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fundamentals of nursing > ch47: bowel elimination > Flashcards

ch47: bowel elimination Flashcards

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1
Q

what do alterations in elimination be a warning for?

A

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

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2
Q

what is the primary organ for bowel elimination?

A

large intestine

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3
Q

where does defecation begin?

A

colon

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4
Q

when does control of defecation start?

A

2-3 years

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5
Q

what effects digestion in elderly patients

A

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

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6
Q

what is the correlation between physical activity and digestion?

A

it promotes peristalsis

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7
Q

what is the correct/natural position for defecation?

A

squatting = normal position

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8
Q

how to position immobile patients for defecation?

A

raise head of the bed = sitting position on bedpan

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9
Q

what are factors of pregnancy that affect digestion?

A
  • 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
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10
Q

what is an ileus?

A

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

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11
Q

what medications are known to cause constipation?

A

analgesics

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12
Q

what can a patient experience after procedure?

A

loose stools or gas

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13
Q

what are some common bowel elimination problems?

A
  • constipation
  • impaction
  • diarrhea
  • incontinence
  • flatulence
  • hemorrhoids
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14
Q

what is flatulence?

A

accumulation of gas in the intestines causing the walls to stretch

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15
Q

what are signs of dehydration in adults?

A
  • thirst
  • decreased urination and dark colored urine
  • dry skin + mucus membranes
  • fatigue, dizziness, light headed
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16
Q

what is an ostomy?

A

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

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17
Q

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

A

liquid, less formed, frequent stool

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18
Q

what would stool look like in a transverse colostomy?

A

thicker liquid, soft stool

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19
Q

what would stool look like in a sigmoid colostomy

A

formed, normal stool

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20
Q

what would stool look like in an ileostomy?

A

liquid stool

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21
Q

what is the difference between a colostomy vs ileostomy?

A

colostomy: large intestine/colon
ileostomy: small intestine

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22
Q

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

A

ileostomy = fewer bacteria

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23
Q

what is a loop colostomy? proximal vs distal end?

A

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

24
Q

what is an end colostomy?

A

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

25
Q

what are other approaches to bowel elimination besides ostomies?

A
  • ileoanal pouch anastomosis
  • continent ileostomy
  • antegrade continence enema (ACE)
26
Q

what is an ileoanal pouch anastomosis?

A

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

27
Q

what is a continent ileostomy?

A

pouch small intestine and pt puts catheter in stoma to drain

28
Q

what is an antegrade continent enema?

A

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

29
Q

what scale is used to categorize and ID stool?

A

bristol stool form scale

30
Q

which type of stool is usually associated with diverticulosis?

A

type 4: sausage/snake smooth like stool

31
Q

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

A

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

32
Q

what is the best position for enemas?

A

left sims position

33
Q

purpose of cleansing enemas?

A

promote the COMPLETE EVACUATION of feces from colon

34
Q

purpose of tap water enemas?

A

hypotonic solution to bring water in

–> need to watch for water toxicity

35
Q

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

A

0.9 normal saline

36
Q

purpose of hypertonic enemas?

A

pulls fluid out of interstitial spaces

37
Q

purpose of soap suds enemas?

A

intestinal irritation to stimulate peristalsis

38
Q

purpose of oil retention enemas?

A

lubricate feces in rectum and colon

39
Q

difference between carminative vs kayexalate enema?

A

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

40
Q

high vs low enemas?

A

high enema: cleanse more of the colon

low enema: cleans only the rectum and sigmoid colon

41
Q

how mL of normal saline in cleansing enemas?

A

750 mL to 1000 mL

42
Q

how to safely put bedpan under patient?

A

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

43
Q

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

A

false

44
Q

t/f: sterile technique is unnecessary for enema administration

A

true

45
Q

when to use digital removal of stool?

A

last resort order if enemas fail

46
Q

which medication will stop medication (according to renna?)

A

imodium: causes diarrhea relief

47
Q

cathartics vs laxatives?

A

cathartics = stronger and faster on intestines

48
Q

when to use large bore vs small bore NG tube?

A

large = for gastric removal

small bore = feedings and med admin

49
Q

purpose of salem sumps?

A

stomach decompression; remove gastric contents and provide air vent

50
Q

purpose of levin tube?

A

stomach decompression; drainage + suctioning

51
Q

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

A

to prevent skin breakdown

52
Q

when to change ostomy bags?

A

every 3-7 days depending on pt’s needs

53
Q

nutritional and fluid considerations after general abdominal surgery?

A

small serving of soft foods

54
Q

nutritional and fluid considerations of colostomy?

A

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

55
Q

nutritional and fluid considerations after an ileostomy?

A

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

56
Q

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

A

fluid from bag CANNOT cover the ostomy

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