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health assessment > module 11: elimination, nutrition and enteral feeding > Flashcards

module 11: elimination, nutrition and enteral feeding Flashcards

1
Q

how long to listen for bowel sounds

A

5-15 secs in each quadrant

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2
Q

what to do if no bowel sounds are heard in 5-15 secs

A

listen for 1 minute or more

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3
Q

palpation used in abdominal assessment

A

light palpation: 1-2 cm

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4
Q

flatulence

A

accumulation of gas in the GI tract; swallowed air, undigested food in large intestine, bi-product of bacterial breakdown of carbohydrates

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5
Q

distention

A

when gas accumulates

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6
Q

melena

A

dark/black tarry stools; sign of upper GI bleed

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7
Q

clay or white stools

A

from lack of bile; difficulty with fat digestion/absorption; associated with cystic fibrosis

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8
Q

red/blood stools

A

lower GI bleed

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9
Q

recommended fiber intake

A

25-38g /day

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10
Q

too much fiber:

A

loose stools

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11
Q

too little fiber:

A

irregular bowel movements

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12
Q

defecation

A

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

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13
Q

gastrocolic reflex

A

intensifies strong mass peristalsis movements that force feces into the rectum; triggered when food enters and distends the stomach

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14
Q

constipation causes

A

certain neurological/neuromuscular conditions (internal sphincter innervation); medications, narcotics and iron supplements; diet

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15
Q

recipe for good bowel health

A

fiber + h2o + activity

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16
Q

diarrhea

A

3 or more stools per day &/or change in consistency; accompanied by intestinal cramps, NV; can cause dehydration and skin breakdown

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17
Q

possible causes of diarrhea

A

hyperthyroidism, medications (antibiotics), infection (food poisoning), malabsorption syndromes, diabetes

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18
Q

bowel incontinence causes

A

loss of anal sphincter tone, neurologic injury, local trauma, inflammation due to infection

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19
Q

fecal impaction

A

prolonged retention of accumulation of fecal matter, hardened mass in rectum; sign: incontinence of liquid stool will no signs of normal feces

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20
Q

fecal impaction treatment

A

oil-retention enemas, digital removal of impaction

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21
Q

enemas MOA

A

distends bowel; irritates bowel mucosa; increases peristalsis; lubricates stool and mucosa

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22
Q

paralytic ileus

A

bowel not functioning; no peristalsis

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23
Q

enema CI

A

pt. with: bowel obstruction, paralytic ileus, risk of thrombocytopenia, risk of leukopenia, immunocompromised

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24
Q

hypertonic enema

A

small volume (70-130mL); retain for 5-10 mins; distends bowel by pulling H2O into colon

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25
Q

retention enema

A

oil based; 150-200mL; lubricates stool and intestinal mucosa; retain for 30-60 mins; mineral, olive, cotton seed oil

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26
Q

carminative enemas

A

help expel gas from rectum and provide relief from distention; could be milk and molasses, or a soap solution cleansing enema

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27
Q

medicated enemas

A

provide medications that are absorbed through the rectal mucosa

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28
Q

large volume enemas

A

500mL - 1L; retain for ~15 mins; tap water, saline, castile soap

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29
Q

soap enemas

A

irritates mucosa to stimulate peristalsis

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30
Q

when collecting stool specimines

A

void first before defecating into required container; need 1 inch of solid stool, or 30 mL of liquid

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31
Q

hemoccult/guaiac test

A

testing for blood in feces; blue = positive; food and medications can cause false positives (ex. red meat and cantaloupe)

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32
Q

fecal immunochemical test (FIT)

A

uses antibodies against hemoglobin to detect blood in urine; tests for bleeding in lower GI; no false positives; done in lab

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33
Q

colonoscopy

A

visual examination of large intestine; requires bowel prep

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34
Q

cologuard

A

colorectal screening done at home, not 100% accurate

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35
Q

bowel training

A

pt. can do at home to control elimination; for pt. w/ spinal cord injury, stroke, CNS injury; may include suppository and digital stimulation

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36
Q

position of pt. when placing enema

A

lying on left side

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37
Q

order of abdominal assessment

A

inspection –> auscultation –> palpation & percussion

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38
Q

muscles during mictruration

A

detrusor muscle contracts, internal sphincter relaxes, perineal and external sphincter relax

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39
Q

nervous system that controls voiding

A

micturition center in pons

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40
Q

bladder palpation

A

a non-distended bladder is not palpable

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41
Q

urine output per hour

A

30 mL/ hour

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42
Q

urine output per void

A

150-250 mL/ void

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43
Q

normal postvoid residual (PVR)

A

<50 mL ; may be more in older adults

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44
Q

abnormal postvoid residual (PVR)

A

> 100 mL

45
Q

normal urination frequency

A

every 3-4 hours

46
Q

immobility effect on urination

A

decreased bladder/sphincter tone –> poor urinary control and urinary stasis

47
Q

factors that decrease bladder tone

A

indwelling urinary catheters, childbearing, menopause (dec. estrogen), immobility

48
Q

stress incontinence

A

involuntary loss of urine caused by increase in intra abdominal pressure; caused by an action like sneezing; treat with pelvic floor training

49
Q

urge incontinence

A

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

50
Q

upper UTI

A

pyelonephritis; kidneys/ureters

51
Q

lower UTI

A

cystitis; bladder/urethra

52
Q

volume needed for urinalysis

A

10 mL

53
Q

volume needed for urine culture

A

3 mL

54
Q

clean catch urine

A

used for culture and sensitivity test; void small amount in toilet and then collect some in cup; sent directly to lab while warm

55
Q

24 hour urine collection

A

discard first void; include last void; can have a preservative or need to be refrigerated

56
Q

anuria

A

24 hour urine output is less than 50mL

57
Q

dysuria

A

painful or difficult urination

58
Q

glycosuria

A

glucose in the urine

59
Q

nocturia

A

awakening at night to urinate

60
Q

oliguria

A

24 hour urine output is less than 400mL

61
Q

polyuria

A

excessive output of urine

62
Q

pyuria

A

pus in the urine

63
Q

urinary incontinence

A

involuntary loss of urine

64
Q

total daily energy expenditure

A

all of the calories used to perform physical activity, maintain metabolism, and digest, absorb, and metabolize food

65
Q

total daily energy intake

A

total calories for each food item eaten

66
Q

basal metabolic rate (BMR)

A

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

67
Q

factors that increase BMR

A

growth, infections, fever, emotional tension, extreme environmental temperatures, elevated levels of certain hormones

68
Q

factors that decrease BMR

A

aging, prolonged fasting, not enough sleep

69
Q

body mass index (BMI)

A

ratio of weight in kilograms to height in meters squared; provides an estimate of body fat and relative risk for diseases

70
Q

underweight BMI

A

<18.5

71
Q

healthy weight BMI

A

18.5 - 24.9

72
Q

overweight BMI

A

25 - 29.9

73
Q

obese BMI

A

30 - 39.9

74
Q

extreme obesity BMI

A

> 40

75
Q

underweight BMI percentile

A

less than 5th percentile

76
Q

healthy weight BMI percentile

A

5th - 85th percentile

77
Q

overweight BMI percentile

A

85% - 95%

78
Q

obese BMI percentile

A

> 95%

79
Q

at risk waist circumference for women

A

> 35 inches

80
Q

at risk waist circumference for men

A

> 40 inches

81
Q

carbohydrate percentage of diet

A

45% - 60%

82
Q

how many amino acids are there?

A

22

83
Q

complete proteins

A

contain all of the essential amino acids needed to support growth

84
Q

incomplete proteins

A

missing one of more essential amino acids

85
Q

protein is broken down into amino acids by

A

pancreatic enzymes in the small intestine

86
Q

protein percentage of diet

A

10% - 35%

87
Q

how is fat broken down?

A

bile secreted by liver emulsifies fat so that pancreatic enzymes can break it down

88
Q

saturated fat percentage of diet

A

less than 10%

89
Q

water soluble vitamins

A

B and C; are not stored in body

90
Q

fat soluble vitamins

A

A, D, E, K; absorbed with fat into lymphatic circulation; stored in liver and adipose tissue

91
Q

DRI

A

dietary reference intakes

92
Q

RDA

A

recommended daily allowance

93
Q

AI

A

adequate intake

94
Q

UL

A

tolerable upper intake level

95
Q

EAR

A

estimated average requirement

96
Q

CDRR

A

chronic disease risk reduction

97
Q

consistent carbohydrate diet

A

high fiber and heart healthy fats; limited sodium and saturated fats
for: diabetes and impaired glucose tolerance

98
Q

fat restricted diet

A

low fat
for: chronic cholecystitis (gallbladder inflammation) and cardiovascular disease

99
Q

renal diet

A

protein (0.6-1g/kg) and sodium (1k-3kmg) restriction; may also have potassium and fluid restriction

100
Q

high fiber diet

A

prevent constipation, IBS, and diverticulosis (bulging pouches in intestine)

101
Q

low fiber diet

A

<10 g/day; before surgery, ulcerative colitis, diverticulitis, crohn disease

102
Q

sodium restricted diet

A

500-3k mg/day; for HTN, HF, renal disease, and liver disease

103
Q

clear liquid diet

A

only clear liquids and foods that become fluid at body temperature; used to prep bowel surgery and for acute GI disorders

104
Q

pureed diet

A

can have any food as long as it’s blenderized into a liquid; used for chewing and swallowing difficulties

105
Q

mechanically altered diet

A

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

106
Q

used to confirm NG feeding tube placement

A

radiographic examination; aspirate and assure pH is <5 (stomach acid)(only for non continuous feeds)

107
Q

gastrostomy

A

enterostomal tube into stomach for nutrition

108
Q

jejunostomy

A

enterostomal tube into jejunum for nutrition

109
Q

parenteral nutrition (PN)

A

concentrated, hypertonic solution containing amino acids, carbohydrates and lipids; given IV through a central venous access device

health assessment (6 decks)

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