected for stools (for culture/blood in stool observed)
75
which measures microscopic amounts of blood in the feces.
- useful screening test for colon cancer
- All positive tests are followed up with flexible sigmoidoscopy or colonoscopy
fecal occult blood test (FOBT)
76
1. guaiac fecal occult blood test (gFOBT) (most common)
| 2. fecal immunochemical test (FIT) (more expensive)
two types of tests (for fecal)
77
repeat the test at least 3 times on three separate bowel movements
is done in a patient’s home or health care provider’s office
-FOBT(fecal occult blood test)
78
, it is important to instruct them to avoid eating red meat for 3 days before testing
- if no contraindications stop taking aspirin, ibuprofen, naproxen, or other nonsteroidal antiinflammatory drugs for 7 days because these could cause a false-positive test result.
- avoid vitamin C supplements and citrus fruits and juices for 3 days before the test because they can cause a false-negative result
gFOBT significane
79
such as a colonoscopy require bowel preparation (bowel prep) for the test to be completed successfully
radiological and diagnostic examinations requirement (ex colonoscopy)
80
Examinations such as a gastroscopy or colonoscopy use a lighted fiberoptic tube
- done under sedation,, usually outpatient centers
- bowel preparation necessary Before colonoscopy
Endoscopy (Direct Visualization)//radiological and diagnostic examinations
81
Measures the pressure activity of internal and external anal sphincters and reflexes during rectal distention, relaxation during straining, and rectal sensation.
Anorectal Manometry (Indirect Visualization)
82
simple x-ray film of the abdomen requiring no preparation.
plain Film of Abdomen/Kidneys, Ureter, Bladder (KUB)
83
- x-ray film examination using an opaque contrast medium (barium, which is swallowed) to examine the structure and motility of the upper GI tract, including pharynx, esophagus, and stomach
- preparation required
- usually includes a clear liquid diet, laxatives the day before the procedure, and in some instances enemas to empty out any remaining stool particles.
Barium Swallow/Enema
84
technique that uses high-frequency sound waves to echo off body organs, creating a picture of the GI tract
Ultrasound Imaging
85
x-ray examination of the body from many angles using a scanner analyzed by a computer.
- An oral contrast solution for the patient to drink may be ordered before the test.
- Intravenous contrast solution may be injected during the test to improve visualization. If contrast is used,
- patient should not have food or fluids for 4 to 6 hours before the examination.
- requires bowel preparation before the test
- does not replace the colonoscopy because it does not allow for removal of polyps and for biopsies to be obtained.
Computed Tomography Scan (Virtual Colonoscopy)
86
- swallows a capsule containing radiopaque markers.
• The patient maintains his or her normal diet and fluid intake for 5 days and refrains from medications that affect bowel function.
- On the fifth day x-ray film examination is performed.
Colonic Transit Study
87
- noninvasive examination that uses magnet and radio waves to produce a picture of the inside of the body
- Preparation is NPO 4 to 6 hours before examination.
- claustrophobia is a problem, light sedation may be ordered.
- No metallic objects,
- contraindicated patient has a pacemaker or a metal implanted
Magnetic Resonance Imaging
88
leg lifts
increases peristalsis (type exercise to do)
89
and are an effective way to relieve constipation and promote normal bowel function when used on a short-term basis
Stimulant laxatives increase peristalsis (relieve constipation)
90
- age > 50
- history Lynch syndrome
- black ppl
- High intake of red meat and processed meats such as lunch meats or hot dogs
- obese
- smoke
- alcohol
risk factors for Colorectal cancer (3rd most common cancer in US)
91
* Change in bowel habits (e.g., diarrhea, constipation, narrowing of stool lasting more than few days)
* Rectal bleeding or blood in stool
* Sensation of incomplete evacuation
* Unexplained abdominal or back pain
Warning Signs for Colorectal cancer (3rd most common cancer in US)
92
1. regular bedpan, made of plastic=has a curved smooth upper end and a sharper-edged lower end and is about 5 cm (2 inches) deep.
2. smaller fracture pan= designed for patients with lower-extremity fractures, has a shallow upper end about 2.5 cm (1 inch) deep.
Two types of bedpans are available
93
- head of the bed elevated 30 to 45 degrees
- patients are immobile or it is unsafe to allow them to raise their hips, it is safest for both caregivers and patients to roll them on to the bedpan
- --Never try to lift a patient onto a bedpan
proper placing for patients on bedpan
94
if the patient had a total hip replacement
fracture pan
95
Changes in a patient’s fluid status, mobility patterns, nutrition, and sleep cycle affect regular bowel habits.
acute illnesses the GI system becomes affected. by
96
have the short-term action of emptying the bowel.
- used to cleanse the bowel for patients undergoing GI tests and abdominal surgery.
- cathartics generally have a stronger and more rapid effect on the intestines.
Laxatives and cathartics
97
laxative (suppository)
- promotes defecation
- act within 30 minutes.
- Give the suppository shortly before a patient’s usual time to defecate or immediately after a meal.
bisacodyl (medication/suppository)
98
- Passage of stool will occur in 12 to 24 hours.
- agents must be taken with water and should be used with patients who have an adequate food and fluid intake.
- choice for chronic constipation (e.g., pregnancy, low-residue diet).
- They also relieve mild diarrhea. If treating diarrhea, administer less water.
- RISK: IF powder form cause constipation if not mixed with at least 240 mL of water or juice and swallowed quickly.
- RISK:are not for patients for whom large fluid intake is contraindicated.
Methylcellulose (Citrucel) //BULK FORMING LAXATIVE MED.
Psyllium (Metamucil, Naturacil)
Polycarbophil (Fibercon)
99
- little value for treatment of chronic constipation
- short-term therapy to relieve straining on defecation (e.g., hemorrhoids, perianal surgery, pregnancy, recovery from myocardial infarction).
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Docusate sodium (Colace)//Emollient or Wetting LAXATIVE MED.
Docusate calcium (Surfak)
Docusate potassium (Dialose)
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100
-pull fluid into the bowel to soften the stool and distend the bowel to stimulate peristalsis.
-only for acute emptying of bowel (e.g., endoscopic examination, suspected poisoning, acute constipation).
-Agents may be used to treat chronic constipation.
-RISK :not for long-term management of constipation or for patients with kidney dysfunction. They may cause toxic buildup of magnesium.
Phosphate salts are not recommended for patients on fluid restriction.
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Saline-based//OSMOTIC LAXATIVE MED.
Magnesium citrate or citrate of magnesia
Magnesium hydroxide (Milk of Magnesia)
Sodium phosphate (Fleet Phospho-Soda)
Polyethylene glycol, lactulose, sorbitol based, Lactulose, Miralax
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101
-drugs cause formation of a soft-to-liquid stool in 6 to 8 hours and usually contain bisacodyl or Senna.
-only used used occasionally
-prepare bowel for diagnostic procedures or may be needed for those with constipation from frequent opioid use
-RISKS: severe cramping.
Agents are not for long-term use.
Chronic use could cause fluid and electrolyte imbalances
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Bisacodyl (Dulcolax)//Stimulant Cathartics (similar to laxative med)
Castor oil
Casanthranol (Peri-Colace)
Correctol
Senna (Ex-Lax, Senokot)
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102
decrease intestinal muscle tone to slow the passage of feces.
Antidiarrheal agents
103
an antibiotic may be used for treatment
if infection is the causative factor of diarrhea =
104
steroids may be given
if inflammation is the cause diarrhea
105
may be used for management of chronic severe diarrhea in patients with diseases such as Crohn’s disease, ulcerative colitis, and acquired immunodeficiency syndrome (AIDS).
Codeine or tincture of opium (diarrhea medication)
106
is the instillation of a solution into the rectum and sigmoid colon.
- promote defecation by stimulating peristalsis.
- also vehicle for medications that exert a local effect on rectal mucosa.
- most commonly for the immediate relief of constipation, emptying the bowel before diagnostic tests or surgery, and beginning a program of bowel training.
enema
107
receive only normal saline because they are at greater risk for fluid imbalance.
Infants and children (type solution used for enema)
108
include tap water, normal saline, soapsuds solution, and low-volume hypertonic saline.
enema (type of solutions)
109
is hypotonic and exerts an osmotic pressure lower than fluid in interstitial spaces.
-use caution: if ordered to repeat tap-water enemas because water toxicity or circulatory overload develops if the body absorbs large amounts of water.
Tap water (type of enema)
110
safest solution to use because it exerts the same osmotic pressure as fluids in interstitial spaces surrounding the bowel
-stimulates peristalsis
Normal saline(type of enema)
111
- infused into the bowel exert osmotic pressure that pulls fluids out of interstitial spaces.
- contraindicated for patients who are dehydrated and young infants
- Patients unable to tolerate large volumes of fluid benefit most from this type of enema, which is by design low volume
- 120 to 180 mL (4 to 6 ounces) is usually effective.
- The commercially prepared Fleet enema is the most common.
Hypertonic solutions (type of enema)
112
-You add soapsuds to tap water or saline to create the effect of intestinal irritation to stimulate peristalsis
-Use only pure castile soap
-Use soapsuds enemas with caution in pregnant women and older adults because they could cause electrolyte imbalance or damage to the intestinal mucosa.
- High enemas 1213cleanse more of the colon
-After the enema is infused, ask the patient to turn from the left lateral to the dorsal recumbent, over to the right lateral position. The position change ensures that fluid reaches the large intestine.
low enema cleanses only the rectum and sigmoid colon.
Soapsuds (type of enema)
113
- Oil-retention enemas lubricate the feces in the rectum and colon
- feces absorb the oil and become softer and easier to pass
Oil Retention (type of enema)
114
provide relief from gaseous distention.
- They improve the ability to pass flatus.
- An example of a carminative enema is MGW solution, which contains 30 mL of magnesium, 60 mL of glycerin, and 90 mL of water.
Carminative enemas (type of enema)
115
used to treat patients with dangerously high serum potassium levels.
-This drug contains a resin that exchanges sodium ions for potassium ions in the large intestine.
sodium polystyrene sulfonate (Kayexalate) (medicated type of enema)
116
, an antibiotic used to reduce bacteria in the colon before bowel surgery. An enema containing steroid medication may be used for acute inflammation in the lower colon.
neomycin solution (medicated type of enema)
117
left side in Sims’ position with knees flexed and back toward you
digital removal of stool position
118
is a pliable hollow tube that is inserted through the patient’s nasopharynx into the stomach.
nasogastric (NG) tube
119
1. fine- or small-bore tubes
| 2. large-bore tubes
two main categories of NG tubes:
120
are frequently used for medication administration and enteral feedings
Small-bore tubes (NG tube)
121
12-Fr and above, are usually used for gastric decompression or removal of gastric secretions.
Large-bore tubes (NG tube)
122
are the most common for stomach decompression
Levin and Salem sump tubes
123
is a single-lumen tube with holes near the tip. It is connected to a drainage bag or an intermittent suction device to drain stomach secretions.
Levin tube
124
- Decompression
- Removal of secretions and gaseous substances from gastrointestinal (GI) tract; prevention or relief of abdominal distention
Salem sump, Levin, Miller-Abbott (type of tube for Nasogastric)
125
- Enteral feeding
- Instillation of liquid nutritional supplements or feedings into stomach or small intestine for patients with impaired swallowing
Duo, Dobhoff, Levin (type of tube for Nasogastric)
126
- Compression
| - Internal application of pressure by means of inflated balloon to prevent internal esophageal or GI hemorrhage
Sengstaken-Blakemore (type of tube for Nasogastric)
127
- Lavage
| - Irrigation of stomach in cases of active bleeding, poisoning, or gastric dilation
Levin, Ewald, Salem sump (type of tube for Nasogastric)
128
The tube has two lumina: one for removal of gastric contents and one to provide an air vent. A blue “pigtail” is the air vent that connects with the second lumen. When the main lumen of the sump tube is connected to suction, the air vent permits free, continuous drainage of secretions. Do not clamp off the air vent if the tube is connected to suction.
Salem sump tube is preferable for stomach decompression.
| Xylocaine jelly or atomized lidocaine to decrease discomfort
129
is a nurse specially educated to care for ostomy patients
wound, ostomy, and continence nurse (WOCN)
130
ileostomies is
aka /called a food blockage.
131
such as sweet corn, popcorn, raw mushrooms, fresh pineapple, and Chinese cabbage can cause this problem
food w/ indigestible fiber= food blockage for ileostomies
132
patient with chronic constipation or fecal incontinence secondary to cognitive impairment may benefit from bowel training, also called .
habit training/ Bowel training
133
attempting to defecate at the same time each day and using measures that promote defecation, a patient may establish a normal defecation pattern.
habit training/ Bowel training purpose
134
available for short-term use with high-volume diarrhea.
- intended for use primarily in acute care settings.
- intra-anal soft silicone catheter with a retention balloon much like a Foley catheter for insertion into the rectal vault to divert liquid stool away from the skin in immobilized patients
- catheter is connected to a drainage bag for collection of the liquid fecal effluent.
fecal-management systems (use to collect decal diarrhea)
135
and sometimes causes a sudden decline in pulse rate
manipulation of rectal tissue stimulates the vagus nerve
136
(adult, 750 to 1000 mL; adolescent, 500 to 700 mL; school-age child, 300 to 500 mL; toddler, 250 to 350 mL; infant, 150 to 250 mL)
Correct volume of warmed (tepid) solution//for enema
137
(adult, 22 to 30 Fr; child, 12 to 18 Fr)
Appropriate-size rectal tube// for enema
138
relaxation of external rectal sphincter.
Breathing out promotes
