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BSNC 3000 > Module 5 - Elimination > Flashcards

Module 5 - Elimination Flashcards

1
Q

Definition of bowel elimination

A

excretion of stool from the body

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2
Q

Factors impacting elimination

A

intake
transit
outlet

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3
Q

Intake

A

food
water
fiber

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4
Q

Transit

A

digestion & absorption
gastric motility (peristalsis & mass movements)
aerobic exercise

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5
Q

Outlet

A

coordinated muscle contraction & relaxation

neurologic function

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6
Q

Gastrocolic reflex

A

stimulates mass movements in response to stretch of stomach following food intake

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7
Q

Types of fiber

A

soluble

insoluble

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8
Q

How does fiber lower cholesterol

A

soluble fiber binds with cholesterol in the colon –> elimination
body is forced to produce new cholesterol

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9
Q

Soluble fiber

A

attracts water & forms a thick gel
adds bulk & softens stool
lowers blood cholesterol
slows sugar absorption

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10
Q

Insoluble fiber

A

indigestible fiber

increases bulk & accelerates gastric transit

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11
Q

Defecation reflex

A

diaphragm, abdomen, rectal muscles contract –> push stool forward
IAS, EAS, puborectalis relax –> allow for voiding

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12
Q

Normal bowel habits

A

x3/daily - x3/weekly
soft, brown, formed stool (bristol stool 3-4)
straining <25%
complete evacuation 250-500 mL

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13
Q

Definition of constipation

A

infrequent bowel movements (<3 week or change in individual pattern)
hardening of stools
retention of stool in rectum –> sense of incomplete evacuation
constipation is a symptom caused by an underlying condition

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14
Q

Fecal impaction

A

mechanical obstruction in the sigmoid colon/rectum

inability to pass hard collection of stool

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15
Q

Risk Factors for post-op constipation

A 
low fluid intake <1500 mL/day
inadequate fiber <25-30 g/daily
decreased intake (NPO, N/V, <50% meal)
immobility, bedrest
medications (opioids, anesthesia)
PSR (reduced GI motility & blood flow)
electrolyte imbalances (hypokalemia)
changes in routine, privacy
abdominal weakness/impaired contraction
comorbidties
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16
Q

Normal fluid intake

A

1500-2000 mL daily

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17
Q

Normal fiber intake

A

25-30 g daily

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18
Q

Opioids & GI function

A

bind to opioid agonists in the enteric nervous system
decrease peristalsis (increase absorption time)
increase sphincter tone

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19
Q

Geriatric RF for constipation

A 
soft, processed diet low in fiber
decreased food intake
impaired thirst response 
reduced mobility & physical activity
weak abdominal/pelvic muscles
medications (anticholinergics, opioids, etc)
depression
demeentia
dulled nerve impulses --> decreased urge to defecate
laxative dependency
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20
Q

Medications causing constipation

A 
opioids
anticholinergics
antihistamines
aluminum antacids
tricyclic antidepressants
laxative abuse
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21
Q

GI RF for constipation

A 
PSR 
ignoring urge to defecate --> overstretching of colon 
abdominal/perianal surgery 
history of chronic constipation/bowel obstruction (IBS) 
painful defecation (hemerrhoids)
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22
Q

Hemorrhoids

A

dilated blood vessels in the rectum

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23
Q

Fissures

A

tears in the anal canal caused by passage of hard stool

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24
Q

Megacolon

A

enlarged colon caused by non-mechanical obstruction (infection, disease, medication, surgery, idiopathic)
can cause perforation of colon

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25
Q

Neurologic RF of constipation

A

stroke
spinal cord injury (sacral)
altered cognition (dementia)

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26
Q

Metabolic RF of constipation

A 
diabetes
hypothyroidism
pregnancy
hypokalemia 
hypercalcemia
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27
Q

Consequences of constipation

A

discomfort/pain
N/V
impaired nutrition
straining –> wound dehiscence, vasovagal response
fecal impaction/obstruction –> perforation
complications of chronic constipation –> hemorrhoids

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28
Q

Location if intestinal obstruction

A

small bowel

large bowel

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29
Q

Duration of obstruction

A

acute

chronic

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30
Q

Extent of intestinal obstruction

A

partial

complete

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31
Q

Etiology of obstruction

A

mechanical (fecal impaction)

functional (paralytic ileus)

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32
Q

Causes of mechanical obstruction

A 
mechanical = physical blockage
adhesions
herniations
volvulus
intussusception
strictures
tumour growth
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33
Q

Adhesions

A

scar tissue forms between adjacent bowel parts

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34
Q

Herniation

A

intestines protrude through abdominal muscle

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35
Q

Volvulus

A

twisting of bowel + mesentery around itself

36
Q

Intussusception

A

part of intestine slides into another part of tissue (telescopic)

37
Q

Strictures

A

narrowing of the intestinal lumen

38
Q

Tumor growth

A

tissue mass

39
Q

Causes of functional obstruction

A

functional = impaired motility
impaired perfusion
disrupted innervation
medications (opioids, anesthesia)

40
Q

Abdominal post-op return of GI motility

A

small intestine = 0-24 hrs
stomach = 24-48 hrs
colon = 48-72 hrs

41
Q

S/S of paralytic ileus

A 
abdominal discomfort/distension 
N/V
retention of stool/flatus
food intolerance 
absent/hypoactive bowel sounds 
not passing gas 
steady pain
radiographic confirmation
42
Q

Prolonged post-op ileus

A

impairment of intestinal motility >3 days

43
Q

Treatment of paralytic ileus

A

chewing gum
ambulation
NG suction (to decompress gastric contents)
NPO status
IV hydration & electrolytes (normovolemia if pt vomiting/ng suctioning >1-2 L)
lower/switch opioids (if risk factor)

44
Q

RF for paralytic ileus

A 
abdominal/pelvic/lower GI surgery --> surgical trauma & bowel manipulation --> inflammation
open surgery 
opioids/anesthesia 
PSR 
electrolyte imbalances (hypokalemia)
NPO/delayed enteral nutrition 
decreased mobility
45
Q

Complications of mechanical obstruction

A

tissue ischemia d/t impaired blood flow through compressed blood vessels
perforation –> peritonitis/sepsis
requires surgical intervention

46
Q

S/S of mechanical obstruction

A 
abdominal distension/tenderness (gas + fluid trapped above obstruction)
pain (colicky)
bowel sounds (hyperactive)
N/V (d/t distension/pain)
constipation/obstipation 
compressed arteries --> ischemia 
bowel perforation
47
Q

Where does bowel gas come from

A

70% swallowed air –> mostly nitrogen which body is unable to reabsorb
bacterial digestion –> fermentation in the large colon

48
Q

Where do bowel fluids come from

A 
digestive secretions (stomach, pancreas, small intestine)
consumed
49
Q

S/S small bowel obstruction

A 
rapid onset
vomiting 
colicky, cramplike, intermittent pain
some bowel movement
varying abdominal distension
50
Q

S/S of large bowel obstruction

A 
gradual onset
vomiting = late sign
low-grade, cramping, abdominal pain
absolute constipation
large distension/bloating
51
Q

Constipation assessment

A

focused GI + bowel history
fluid, fiber, food intake
mobility assessment
pain + medication hx

52
Q

Hypoactive bowel sounds

A

1-2 sounds every 2 min

53
Q

Absent bowel sounds

A

no sounds in 3-5 minutes

54
Q

Hyperactive bowel sounds

A

high pitched, rumbling

5-6 sounds <30 sec

55
Q

Normal bowel sounds

A

clicks/gurgles every 5-20 seconds

56
Q

Causes of hypoactive BS

A

paralytic ielus
late intestinal obstruction
peritonitis

57
Q

Causes of hyperactive BS

A

diarrhea
gastroenteritis
IBD

58
Q

S/S of constipation

A 
<3 BM/week or change in pattern
strains at stool
hard, dry stool
abdominal distension
rectal pressure
absence of bowel sounds
unexplained N/V
rectal pain/stool passing 
incomplete evacuation 
oozing/diarrhea
incontinence
59
Q

Alarm symptoms

A

fresh blood in stool
occult blood
S/S mechanical obstruction
family hx of colorectal cancer/IBD

60
Q

FIT

A

fecal immunochemical test

61
Q

FOBT

A

fecal occult blood test

62
Q

Diagnostics

A

abdominal x-ray (white = stool)
colonoscopy
FIT/FOBT
colonic transit study

63
Q

Non-pharm constipation mgmt

A 
toileting routine (30 min after meals)
positioning (squatting, commode)
diet (limit caffeine/alcohol, increase fiber/fluid)
Fruit lax 
gum chewing
physical activity
digital disimpaction
64
Q

When is Fruit lax contraindicated

A

diabetes (high in sugar)
renal failure
hyperkalemia

65
Q

Types of laxatives

A 
stool softeners (docusate)
lubricants (glycerin, mineral oil)
bulk-forming (psyllium, methylcellulose)
stimulant laxatives (sennosides, bisacodyl)
osmotic laxative (lactulose, PEG)
66
Q

Stool softeners

A

increases water content of stool –> softening of stool allows for easier passage
reduced straining

67
Q

Lubricant

A

coat stool & colon allowing for easier passage

68
Q

Bulk-forming

A

increase bulk & soften stool by adding water

stimulates stretch receptors increasing GI motility

69
Q

Stimulant laxatives

A

irritate intestinal mucosa & stimulate enteric nerves –> increasing motility

70
Q

Osmotic laxatives

A

osmotic fx –> rapidly draws water into bowel lumen to soften stools & increase motility

71
Q

Adverse fx of laxatives

A

flatus,
bloating
diarrhea
abdominal cramping
nausea
F/E loss –> dizziness, headache, weakness
sympathetic fx –> sweating, palpitations

72
Q

Cathartic dependence

A

reliance on laxatives for bowel movements

73
Q

GI laxative contraindications

A

intestinal obstruction
ulcerative colitis
appendicitis

74
Q

Cardiac laxative CI

A

heart block

electrolyte imbalances can affect electrical conduction

75
Q

GU laxative CI

A

chronic kidney disease

exacerbate F/E imbalances

76
Q

Pregnancy laxative CI

A

can induce labour
can cross placenta
can enter breast milk

77
Q

Laxatives & med admin

A

space out by 30 min as can affect absorption

78
Q

When is post-op ileus dx?

A

3-5 days of symptoms + mechanical obstruction ruled out via imaging

nausea/vomiting
abdominal distension/bloating
food intolerance
absent bowel sounds 
no flatus
79
Q

Bowel sounds & flatus

A

bowel sounds DO NOT mean pt is passing gas
gas/bowel movement = better indicators of bowel function
bowel sounds/flatus not + assoc w/ food tolerance

80
Q

Normal-transit constipation

A

perceived difficulty in having a bowel movement

bowels are working properly. constipation result of external factors (fiber, fluid)

81
Q

Slow-transit constiptaion

A

infrequent bowel movements. alterations in intestinal innervation = slowed peristalsis causing constipation

82
Q

Defecation disorders

A

usually d/t dysfunction of pelvic floor & sphincters impairing defecation

83
Q

Drugs causing constipation

A 
opioids
anticholinergics
calcium-channel blockers
diuretics
calcium (antacids/supplements)
iron supplements
aluminum antacids
84
Q

Simple mechanical obstruction

A

0 altered blood flow

85
Q

Strangulated mechanical obstruction

A

compressed blood vessels –> ischemia progressing to infarction of the affected GI tract
weakens GI tract increasing risk of perforation –> sepsis

86
Q

Factors causing GI inflammation

A

chemcial irritation
bacterial toxins
electrolyte imbalances (hypokalemia)
vascular insufficiency

BSNC 3000 (11 decks)

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