L5+6 Fecal Flashcards
Physiology of faecal elimination
Large intestine
Rectum…
Large intestine
1.Absorb water and nutrient
2.Fecal eliminate
Rectum+canal
1.Internal muscle—) involuntary muscle
2.External muscle—) voluntary muscle
3.Defecation—) expulse feces from rectum
External sphincter relax—) expulsion of faeces( contraction of abdominal muscle)
Faeces physiology
1.Soft but formed (75% water)
2. Brown colour due to bilirubin
3.microorganism’s action in faeces leads to odour
4.normally fart 13-21/day
Adult faeces normal abnormal
Adult
1.colour brown vs clay or white
2. Consistency formed, soft, moist vs hard & dry
3.shape cylindrical vs narrow, pen shape
4.amount 100-400g
5. Aromatic: depends on food vs pungent(勁）
Factors affecting defecation
1.development
2.Activity
3.Diet
4.fluid intake/ output
5.psychological factors
6.daefecation habit
7. Medication
8.diagnostic procedures
9.surgery
10.pathologic conditions
11.pain
Development of faeces
Infant:
1.Meconium: first stool after born <24h
Transition stool: after a week— greenish yellow
2.Immature intestine: cannot well absorb water: watery stool, soft and liquid
3.Breast feed: light yellow to golden feces
Formula: dark yellow to yellow green feces
Less frequent and dryer after intestine mature
4.control of daefecation starts at 1.5-2
5. 17% older adult suffer from constipation
Activity factors affect daefecation
1.activity stimulate peristalsis
2.weak abdominal and pelvic muscle are often ineffective in defecation
Diet affecting daefecation
1.insoluble fibre promotes movement of faeces thru digestive system.
2.drink enough water as fibre work best with water
3. Regular diet helps in regulating peristalsis action in colon
4. Spicy food can produce Diarrhea and flatus
5.constipation-food: egg, pizza, lean meat
6.laxative food: sugar, chocolate, alcohol
7.hard feces with less water intake or excessive output
8.move too quick=watery
Psychological factors
Anxious or angry: diarrhea
Depress: contipation
Defecation habit related defecation
1.Early bowel training can establish the habit of defecating at a regular time.
2.person ignore urge to defecate—) water continue to dry up—) dry stool
3. Reflex to shit is weaken when keep ignore
Medication related to shit
Drugs cause constipation: morphine, codeine
Drugs cause diarrhea
Laxatives: stimulate bowel
Lomotil: suppress peristalic activity
D rug cause GI bleeding will cause red stool, black
Surgery
Surgery related to GI tract can cause stopped bowel movement which last 24-48hr
Pathological
1.Spinal cord & brain injury can decrease stimulation of defecation
2.impaired mobility may decrease the urge of defecation—) constipation
Pain
Feeling of pain( hemorrhoid injury) will suppress shit
Constipation
Cause of defecation
Headache
Anorexia, nausea
Abdominal pain, cramp
Decreased defecation
Hard dry stool
Painful defecation
Cause:
1.insuffcient fluid intake
2.insufficient fibre intake
3.insufficient activity/ mobility
4.irregular defecation habit
5.ignoring urge to defecate
6.lack of privacy
7.depression
Fecal impaction(積屎）
factors
Treatment
Too much hard shit
Abdominal distend
Anorexia, nausea, vomiting
Treatment
Oil retension enema
Suppositories
Manual removal
Diarrhea
Fatigue, weakness
Hard or impossible to control the urge of defecation
Spasmodic cramp
Increase bowel sound
Unformed stool or liquid
Bowel incontinence
Loss of ability to control fecal
Partial incontinence: cannot control flatus or minor soiling
Major incontinence: inability to control feces
Reason: impaired functioning of anal sphincter
Flatulence
Action of bacteria in chyme
Air defuse in blood stream
Air swallowed
Food
Infection
Medication
Surgery
Ostomy
Jejunostomy
Colonostomy
Temporary colonostomy: related to traumatic injury
Allow distal diseased colon rest and heal
Permanent colonostomy: outlet of colon as colon itself loss function
Fecal elimination assesment
Nursing history
Physical examination
Inspection of feces
Diagnosis
Nursing history- assesment
Usual feces?
Recent bowel change?
Elimination problem?
Have ostomy?
Any factors affecting elimination pattern?
When usually have bowel movement?
Any change recently?
Describe feces: colour, texture, amount
Diagnositic study-
direct visualisation techniques
X-ray
Lab test
Colonoscopy-viewing colon
Anoscopy- anal canal
X-ray at GI tract
Lab test: need 1” faeces
Wear clean glove
—) fecal occult blood testing
Fecal elimination problems may lead to …
Risk of dehydration/ electrolyte imbalance
Impaired skin integrity( prolonged Diarrhea, incontinence)
Low esteem related to ostomy, fecal incontinence
Low body-image
Anxiety related to lack of control of fecal elimination
Planing related to fecal elimination
1.promote regular defecation
2.teaching about medication
3.reduce flatulence
4.administating enemas灌腸
5.digital removal of fecal impaction
6.bowel training programs
Promote regular defecation
1.privacy
2.timing
3.nutrient & liquid
4.exercise
5.positioning
5 factors of promoting regular defecation
- Privacy: stay with them if need
Provide wiping tools for them
2.timing: request not to ignore urge of defecation
3.nutrients: less carb high fibre, less gas-producing food e.g. cabbage
Constipation: increase water intake, hot or warm water
Diarrhea: 8 cups of water to prevent dehydration
Electrolyte drinks
Potassium and sodium intake e.g. grape juice
Limit fat and spicy food
4.exercise: strengthen abdominal muscle
5.positioning: difficult to sit—) elevated toilet
Commode chair
Bedpan from restricted client
Teaching about medication
1.Laxative CANNOT give nausea, cramp, vomiting clients
2. Inform the danger of laxatives
3.suppository best effects with 30min b4 shit and wait super want shit
4. Antidiarrheal drug
3-4 day no ok then need find cause
Long term usage of OTC will cause dependence
Lomotil will cause drowsiness
Administering enemas
- Introduce and verify client
2.provide privacy - Explain what going on
4,explain will feel full when solution is being administered
5.request to hold shit
6.assist to hold left lateral position
7.clean glove
8.insert tube smoothly into rectum
9.ask to take deep breath when have resistance - Compress the container in hand
11.lying down for 5-10min
Administering suppository
1.unwrap the suppository
2.lubricate the tip of suppository
3.lubricate gloved index finger
4.encourage relax by deep breath
5.insert suppostory along the rectal wall
6. Avoid suppository embed to feces
7.remain in position from at least 5min, ard 30min then sin shit
8.assisit to bedpan or commode chair
9. Remove glove
10. Documentation
Bowel training program
- Give suppository
2.urge then assist to bedpan or commode chair
3.provide privacy
4.teach to lean forward
5.positive feedback if successfully shitted
Setting goals
- Fluid intake output appropriate?
2.activity level appropriate?
3.physical and emotional support provided?
4.client and family understand the medicine to comply therapy?
Physiology of urinary
250-400mL
Stretch receptor transmit impulse to spinal cord when been stimulate by pressure of bladder
Voluntary control of urine when
1. Nerve supplying the bladder. & urethra
2. Motor area of cerebrum works normally
Factors affecting urinary
Development
Fluid intake
Muscle tone
Medication
Pathological
Surgical
Psychological
Oliguria, anuria
<500 per day
Frequency of urinary
> 6
4 types of urinary incontinence
Stress urinary incontinence
Urge urinary incontinence
Mixed urinary incontinence
Overflow urinary inconitinence
Stress urinary incontinence
Stress urinary incontinence
1. Weak pelvic floor muscle—) urine leakage when laughing, coughing or sneezing
To women:
1. Shorter urethra
2. Trauma to pelvic floor e.g. childbirth
3. Change related to menopause
To men:
Prostatectomy切咗前列腺
Urge urinary incontinence
Reason drink too much coffee or alcohol
Constipation
UTI or tumour in bladder
Mixed urinary incontinence
Both stress and urgency
Overflow urinary incontinence
Cause:
Neurogenic blsdder (not feeling bladder fullness)
—) not anle to control sphincter when full—) involuntary urination
