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83 Cards in this Set

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Explain how fiber affects the diet
Fiber, the nondigestible residue in the diet, provides the bulk of fecal material.
Give some examples of good fiber sources
Bulk-forming foods, such as whole grains, fresh fruits, and vegetables, help flush the fats and waste products from the body with more efficiency.
Why do we need fiber?
When there is no fiber to transport waste matter through the colon, there is an increased risk for polyps
Define lactose intolerance
Lack of an enzyme needed to digest the milk sugar lactose. The result is diarrhea, cramps, or flatulence.
Summarize how fluids can affect the character of feces.
Fluid liquefies intestinal contents, easing its passage through the colon. Reduced fluid intake slows passage of food through the intestine and results in hardening of stool contents.
How much fluid does and adult need?
Unless there is a medical contraindication, an adult needs to drink six to eight glasses (1500 to 2000 mL) of noncaffeinated fluid daily.
What increases the risk of constipation?
Poor fluid intake increases the risk of constipation due to reabsorption of fluid in the colon, resulting in hard, dry stools
Summarize the benefits of physical activity
Physical activity promotes peristalsis, whereas immobilization depresses peristalsis.
Why is maintaining tone of skeletal muscles used during defecation important?
Weakened abdominal and pelvic floor muscles impair the ability to increase intraabdominal pressure and to control the external sphincter.
What causes a decrease in muscle tone?
Muscle tone is sometimes weakened or lost as a result of long-term illness or neurological disease that impairs nerve transmission. As a result of these changes in the abdominal and pelvic floor muscles, there is an increased risk for constipation.
List the diseases of the GI tract that may be associated with stress.
Ulcerative colitis
Irritable bowel syndrome
Certain gastric and duodenal ulcers
Crohn's disease.
List six personal elimination habits that influence bowel function.
Effective and timely elimination, Privacy, Embarrassment, Balance, activity tolerance and physical activity.
List conditions that may result in painful defecation.
Hemorrhoids, Rectal surgery, Rectal fistulas, Abdominal surgery
What effect does General anesthesia have on peristalsis and defecation?
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.
What is paralytic ileus and how long does it last after surgery?
Any surgery that involves direct manipulation of the bowel temporarily stops peristalsis. This condition, called 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.
What is the action of Dicyclomine HCl (Bentyl)? What is it used for?
Suppresses peristalsis and decreases gastric emptying.
Diarrhea
What effect does Opioid analgesics have on the bowels?
Slow peristalsis and segmental contractions, often resulting in constipation
What do Anticholinergic drugs, such as atro-pine or glycopyrrolate (Robinul) do?
Inhibit gastric acid secretion and depress GI motility. Although useful in treating hyperactive bowel disorders, anticholinergics cause constipation.
What effect do Antibiotics have on the bowels?
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.
What effects do Nonsteroidal antiinflammatory drugs have on the bowels?
Causes gastrointestinal irritation that increases the incidence of bleeding with serious consequences to older adults.
What effect does Aspirin have on the bowels?
A prostaglandin inhibitor, it interferes with the formation and production of protective mucus and causes GI bleeding (McKenry and others, 2006).
What effect do Histamine2 (H2) antagonists have on the GI system?
Suppress the secretion of hydrochloric acid and interferes with the digestion of some foods.
What effect does Iron have on bowels?
Causes discoloration of the stool (black), nausea, vomiting, constipation (diarrhea is less commonly reported), and abdominal cramps (McKenry and others, 2006).
List types of diagnostic tests for visualization of GI structures.
Colonoscopy, Endoscopy
List four factors that place a client at risk for elimination problems.
Emotional stress (anxiety or depression),
Physiological changes in the GI tract such as surgical alteration of intestinal structures,
Inflammatory diseases,
Prescribed therapy
List the signs of constipation
Hard feces
Infrequent BM (less than every 3 days)
Difficulty passing stools
Excessive straining
Inability to defecate at will
List common causes of constipation
Improper diet, Reduced fluid intake, Lack of exercise, Certain medications
What are Some Common Causes of Constipation
Irregular bowel habits and ignoring the urge to defecate. Lengthy bed rest or lack of regular exercise. Laxative misuse.
What Chronic illnesses cause constipation?
Parkinson's disease, multiple sclerosis, rheumatoid arthritis, chronic bowel diseases, depression, diabetic neuropathy, eating disorders.
What kind of diet causes constipation?
Low-fiber diet high in animal fats (e.g., meats, dairy products, eggs). Also, low fluid intake slows peristalsis.
What psychological conditions cause constipation?
Anxiety, depression, cognitive impairment.
Why are older adults more likely to develop constipation?
Older adults experience slowed peristalsis, loss of abdominal muscle elasticity, and reduced intestinal mucus secretion. Older adults often eat low-fiber foods.
What kind of neurological conditions cause constipation?
Neurological conditions that block nerve impulses to the colon (e.g., spinal cord injury, tumor).
What organic illnesses cause constipation?
Organic illnesses such as hypothyroidism, hypocalcemia, or hypokalemia.
List the groups of clients in whom constipation could pose a significant health hazard.
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. In addition, clients with histories of cardiovascular disease, diseases causing elevated intraocular pressure (glaucoma), and increased intracranial pressure need to prevent constipation and avoid using the Valsalva maneuver.
Define fecal impaction
(Results from unrelieved constipation)-a collection of hardened feces, wedged in the rectum that a person cannot expel.
List signs and symptoms of fecal impaction
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.
Define diarrhea
An increase in the number of stools and the passage of liquid, unformed feces.
Name the two complications associated with diarrhea
Excess loss of colonic fluid results in serious fluid and electrolyte or acid-base imbalances. Repeated passage of diarrhea stools also exposes the skin of the perineum and buttocks to irritating intestinal contents can cause skin breakdown
What are the symptoms of Clostridium difficile infection
Symptoms range from mild diarrhea to severe colitis.
How is C.diff acquired?
C. difficile infection is acquired in one of two ways, by factors that cause an overgrowth of C. difficile and by contact with the C. difficile organism.
What medical interventions cause the growth of C. difficile?
Antibiotics (cephalosporins, ampicillin, amoxicillin, and clindamycin), chemotherapy, and invasive bowel procedures such as surgery or colonoscopy disrupt normal bowel flora and cause an overgrowth of C. difficile.
How is C. difficile spread in hospitals?
Some clients acquire the organism from a health care worker's hands or direct contact with the environmental surfaces contaminated with C. difficile.
What is the most common diagnostic test for C. difficile?
The most common diagnostic test for the bacteria is the enzyme-linked immunosorbent assay (ELISA) test. It detects C. difficile A and B in the stool. Two to three stool specimens are required for this test.
Communicable food-borne pathogens cause diarrhea, how can this be stopped?
Simple hand washing following the use of the bathroom, before and after preparing foods, and cleaning and storing fresh produce and meats greatly reduces the risk of food-borne illnesses.
What is the goal when diarrhea is the result of a food-borne virus
The goal is usually to rid the gastrointestinal system of the pathogen, rather than to slow peristalsis.
Explain fecal incontinence
inability to control passage of feces and gas from the anus
Explain flatulence
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally, intestinal gas escapes through the mouth (belching) or the anus (passing of flatus).
Define stoma
A temporary or permanent artificial opening in the abdominal wall
Define ileostomy
Surgical opening created in the ileum with the ends of the intestine brought through the abdominal wall to create the stoma.
Define colostomy
Surgical opening created in the colon with the ends of the intestine brought through the abdominal wall to create the stoma.
Identify the three types of colostomy constructions available.
Loop Colostomy, End colostomy, Double Barrel Colostomy
When is a loop colostomy usually performed?
A loop colostomy is usually performed in a medical emergency when health care providers anticipate closure of the colostomy.
Describe a loop colostomy.
Loop Colostomies are usually temporary large stomas constructed in the transverse colon. 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.
Describe an end colostomy.
The 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.
Describe a double-barrel colostomy.
Unlike the loop colostomy, the bowel is surgically severed in a double-barrel colostomy, 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.
Define fecal occult blood testing (FOBT)
Or guaiac test. Measures microscopic amounts of blood in feces.
List the common radiological and diagnostic tests used with the client with altered bowel elimination.
Plain Film of Abdomen/Kidneys, Ureter, Bladder.
A simple x-ray film of the abdomen requiring no preparation.
Upper GI/Barium Swallow.
An x-ray examination using an opaque contrast medium (barium) to examine the structure and motility of the upper GI tract, including pharynx, esophagus, and stomach.
What precautions do clients going into testing need to take?
Client must be allowed nothing by mouth (NPO) after midnight the night before the examination. Client needs to remove all jewelry or other metallic objects.
Why do radiology clients need to increase fluids after tests?
After the test, client needs to increase fluids to facilitate passage of barium.
What is an Upper Endoscopy?
An endoscopic examination of the upper GI tract allowing more direct visualization through a lighted fiber-optic tube that contains a lens, forceps, and brushes for biopsy.
What preparations need to be taken for an endoscopy?
Light sedation is required. Barium Enema, An x-ray examination using an opaque contrast medium to examine the lower GI tract., Preparation includes NPO after midnight, a bowel prep such as magnesium citrate, and in some instances enemas to empty out any remaining stool particles.
Ultrasound
A technique that uses high-frequency sound waves to echo off body organs, creating a picture.
What are the preparations for an ultrasound?
Preparation depends on the organ to be visualized and includes NPO or no preparation.
What is a Colonoscopy?
An endoscopic examination of the entire colon with the use of colonoscope inserted into the rectum.
What are the preparations for a colonoscopy?
Preparation is similar to that of barium enema: clear liquids the day before and then some form of bowel cleanser, such as GoLytely. Enemas until clear are also common. Light sedation is required.
What is a Flexible Sigmoidoscopy?
An examination of the interior of the sigmoid colon through the use of a flexible or rigid lighted tube.
What preparations are needed for a Flexible Sigmoidoscopy?
Preparation is similar to that of a barium enema or colonoscopy. Light sedation is required.
Computerized Tomography Scan
An x-ray examination of the body from many angles utilizing a scanner analyzed by a computer.
What preparations and precautions are needed for a CT Scan?
Preparation is usually NPO. The client needs to lie very still. If claustrophobia is a problem, use light sedation.
Magnetic Resonance Imaging
A noninvasive examination that uses magnet and radio waves to produce a picture of the inside of the body.
What preparations and precautions are need for an MRI?
Preparation is NPO 4 to 6 hours before examination. No metallic objects are allowed in the room, including metal objects on clothes.
Enteroclysis
Introduction of contrast material to jejunum, allowing entire small intestine to be studied. Preparation is 24 hours of clear liquid diet and colon cleansing, such as GoLytely or enemas until clear.
Identify the primary action of cathartics and laxatives
Short-term action of emptying the bowel
Identify the primary action of antidiarrheals
Decrease intestinal muscle tone to slow passage of feces
Identify the primary action of enemas
Promotes defecation by stimulating peristalsis, temporary
Cleansing enema
Promote the complete evacuation of feces from the colon. They act by stimulating peristalsis through the infusion of a large volume of solution or through local irritation of the colon’s mucosa.
Tap water enema
Tap water is 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.
Normal saline
Physiologically normal saline is 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.
Hypertonic solution
Hypertonic solutions infused into the bowel exert osmotic pressure that pulls fluids out of interstitial spaces. The colon fills with fluid, and the resultant distention promotes defecation. 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.
Soapsuds
You can add soapsuds 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.
What is an Oil retention enema?
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.
Explain the purpose of a carminative enema
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.