Elimination (Fecal) Flashcards
excreted waste products are referred to as
Feces or stool
_____extends from the ileocecal (ileocolic) valve, which lies between the small and large intestines, to the anus.
Large Intestine
colon (large intestine) in the adult is generally about ______ cm long
125 to 150 cm
The colon’s main functions are:
- absorption of water and nutrients,
- the mucoid protection of the intestinal wall
- fecal elimination.
The waste products leaving the stom- ach through the small intestine and then passing through the ileocecal valve are called______
Chyme
The _____ regulates the flow of chyme into the large intestine and prevents backflow into the ileum.
ileocecal valve
As much as ______mL of chyme passes into the large intestine daily, and all but about ____ mL is reabsorbed in the proximal half of the colon.
1500 mL; 100mL
_____ serves to protect the wall of the large intestine from trauma by the acids formed in the feces, and adherent for holding the fecal material together.
Mucus
______is largely air and the by-products of the digestion of carbo- hydrates.
Flatus
_____ wavelike movement produced by the circular and longitudinal muscle fibers of the intestinal walls; it propels the intestinal contents forward.
Peristalsis
The rectum in the adult is usually _____ cm long
10-15 cm
The anal canal, which is the distal portion is ______ cm long
2.5 to 5cm
______ has folds that extend vertically. Each of the vertical folds contains a vein and an artery.
Rectum
What helps retain the feces within the rectum?
vertical folds that contains a vein and an artery.
When the veins become distended, as can occur with repeated pressure, a condition known as _____
hemorrhoids
The _____ sphincter is under involuntary control; innervated by the autonomic nervous system
Internal sphincter
The ____ sphincter normally is voluntary controlled; innervated by the somatic nervous system.
external sphincter
______is the expulsion of feces from the anus and rectum. It is also called a bowel movement.
Defecation
Repeated inhibition of the urge to defecate can result in ________ to accommodate accumulated feces and eventual loss of sensitivity to the need to defecate.
expansion of the rectum
If the defecation reflex is ignored, ______ can be the ultimate result
Constipation
Normal feces are made of about _____ and _____
75% water and 25% solid materials
Feces are normally brown, chiefly due to the presence of ______ and ______
stercobilin and urobilin
Bacteria which are normally present in the large intestine
Escherichia coli or staphylococci
_____ is the first fecal material passed by the newborn, normally up to 24 hours after birth.
Meconium
_____ promotes the movement of material through the digestive system and increases stool bulk.
Ex. whole-wheat flour, wheat bran, nuts, and many vegetables.
Insoluble fiber
______ dissolves in water to form a gel-like material. It can help lower blood cholesterol and glucose levels.
Ex. oats, peas, beans, apples, citrus fruits, carrots, barley, and psyllium
Soluble fiber
_____ foods, such as rice, eggs, and lean meats, move more slowly through the intestinal tract.
Low residue foods
Gas-producing foods:
cabbage, onions, cauliflower, bananas, and apples
Laxative-producing foods:
bran, prunes, figs, chocolate, and alcohol
Constipation-producing foods:
cheese, pasta, eggs, and lean meat
________ fluid intake slows the chyme’s passage along the intestines, further increasing the reabsorption of fluid from the chyme.
Reduced fluid intake
Healthy fecal elimination usually requires a daily fluid intake of ______
2000 to 3000 mL
What psychologic factors that increases the peristaltic activity and subsequent nausea or diarrhea?
Being anxious or angry
What psychologic factor that slows down the intestinal motility, resulting in constipation?
Individuals who are depressed
Many individuals defecate after breakfast due to the ______ reflex; increased peristalsis of the colon after food has entered the stomach
gastrocolic reflex
Medication that causes diarrhea:
Tranquilizers
Medication that causes constipation:
Opioids
______ are medications that stimulate bowel activity and so assist fecal elimination.
Laxatives
Any drug that causes gastrointestinal bleeding (e.g., aspirin products) can cause the stool to be ______ or _____
Red or black
Iron salts lead to ______ stool because of the oxidation of the iron;
Black stool
Medication such as _______ may cause a gray-green discoloration
Antibiotics
Medication such as ________ can cause a whitish discoloration or white specks in the stool
Antacids
_________ cause the normal colonic movements to cease or slow by blocking parasympathetic stimulation to the muscles of the colon.
General anesthetics
Surgery that involves direct handling of the intestines can cause temporary stoppage of intestinal movement. This condition, called______, usually lasts 24-48 hrs
ileus
______ may be defined as fewer than three bowel movements per week. This infers the passage of dry, hard stool or the passage of no stool.
Constipation
_______associated with constipation is often accompanied by holding the breath.
Straining
______ can present serious problems to people with heart disease, brain injuries, or respiratory disease. Holding the breath while bearing down increases intra- thoracic pressure and vagal tone, slowing the pulse rate.
Valsalva maneuver
______ is a mass or collection of hardened feces in the folds of the rectum. It results from prolonged retention and accumulation of fecal material.
Fecal Impaction
_____ or _____ are usually given to ensure removal of the barium from the radiologic examination of the GI tracts.
laxatives or enemas
Impaction can also be assessed by _____ examination of the rectum, during which the hardened mass can often be palpated.
digital examination
______ refers to the passage of liquid feces and an increased frequency of defecation. t is the opposite of constipation and results from rapid movement of fecal con- tents through the large intestine.
Diarrhea
diarrhea is thought to be a protective flushing mechanism. It can create serious ____ and _____ losses in the body.
Fluid and electrolytes
__________ produces mucoid and foul-smelling diarrhea
Clostridium difficile infection (CDI)
_____ refers to the loss of voluntary ability to control fecal and gaseous discharges through the anal sphincter.
Bowel incontinence, also called fecal incontinence
The prevalence of bowel incontinence increases with ____
Age
Major causes of Diarrhea:
- Psychologic factors
- Medications
- Allergy to food, fluids, drugs
- Intolerance of food or fluids
- Diseases of the colon
The three primary sources of flatus are:
(1) action of bacteria on the chyme in the large intestine,
(2) swallowed air, and
(3) gas that diffuses between the bloodstream and the intestine.
Most gases that are swallowed are expelled through the mouth by _____
Eructation (Belching)
_______ is the presence of excessive flatus in the intestines and leads to stretching and inflation of the intestines (intestinal distention).
Flatulence
Physical examination of the abdomen in relation to fecal elimination problems includes:
IAPerPal
1. Inspection
2. Auscultation
3. Percussion
4. Palpation
Why auscultation precedes palpation?
because palpation can alter peristalsis
For clients who have difficulty sitting down and getting up from the toilet, an ________ can be attached to a regular toilet.
elevated toilet seat
______, a portable chair with a toilet seat and a receptacle beneath that can be emptied, is often used for the adult client who can get out of bed but is unable to walk to the bathroom
Bedside commode
Clients restricted to bed may need to use a _____, a receptacle for urine and feces.
bedpan
The two main types of bedpans:
- Regular high-back pan
- Slipper pan
If the bedpan is metal, warm it by rinsing it with_____
warm water
_____ are drugs that induce defecation. They can have a strong, emptying effect.
Cathartics
_____ is mild in comparison to a cathartic, and it produces soft or liquid stools that are sometimes accompanied by abdominal cramps.
Laxative
Some laxatives are given in the form of ______. These act in various ways: by softening the feces, by releasing gases such as carbon dioxide to distend the rectum, or by stimulating the nerve endings in the rectal mucosa.
suppositories
The best results can be obtained by inserting the suppository _____ mins before the client’s usual defecation time or when the peristaltic action is greatest, such as after breakfast.
30 mins
These medications slow the motility of the intestine or absorb excess fluid in the intestine.
Antidiarrheal Medications
_____, medication that do not decrease the formation of flatus but they do coalesce the gas bubbles and facilitate their passage by belching through the mouth or expulsion through the anus.
Antiflatulent Medications
A combination of ____ and_____ (Imodium Advanced) is effective in relieving abdominal bloat- ing and gas associated with acute diarrhea;
simethicone and loperamide
_____ are herbal oils known to act as agents that help expel gas from the stomach and intestines.
Carminatives
There are a number of ways to reduce or expel flatus, including:
exercise, moving in bed, ambulation, and avoiding gas-producing foods
_____ is a solution introduced into the rectum and large intestine. The action of an it is to distend the intestine and sometimes to irritate the intestinal mucosa, thereby increasing peristalsis and the excretion of feces and flatus.
Enema
he enema solution should be at _____ because a solution that is too cold or too hot is uncomfortable and causes cramping.
37.7°C (100°F)
Enema that is intended to remove feces
Cleansing Enema
______ exert osmotic pressure, which draws fluid from the interstitial space into the colon. The increased volume in the colon stimulates peristalsis and thus defecation.
Hypertonic solutions
_____ exert a lower osmotic pressure than the surrounding interstitial fluid, causing water to move from the colon into the interstitial space.
Hypotonic solutions
Because the water moves out of the colon, the tap water enema should not be _____ because of the danger of circulatory overload
repeated
______ such as physiologic (normal) saline, are considered the safest enema solutions to use. They exert the same osmotic pressure as the interstitial fluid surround- ing the colon. Therefore, there is no fluid movement into or out of the colon.
______ enemas stimulate peristalsis by increasing the volume in the colon and irritating the mucosa.
_____ enema is given to cleanse as much of the colon as possible. The client changes from the left lateral position to the dorsal recumbent position and then to the right lateral position during administration
_____ enema is used to clean the rectum and sigmoid colon only. The client maintains a left lateral position during administration.
The higher the enema solution container is held above the rectum, ____ the flow and the greater the force (pressure) in the rectum.
the faster
During most adult enemas, the solution container should be no higher than _____ cm above the rectum.
30 cm (12 in)
During a high cleansing enema, the solution container is usually held ____ cm
30 to 48cm (12 to 18 in)
_____ enema introduces oil or medication into the rectum and sigmoid colon. The liquid is retained for a relatively long period (e.g., 1 to 3 hours)
Retention enema
_____ enema acts to soften the feces and to lubricate the rectum and anal canal, thus facilitating passage of the feces.
Oil retention
_____ enemas are used to treat infections locally, anthelmintic enemas to kill helminths such as worms and intestinal parasites
Antibiotic enemas
_____ enemas to administer fluids and nutrients to the rectum.
Nutritive enemas
____ enema is given primarily to expel flatus. The solution instilled into the rectum releases gas, which in turn distends the rectum and the colon, thus stimulating peristalsis
Carminative enema
_____ also called a Harris flush, is occasionally used to expel flatus. Alternating flow of ____mL of fluid into and out of the rectum and sigmoid colon stimulates peristalsis. This process is repeated five or six times
Return flow enema; 100 to 200 mL
_____ involves breaking up the fecal mass digitally and removing it in portions.
Digital Removal
Before disimpaction it is suggested an _____ enema be given and held for 30 minutes.
oil retention
Because manual removal of an impaction can be painful, the nurse may use, if the agency permits, 1 to 2 mL of _______ gel on a gloved finger inserted into the anal canal as far as the nurse can reach.
lidocaine (Xylocaine)
To collect and contain large volumes of liquid feces, the nurse may place a ______ around the anal area
fecal incontinence collector pouch
The artificial sphincter consists of three parts:
a cuff around the anal canal, a pressure-regulating balloon, and a pump that inflates the cuff
_____ is an opening for the gastrointestinal, urinary, or respiratory tract onto the skin
ostomy
_____ is an opening through the abdominal wall into the stomach
Gastrostomy
_____ opens through the abdominal wall into the jejunum
jejunostomy
_____ opens into the ileum (small bowel); empties from the distal end of the small intestine. It produces liquid fecal drainage.
ileostomy
____ opens into the colon (large bowel).
Colostomy
____ and _____ are generally performed to provide an alternate feeding route.
Gastrostomies and jejunostomies
The purpose of ______ is to divert and drain fecal material.
bowel ostomies
_____ , the opening created in the abdominal wall by the ostomy; generally red in color and moist.
Stoma
The client does not feel the stoma because there are ______
no nerve endings in the stoma
____ empties from the ascending colon; drainage is liquid and cannot be regulated, and digestive enzymes are present.
Ascending colostomy
_____ empties from the cecum (the first part of the ascending colon)
Cecostomy
____ empties from the transverse colon; produces a malodorous, mushy drainage because some of the liquid has been reabsorbed. Usually there is no control
transverse colostomy
_____ empties from the descending colon; produces increasingly solid fecal drainage.
descending colostomy
_____ empties from the sigmoid colon; normal or formed consistency
sigmoidostomy
____ is created when one end of bowel is brought out through an opening onto the anterior abdominal wall. This is referred to as an_______ ; the stoma is permanent
Single stoma; end or terminal colostomy
______ a loop of bowel is brought out onto the abdominal wall and supported by a plastic bridge or by a piece of rubber tubing
Loop colostomy
____ consists of two edges of bowel brought out onto the abdomen but separated from each other
Divided colostomy
the distal end in In divided colostomy situation is often referred to as a _____, since this section of bowel continues to secrete mucus
mucous fistula
_____ resembles a double- barreled shotgun; the proximal and distal loops of bowel are sutured together for about 10 cm (4 in.) and both ends are brought up onto the abdominal wall.
double-barreled colostomy
_____ absorbs moisture and also creates a dry coating, increasing adhesion of the stoma appliance
Stoma powder
____ available as wipes or spray, act as a barrier against the fecal material and are applied prior to attaching the appliance.
Protective films
Appliances can be _____ where the skin barrier is already attached to the pouch
One piece
appliance can consist of two pieces: a ____ with a flange and a separate _____ with a flange where the pouch fastens to the barrier at the flange
separate pouch; skin barrier
_____ pouch that usually has a clip where the end of the pouch is folded over the clamp and clipped. Used by clients who need to empty the pouch more than twice a day.
Drainable pouch
____ pouches are often used by clients who have a regular stoma discharge (e.g., sigmoid colostomy) and only have to empty the pouch one or two times a day.
Closed pouches
The most common routine for changing the appliance is every ______ days
2-3 days
If the skin is erythematous, eroded, or ulcerated, the pouch should be changed every _____ hrs
24-48 hrs
The pouch is emptied when it is ______ of discharge or gas.
one-third to one-half full
_____ similar to an enema, is a form of stoma management used only for clients who have a sigmoid or descending colostomy.
colostomy irrigation (CI)
