Chapter 38 Bowel Elimination Flashcards by Lyndsay Floystad

GI tract route:

mouth to anus

- esophagus to the stomach to the small intestine to the large intestine to the anus.

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Functions of the large intestine:

Absorption of water
Formation of feces
Expulsion of feces from the body (secretion)

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Functions of the small intestine:

-the reabsorption of the GI system occurs!!!

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The large intestine extends from the __ to the __.

-ileocecal valve to the anus

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What is a thick fluid mass of partially digested food and gastric secretions that is passed from the stomach to the small intestine.?

-Chyme

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What is the wave of progressive contraction and relaxation of the walls of the intestine?

-Peristalsis

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What does peristalsis do when it comes to chyme?

-This forces chyme into the large intestine through the ileocecal valve, which prevents regurgitation of chyme.

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Peristalsis is under control of ___.

the nervous system

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Contractions for peristalsis occur every:

3-12 minutes

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Mass peristalsis sweeps occur:

once to four times every 24 hours.

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___ of food waste is excreted in stool within 24 hours.

One-third to one-half

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Who could have issues with peristalsis?

-people with spinal cord injuries

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What can cause temporary cessation of intestinal movement?

Surgery and anesthesia that requires manipulation of the intestines

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What is the stoppage of peristalsis?

Paralytic ileus

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___ ease defecation and stimulate bowel movement

laxatives

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What are 5 different types of laxatives?

bulk forming
osmotic
stimulant
stool softeners
lubricants

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What laxative absorbs liquid in intestines and allows the stool to swell which forms a softer stool to pass?

Bulk Forming (psyllium, methylcellulose)

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What laxative draws water into the bowel, softens stool mass, increases bowel action, and can be used prior to some diagnostic tests too (the PEG in particular)?

Osmotic (PEG, lactulose, sorbitol, magnesium citrate, sodium phosphate)

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What laxative is found over the counter, increases muscle contractions that help move the stool along, and have the most potential to leave side effects.

Stimulant (biscodyl, sena (PO or rectal)

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What laxative brings liquid into the stool so it prevents the stool from being hard and dry?

Stool Softener (colace)

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What laxative puts a protective seal over the stool with like a waterproof stool, to keep the moisture and water in the stool ot make it easier to pass?

Lubricants (mineral oil)

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What is a chronic problem in older adults?

constipation, diarrhea, and fecal incontinence.

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What affects bowel elimination?

developmental considerations
daily patterns
food and fluid intake
activity and muscle tone
lifestyle
psychological variables
pathologic conditions
medications
diagnostic studies
surgery and anesthesia

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Which food is a recommended for an older adult who is constipated?

Fruits

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__ helps soften the stool.

Fiber

What are some constipating foods?

cheese, lean meat, eggs, pasta

What are some foods with laxative effect?

fruits and vegetables, bran, chocolate, alcohol, coffee

What are some gas-producing foods?

onions, cabbage, beans, cauliflower

What effect does aspirin have on stool color?

pink to red to black stool.

Black stool w/o medications is a sign of ___.

bleeding in some sort. (they could be taking too much medication)

What effect do iron salts have on stool color?

Black stool

What effect does bismuth subsalicylate have on stool color?

- black stools | - treats diarrhea

What effect do antacids have on stool color?

white discoloration or speckling in stool

What effect do antibiotics have on stool color?

green-gray color

What are some details on obtaining a stool sample?

- medical aseptic - hand hygiene before and after glove use - wear disposable gloves - do not contaminate outside of container with stool - obtain stool and package, label, and transport according to agency policy.

What are the patient guidelines for stool collection?

- void first so that urine is not in the stool sample-defecate into the container not the toilet - do not place toilet paper in bedpan or specimen container - avoid contacts with soaps, detergents, and disinfectants as they may affect the test results - notify nurse when specimen is available

What is a timed stool collection?

- collect stool over time | - 1st stool is the start of the collection

What is a screening to see if there's blood or not and also tests for cancer, GI bleeds, ulcers, polyps, inflammatory bowel disease, etc?

Fecal occult blood test

What is an invasive test, that is a direct visual of the bowel and can take pictures and perform a biopsy?

endoscopic examinations

What test involves swallowing a liquid and then an x-ray is used to see what is lit up inside the body?

Barium studies (should precede UGI)

What is the fluoroscopic examination of the esophagus, stomach, and small intestine. It is done after ingestion of barium medication. It is a radiographic (X-ray) that lights up the areas we need to look at.

Upper gastrointestinal (UGI) study

What is a series of x-rays that examine the large intestine after a rectal infusion of barium into the rectum?

barium enema

What test visualizes organs with a small transducer that's placed on the skin?

abdominal ultrasound

What test is noninvasive, and is a detailed atomic view of tissues using a magnet?

MRI- magnetic resonance imaging

What is an x-ray directed at the abdomen and the computer can take pictures of it. We also need to have a patient take an oral contrast or IV iodine.

abdominal CT scan

Any kind of contrast necessary study, is contraindicated for people ___

who are allergic to iodine

A visual exam of the esophagus, stomach, and duodenum. Can have an endoscope. Can take biopsies.

Esophagogastroduodenoscopy (EGD)

A visual examination of the large intestine from the anus to ileocecal valve. Need to take a laxative before surgery to clean out the colon.

Colonoscopy

Uses a scope. A visual examination of the sigmoid colon, rectum and anal canal.

Sigmoidoscopy

A tiny wireless camera takes pictures of your digestive tract It is swallowed.

Wireless capsule endoscopy

Patient outcomes for normal bowel elimination? (3)

- Patient has a soft, formed bowel movement every 1 to 3 days without discomfort. - The relationship between bowel elimination and diet, fluid, and exercise is explained. - Patients should seek medical evaluation if changes in stool color or consistency persist.

5 ways to promote regular bowel habits?

- timing - positioning - privacy - nutrition (increase in fluids and fiber) - exercise

Individuals at High Risk for Constipation: (4)

- Patients on bedrest taking constipating medicines - Patients with reduced fluids or bulk in their diet - Patients who are depressed - Patients with central nervous system disease or local lesions that cause pain while defecating

4 Nursing Measures for the Patient With Diarrhea:

- answer call bell immediately - remove the cause of diarrhea whenever possible (meds, parasite, etc) - If there is impaction, obtain physician order for rectal examination - give special care to the region around the anus.

a stool in the rectum that causes a blockage that results in a little diarrhea.

Impaction

4 ways to empty colon of feces?

- enemas - rectal suppositories - oral intestinal lavage - digital removal of stool

What can be a laxative used to stimulate the bowel to relieve constipation?

rectal suppositories

We take this before a procedure like a CT scan. Polyethyl Glycol solution is used, trade name is “go lightly”. Makes it easier to go.

oral intestinal lavage

What are used to simply empty the colon of feces?

enemas

4 types of enemas:

- cleansing - retention - small volume - large volume

retention enema: Lubricate the stool and intestinal mucosa, easing defecation

oil-retention

retention enema: help expel flatus (gas) from the rectum

carminative

retention enema: provide medications absorbed through the rectal mucosa

medicated

retention enema: destroy intestinal parasites

anthelmintic

Goal of bowel-training programs:

Eliminate (have) a soft, formed stool at regular intervals without laxatives.

5 types of ostomies?

- sigmoid colostomy - descending colostomy - transverse colostomy - ascending colostomy - Ileostomy

Colostomy care: (5)

- Keep the patient as free of odors as possible; empty the appliance frequently. - Inspect the patient’s stoma regularly (stoma should be moist. Keep the skin around the stoma site clean and dry). - Measure the patient’s fluid intake and output. - Explain each aspect of care to the patient and self-care role. - Encourage the patient to care for and look at ostomy.

Patient teaching for colostomies: (6)

- Explain the reason for bowel diversion and the rationale for treatment. - Demonstrate self-care behaviors that effectively manage the ostomy. - Describe follow-up care and existing support resources. - Report where supplies may be obtained in the community. - Verbalize related fears and concerns. - Demonstrate a positive body image.

Whether the goals include a return to normal bowel function or maintaining existing function within the parameters of the patient’s condition, it is important for the nurse to:

determine whether they have been met, and if not, why.