Chapter 46 Bowel Elimination Flashcards
Mouth:
digestion begins with mastication (breaks down food)
Issues: dentures, no teeth, pouching/drooping –> aspiration
Stomach:
stores food; mixes food, liquid, and digestive juices; moves food into small intestines
Large intestine:
The primary organ of bowel elimination
Esophagus:
Peristalsis moves food into the stomach
Small intestine:
duodenum - process chyme from stomach, jejunum - absorbs carbs and protein, and ileum - absorbs water, fat, vitamins, iron, and bile salts
Anus:
expects, feces and flatus from the rectum
Factors affecting bowel elimination:
- 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
Bristol stool Form Scale Type 1:
Separate hard lumps like nuts
Type 2:
Sausage shaped but lumpy
Type 3:
Like a sausage but with cracks on surface
Type 4:
Like a sausage or snake, smooth and soft
Type 5:
Soft blobs with clear-cut edges
Type 6:
Fluffy pieces w/ ragged edges and mushy stool
Type 7:
Watery, no solid pieces
Constipation:
a symptom, not a disease; infrequent stool and/or hard, dry, small stools that are difficult to eliminate
Diarrhea:
an increase in the number of stools and the passage of liquid, unformed feces
-dehydration, disruption in normal bowel flora –> c-diff
Flatulence:
accumulation of gas in the intestines causing the walls to stretch
Impaction:
results from unrelieved constipation; a collection of hardened feces wedges in the rectum that a person cannot expel AT ALL
Incontinence:
inability to control passage of feces and gas to the anus
Hemorrhoids:
Dilated, engorged veins in the lining of the rectum
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:
Constipation
Nursing history
- 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
Physical assessment:
Mouth -chewing abilities, abdomen - soft, hard, descended, and rectum - any obstruction
Laboratory tests:
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
Diagnostic examinations:
- 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)
Health promotion
- Promotion of normal defecation: Establish a routine an hour after a meal, or maintain the patient’s routine.
- Sitting position
- Privacy
- Positioning on bedpan
To maintain normal elimination patterns in the hospitalized patient, you should instruct the patient to defecate 1 hour after meals because
Mass colonic peristalsis occurs at this time
Continuing and Restorative Care
-Bowel training: Training program- provide privacy Diet Promotion of regular exercise Management of hemorrhoids -Skin integrity
Evaluation:
- 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?
Bowels depend on
nutrition
GI tract functions:
storage of feces
absorption
mastication
peristalsis: help move food down esophagus
3 tasks of stomach
- digest - empties into small intestine
- mixing of food absorb
- storing of swallowing food and liquid
- producing chyme and hydrocloric acid (can lead to ulcers)
- Intristic factor and Vit D
Large intestine functions:
- waves of peristalsis
- accommodate and empty waste
Large intestine 3 tasks:
- absorption -Na, Cl
- secretion
- elimination
Losing electrolytes from diarrhea and effect your
heart
Bowel movements are strongest in older adults when?
after meal time
valsopha maneuver:
helps defecation
can make someone pass out
-cranial or cardiac problems effect this
depression decreases
peristalsis –> constipation
Vagal stimulation or stool softeners:
slows heart rate that occurs during defecation, enema, taking rectum temperatures
-narcotics
gallbladder =
break down fat
2 types of bed pans:
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
Incontinence use:
use bath wipes
effects for irritation
