Chapter 41 Management of Patients with Intestinal and Rectal Disorders

Question 1

Most Common Changes in Patterns of Fecal Elimination

Answer 1

Constipation, diarrhea, & fecal incontinence

Question 2

Constipation

Answer 2

3 or fewer bowel movements weekly or BMs that are hard, dry, small, or difficult to pass

Question 3

Prevalence of Chronic Constipation

Answer 3

~ 63 million Americans have chronic constipation

Question 4

Risk Factors of Constipation

Answer 4

Women: Especially pregnant women

Patients who recently had surgery

Older adults

Non-Caucasians

People w/ hx of IBS

Question 5

Constipation Causes

Answer 5

Certain medications
- Anticholinergic meds
- Antidepressants
- Anticonvulsants
- Antispasmodics ( muscle relaxers)
- Calcium channel antagonists
- Diuretic agents

Weakness

Immobility

Debility

Fatigue

Celiac’s Disease

People who do not take the time to defecate or ignore the urge

Sedentary lifestyle

Low-fiber diet

High-stress lifestyle

Question 6

Functions of the Colon

Answer 6

Mucosal transport: Mucosal secretions facilitate the movement of colon contents

Myoelectric Activity: Mixing of the rectal mass & propulsive actions

Defecation

Question 7

Clinical Manifestations of Constipation

Answer 7

< 3 BMs per week

Abdominal distension, pain, & bloating

Sensation of incomplete evacuation

Straining at stool

Elimination of small-volume, lumpy, hard, dry stool

May report tenesmus or lower back pain

Chronic constipation: Presence of these symptoms for at least 12 weeks during the previous year

Question 8

Tenesmus

Answer 8

Ineffective & sometimes painful straining & urge to eliminate feces

Question 9

Hemorrhoids

Answer 9

Dilated portions of anal veins

Question 10

Fissures

Answer 10

Normal or abnormal folds, grooves, or cracks in body tissue

Question 11

Fecal Impaction

Answer 11

Occurs when an accumulated mass of dry feces (fecalith) cannot be expelled

Question 12

Gerontological Considerations of Bowel Movements

Answer 12

Visits to primary providers for treatment of constipation are common in people 65 years or older

Most common complaint: Need to strain at stool

Frequently choose soft, processed foods that are low in fiber

Older adults tend to have decreased food intake, reduced mobility, & weak abdominal & pelvic muscles
- More likely to have multiple chronic illnesses that req multiple meds-> constipation

Some adults tend to lower their fluid intake if they are not eating

Decreased intestinal motility & anal sphincter tone

Nerve impulses are dulled, & decreased urge to defecate

Many older adults consume laxatives to combat this issue but become overdependent on them

Question 13

Diarrhea

Answer 13

Increased frequency of BMs of > 3 per day w/ increased liquidity of stool

Any condition that causes increased intestinal secretions, decreased mucosal absorption, or altered motility can cause diarrhea