Exam 4 Bowel Elimination

Question 1

What are the elimination concepts?

Answer 1

control, retention, and discomfort

Question 2

What is the process of peristalsis?

Answer 2

under control of nervous system, contractions every 3 to 12 minutes; mass sweeps 1-4 times in 24 hour period

Question 3

What are variables influencing bowel elimination?

Answer 3

developmental considerations, daily patterns, food and fluid, activity and muscle tone, lifestyle, psychological variables, medications, diagnostic studies, surgery and anesthesia

Question 4

What foods cause constipation?

Answer 4

cheese, lean meat, eggs, pasta

Question 5

What foods have laxative effects?

Answer 5

fruits and vegetables, bran, chocolate, alcohol, coffee

Question 6

What are gas-producing foods?

Answer 6

onions, cabbage, beans, cauliflower

Question 7

Who are at highest risk for bowel incontinence?

Answer 7

people with cognitive issues and people who have had radiation to the area

Question 8

Who are at highest risk for retention?

Answer 8

those with inadequate fluid intake, fiber or exercise, on certain meds, and pregnancy

Question 9

What to inspect during abdomen assessment?

Answer 9

observe contour, any masses, scars, or distention

Question 10

What to auscultate during physical assessment on abdomen?

Answer 10

listen for bowel sounds in all 4 quadrants, note frequency and character, audible clicks, and flatus; describe as hypoactive, hyperactive, absent or frequent

Question 11

What to inspect and palpate during physical assessment of anus and rectum?

Answer 11

lesions, ulcers, fissures, inflammation, and external hemorrhoids; ask pt to bear down as if they were having a BM, assess appearance of internal hemorrhoids or fissures and fecal masses; inspect perineal area for skin irritation secondary to diarrhea or incontinence

Question 12

What are the types of direct visualization studies?

Answer 12

esophagogastroduodenoscopy, colonoscopy, sigmoidoscopy, wireless capsule endoscopy

Question 13

What are the indirect visualization studies?

Answer 13

upper GI, small bowel series, barium enema, abdominal ultrasound, MRI, abdominal CT scan

Question 14

Order of scheduling diagnostic tests

Answer 14

1. fecal occult blood test
2. barium studies
3. endoscopic exam

Question 15

What are patient outcomes for normal bowel elimination?

Answer 15

pt has soft, formed bowel movement every 1-3 days without discomfort; relationship between diet, fluid, and exercise is explained; pt to seek eval if changes in stool color or consistency persist

Question 16

How do you promote regular bowel habits?

Answer 16

timing, positioning, privacy, nutrition, exercise (abdominal and thigh strengthening)

Question 17

Who is at high risk for constipation?

Answer 17

pt on bedrest taking constipating medicine, pt with reduced fluid intake or bulk in their diet, pt who is depressed, pt with CNS disease or local lesions that cause pain while defecating

Question 18

What are the methods of emptying the colon of feces?

Answer 18

enemas, rectal suppositories, oral intestinal lavage, digital removal of stool

Question 19

What are the types of enemas?

Answer 19

cleansing; retention: oil, carminative, medicated, anthelmintic; large volume; small volume

Question 20

How do oil-retention enemas work?

Answer 20

lubricate the stool and intestinal mucosa, easing defecation

Question 21

How do carminative enemas work?

Answer 21

help expel flatus from rectum

Question 22

How do medicated enemas work?

Answer 22

provide meds absorbed through rectal mucosa

Question 23

How do anthelmintic enemas work?

Answer 23

destroy intestinal parasites

Question 24

What are nasogastric tubes used for?

Answer 24

to allow the GI tract to rest before or after abdominal surgery to promote healing; inserted to decompress or drain the stomach of fluid or unwanted stomach contents; monitors GI bleeding

Question 25

What are the types of ostomies?

Answer 25

sigmoid colostomy, descending colostomy, transverse colostomy, ascending colostomy, ileostomy

Question 26

What does colostomy care entail?

Answer 26

keep pt free of odors as much as possible, empty bag frequently; inspect stoma regularly; measure fluid I&O; explain each aspect of care; encourage pt to care for and look at ostomy

Question 27

What does patient teaching for colostomies include?

Answer 27

explain reason for bowel diversion and rationale for tx; demonstrate self-care behaviors that effectively manage the ostomy; describe f/u care and supporting resources; report where they can get supplies; verbalize related fears and concerns; demonstrate positive body image

Question 28

What are comfort measures for ostomy patients?

Answer 28

encourage recommended diet and exercise; use meds only as needed; apply ointments or astringents; use suppositories that contain anesthetics