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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
retention enema
oil based; 150-200mL; lubricates stool and intestinal mucosa; retain for 30-60 mins; mineral, olive, cotton seed oil
26
carminative enemas
help expel gas from rectum and provide relief from distention; could be milk and molasses, or a soap solution cleansing enema
27
medicated enemas
provide medications that are absorbed through the rectal mucosa
28
large volume enemas
500mL - 1L; retain for ~15 mins; tap water, saline, castile soap
29
soap enemas
irritates mucosa to stimulate peristalsis
30
when collecting stool specimines
void first before defecating into required container; need 1 inch of solid stool, or 30 mL of liquid
31
hemoccult/guaiac test
testing for blood in feces; blue = positive; food and medications can cause false positives (ex. red meat and cantaloupe)
32
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
33
colonoscopy
visual examination of large intestine; requires bowel prep
34
cologuard
colorectal screening done at home, not 100% accurate
35
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
36
position of pt. when placing enema
lying on left side
37
order of abdominal assessment
inspection --> auscultation --> palpation & percussion
38
muscles during mictruration
detrusor muscle contracts, internal sphincter relaxes, perineal and external sphincter relax
39
nervous system that controls voiding
micturition center in pons
40
bladder palpation
a non-distended bladder is not palpable
41
urine output per hour
30 mL/ hour
42
urine output per void
150-250 mL/ void
43
normal postvoid residual (PVR)
<50 mL ; may be more in older adults
44
abnormal postvoid residual (PVR)
>100 mL
45
normal urination frequency
every 3-4 hours
46
immobility effect on urination
decreased bladder/sphincter tone --> poor urinary control and urinary stasis
47
factors that decrease bladder tone
indwelling urinary catheters, childbearing, menopause (dec. estrogen), immobility
48
stress incontinence
involuntary loss of urine caused by increase in intra abdominal pressure; caused by an action like sneezing; treat with pelvic floor training
49
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
50
upper UTI
pyelonephritis; kidneys/ureters
51
lower UTI
cystitis; bladder/urethra
52
volume needed for urinalysis
10 mL
53
volume needed for urine culture
3 mL
54
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
55
24 hour urine collection
discard first void; include last void; can have a preservative or need to be refrigerated
56
anuria
24 hour urine output is less than 50mL
57
dysuria
painful or difficult urination
58
glycosuria
glucose in the urine
59
nocturia
awakening at night to urinate
60
oliguria
24 hour urine output is less than 400mL
61
polyuria
excessive output of urine
62
pyuria
pus in the urine
63
urinary incontinence
involuntary loss of urine
64
total daily energy expenditure
all of the calories used to perform physical activity, maintain metabolism, and digest, absorb, and metabolize food
65
total daily energy intake
total calories for each food item eaten
66
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
67
factors that increase BMR
growth, infections, fever, emotional tension, extreme environmental temperatures, elevated levels of certain hormones
68
factors that decrease BMR
aging, prolonged fasting, not enough sleep
69
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
70
underweight BMI
<18.5
71
healthy weight BMI
18.5 - 24.9
72
overweight BMI
25 - 29.9
73
obese BMI
30 - 39.9
74
extreme obesity BMI
>40
75
underweight BMI percentile
less than 5th percentile
76
healthy weight BMI percentile
5th - 85th percentile
77
overweight BMI percentile
85% - 95%
78
obese BMI percentile
>95%
79
at risk waist circumference for women
>35 inches
80
at risk waist circumference for men
>40 inches
81
carbohydrate percentage of diet
45% - 60%
82
how many amino acids are there?
22
83
complete proteins
contain all of the essential amino acids needed to support growth
84
incomplete proteins
missing one of more essential amino acids
85
protein is broken down into amino acids by
pancreatic enzymes in the small intestine
86
protein percentage of diet
10% - 35%
87
how is fat broken down?
bile secreted by liver emulsifies fat so that pancreatic enzymes can break it down
88
saturated fat percentage of diet
less than 10%
89
water soluble vitamins
B and C; are not stored in body
90
fat soluble vitamins
A, D, E, K; absorbed with fat into lymphatic circulation; stored in liver and adipose tissue
91
DRI
dietary reference intakes
92
RDA
recommended daily allowance
93
AI
adequate intake
94
UL
tolerable upper intake level
95
EAR
estimated average requirement
96
CDRR
chronic disease risk reduction
97
consistent carbohydrate diet
high fiber and heart healthy fats; limited sodium and saturated fats for: diabetes and impaired glucose tolerance
98
fat restricted diet
low fat for: chronic cholecystitis (gallbladder inflammation) and cardiovascular disease
99
renal diet
protein (0.6-1g/kg) and sodium (1k-3kmg) restriction; may also have potassium and fluid restriction
100
high fiber diet
prevent constipation, IBS, and diverticulosis (bulging pouches in intestine)
101
low fiber diet
<10 g/day; before surgery, ulcerative colitis, diverticulitis, crohn disease
102
sodium restricted diet
500-3k mg/day; for HTN, HF, renal disease, and liver disease
103
clear liquid diet
only clear liquids and foods that become fluid at body temperature; used to prep bowel surgery and for acute GI disorders
104
pureed diet
can have any food as long as it's blenderized into a liquid; used for chewing and swallowing difficulties
105
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
106
used to confirm NG feeding tube placement
radiographic examination; aspirate and assure pH is <5 (stomach acid)(only for non continuous feeds)
107
gastrostomy
enterostomal tube into stomach for nutrition
108
jejunostomy
enterostomal tube into jejunum for nutrition
109
parenteral nutrition (PN)
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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