Bowl elimination

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Bowl elimination
2010-10-27 12:16:25

Notes from book
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  1. Masticate
    breaking food down into a size suitable for swallowing
  2. peristalsis
    • propels food through the length of the GI tract.
  3. The stomach produces and secretes
    hydrochloric acid (HCl), mucus, the enzyme pepsin, and the intrinsic factor
  4. Pepsin and HCl facilitate...????
    the digestion of protein
  5. The intrinsic factor is essential for
    absorption of vitamin B12
  6. The small intestine has three sections
    the duodenum, the jejunum, and the ileum
  7. Duodenum
    continues to process the chyme from the stomach
  8. Jeuenum
    absorbs carbohydrates and proteins.
  9. ileum
    absorbs water, fats, and bile salts.
  10. The small intestines, specifically the duodenum and jejunum, absorb most of the ???
    nutrients and electrolytes.
  11. The ileum absorbs certain vitamins
    iron, and bile salts
  12. Impairment of the small intestine alters the digestive process.
    conditions such as inflammation, surgical resection, or obstruction disrupt peristalsis, reduce the area of absorption, or block the passage of chyme. Electrolyte and nutrient deficiencies then develop
  13. The large intestine is divided into
    the cecum, colon, and rectum
  14. The large intestine is the
    primary organ of bowel elimination
  15. The colon is divided into
    the ascending, transverse, descending, and sigmoid colons
  16. The colon has three functions
    • absorption, secretion, and elimination
  17. The large intestine absorbs
    • water, sodium, and chloride from the digested food that has passed from the small intestine.
  18. Healthy adults absorb more than.....
    a gallon of water and an ounce of salt from the colon every 4 hours.
  19. Bicarbonate is secreted in exchange for
    • chloride
  20. The colon excretes about
    4 to 9 mEq of potassium daily. Serious alterations in colon function (e.g., diarrhea) cause severe electrolyte disturbances.
  21. Bulk-forming foods
    whole grains, fresh fruits, and vegetables, help flush the fats and waste products from the body with more efficiency
  22. Fiber
    the nondigestible residue in the diet, provides the bulk of fecal material
  23. Gas-producing foods
    such as onions, cauliflower, and beans also stimulate peristalsis
  24. Food intolerance
    is not an allergy, but a particular food that causes the body distress within a few hours of ingestion. The result is diarrhea, cramps, or flatulence. For example, people who drink cow's milk who have these symptoms are not allergic to milk
  25. Decreased chewing and decreased salivation, including oral dryness in the mouth Casuses.......
    Degeneration of cells, medications.
  26. Reduced motility, especially in lower third of the esophagus Causes....
    Degeneration of neural cells.
  27. Decrease in: Acid secretions in the Stomach CAuses....
    Degeneration of gastric mucosa. Alkaline gastric medium contributes to malabsorption of iron. Although digestive enzymes are decreased, enough remain available for digestion.
  28. Decrease in motor activity in the stomach Causes....
    Delayed gastric emptying, causing fewer hunger contractions.
  29. A decrease in Mucosal thickness in the Stomach Causes...
    Loss of parietal cells also leads to loss of intrinsic factor, which is necessary for vitamin B12 absorption.
  30. Decreased nutrient absorption in the Small Intestine Causes.....
    Fewer absorbing cells.
  31. Large Intestines: Increase in pouches on the weakened intestinal wall called diverticulosis Causes....
    Weakened musculature. Does not significantly affect absorption.
  32. Constipation in the Large Intestine Causes....
    Decreased peristalsis
  33. Missed defecation signal in the Large Intestine Causes...
    Duller nerve sensations.
  34. Size decreased in Liver Causes....
    Reduced storage capacity and ability to synthesize protein and metabolize medications.
  35. Physical activity promotes
  36. immobilization depresses
  37. Weakened abdominal and pelvic floor muscles impair
    the ability to increase intraabdominal pressure and to control the external sphincter and an increased risk for constipation.

  38. During emotional stress the digestive process is
    accelerated, and peristalsis is increased. Side effects of increased peristalsis are diarrhea and gaseous distention
  39. A number of diseases of the GI tract are associated with stress. These include
    ulcerative colitis, irritable bowel syndrome, certain gastric and duodenal ulcers, and Crohn's disease.
  40. If a person becomes depressed,
    the autonomic nervous system slows impulses and peristalsis decreases, resulting in constipation.
  41. a number of conditions result in discomfort during defecation they are....
    hemorrhoids, rectal surgery, rectal fistulas, and abdominal surgery. In these instances the client often suppresses the urge to defecate to avoid pain, and thus develops constipation
  42. Pregnancy
    Slowing of peristalsis during the third trimester often leads to constipation. A pregnant woman's frequent straining during defecation or delivery results in formation of permanent hemorrhoids.
  43. General anesthetic agents used during surgery cause
    • -temporary cessation of peristalsis
    • -Inhaled anesthetic agents block parasympathetic impulses to the intestinal musculature. The anesthetic's action slows or stops peristaltic waves
    • ** The client who receives local or regional anesthesia is less at risk for elimination alterations because this often affects bowel activity minimally or not at all.

  44. Paralytic ileus
    usually lasts about 24 to 48 hours. If the client remains inactive or is unable to eat after surgery, return of normal bowel function is further delayed.
  45. Laxatives and cathartics
    • soften the stool and promote peristalsis.
    • *When used correctly maintain normal elimination patterns
  46. chronic use of cathartics causes
    the large intestine to lose muscle tone and become less responsive to stimulation by laxatives.
  47. Laxative overuse causes
    • causes serious diarrhea that leads to dehydration and electrolyte depletion.
    • *Laxatives often influence the efficacy of other medications by altering the transit time (i.e., the time the medication remains in the GI tract and is available for absorption)
  48. Dicyclomine HCl (Bentyl)
    Suppresses peristalsis and decreases gastric emptying.
  49. Opioid analgesics
    Slow peristalsis and segmental contractions, often resulting in constipation
  50. Anticholinergic drugs, such as atro-pine or glycopyrrolate (Robinul)
    Inhibit gastric acid secretion and depress GI motility (McKenry and others, 2006). Althoughuseful in treating hyperactive bowel disorders, anticholinergics cause constipation.
  51. Antibiotics
    Produce diarrhea by disrupting the normal bacterial flora in the GI tract. An increase in the use of fluoroquinolones in recent years has provided a selective advantage for the epidemic of C. difficile
  52. Nonsteroidal antiinflammatory drugs
    Causes gastrointestinal irritation that increases the incidence of bleeding with serious consequences to older adults
  53. Aspirin
    A prostaglandin inhibitor, it interferes with the formation and production of protective mucus and causes GI bleeding
  54. Histamine2 (H2) antagonists
    Suppress the secretion of hydrochloric acid and interferes with the digestion of some foods.
  55. Iron
    Causes discoloration of the stool (black), nausea, vomiting, constipation (diarrhea is less commonly reported), and abdominal cramps
  56. Constipation
    is a symptom, not a disease (Box 46-1). Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation
  57. The signs of constipation usually include
    infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feces
  58. Straining during defecation causes
    problems to the client with recent abdominal, gynecological, or rectal surgery. The effort to pass a stool can cause sutures to separate, reopening the wound
  59. An obvious sign of impaction is
    • the inability to pass a stool for several days, despite the repeated urge to defecate.
    • *When a continuous oozing of diarrhea stool occurs, suspect impaction.
    • *The liquid portion of feces located higher in the colon seeps around the impacted mass.
    • *Loss of appetite (anorexia), nausea and/or vomiting, abdominal distention and cramping, and rectal pain often accompany the condition.
    • *If you suspect an impaction, gently perform a digital examination of the rectum and palpate for the impacted mass.
  60. What Chronic illnesses cause Constipation???
    Parkinson's disease, multiple sclerosis, rheumatoid arthritis, chronic bowel diseases, depression, diabetic neuropathy, eating disorders
  61. Type 1 Bristol Stool
    Separate hard lumps like nuts ( difficult to pass)
  62. Type 2 Bristol Stool
    Sausage shaped but lumpy
  63. Type 3 Bristol Stool
    Like a sausage but with cracks on surface
  64. Type 4 Bristol Stool
    like a sausage or snake, smooth and soft
  65. Type 5 Bristol Stool
    Soft blobs with clear cut edges (passed easily)
  66. Type 6 Bristol Stool
    Fluffy pieces with ragged edges, a mushy stool
  67. Type 7 Bristol Stool
    Watery, no solid pieces (entirely liquid)
  68. loop colostomy
    • usually performed in a medical emergency when health care providers anticipate closure of the colostomy. These are usually temporary large stomas constructed in the transverse colon.
    • *The surgeon pulls a loop of bowel onto the abdomen
    • *An external supporting device such as a plastic rod, bridge, or rubber catheter is temporarily placed under the bowel loop to keep it from slipping back.
    • *The surgeon then opens the bowel and sutures it to the skin of the abdomen
    • *A communicating wall remains between the proximal and distal bowel
    • *The loop ostomy has two openings through the one stoma.The proximal end drains stool, whereas the distal portion drains mucus.
    • *Within 7 to 10 days the surgeon removes the external supporting device.
  69. End colostomy
    • consists of one stoma formed from the proximal end of the bowel with the distal portion of the GI tract either removed or sewn closed (called Hartmann's pouch) and left in the abdominal cavity
    • *end colostomies are a result of surgical treatment of colorectal cancer.
    • *In such cases the rectum is usually removed.
    • *Clients with diverticulitis who are treated surgically often have a temporary end colostomy with a Hartmann's pouch
  70. Double-barrel colostomy
    • the bowel is surgically severed and the two ends are brought out onto the abdomen
    • *the double-barrel colostomy consists of two distinct stomas: the proximal functioning stoma and the distal nonfunctioning stoma.
  71. Ascending
    • usually on right side of abdomen, still liquid stool, not going to be able to regulate
    • how it comes out
  72. Descending
    • Upper part ; form and regualted stool. Patient can
    • be taught to when to ut the tube, can
    • regulate stool
  73. End-Colostomy
    pull one end of the valve through wherever they cut is where it ends permenent
  74. White or clay Poo color
    • abnormal
    • *Absence of bile
  75. Black or tarry (melena) Poo color
    • Abnormal
    • *Iron ingestion or upper GI bleeding
  76. Red Poo Color
    • Abnormal
    • *Lower GI bleeding, hemorrhoids
  77. Pale with fat Poo
    • Abnormal
    • *Malabsorption of fat
  78. Translucent mucus in Poo
    • Abnormal
    • *Spastic constipation, colitis, excessive straining
  79. Bloody mucus in Poo
    Blood in feces, inflammation, infection
  80. Pungent Oder
    • affected by food type
    • *abnormal Noxious change
    • *Blood in feces or infection
  81. Consistency Soft, formed
    • *Abnormal liquid
    • Diarrhea, reduced absorption
  82. Hard consistency of Poo
  83. Normal Frequency
    Varies: Infant 4-6 times daily (breast-fed) or 1-3 times daily (bottle-fed); adult daily or 2-3 times a week
  84. Abnormal Frequency
    Infant more than 6 times daily or less than once every 1-2 days; adult more than 3 times a day or less than once a week
  85. Normal amount of Poo to eliminate
    • 150 g/day (adult)
    • *Abnormal Causes: Hypomotility or hypermotility
  86. Normal Shape of Poo
    Resembles diameter of rectum
  87. Abnormal Shape Poo
    • Narrow, pencil shaped
    • *Abnormal Causes: Obstruction, rapid peristalsis
  88. Normal Constituents
    Undigested food, dead bacteria, fat, bile pigment, cells lining intestinal mucosa, water
  89. Abnormal constituents
    • Blood, pus, foreign bodies, mucus, worms
    • *Abnormal Causes: Internal bleeding, infection, swallowed objects, irritation, inflammation
  90. Abnormal Excess fat
    Malabsorption syndrome, enteritis, pancreatic disease, surgical resection of intestine
  91. If the bed is flat
    the hips remain hyperextended.
  92. When positioning a client, it is important to prevent muscle strain and discomfort
    What should you NEVER DO...???
    • *Never try to lift a client onto a bedpan.
    • *Never place a client on a bedpan and then leave with the bed flat unless activity restrictions demand it.
  93. The best method for bedpan placement is to (Steps)
    • *first be sure the client is positioned high in bed.
    • *Then raise the client's head about 30 degrees, to prevent hyperextension of the back and to provide support to the upper torso.
    • *The client then raises the hips by bending the knees and lifting the hips upward. *Place a hand palm up under the client's sacrum, resting the elbow on the mattress and using it as a lever to help in lifting, while slipping the pan under the client
    • *Clients who have had abdominal surgery are hesitant to exert strain on suture lines and often have difficulty positioning on a pan.
    • *Always wear gloves when handling a bedpan.
  94. If the client is immobile or it is unsafe to allow the client to exert such effort, What should YOu do??? and Steps
    • the client remains flat and rolls onto the bedpan
    • 1-Lower the head of the bed flat, and assist the client in rolling onto one side, backside toward the nurse.
    • 2-Apply a little powder to back and buttocks to prevent skin from sticking to the pan.
    • 3-Place the bedpan firmly against the buttocks, down into the mattress with the open rim toward the client's feet
    • 4-Keeping one hand against the bedpan, place the other around the client's far hip. Ask the client to roll back onto the pan, flat in bed. Do not shove the pan under the client.
    • 5-With the client positioned comfortably, raise the head of the bed 30 degrees.
    • 6-Place a rolled towel or small pillow under the lumbar curve of the client's back for added comfort.
    • 7-Raise the knee gatch or ask the client to bend the knees to assume a squatting position. Do not raise the knee gatch if contraindicated.
  95. Who gets prescribed to Cathartics and laxatives
    • clients undergoing GI tests and abdominal surgery
    • *cathartics have a stronger effect on the intestine
  96. Cathartics and laxatives are available
    in oral, tablet, and powder suppository dosage forms
  97. Enema
    • the instillation of a solution into the rectum and sigmoid colon.
    • *The primary reason for an enema is to promote defecation by stimulating peristalsis. The volume of fluid instilled breaks up the fecal mass, stretches the rectal wall, and initiates the defecation reflex.
  98. The most common use for an enema is....
    • temporary relief of constipation.
    • *Other indications include removing impacted feces, emptying the bowel before diagnostic tests or surgery, and beginning a program of bowel training.
  99. Cleansing enemas include
    • tap water, normal saline, soapsuds solution, and low-volume hypertonic saline. *Each solution has a different osmotic effect, influencing the movement of fluids between the colon and interstitial spaces beyond the intestinal wall.
    • *Infants and children should receive only normal saline because they are at risk for fluid imbalance.
  100. Tap water
    • hypotonic and exerts a lower osmotic pressure than fluid in interstitial spaces. *After infusion into the colon, tap water escapes from the bowel lumen into interstitial spaces. The net movement of water is low.
    • *The infused volume stimulates defecation before large amounts of water leave the bowel.
    • *Do not repeat tap water enemas because water toxicity or circulatory overload will develop if the body absorbs large amounts of water.
  101. normal saline
    • the safest solution to use because it exerts the same osmotic pressure as fluids in interstitial spaces surrounding the bowel.
    • *The volume of infused saline stimulates peristalsis. Giving saline enemas does not create the danger of excess fluid absorption.
  102. Hypertonic solutions
    • infused into the bowel exert osmotic pressure that pulls fluids out of interstitial spaces
    • Clients unable to tolerate large volumes of fluid benefit most from this type of enema, which is, by design, low volume.
    • *This type of enema is contraindicated in clients who are dehydrated and young infants.
    • *A hypertonic solution of 120 to 180 mL (4 to 6 ounces) is usually effective.
    • *The commercially prepared Fleet Enema is the most common.
  103. Soapsuds
    • can be added to tap water or saline to create the effect of intestinal irritation to stimulate peristalsis.
    • *Only pure castile soap is safe, and it comes in a liquid form included in most soapsuds enema kits.
    • *Harsh soaps or detergents cause serious bowel inflammation.
  104. High enemas cleanse
    • the entire colon
    • *After the enema is infused, ask the client to turn from the left lateral to the dorsal recumbent, over to the right lateral position.
    • *The position change ensures that fluid reaches the large intestine

  105. A low enema cleanses only
    the rectum and sigmoid colon.
  106. Oil-retention enemas
    • lubricate the rectum and colon.
    • *The feces absorb the oil and become softer and easier to pass.
    • *To enhance action of the oil, the client retains the enema for several hours if possible.
  107. Carminative enemas provide
    • relief from gaseous distention.
    • *They improve the ability to pass flatus.
    • *An example of a carminative enema is MGW solution, which contains 30 mL of magnesium, 60 mL of glycerin, and 90 mL of water.
  108. For clients with an impaction, the fecal mass is sometimes too large for the client to pass voluntarily. If enemas fail,
    • break up the fecal mass with the fingers and remove it in sections.
    • **This is a last resort in the management of severe constipation and practiced when all other methods have failed.
    • *The procedure is very uncomfortable for the client.
    • *Excess rectal manipulation can cause irritation to the mucosa, bleeding, and stimulation of the vagus nerve, which results in a reflex slowing of the heart rate.
  109. Decompression
    • Removal of secretions and gaseous substances from gastrointestinal tract; prevention or relief of abdominal distention
    • **Type of tubes that can be used: Salem sump, Levin, Miller-Abbott
  110. Enteral feeding
    • Instillation of liquid nutritional supplements or feedings into stomach for clients unable to swallow fluid
    • **Types of tubes that can be used: Duo, Dobhoff, Levin
  111. Compression
    • Internal application of pressure by means of inflated balloon to prevent internal esophageal or gastrointestinal hemorrhage
    • Types of Tubes: Sengstaken-Blakemore
  112. Lavage
    • Irrigation of stomach in cases of active bleeding, poisoning, or gastric dilation
    • Types of Tubes: Levin, Ewald, Salem sump