ch47: bowel elimination

Question 1

what do alterations in elimination be a warning for?

Answer 1

early warning symptom of problems in GI tract/other organ systems

Question 2

what is the primary organ for bowel elimination?

Answer 2

large intestine

Question 3

where does defecation begin?

Answer 3

colon

Question 4

when does control of defecation start?

Answer 4

2-3 years

Question 5

what effects digestion in elderly patients

Answer 5

decreased chewing ability
decreased peristalsis
slowed esophageal emptying
weakened muscle tone + sphincter

Question 6

what is the correlation between physical activity and digestion?

Answer 6

it promotes peristalsis

Question 7

what is the correct/natural position for defecation?

Answer 7

squatting = normal position

Question 8

how to position immobile patients for defecation?

Answer 8

raise head of the bed = sitting position on bedpan

Question 9

what are factors of pregnancy that affect digestion?

Answer 9

• size of fetus increases = pressure exerted on rectum
• temporary obstruction (the fetus) = impairs passage of feces
• slowing of peristalsis (3rd trimester) = constipation
• hemorrhoids from straining during defecation/delivery

Question 10

what is an ileus?

Answer 10

surgery that involves direct manipulation of the bowel temporarily stops peristalsis (24-48 hours)

Question 11

what medications are known to cause constipation?

Answer 11

analgesics

Question 12

what can a patient experience after procedure?

Answer 12

loose stools or gas

Question 13

what are some common bowel elimination problems?

Answer 13

• constipation
• impaction
• diarrhea
• incontinence
• flatulence
• hemorrhoids

Question 14

what is flatulence?

Answer 14

accumulation of gas in the intestines causing the walls to stretch

Question 15

what are signs of dehydration in adults?

Answer 15

• thirst
• decreased urination and dark colored urine
• dry skin + mucus membranes
• fatigue, dizziness, light headed

Question 16

what is an ostomy?

Answer 16

operation to create an opening (stoma) from an area inside the body to outside

Question 17

what would stool look like in an ascending colostomy (cecostomy)?

Answer 17

liquid, less formed, frequent stool

Question 18

what would stool look like in a transverse colostomy?

Answer 18

thicker liquid, soft stool

Question 19

what would stool look like in a sigmoid colostomy

Answer 19

formed, normal stool

Question 20

what would stool look like in an ileostomy?

Answer 20

liquid stool

Question 21

what is the difference between a colostomy vs ileostomy?

Answer 21

colostomy: large intestine/colon
ileostomy: small intestine

Question 22

if stool has minimal odor, would it most likely be from an ileostomy or colostomy?

Answer 22

ileostomy = fewer bacteria

Question 23

what is a loop colostomy? proximal vs distal end?

Answer 23

reversible stomas that a surgeon constructs in ileum or colon
proximal end = drains FECAL EFFLUENT
distal end = drains MUCUS

Question 24

what is an end colostomy?

Answer 24

stoma formed like a turtleneck lol; brings piece of intestine down and suturing it to abdominal wall

Question 25

what are other approaches to bowel elimination besides ostomies?

Answer 25

- ileoanal pouch anastomosis - continent ileostomy - antegrade continence enema (ACE)

Question 26

what is an ileoanal pouch anastomosis?

Answer 26

remove colon --> pouch from end of small intestine + anus for fecal collection - usually for pts with ulcerative colitis

Question 27

what is a continent ileostomy?

Answer 27

pouch small intestine and pt puts catheter in stoma to drain

Question 28

what is an antegrade continent enema?

Answer 28

usually for CHILDREN with fecal soiling due to neuropathic/structural abnormalities of anal sphincter - insert tube --> give self enema --> out through anus

Question 29

what scale is used to categorize and ID stool?

Answer 29

bristol stool form scale

Question 30

which type of stool is usually associated with diverticulosis?

Answer 30

type 4: sausage/snake smooth like stool

Question 31

why is it important not to lift patient on bedpan or leave them on it with the HOB flat?

Answer 31

causes muscle strain and discomfort; might lead to hyperextension of the back

Question 32

what is the best position for enemas?

Answer 32

left sims position

Question 33

purpose of cleansing enemas?

Answer 33

promote the COMPLETE EVACUATION of feces from colon

Question 34

purpose of tap water enemas?

Answer 34

hypotonic solution to bring water in | --> need to watch for water toxicity

Question 35

which enema is safest to use? (especially on infants and children)

Answer 35

0.9 normal saline

Question 36

purpose of hypertonic enemas?

Answer 36

pulls fluid out of interstitial spaces

Question 37

purpose of soap suds enemas?

Answer 37

intestinal irritation to stimulate peristalsis

Question 38

purpose of oil retention enemas?

Answer 38

lubricate feces in rectum and colon

Question 39

difference between carminative vs kayexalate enema?

Answer 39

carminative: relief from gas distention kayexalate: for pts with high serum potassium levels

Question 40

high vs low enemas?

Answer 40

high enema: cleanse more of the colon | low enema: cleans only the rectum and sigmoid colon

Question 41

how mL of normal saline in cleansing enemas?

Answer 41

750 mL to 1000 mL

Question 42

how to safely put bedpan under patient?

Answer 42

turn pt onto side and hold bedpan along buttocks and push underneath hip --> have them roll back onto it

Question 43

t/f: you don't need a physician order to administer an enema

Answer 43

false

Question 44

t/f: sterile technique is unnecessary for enema administration

Answer 44

true

Question 45

when to use digital removal of stool?

Answer 45

last resort order if enemas fail

Question 46

which medication will stop medication (according to renna?)

Answer 46

imodium: causes diarrhea relief

Question 47

cathartics vs laxatives?

Answer 47

cathartics = stronger and faster on intestines

Question 48

when to use large bore vs small bore NG tube?

Answer 48

large = for gastric removal | small bore = feedings and med admin

Question 49

purpose of salem sumps?

Answer 49

stomach decompression; remove gastric contents and provide air vent

Question 50

purpose of levin tube?

Answer 50

stomach decompression; drainage + suctioning

Question 51

why does ostomy pouch have to be flush against the skin?

Answer 51

to prevent skin breakdown

Question 52

when to change ostomy bags?

Answer 52

every 3-7 days depending on pt's needs

Question 53

nutritional and fluid considerations after general abdominal surgery?

Answer 53

small serving of soft foods

Question 54

nutritional and fluid considerations of colostomy?

Answer 54

no diet restrictions other than diet discussed for pt's normal bowel function

Question 55

nutritional and fluid considerations after an ileostomy?

Answer 55

able to digest food but lose fluid and salt through stoma --> need to compensate to avoid dehydration

Question 56

what is the "secret to changing an ostomy bag" according to renna?

Answer 56

fluid from bag CANNOT cover the ostomy