Elimination- GI

Question 0

normal changes of aging related to the G.I. system

Esophagus

Answer 0

L ES pressure is decline

motility decreased

Question 1

Normal changes of aging related to G.I. system

Mouth

Answer 1

Mouth: Gingival retraction 
Decreased taste buds 
decreased since a smell 
decrease volume of saliva
Atrophy of gingival tissue

Question 2

Normal changes of aging related to the G.I. system

Abdominal wall

Answer 2

Thinner and less taught

decrease number and sensitivity of sensory receptors

Question 3

Normal changes of aging related to the G.I. system

Stomach

Answer 3

Atrophy of gastric mucosa

Decreased blood flow

Question 4

Normal changes of aging related to GI system

small intestine

Answer 4

Slightly decreased secretion of most digestive enzymes and motility

Question 5

Normal changes of aging related to G.I. system

Liver

Answer 5

Decrease in size and lower position decreased protein synthesis decreased ability to regenerate

Question 6

Normal changes of aging related to G.I. system

large intestine, anus, rectum

Answer 6

Decreased anal sphincter tone decrease nerve supply to rectal area decreased muscular tone
decrease motility
increased transit time
decreased sensation to defecation

Question 7

Normal changes of aging related to G.I. system

pancreas

Answer 7

Pancreatic ducts distended decreased lipase production impaired pancreatic reserves

Question 8

Stool softener

Answer 8

Pulls water into the colon to soften stool

may also promote electrolyte and water secretion into the stool

Question 9

Laxatives (sennosides)

Answer 9

Alter water and electrolyte transport in the large intestine, resulting in accumulation of water and increased peristalsis.

Question 10

Osmotic solutions ( milk of magnesia, lactulose)

Answer 10

Essential for the activity of many enzymes
play an important role in neurotransmission and muscular excitability
are osmotically active in GI tract, drawing water into the lumen and causing peristalsis

Question 11

Stimulants ( ducolax)

Answer 11

Stimulates peristalsis

Alters fluid and electrolyte transport, producing fluid accumulation in the colon.

Question 12

Bulk forming ( Metamucil)

Answer 12

Combines with water in the intestinal contents to form a Emmollient gel or viscous solution that promotes peristalsis and reduces transit time

Question 13

Stool sample collection

Answer 13

Suspected GI bleed
They can be examined for the presence of blood, mucus, WBCs and parasites
Culture are preformed to identify infectious organisms.
Suspected C diff infection

Question 14

Stool sample

Answer 14

In patients with diarrhea, measurement of stool electrolytes, PH, and osmolality help determine whether the diarrhea is related to decrease fluid absorption or increase fluid secretion.
Measurement of still far and I digested muscle fibers may indicate fat and protein malabsorption conditions including pancreatic insufficient.

Question 15

Explain the risks from straining at stool, as well as fecal incontinence

Answer 15

Straining: constipated patients tend to strain during defecation, straining contributed to incontinence because it weakness the pelvic floor muscles.
Patients with decal impact ion, common in older adults with limited mobility. Straining often causes venous enlargement leading to hemorrhoids.
Straining (valsalva maneuver) increases both intraabdominal and intrathoracic pressures and reduces venous return to heart. The heart rats decreases temp, and there is transient drop in arterial press.
When the patient relaxes, thoracic pressure falls, resulting in a sudden flow of blood into the heart, increases heart rate and an immediate rise in arterial press.
These changes may be fatal for the patient who cannot compensate for the sudden increased blood flow returning to the heart.

Question 16

Fecal incontinenece

Answer 16

Is the involuntary passage of stool, and it occurs when the normal structures that maintain continence are disrupted.
Prob with motor function ( contraction of the sphincter and rectal floor muscles) and/or sensory function ( ability to perceive the presence of stool or to experience the urge to defecate) can result in fecal incontinence.

Question 17

FecAl incontinence

Answer 17

Weakness or distribution of the internal or external anal sphincter, damage to the pudendal nerve or other nerves that innervate the anorectum, damage to the anal tissue, weakness of or trauma to the puborectalis muscle all contribute to incontinenece.

Question 18

Fecal incontenence

Answer 18

For women obstetic trauma is the most common cause of sphincter disruption
childbirth, aging, and menopause contribute to the development of fecal incontinence
Anorectal surgery can damage the sphincter and pudenal nerves
Irradiation for prostate cancer decreases rectal compliance.
Neurological conditions( stroke, spinal cord injury, multiple sclerosis, Parkinson’s disease) and diabetic neuropathy also interfere with defecation.

Question 19

Colonoscopy

Answer 19

Directly visualizes entire colon up to ilelcecal valve with flexible fiber optic scope.
Patient’s position change frequently during procedure to assist with advancement of scope to cecum. Used to diagnose/ detect inflammatory bowel dissuade, polyps, rumors , diverticulosis, and dilate strictures. Procedure slows for biopsy and removal of polys without laparotomy .

Question 20

Colonoscopy, before procedure

Answer 20

Bowel preparation is done. This varied depending on physician. For ex: patients may be kept off clear liquids 1-2 days before procedure. Cathartic and /or enema given the night before. An alternative is to give 1 gal of polyethylene glycol evening before (8oz every 10 Min) . Explain to the patient that flexible scope will be inserted while patient is in side- lying position. Explain to patient sedation will be given.

Question 21

Colonoscopy, post

Answer 21

Be aware that patient may experience abdominal cramps caused by stimulation of peristalsis because the bowel is constantly inflated with air during procedure.

Observe for recital bleeding and signs of perforation ( malaise, abdominal dissension, tenesmus) check vital signs.

Question 22

Stoma post-op

Answer 22

Should be pink, will have some bleeding and edema for the first 2-3 weeks after surgery. Bleeding occurs due to high vascularity of the stoma. Call MD is stoma appears pale which may indicate anemia, blanching, dark red or purple, which may indicate inadequate blood supply to the stoma or bowel from adhesions, low-flow state, or excessive tension on the bowel at the time of construction.

Question 23

Lower GI series vowel evacuation

Answer 23

After procedure, fluids should be encouraged, give laxatives, or suppositories to assist in expelling barium. Observe stool for the passage of the contrast medium

Question 24

Patient with high intestinal obstruction is more likely to have metabolic: alkalosis or acidosis?

Answer 24

Alkalosis

Question 25

Patient with low obstruction is at greater risk of metabolic alkalosis or acidosis?

Answer 25

Acidosis ( think low- acid)