module 11: elimination, nutrition and enteral feeding Flashcards
how long to listen for bowel sounds
5-15 secs in each quadrant
what to do if no bowel sounds are heard in 5-15 secs
listen for 1 minute or more
palpation used in abdominal assessment
light palpation: 1-2 cm
flatulence
accumulation of gas in the GI tract; swallowed air, undigested food in large intestine, bi-product of bacterial breakdown of carbohydrates
distention
when gas accumulates
melena
dark/black tarry stools; sign of upper GI bleed
clay or white stools
from lack of bile; difficulty with fat digestion/absorption; associated with cystic fibrosis
red/blood stools
lower GI bleed
recommended fiber intake
25-38g /day
too much fiber:
loose stools
too little fiber:
irregular bowel movements
defecation
emptying of large intestine; parasympathetic NS signals relaxation of internal anal sphincter and contracts colan so fecal matter enters rectum –> rectum distended triggering defecation reflex/urge to eliminate
gastrocolic reflex
intensifies strong mass peristalsis movements that force feces into the rectum; triggered when food enters and distends the stomach
constipation causes
certain neurological/neuromuscular conditions (internal sphincter innervation); medications, narcotics and iron supplements; diet
recipe for good bowel health
fiber + h2o + activity
diarrhea
3 or more stools per day &/or change in consistency; accompanied by intestinal cramps, NV; can cause dehydration and skin breakdown
possible causes of diarrhea
hyperthyroidism, medications (antibiotics), infection (food poisoning), malabsorption syndromes, diabetes
bowel incontinence causes
loss of anal sphincter tone, neurologic injury, local trauma, inflammation due to infection
fecal impaction
prolonged retention of accumulation of fecal matter, hardened mass in rectum; sign: incontinence of liquid stool will no signs of normal feces
fecal impaction treatment
oil-retention enemas, digital removal of impaction
enemas MOA
distends bowel; irritates bowel mucosa; increases peristalsis; lubricates stool and mucosa
paralytic ileus
bowel not functioning; no peristalsis
enema CI
pt. with: bowel obstruction, paralytic ileus, risk of thrombocytopenia, risk of leukopenia, immunocompromised
hypertonic enema
small volume (70-130mL); retain for 5-10 mins; distends bowel by pulling H2O into colon
retention enema
oil based; 150-200mL; lubricates stool and intestinal mucosa; retain for 30-60 mins; mineral, olive, cotton seed oil
carminative enemas
help expel gas from rectum and provide relief from distention; could be milk and molasses, or a soap solution cleansing enema
medicated enemas
provide medications that are absorbed through the rectal mucosa
large volume enemas
500mL - 1L; retain for ~15 mins; tap water, saline, castile soap
soap enemas
irritates mucosa to stimulate peristalsis
when collecting stool specimines
void first before defecating into required container; need 1 inch of solid stool, or 30 mL of liquid
hemoccult/guaiac test
testing for blood in feces; blue = positive; food and medications can cause false positives (ex. red meat and cantaloupe)
fecal immunochemical test (FIT)
uses antibodies against hemoglobin to detect blood in urine; tests for bleeding in lower GI; no false positives; done in lab
colonoscopy
visual examination of large intestine; requires bowel prep
cologuard
colorectal screening done at home, not 100% accurate
bowel training
pt. can do at home to control elimination; for pt. w/ spinal cord injury, stroke, CNS injury; may include suppository and digital stimulation
position of pt. when placing enema
lying on left side
order of abdominal assessment
inspection –> auscultation –> palpation & percussion
muscles during mictruration
detrusor muscle contracts, internal sphincter relaxes, perineal and external sphincter relax
nervous system that controls voiding
micturition center in pons
bladder palpation
a non-distended bladder is not palpable
urine output per hour
30 mL/ hour
urine output per void
150-250 mL/ void
normal postvoid residual (PVR)
<50 mL ; may be more in older adults
abnormal postvoid residual (PVR)
> 100 mL
normal urination frequency
every 3-4 hours
immobility effect on urination
decreased bladder/sphincter tone –> poor urinary control and urinary stasis
factors that decrease bladder tone
indwelling urinary catheters, childbearing, menopause (dec. estrogen), immobility
stress incontinence
involuntary loss of urine caused by increase in intra abdominal pressure; caused by an action like sneezing; treat with pelvic floor training
urge incontinence
loss of urine from the time the pt. feels the urge to urinate to the time it takes to get to the bathroom; caused by involuntary bladder contractions/spasms
upper UTI
pyelonephritis; kidneys/ureters
lower UTI
cystitis; bladder/urethra
volume needed for urinalysis
10 mL
volume needed for urine culture
3 mL
clean catch urine
used for culture and sensitivity test; void small amount in toilet and then collect some in cup; sent directly to lab while warm
24 hour urine collection
discard first void; include last void; can have a preservative or need to be refrigerated
anuria
24 hour urine output is less than 50mL
dysuria
painful or difficult urination
glycosuria
glucose in the urine
nocturia
awakening at night to urinate
oliguria
24 hour urine output is less than 400mL
polyuria
excessive output of urine
pyuria
pus in the urine
urinary incontinence
involuntary loss of urine
total daily energy expenditure
all of the calories used to perform physical activity, maintain metabolism, and digest, absorb, and metabolize food
total daily energy intake
total calories for each food item eaten
basal metabolic rate (BMR)
energy (number of cals) required to fuel the involuntary activities of the body at rest after 12 hours; energy needed to sustain metabolic activities of cells and tissues
factors that increase BMR
growth, infections, fever, emotional tension, extreme environmental temperatures, elevated levels of certain hormones
factors that decrease BMR
aging, prolonged fasting, not enough sleep
body mass index (BMI)
ratio of weight in kilograms to height in meters squared; provides an estimate of body fat and relative risk for diseases
underweight BMI
<18.5
healthy weight BMI
18.5 - 24.9
overweight BMI
25 - 29.9
obese BMI
30 - 39.9
extreme obesity BMI
> 40
underweight BMI percentile
less than 5th percentile
healthy weight BMI percentile
5th - 85th percentile
overweight BMI percentile
85% - 95%
obese BMI percentile
> 95%
at risk waist circumference for women
> 35 inches
at risk waist circumference for men
> 40 inches
carbohydrate percentage of diet
45% - 60%
how many amino acids are there?
22
complete proteins
contain all of the essential amino acids needed to support growth
incomplete proteins
missing one of more essential amino acids
protein is broken down into amino acids by
pancreatic enzymes in the small intestine
protein percentage of diet
10% - 35%
how is fat broken down?
bile secreted by liver emulsifies fat so that pancreatic enzymes can break it down
saturated fat percentage of diet
less than 10%
water soluble vitamins
B and C; are not stored in body
fat soluble vitamins
A, D, E, K; absorbed with fat into lymphatic circulation; stored in liver and adipose tissue
DRI
dietary reference intakes
RDA
recommended daily allowance
AI
adequate intake
UL
tolerable upper intake level
EAR
estimated average requirement
CDRR
chronic disease risk reduction
consistent carbohydrate diet
high fiber and heart healthy fats; limited sodium and saturated fats
for: diabetes and impaired glucose tolerance
fat restricted diet
low fat
for: chronic cholecystitis (gallbladder inflammation) and cardiovascular disease
renal diet
protein (0.6-1g/kg) and sodium (1k-3kmg) restriction; may also have potassium and fluid restriction
high fiber diet
prevent constipation, IBS, and diverticulosis (bulging pouches in intestine)
low fiber diet
<10 g/day; before surgery, ulcerative colitis, diverticulitis, crohn disease
sodium restricted diet
500-3k mg/day; for HTN, HF, renal disease, and liver disease
clear liquid diet
only clear liquids and foods that become fluid at body temperature; used to prep bowel surgery and for acute GI disorders
pureed diet
can have any food as long as it’s blenderized into a liquid; used for chewing and swallowing difficulties
mechanically altered diet
excludes most raw fruits and vegetables and foods with seeds, nits, and dried fruit; only given chopped, ground, mashed, or soft foods; for chewing/swallowing issues and post surgery on the head, neck or mouth
used to confirm NG feeding tube placement
radiographic examination; aspirate and assure pH is <5 (stomach acid)(only for non continuous feeds)
gastrostomy
enterostomal tube into stomach for nutrition
jejunostomy
enterostomal tube into jejunum for nutrition
parenteral nutrition (PN)
concentrated, hypertonic solution containing amino acids, carbohydrates and lipids; given IV through a central venous access device
