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NURS 305 > Chapter 47: Bowel Elimination > Flashcards

Chapter 47: Bowel Elimination Flashcards

1
Q

The GI Tract

A

series of hollow, mucous membrane-lined, muscular organs

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2
Q

What is the function of the GI tract?

A
  • Absorbs high volumes of fluid and nutrients - makes fluid and electrolyte balance a key function of this system
  • Prepare food for absorption and use by body cells - receives secretions from the gallbladder and pancreas
  • Provides for temporary storage of feces
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3
Q

Mouth

A

mastication and mixing with saliva and enzymes such as amylase

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4
Q

Esophagus

A

food enters esophagus via the esophageal sphincter

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5
Q

Stomach

A

Food mixes with HCL, mucus, enzyme pepsin and intrinsic factor.

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6
Q

HCL and pepsin aid in

A

the digestion of proteins

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7
Q

Intrinsic factor is essential for

A

absorption of Vit B12

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8
Q

Small Intestine has 3 sections, what are they?

A

Duodenum
Jejunum
Ileum

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9
Q

Duodenum

A

Approximately 8-11” long. Continues to process chyme.

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10
Q

Jejunum

A

Approximately 8 feet long. Absorbs carbohydrates and proteins.

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11
Q

What parts of the small intestine absorb most of the nutrients and electrolytes?

A

duodenum and jejunum

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12
Q

Ileum

A

Approximately 12 feet long. Absorbs water, fats, certain vitamins, iron and bile salts.

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13
Q

The Large Intestine (Colon)

A

Approximately 5-6 feet long.

Divided into the: cecum, colon and rectum

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14
Q

The colon is divided into

A

Ascending
Transverse
Descending
Sigmoid

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15
Q

Rectum

A

bacteria convert fecal matter into its final form

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16
Q

The large intestine has three functions

A
  1. Absorption- water, sodium and chloride
  2. Secretion- bicarbonate in exchange for chloride and potassium.
  3. Elimination
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17
Q

Anus

A

expels feces and flatus from the rectum

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18
Q

Physiological factors critical to bowel function and defecation include:

A

Normal GI tract function
Sensory awareness of rectal distention
Voluntary sphincter control
Adequate rectal capacity and compliance

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19
Q

What causes the awareness of the need to defecate?

A

when stool reaches the rectum, the distention causes relaxation of the internal sphincter and awareness of the need to defecate

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20
Q

Valsalva Maneuver

A

voluntary contraction of abdominal muscles while maintaining a forced expiration against a closed airway.

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21
Q

Valsalva Maneuver should be cautioned in patients with

A

Glaucoma
Increased intracranial pressure
New surgical wounds … at risk for cardiac dysrhythmias and HTN

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22
Q

What are factors that influence bowel elimination?

A 
Age
Diet
Fluid Intake
Physical Activity
Psychological Factors
Personal Habits
Position During Defecation
Pain
Pregnancy
Surgery and Anesthesia
Medications
Diagnostic tests
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23
Q

How does age influence bowel elimination?

A

in an older adult:
decreased peristalsis
esophageal emptying slows
decreased muscle tone in the perineal floor
nerve impulse to anal region slow (less aware of need to defecate)

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24
Q

How does diet influence bowel elimination?

A

Fiber
Gas producing foods also stimulate peristalsis
Food intolerance

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25
Q

Fiber

A

Provides the bulk of fecal matter.
Keeps food moving through the intestines.
Keeps stool soft.

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26
Q

Gas producing foods also stimulate peristalsis including

A

cauliflower and beans

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27
Q

Food intolerance can cause

A

diarrhea, cramps and flatulence

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28
Q

How does fluid intake influence bowel elimination?

A

Helps intestinal contents pass through the colon: decreased fluid intake slows passage of food causing hard stool

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29
Q

What is the recommended daily fluid intake for men and women?

A

3L/day for men

2.2L/day for women

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30
Q

How does physical activity influence bowel elimination?

A

physical actively promotes peristalsis

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31
Q

What psychological factors can influence bowel elimination?

A

Emotional Stress
Depressed Response
Associated with diseases of the GI tract

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32
Q

How does emotional stress influence bowel elimination?

A

increases peristalsis/digestive process

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33
Q

How does a depressed response influence bowel elimination?

A

decreases peristalsis leading to constipation

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34
Q

What diseases of the GI tract are associated with psychological factors?

A

Ulcerative colitis
Irritable Bowel Syndrome
Ulcers
Crohn’s Disease

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35
Q

How can personal habits influence bowel elimination?

A

privacy to avoid/minimize embarrassment

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36
Q

How does positioning during defecation influence bowel elimination?

A

Sitting upright or standing position.

Lying in bed may be impossible for some people.

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37
Q

How does pain influence bowel elimination?

A

Hemorrhoids/rectal surgery, rectal fistulas.
Abdominal surgery may make it difficult to bear down to defecate.
Fear of opening incision.

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38
Q

How does pregnancy influence bowel elimination?

A

Decreased motility/peristalsis

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39
Q

Common Bowel Elimination problems include

A 
Constipation
Impaction
Diarrhea
C. diff
Incontinence
Flatulence
Hemorrhoids
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40
Q

Constipation

A

water absorbed from the bowel the longer it stays in the colon.
a hard mass of stool forms.

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41
Q

What can cause constipation?

A

-improper diet - low fiber, high in animal fats
stress
-reduced fluid intake
-lack of exercise
-chronic illnesses
-irregular bowel habits and ignoring the urge to defecate
-medications

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42
Q

Impaction

A

hard feces in the rectum that a person cannot expel

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43
Q

What are signs and symptoms of impaction?

A

N/V
Loss of appetite
Abdominal Distention and Cramping
Rectal Pain

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44
Q

Impaction can result in

A

intestinal obstruction

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45
Q

Patients most at risk for impaction include

A

confused
debilitated
unconscious

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46
Q

What may indicate an impaction?

A

continuous oozing of diarrhea stool may indicate impaction

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47
Q

Diarrhea is associated with

A

disorders affecting digestion, absorption and secretion in the GI tract

48
Q

Diarrhea

A

increased in bowel irritation from diarrhea increases mucous secretion
makes stool watery

49
Q

Thus, diarrhea can lead to

A

increased urge to defecate
increased risk for skin breakdown
increased risk for fluid and electrolyte imbalances

50
Q

What can disrupt the normal GI flora?

A

antibiotics

51
Q

When diarrhea is the result of a foodborne illness, the goal of the GI system is to

A

rid the body of the pathogen by increasing peristalsis

52
Q

Clostridium Difficile is acquired in one of two ways

A
  1. Factors that can cause an overgrowth of C. diff

2. By contact with the C. diff organism

53
Q

What factors can cause an overgrowth of C. diff?

A

Antibiotics
Bowel Preps
Chemotherapy disrupt normal bowel flora and may cause an overgrowth

54
Q

How can people get C. diff through contact?

A

poor hand hygiene by caregivers or contact with contaminated surfaces

55
Q

How can you remove c diff. from your hands?

A

only soap and water effectively removes the spores from the hands

56
Q

How can you remove c diff from surfaces?

A

diluted bleach (1:10) used as an environmental disinfectant

57
Q

Effect of incontinence on a patient

A

harms a patient’s body image

may lead to social isolation

58
Q

Flatuelence

A
  • causes abdominal distention

- assess patients on opiates, those recovering from general anesthesia, abdominal surgery or immobilization.

59
Q

Hemorrhoids

A

dilated, engorged veins in the lining of the rectum

60
Q

Hemorrhoids can be caused by

A

increased venous pressure from straining at defecation
pregnancy
heart failure
chronic liver disease

61
Q

Ostomies include

A

Colostomy
Ileostomy
Ileoanal Pouch Anastomosis

62
Q

Types of Colostomies

A
  1. loop
  2. end
  3. double-barrel
63
Q

Loop Colostomy

A

usually performed in an emergency

64
Q

End Colostomy

A

one stoma from proximal end of bowl with distal end removed, or sutured closed

65
Q

Psychological Consideration for patients with ostomies

A
  • Causes serious body image changes - emotional support
  • Foul Odors
  • Inability to regulate bowel movements
66
Q

Ostomies

A

F. 47-2, 3, 4 p. 1153-4

67
Q

Nursing Process: Assessment

A 
Usual elimination patterns
Stool characteristics T. 47-1  p. 1157
Routines to promote normal elimination
Use of artificial aids
Presence and status of bowel diversions
Changes in appetite
Diet history
Daily fluid intake
History of surgery/illnesses affecting the GI tract Box 46-5, p. 1100
Medication history
Emotional state
History of exercise
Pain or discomfort
68
Q

Stool Characteristics

A 
Color
Odor
Consistency
Frequency
Shape
Constituents
69
Q

Normal Stool Color

A

adult: brown
infants: yellow

70
Q

Abnormal Stool Color

A

white or clay
black or tarry (melena)
red
pale and oily

71
Q

What causes the stool to be a white or clay color?

A

absence of bile

72
Q

What causes the stool to be black or tarry?

A

iron ingestion or gastrointestinal bleeding

73
Q

What causes the stool to be red?

A

GI bleeding
hemorrhoids
ingestion of beets

74
Q

What causes the stool to be pale and oily?

A

malabsorption of fat

75
Q

Normal frequency for stools

A

Varies:
In adults, 2 x daily to 3 times a week.
In infants 4-6 times daily (breastfed) or 1-3 times daily (bottle-fed).

76
Q

Abnormal frequency for stools

A

Infants: more than 6 x daily or less than 1 -2 days
Adult: more than 3 times a day or less than once a week

77
Q

What can cause an abnormal frequency of stools?

A

hypermotility or hypomotility

78
Q

What is the usual shape of stool?

A

resembles the diameter of the rectum

79
Q

What is an unusual shape for stool?

A

narrow, pencil shaped

80
Q

What can cause an abnormal shape for stool?

A

obstruction, increased peristalsis

81
Q

Normal constituents in stool

A 
Undigested food
Dead bacteria
Fat 
Bile pigment
Cells lining intestinal mucosa
Water
82
Q

Abnormal constituents in stool

A

Blood, pus, foreign bodies, mucus, worms
Oily stool
Mucus

83
Q

What can cause blood, pus foreign bodies, mucus and worms in stool?

A

internal bleeding, infection, swallowed objects, irritation, inflammation and infestation of parasites

84
Q

What can cause oily stool?

A

malabsorption syndrome, enteritis, pancreatic disease, surgical resection of intestine

85
Q

What can cause mucus in the stool?

A

intestinal irritation
inflammation
infection
injury

86
Q

Physical Assessment of the GI tract

A

Mouth
Abdomen
Rectum
Radiological/Diagnostic Tests

87
Q

Abdomen assessment

A

a distended abdomen feels like a drum and the skin is taut and appears stretched

88
Q

Radiological/Diagnostic Tests (B. 47-5 p. 1158)

A 
Fecal Specimen (25% of stool is bacteria from the colon)
Fecal Occult Blood (Guaiac) (B. 47-4 p. 1157)
89
Q

Possible Nursing Diagnosis RT Bowel Elimination

A 
Disturbed Body Image
Bowel Incontinence
Constipation
Risk For Constipation
Diarrhea
Nausea
Deficient Knowledge: Nutrition
Toileting Self-care Deficit
90
Q

Nursing Process: Planning

Consider preexisting health concerns

A

diet
activity
irregular bowel habits

91
Q

Teamwork and Collaboration

A

Dietitians

WOCNs

92
Q

Health Promotion

A
  • Teach proper diet

- Effects of stress on peristalsis

93
Q

If patients are a risk for falls always

A

stand by them or leave the door partially open to see them at all times

94
Q

Nursing Process: Implementation

A

Provide normal positioning of defecation if possible.
Provide privacy if possible.
Implement measures in the acute care setting to promote defecation. (B. 47-9 p. 1164)

95
Q

If a bedpan is necessary, what position should you sit the patient?

A

sit the patient up as high as possible

96
Q

Implementation meausres in the acute care setting that promotes defecation includes

A

hydration
movement
pain control

97
Q

Cathartics

A

Medications that stimulate the bowel motility.

i.e dulcolax

98
Q

Laxatives (T. 47-2 p. 1165)

A

Medications that pull water into the bowel.

i.e mag citrate, correctol

99
Q

Antidiarrheal Agents

A

prescription opiates

i.e lomotil

100
Q

Enemas include

A 
Cleansing enemas
Tap Water 
Normal Saline
Hypertonic Solutions
Soapsuds
Oil Retention
101
Q

The digital removal of stool is usually (B,. 47-10 p. 1166)

A

a last resort if enemas fail

very uncomfortable to the patient

102
Q

Caution for the digital removal of stool

A

bleeding and stimulation of the vagus nerve which results in slowing of the heart rate.
know your policy and procedure if MD order is necessary.

103
Q

Nasogastric tubes are used for (T. 47-3 p. 1167)

A
  1. stomach decompression: gastric contents or gas
  2. feeding and hydration
  3. lavage
  4. compression
104
Q

Lavage

A

poisoning
active bleeding
gastric dilation

105
Q

Compression

A

internal, esophageal or GI hemorrhage

106
Q

Wound Ostomy Continence Nurse (WOCN)

A

Specialist in ostomy and wound care

107
Q

A normal ostomy is

A

bright pink.

Notify the MD if blue, brown or black.

108
Q

Care of Ostomies (B. 47-11 p. 1167)

A
  • Never use an enema set up to irrigate a colostomy
  • Irrigate with cone shaped irrigator per manufacturer instructions
  • Consider Psychological implications
109
Q

Why should you never use an enema set up to irrigate a colostomy?

A

risk for bowel perforation

110
Q

Bowel Training

A

using measures to promote defecation by setting up a normal daily routine.

111
Q

Bowel Training includes

A

Assess normal elimination pattern
Incorporate principles of gerontology
Choose a time in the patients day to initiate defecation
Give stool softeners or cathartic ½ hour before desired time
Offer a hot drink to stimulate peristalsis
Help the patient to the toilet
Avoid medications such as opioids if an option
Provide privacy
Offer encouragement

112
Q

What patients are usually at risk for impaired skin integrity?

A

every patient with fecal incontinence or prolonged diarrhea

113
Q

Liquid stool contains

A

digestive enzymes which causes rapid skin breakdown

114
Q

Repeated wiping can

A

further irritate the skin.

115
Q

Fecal management systems are available for

A

short-term use

116
Q

Meticulous perianal skin care is essential to

A

prevent skin breakdown

NURS 305 (30 decks)

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