GI Elimination Flashcards
Elimination
excretion of waste products from kidneys and intestines
Defecation
process of elimination of waste
Feces
semisolid mass of fiber, undigested food, inorganic matters
Incontinence
inability to control urine or feces
Void, Micturate
to urinate
Dysuria
painful or difficult urination
hematuria
blood in urine
Nocturia
frequent night urination
T/F: Feces should only be in the rectum when ready to void.
True
Polyuria
large amounts of urine
-do not use a diuretic or drink large amounts
T/F: Nocturia is frequent in patients with heart issues.
True
Urinary frequency
voiding at frequent intervals
Urinary urgency
need to void
Valsalva Manuever
increase the pressure while bearing down
-straining the abdominal muscles and closing their airway
Pts we don’t want to Valsalva maneuver
mother’s after C-section
pt after abdominal surgery
at risk pt (aneurysm, stroke with blood thinner)
Proteinuria
presence of large protein in urine
Hesitancy
difficulty initiating urination
Dribbling
leakage of urine despite voluntary control of urination
Retention
accumulation of urine in bladder without the ability to completely empty
Residual
urine remaining post void greater than 100 mL
Bowel Elimination Process
-fecal material reaches the rectum (causes distention)
- stretch receptors initiate contraction of sigmoid colon/rectal muscles
-internal anal sphincter relaxes
-sensory impulses cause voluntary “bearing down” (diaphragmatic and abdominal muscles to increase downward pressure
-external sphincter relaxes
Hemorrhoids
occur due to pressure on uterus and increased blood volume
Factors Affecting Bowel Elimination
Developmental stage: young and old
Personal factors: privacy, time, job speed
Sociocultural: stress
Nutrition/Hydration: regular schedules, high fiber, fluid intake
Activity
Medications: oral meds
Surgery and Procedures: NG Tube, paralytic ileus
Pregnancy
Pathological conditions
A fecal transplant can be used if the pt has
C. diff
If the signal to defecate is ignored, the reflexive contractions
ease for a few minutes, until mass peristalsis occurs again
What developmental stages change bowel elimination patterns?
Young and the old
When you ignore the need to defecate, it promotes
bowel dysfunction
- no privacy, significant time
- fast-paced jobs ignore the need
Sociocultural factors affecting bowel elimination
stress has a major influence
- cause diarrhea or constipation
- risk development of IBS
IBS
Irritable Bowel Syndrome
-stress is a primary risk factor in the development
- associated with bloating, pain, and altered bowel function
Nutrition/Hydration factors affecting bowel elimination
- regular intake of food promotes peristalsis
- regular intake schedule
- irregular schedule = irregularity
- high fiber
- fluid intake
High fiber promotes
peristalsis and defecation by increasing bulk, bulky foods absorb fluids and increase stool mass
Proper Fluid Intake
6 to 8 oz. glasses of water a day
Inadequate Fluid Intake can lead to
dry, hard stools that are difficult to pass
Nutrition has _________, _______ meals tend to work better, regular schedule promoting regular elimination.
several, small
Activity can stimulate
peristalsis
Sedentary people have _______ abdominal muscles.
weaker
Patients with limited activity often have what type of bowel movements?
constipation
What types of medications have the potential to affect the function of the GI Tract? Symptoms?
All oral meds
-Symptoms: N/V/D, constipation
Surgery/Procedures affecting bowel elimination
- bowel manipulation leads to paralytic ileus
- NG tube on low or intermittent suction
How does pregnancy affect bowel elimination?
- morning sickness at any time
- Growing uterus crowds and displaces intestines
-slowing of intestinal motility - increase in progesterone
- often experience constipation, decreased appetite, irregular food intake
- risk of hemorrhoids from the pressure of the uterus and increased blood volume
Paralytic ileus
no bowel peristalsis, the bowel continues to produce secretions that remain stagnant causing distension and discomfort
NG Tube removes secretions until
peristalsis
Pathological factors affecting bowel elimination
- neurological disorders affect the innervation of the lower GI Tract
- cognitive conditions limit the ability to sense “the urge” = incontinence
- Pain or immobility leads to sluggish peristalsis
General Overall Goal is for pt to have
soft, formed, regular BM
- no N/V, bloating
Promoting Regular Defecation
- privacy
- correct position: seated upright
- timing: after meals, may need assistance
What is the proper diet?
fresh fruits, veggies, whole grains, fiber
Proper Exercise
- 3-5 times a week
- ROM for pts on bed rest
- Positioning
- Encourage exercise
Bristol Stool Chart ( Type 1-7 )
1) Severe constipation: hard lumps
2) Mild constipation: lump and sausage like
3) Ideal: sausage shape with cracks
4) Ideal: smooth, soft sausage
5) Lacking fiber: soft blobs with clear edges
6) Mild diarrhea: mushy consistency
7) Severe diarrhea: liquid consistency
Flexi-seal rectal tube process
- inserted into the rectum with
-inflate the retention balloon easily by filling it with tap water or saline - connected to a collection bag
Flexi-seal rectal tube used for
severe incontinence (C. diff, severe diarrhea, and to prevent breakdown)
What candies represent all 7 on the Bristol scale?
1) Raisenets
2) Baby Ruth
3) Twix/Snickers
4) Swiss Cake Rolls
5) Marshmallows
6) Pudding
7) YooHoo milk aka Big Summer
Severe Constipation (1) caused by
immobile, inadequate diet, not enough fluid, too much fiber
Mild Constipation (2) caused by
dehydration, side effect of medications, stress, too much fiber
Ideal (3&4) is caused by
active, good fluid intake, low stress
Lacking fiber (5) is caused by
no fiber, poor nutrition, too much fluid
Mild diarrhea (6) is caused by
stress, no fiber, laxative abuse, Celiac disease
Severe diarrhea (7) is caused by
Big Summer Blowout
- stress, no fiber, laxative abuse, rotavirus infections
Fluid Balance
= kidneys maintaining the volume and composition of extracellular and to a lesser extent
= intracellular fluid by continuously exchanging water and solutes
Interstitial fluid components and flow
Sodium and potassium change places
Water follows sodium
What do the kidneys do to maintain fluid balance?
regulate the amount of makeup of the fluids inside and around the cells
- partially controlled by hormones
What 2 hormones are involved in fluid balance?
Antidiuretic hormone (ADH)
Aldosterone
Fecal matter in Bowel Incontinence Devices
when a pt has diarrhea, the watery stool travels through the small and large bowels much faster than solid waste
-prevents the reabsorption of stomach acid which causes the fecal matter to be caustic to the skin increasing the risk of skin breakdown
Antidiuretic hormone is produced by
pituitary gland
Antidiuretic hormone if high
causes more water to be absorbed creating a high concentration but small volume of urine
Antidiuretic hormone if low
causes more water to be excreted creating a larger volume of urine
Aldosterone produced by
adrenal gland
Aldosterone
regulates water reabsorption and changes urine concentration by increasing sodium reabsorption
- helps control of secretion of potassium
Normal Urinary Patterns
kidneys produce ~ 50-60mL/hr or 1500 mL/day
= normal voiding is ~ 5-6 times per day depending on fluid intake
Characteristics of Normal Urine
- Specific Gravity (1.002 - 1.003)
- Color
Specific Gravity
a measure of dissolved solutes in a solution
Increased specific gravity means increased
urine solutes
Fluid intake increases urine and becomes
more diluted and lighter in color
Fluid intake decreases urine becomes
darker and specific gravity rises
Abnormal Urine Meaning
Dark Yellow
less water, more waste, dehydration
Abnormal Urine Meaning
Red/Pink
blood in urine
Abnormal Urine Meaning
Brown
liver conditions, gallbladder (bile), fava beans, rhubarb
Abnormal Urine Meaning
Orange
TB drug, carrots (beta-carotene)
Abnormal Urine Meaning
Milky White
WBCs, purine rich foods like anchovies, herring, red meat
Abnormal Urine Meaning
Blue
methylene blue (dye in diagnostic tests)
Abnormal Urine Meaning
Green
drugs (Tagament, Elavil)
Abnormal Urine Meaning
Purple
“Purple Urine Bag Syndrome”
- colonized bacteria in catheter or collection bag
Condom catheter
applied to the tip of the penis and attached to a collection bag (looks like a flower)
- only on males
- low risk except for the potential for skin tears
PureWick catheter
lays between the labia and attached to a suction device (looks like hot dog)
- only for women
- low risk
- may not stay in place if the patient moves around too much
Foley catheter
inserted into the bladder and attached to a collection bag
- both genders
- not to be used for incontinence alone, use briefs instead
- if not clean can introduce pathogens into the GU tract
A Three-way urinary catheter is used for
bladder irrigation
Coude tip catheter is used for
passage past enlarged prostate
Promoting Normal Urination
- provide privacy
- assist with positioning: men standing, women upright seating or squatting
- facilitating toileting routines
- promote adequate fluids and nutrition
- assist with hygiene as needed
Normal Urine color, clarity, and odor
pale yellow, clear, and w/o smell
Urine color
indicate some form of intake or lack of fluid
Urine clarity
appear cloudy if pathogen is present
Urine Odor
pathogens can change odor as well as intake
-asparagus smells
Specimen Collection devices
urinal, hat, bedpan, bedside commode
Record ALL Fluid - Intake
semi-liquid foods, ice chips, fluids, IV fluids, tube feeding, and irrigations instilled and not immediately removed
Record ALL Fluids - Output
fluid loss via emesis, urine output, diarrhea, drainage from suction or wounds
Accuracy of I&O
teach pt and family members
used measured collection devices to get accurate counts
