Module 5 - Elimination Flashcards
1
Q
Definition of bowel elimination
A
excretion of stool from the body
2
Q
Factors impacting elimination
A
intake
transit
outlet
3
Q
Intake
A
food
water
fiber
4
Q
Transit
A
digestion & absorption
gastric motility (peristalsis & mass movements)
aerobic exercise
5
Q
Outlet
A
coordinated muscle contraction & relaxation
neurologic function
6
Q
Gastrocolic reflex
A
stimulates mass movements in response to stretch of stomach following food intake
7
Q
Types of fiber
A
soluble
insoluble
8
Q
How does fiber lower cholesterol
A
soluble fiber binds with cholesterol in the colon –> elimination
body is forced to produce new cholesterol
9
Q
Soluble fiber
A
attracts water & forms a thick gel
adds bulk & softens stool
lowers blood cholesterol
slows sugar absorption
10
Q
Insoluble fiber
A
indigestible fiber
increases bulk & accelerates gastric transit
11
Q
Defecation reflex
A
diaphragm, abdomen, rectal muscles contract –> push stool forward
IAS, EAS, puborectalis relax –> allow for voiding
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
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
14
Q
Fecal impaction
A
mechanical obstruction in the sigmoid colon/rectum
inability to pass hard collection of stool
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
16
Q
Normal fluid intake
A
1500-2000 mL daily
17
Q
Normal fiber intake
A
25-30 g daily
18
Q
Opioids & GI function
A
bind to opioid agonists in the enteric nervous system
decrease peristalsis (increase absorption time)
increase sphincter tone
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
20
Q
Medications causing constipation
A
opioids anticholinergics antihistamines aluminum antacids tricyclic antidepressants laxative abuse
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)
22
Q
Hemorrhoids
A
dilated blood vessels in the rectum
23
Q
Fissures
A
tears in the anal canal caused by passage of hard stool
24
Q
Megacolon
A
enlarged colon caused by non-mechanical obstruction (infection, disease, medication, surgery, idiopathic)
can cause perforation of colon
25
Neurologic RF of constipation
stroke
spinal cord injury (sacral)
altered cognition (dementia)
26
Metabolic RF of constipation
```
diabetes
hypothyroidism
pregnancy
hypokalemia
hypercalcemia
```
27
Consequences of constipation
discomfort/pain
N/V
impaired nutrition
straining --> wound dehiscence, vasovagal response
fecal impaction/obstruction --> perforation
complications of chronic constipation --> hemorrhoids
28
Location if intestinal obstruction
small bowel
| large bowel
29
Duration of obstruction
acute
| chronic
30
Extent of intestinal obstruction
partial
| complete
31
Etiology of obstruction
mechanical (fecal impaction)
| functional (paralytic ileus)
32
Causes of mechanical obstruction
```
mechanical = physical blockage
adhesions
herniations
volvulus
intussusception
strictures
tumour growth
```
33
Adhesions
scar tissue forms between adjacent bowel parts
34
Herniation
intestines protrude through abdominal muscle
35
Volvulus
twisting of bowel + mesentery around itself
36
Intussusception
part of intestine slides into another part of tissue (telescopic)
37
Strictures
narrowing of the intestinal lumen
38
Tumor growth
tissue mass
39
Causes of functional obstruction
functional = impaired motility
impaired perfusion
disrupted innervation
medications (opioids, anesthesia)
40
Abdominal post-op return of GI motility
small intestine = 0-24 hrs
stomach = 24-48 hrs
colon = 48-72 hrs
41
S/S of paralytic ileus
```
abdominal discomfort/distension
N/V
retention of stool/flatus
food intolerance
absent/hypoactive bowel sounds
not passing gas
steady pain
radiographic confirmation
```
42
Prolonged post-op ileus
impairment of intestinal motility >3 days
43
Treatment of paralytic ileus
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
RF for paralytic ileus
```
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
Complications of mechanical obstruction
tissue ischemia d/t impaired blood flow through compressed blood vessels
perforation --> peritonitis/sepsis
requires surgical intervention
46
S/S of mechanical obstruction
```
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
Where does bowel gas come from
70% swallowed air --> mostly nitrogen which body is unable to reabsorb
bacterial digestion --> fermentation in the large colon
48
Where do bowel fluids come from
```
digestive secretions (stomach, pancreas, small intestine)
consumed
```
49
S/S small bowel obstruction
```
rapid onset
vomiting
colicky, cramplike, intermittent pain
some bowel movement
varying abdominal distension
```
50
S/S of large bowel obstruction
```
gradual onset
vomiting = late sign
low-grade, cramping, abdominal pain
absolute constipation
large distension/bloating
```
51
Constipation assessment
focused GI + bowel history
fluid, fiber, food intake
mobility assessment
pain + medication hx
52
Hypoactive bowel sounds
1-2 sounds every 2 min
53
Absent bowel sounds
no sounds in 3-5 minutes
54
Hyperactive bowel sounds
high pitched, rumbling
| 5-6 sounds <30 sec
55
Normal bowel sounds
clicks/gurgles every 5-20 seconds
56
Causes of hypoactive BS
paralytic ielus
late intestinal obstruction
peritonitis
57
Causes of hyperactive BS
diarrhea
gastroenteritis
IBD
58
S/S of constipation
```
<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
Alarm symptoms
fresh blood in stool
occult blood
S/S mechanical obstruction
family hx of colorectal cancer/IBD
60
FIT
fecal immunochemical test
61
FOBT
fecal occult blood test
62
Diagnostics
abdominal x-ray (white = stool)
colonoscopy
FIT/FOBT
colonic transit study
63
Non-pharm constipation mgmt
```
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
When is Fruit lax contraindicated
diabetes (high in sugar)
renal failure
hyperkalemia
65
Types of laxatives
```
stool softeners (docusate)
lubricants (glycerin, mineral oil)
bulk-forming (psyllium, methylcellulose)
stimulant laxatives (sennosides, bisacodyl)
osmotic laxative (lactulose, PEG)
```
66
Stool softeners
increases water content of stool --> softening of stool allows for easier passage
reduced straining
67
Lubricant
coat stool & colon allowing for easier passage
68
Bulk-forming
increase bulk & soften stool by adding water
| stimulates stretch receptors increasing GI motility
69
Stimulant laxatives
irritate intestinal mucosa & stimulate enteric nerves --> increasing motility
70
Osmotic laxatives
osmotic fx --> rapidly draws water into bowel lumen to soften stools & increase motility
71
Adverse fx of laxatives
flatus,
bloating
diarrhea
abdominal cramping
nausea
F/E loss --> dizziness, headache, weakness
sympathetic fx --> sweating, palpitations
72
Cathartic dependence
reliance on laxatives for bowel movements
73
GI laxative contraindications
intestinal obstruction
ulcerative colitis
appendicitis
74
Cardiac laxative CI
heart block
| electrolyte imbalances can affect electrical conduction
75
GU laxative CI
chronic kidney disease
| exacerbate F/E imbalances
76
Pregnancy laxative CI
can induce labour
can cross placenta
can enter breast milk
77
Laxatives & med admin
space out by 30 min as can affect absorption
78
When is post-op ileus dx?
3-5 days of symptoms + mechanical obstruction ruled out via imaging
```
nausea/vomiting
abdominal distension/bloating
food intolerance
absent bowel sounds
no flatus
```
79
Bowel sounds & flatus
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
Normal-transit constipation
perceived difficulty in having a bowel movement
| bowels are working properly. constipation result of external factors (fiber, fluid)
81
Slow-transit constiptaion
infrequent bowel movements. alterations in intestinal innervation = slowed peristalsis causing constipation
82
Defecation disorders
usually d/t dysfunction of pelvic floor & sphincters impairing defecation
83
Drugs causing constipation
```
opioids
anticholinergics
calcium-channel blockers
diuretics
calcium (antacids/supplements)
iron supplements
aluminum antacids
```
84
Simple mechanical obstruction
0 altered blood flow
85
Strangulated mechanical obstruction
compressed blood vessels --> ischemia progressing to infarction of the affected GI tract
weakens GI tract increasing risk of perforation --> sepsis
86
Factors causing GI inflammation
chemcial irritation
bacterial toxins
electrolyte imbalances (hypokalemia)
vascular insufficiency
