Chapter 46 Bowel Elimination

Question 1

Mouth:

Answer 1

digestion begins with mastication (breaks down food)

Issues: dentures, no teeth, pouching/drooping –> aspiration

Question 2

Stomach:

Answer 2

stores food; mixes food, liquid, and digestive juices; moves food into small intestines

Question 3

Large intestine:

Answer 3

The primary organ of bowel elimination

Question 4

Esophagus:

Answer 4

Peristalsis moves food into the stomach

Question 5

Small intestine:

Answer 5

duodenum - process chyme from stomach, jejunum - absorbs carbs and protein, and ileum - absorbs water, fat, vitamins, iron, and bile salts

Question 6

Anus:

Answer 6

expects, feces and flatus from the rectum

Question 7

Factors affecting bowel elimination:

Answer 7

• Age: Older - less movement, kids- diet, nutrition, capacity
• Fluid intake = increased fiber
• Psychological factors
• Position during defecation
• Pregnancy –> constipation
• Medications, laxatives, and cathartics
• Diet: 6-8 cups of water a day
• Physical Activity
• Personal habits: emotion or stress
• Pain
• Surgery and anesthesia
• Diagnostic tests

Question 8

Bristol stool Form Scale Type 1:

Answer 8

Separate hard lumps like nuts

Question 9

Type 2:

Answer 9

Sausage shaped but lumpy

Question 10

Type 3:

Answer 10

Like a sausage but with cracks on surface

Question 11

Type 4:

Answer 11

Like a sausage or snake, smooth and soft

Question 12

Type 5:

Answer 12

Soft blobs with clear-cut edges

Question 13

Type 6:

Answer 13

Fluffy pieces w/ ragged edges and mushy stool

Question 14

Type 7:

Answer 14

Watery, no solid pieces

Question 15

Constipation:

Answer 15

a symptom, not a disease; infrequent stool and/or hard, dry, small stools that are difficult to eliminate

Question 16

Diarrhea:

Answer 16

an increase in the number of stools and the passage of liquid, unformed feces
-dehydration, disruption in normal bowel flora –> c-diff

Question 17

Flatulence:

Answer 17

accumulation of gas in the intestines causing the walls to stretch

Question 18

Impaction:

Answer 18

results from unrelieved constipation; a collection of hardened feces wedges in the rectum that a person cannot expel AT ALL

Question 19

Incontinence:

Answer 19

inability to control passage of feces and gas to the anus

Question 20

Hemorrhoids:

Answer 20

Dilated, engorged veins in the lining of the rectum

Question 21

A newly admitted patient states that he has recently had a change in medications and reports that stools are now dry and hard to pass. This type of bowel pattern is consistent with:

Answer 21

Constipation

Question 22

Nursing history

Answer 22

• What a patient describes as normal or abnormal is often different from factors and conditions that tend to promote normal elimination.
• Identifying normal and abnormal patterns, habits, and the patient’s perception of normal and abnormal with regard to bowel elimination allows you to accurately determine a patient’s problems

Question 23

Physical assessment:

Answer 23

Mouth -chewing abilities, abdomen - soft, hard, descended, and rectum - any obstruction

Question 24

Laboratory tests:

Answer 24

Fecal characteristics - any blood –> fecal occult blood testing (3 blue ring positives = foods could make false positives – red meat, fish, vegetable)
-Apsirin, ib profin or motrin, Vitamin C, blood thinners = false +
Fecal specimens: separate urine from stool

Question 25

Diagnostic examinations:

Answer 25

• Radiologic imaging, with or without contrast
• Endoscopy: tube down esophagus –>upper half of GI
• Ultrasound: lower half of GI
• Computed tomography (CT) or magnetic resonance imaging (MRI)

Question 26

Health promotion

Answer 26

• Promotion of normal defecation: Establish a routine an hour after a meal, or maintain the patient’s routine.
• Sitting position
• Privacy
• Positioning on bedpan

Question 27

To maintain normal elimination patterns in the hospitalized patient, you should instruct the patient to defecate 1 hour after meals because

Answer 27

Mass colonic peristalsis occurs at this time

Question 28

Continuing and Restorative Care

Answer 28

-Bowel training:
Training program- provide privacy 
Diet
Promotion of regular exercise
Management of hemorrhoids
-Skin integrity

Question 29

Evaluation:

Answer 29

• Do you use medications such as laxatives or enemas to help you defecate?
• What barriers are preventing you from eating a diet high in fiber and participating in regular exercise?
• How much fluid do you drink in a typical day? What types of fluids do you normally drink?
• What challenges do you encounter when you change your ostomy pouch?

Question 30

Bowels depend on

Answer 30

nutrition

Question 31

GI tract functions:

Answer 31

storage of feces
absorption
mastication
peristalsis: help move food down esophagus

Question 32

3 tasks of stomach

Answer 32

1. digest - empties into small intestine
2. mixing of food absorb
3. storing of swallowing food and liquid
   - producing chyme and hydrocloric acid (can lead to ulcers)
   - Intristic factor and Vit D

Question 33

Large intestine functions:

Answer 33

• waves of peristalsis

- accommodate and empty waste

Question 34

Large intestine 3 tasks:

Answer 34

1. absorption -Na, Cl
2. secretion
3. elimination

Question 35

Losing electrolytes from diarrhea and effect your

Answer 35

heart

Question 36

Bowel movements are strongest in older adults when?

Answer 36

after meal time

Question 37

valsopha maneuver:

Answer 37

helps defecation
can make someone pass out
-cranial or cardiac problems effect this

Question 38

depression decreases

Answer 38

peristalsis –> constipation

Question 39

Vagal stimulation or stool softeners:

Answer 39

slows heart rate that occurs during defecation, enema, taking rectum temperatures
-narcotics

Question 40

gallbladder =

Answer 40

break down fat

Question 41

2 types of bed pans:

Answer 41

Fracture pan: for patients who have hip fractures or upper extremities (normal ones that you’ve used at work)
Normal pan: curved sides
-do not lay flat, keep head elevated and bend knees = keep track of output

Question 42

Incontinence use:

Answer 42

use bath wipes

effects for irritation