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