potter & Perry cp 48 bowel Flashcards
aspiration anatomy
the vocal cords in the glottis, the epiglottis moves downward to seal off the tracehea
where does defecation begin
contraction in the left colon, moving the stool towards the anus. When a stool reaches the rectum, the distension causes relaxation of the internal anal sphincter and signals an aware- ness of the need to defecate
characteristics of normal defecation
normal defecation should be painless, resulting in the passage of a soft, formed stool
men only use bedpands only for
defecation
proper positioning during defecation
squatting is the normal.
Toilets are designed to facilitate this posture, by allowing the person to lean forward, exert intra-abdominal pressure, and contract the thigh muscles.
for pt who are immobilized a supine position is impossible to contract the muscles used during defecation. if possible raise the head of the bed to a sitting position about 30 degrees to prevent hyperextension of the back and provide upper torso support
gastrocolic reflex
the ingestion of food is the main stimulus for peristalsis
- the reflex is strongest when the stomach is empty, and this is why breakfast is referred to as the “triggering meal” for a bowel movement for most people
- The nurse can capitalize on this by offering the patient assist- ance to toilet 15 to 20 minutes after the patient’s breakfast
why is avoiding spillage critical for pt when using a bedpan?
for universal infection control precautions
placing a bedpan on a pt who cannot raise their hips
- lower the HOB into a supine, have the pt roll, their back against u
- place the bedpan firmly
- keeping on hand on the bedpan place ur other hand on the pt far hip and have them roll back
- ever shove the bedpan
- when they are positioned correctly raise the HOB at 30 degrees
- roll a towel, or small pillow under the pt lumbar curve for additional comfort
factors affecting normal bowel elimination
- diet (fibre, insoluble fibre e., whole grains, wheat bran, veggies) lack of fibre make stool dry and hard to pass
- fluid intake of 1.5L is a must or 6-8 classes (1400-2000mL)
- vomiting can affect the character of faces
- fluid liquefies intestinal contents to ease their passage through the colon
- physical activity promotes peristalsis
- wakened abdominal and pelvic floor muscles impair the ability to increase intra-abdominal pressure and to control the external sphincter
- sometimes elders will reduce their fluid intake in an attempt to reduce micturition
assessment of bowel elimination
- pt usual bowel pattern (ex., diary for a week)
- description of the usual stool characteristics
- routines that promote normal bowel elimination (ex., hot liquid, spicy foods)
- assessment of the use of laxatives, suppositories or enemas
- cognitive ability
- changes in appetite (lost or gained weight)
- diet history
- daily fluid intake
- medication history
- history of physical activity
- history of pain/discomfort
- environment and adaptive aids
- mobility and dexterity
- presence and status of bowel diversions
physical assessment for bowel elimination
- mouth (can impair the ability to chew)
- abdomen (inspect all four quadrants for contour, shape, symmetry and skin colour. masses peristaltic waves, scars, venous patterns, stomas, and lesions should be notes)
- abdominal distension appears as an overall outward protuberance of the abdomen. Distension may be caused by intestinal gas, large tumours, or fluid in the peritoneal cavity. A distended abdomen feels tight, like a drum, and the skin appears taut, as if stretched
- assessment of the rectum- inspect for lesions, discolorations, inflammation, and hemorrhoids
what does observable peristalsis can indicate
intestinal obstruction
purpose of percussion of the abdomen
detect lesions, fluid, or gas in the abdomen
what note does gas/flatus create during percussion of abdomen?
a tympanic note
what does masses, tumours, and fluid make during percussion?
a dull sound
how often do normal bowel sound occur during auscultation?
5-15 seconds and last from 1 second to several seconds
-high-pitched and hyperactive bowel sounds (35 or more sounds per minute) occur when the small intestine is obstructed or when inflammatory disorders are present
what sound would u hear if the abdomen is distended?
a pitch or tinkling sound
hypoactive bowel sounds are heard when?
they are fewer than 5 sounds per min
-occurs when a pt has paralytic ileus (example after abdominal surgery)
IBS. What is it?
Irritable bowel syndrome- it cannot be explained by any structural or biochemical abnormalities.
symptoms include- abdo pain, altered bowel function, flatulence, bloating, nausea, anorexia and diarrhea
-the hallmark symptom is abdo pain that is relieved by defecation and a change accompanied by the frequency and consistency of stools
-IBS is r/t diet, stress, psychological factors and onset may be triggered by GI infection
Crohn’s disease usually affects
any part of the GI from the mouth to the anu
UC- Ulcerative colitis
-affects only the large intestine
treatment of IBD
anti-inflammatory steroids, immunosuppressants to reduce inflammation, dietary changes, and remove of environmental triggers
and in severe cases surgery to remove the damage portion of the bowel
diabetes and bowel elimination
hyperglycemia can directly reduce/slow gastric contractions and the GI emptying rate
-treatment include reducing fats, and increase fibre intake
pain and bowel elimination
on usual conditions, delectation is painless
- but if pt has hemorrhoids, rectal surgery, rectal fistulas and abdo surgery
- often to avoid pain pt will suppress the urge to defectate
paralytic ileus
any surgery that involves direct manipulation of the bowel temporarily stops peristalsis
-usually last 24-48 hours
enteral feeding
- may experience diarrhea- could be d/t the feed running too quickly, meds, or an active infection
- pt can also experience constipation (usually d/t the type of formula used, and a change to high-fibre formula may resolve the constipation
total bilirubin
Increased levels of bilirubin may result from hepatobiliary diseases, obstructions in the bile duct, certain anemias, and reactions to blood transfusions.
alkaline phosphatase
Elevated levels of alkaline phosphatase may indicate obstructive hepatobiliary diseases, hepatobiliary carcinomas, bone tumours, or healing fractures.
amylase
Elevated levels of amylase may indicate abnormalities of the pancreas, such as inflammation, tumours, cholecystitis, necrotic bowel, and diabetic ketoacidosis.
carcionembryonic antigen (CEA)
The carcinoembryonic antigen is elevated in the presence of cancer, inflammation of the gastrointestinal (GI) tract, or hepatobiliary organs.
fecal occult blood test (FOBT), or guaiac test
measures microscopic amounts of blood in the faces
-useful for screening for colon cancer
-a single positive test does not confirm GI bleeding
The test should be repeated at least three times while the patient refrains from ingesting foods and medications that can cause false-positive results
what to tell the pt when doing a fecal occult blood test?
during the test period, the patient should avoid ingesting red meat, poultry, fish, some raw vegetables, vitamin C, aspirin, or other nonsteroidal anti-inflammatory drugs (NSAIDs) that can cause false-positive results
abnormal bowel characteristics
white or clay black or tarry red pale w/ fat or frothy mucus or pus bloody mucus
