Bowel Elimination

Front 1

The GI tract

Back 1

is a smooth-musle tube 9m (30ft) long for average adult males.

Front 2

Mechanical digestion

Back 2

begins with mouth "MASTICATION"

Front 3

Chyme

Back 3

food leaves the stomach "liquid form"

Front 4

Defecation

Back 4

removing stool "feces"

Front 5

Haustra

Back 5

normal pouches of colon that occur when longitudinal muscles contract.

Front 6

Elimination

Back 6

occurs through skin (perspiration), Lungs (water vapor), Bowels (feces), Kidneys (Urine)

Front 7

Bowel Elimination

Back 7

removal of waste products of digestion from body.

1.) Essential for health

2.) Defecation "Feces"

Front 8

Large Intestine

Back 8

secrets mucus, lubricates and binds, breakdown bacteria, amino-acids, bilirubin, synthesize Vitamin K & B12, Thiamin & Ribflaurin. Absorption of water, NAcI, ions from chyme.

Ex: Chyme (proximal half) What stores fecal matter (Distal half)

50-60 inches long (5ft) 1-3 inches around

7 parts of large intestine

Front 9

1500 ml

Back 9

of chyme

Front 10

100ml

Back 10

digested in large intestine

food stays in intestine max of 4 days

Front 11

Small Intestine

Back 11

Largest 7m (22ft) long. Most digestion and absorption occurs here.

Front 12

Duodenumm

Jejunum

Ileum

Back 12

All part of the SMALL INTESTINE

Front 13

Cecum

Back 13

consists mainly of cellulose and water

Front 14

Three segments of Large Intestine

Back 14

Ascending, Transverse, Descending colon

Front 15

Sigmoid Colon

Back 15

Final small segment of bowel that twists medially and downward to connect with the rectum and anus.

Front 16

Internal sphincter

Back 16

involuntarily, relaxes, and opens when stool is present in the rectum.

Front 17

Infants

Back 17

Meconium (1st stool to be passed)-Black, tardy stool 24 hours after birth.

Transitional 1 week- loose green or yellow in color

Babies have frequent stools.

Front 18

Toddler

2-3 years

Back 18

Potty training begins

Nervous & MS systems mature

Front 19

School age/Adolescent

Back 19

Possible constipation

Reluctant to stop activities

Fear of BM in public

Patterns similar to adults

Front 20

Elderly

Back 20

HRF (High risk for) constipation due to

decreased fiber

decreased fluids

decreased peristalsis (due to aging)

Muscle weakness

Front 21

Everyone has individual pattern to move bowels.

Back 21

If ignored urge to defecate is lost leads to constipation

Hospitalized adult/elderly may be reluctant to defecate due to embarrassment.

Front 22

Rectal compliance

Back 22

unable to defecate

Front 23

ABDOMINAL ASSESSMENT

Back 23

Inspection
Ausulation
Palpation
Percussion

Front 24

Inspections of ABDOMEN

Back 24

Contour & appearance of umbilicus ( hernia)

Skin integrity (Stretch marks, surgical woulds, ostomy)

Scars, masses, rashes

Color- Jaundiced, purple discolartions

Front 25

Ascites

Back 25

Yellow in color ENLARGED GALLBLADDER

Front 26

SYMMETRIC

Back 26

even on both sides

Front 27

A SYMMETRIC

Back 27

not even on both sides

Front 28

6 F's of distended abdomen

Back 28

1. Flatus

2. Fetus

3. Foreign matter/Fibroid

4. Feces

5. Fat

6. Fluid

Front 29

Concave

Back 29

IN

Front 30

CONVEX

Back 30

OUT

Front 31

When listening (Auscultation)

Back 31

Listen in all 4 quadrants for 3-5 minutes

Air & fluid create sound during peristalsis

Describe frequency, intensity and pitch.

Front 32

NORMAL bowel sounds

Back 32

High pitch gurgling 15-20 seconds

Front 33

HYPERACTIVE bowel sounds

Back 33

2-3 seconds or > 30 bowel sounds per min (diarrhea, laxatives could be cause)

Front 34

HYPOACTIVE bowel sounds

Back 34

less than 5 per minute, may be ileum ( T&P) patient. Have them empty bladder & try to listen again.

Front 35

ABSENT bowel sounds

Back 35

none after 5 minutes, surgery, paralytic ileum.

Ileus- intestinal destruction of peristalsis.

Front 36

Procedure to listen

Back 36

start at Right lower quadrant (ascending colon)

then Right upper quadrant (Transverse liver)

Then Left upper quadrant (stomach)

then left lower (descending colon) Small intestine.

May be HIGHER PITCH IN UPPER QUADRANT

LOWER IN lower quadrant

Document frequency, intensity, and pitch

Note BS + times 4)

Front 37

Precussion (tap & Listen)

Back 37

Done to detect flatus, masses, feces & position of spleen

Front 38

Normal Percussion

Back 38

Tympanic or tympany (air filled) like a drum

Front 39

Dull percussion sound

Back 39

Organs (liver, muscles) ascites (fluid in abdomen) distended bladder or full colon

Front 40

Flat percussion sound

Back 40

BONE

Front 41

Procedure for precussion

Back 41

place distal portion of MIDDLE FINGER firmly against the patients skin.

MIDDLE FINGER dominant hand as striking finger

Aim for behind the nail bed

Percuss all four quadrants

Front 42

Palpation (feel)

Back 42

Detect tenderness, masses, distention

Light- 1 cm flat hand not fingers

Deep 4-5 cm (MD or NP)

soft? firm?

Board (like organ rupture)

Measure abdominal girth (ascites)

Front 43

Factors effecting normal bowel elimination

Back 43

Timing-routine

Bulk-Fluid

Exercise- isometric

Immobility

Position-privacy

Surgery-Anesthesia

Front 44

Subjective data

Back 44

Told information you given

Ex: Pattern varies person to person

Laxative & enemas stimulate to bowel

Medications: Antibiotics, narcotics

Fluid 2000-3000ml/day (water)

Diet need bulk, fiber, cellulose

Exercise Stimulates GI motility

Health GI problems SCI, flu, surgery, spinal cord injury

Age: Elderly atony & drier feces

Changes: Cancer

Stress & pain Constipation and diarrhea

Front 45

Objective data

Back 45

What you see

Ex: Stool softener

Front 46

Normal bowel movements

Back 46

Soft formed 3/4 water 1/4 solid

Brown color

Described as large, small, moderate, medium

Odor- related to bacteria normally found in the intestine.

Constituents- None

Shape normally shape of the rectum

Front 47

Common variations of bowel movements

Back 47

Hard-Constipation

Watery

Loose

unformed (diarrhea)

Causes- Medications

Decreased fluid intake

decreased bulk/roughage

decreased activity

Avoid urge to defecate

Excessive laxative use

Color- Black Tarry (Melena)- means intestinal bleeding (old blood) Iron (black color)

Red Food (i.e., beets)

Green/orange (Intestinal infection)

Clay/gray (lack of bile)

Bright red-obvious blood (Hemorrhage, hemorrhoids)

Odor- Increased Odor

Constituents

Food

Foreign objects

Fat

Pus

Parasites

Pathogenic bacteria (food poisoning)

Barium ( upper or lower x-ray prep of intestine)

Shape

String like

Front 48

Constipation Assessment

Back 48

Less than 3 in a week

Decrease frequency amount

Hard formed

Straining pain

decrease appetite

decrease fluids

distention

Flatulence

Mass

decrease bowel sounds

Front 49

Causes of constipation

Back 49

Irregular bowel habits, ignored urge, overuse of laxatives, increased stress, exercise, medications, age, painful defecation, dehydration, NO PRIVACY. FIBER=BULK, Iron can cause constipation.

Front 50

Fecal impaction

Back 50

large hard mass of stool due to prolonged period of constipation

Front 51

Flatulence/ flatus air

Back 51

Causes:

Swallowed air, bacterial breakdown

Ex: babies sometimes swallow air with bottles

Gas producing foods

Decreased GI motility

Constipation, bowel disease

Front 52

Assessment of Flatus

Back 52

Abdominal pain, cramping, abdominal distention

Treatment: Heat to abdomen (MD order), Rectal tube, Ambulation (AROM), suppositories, enema

Front 53

Bowel incontinence

Back 53

involuntary passage of stool, inability to control fecal and gaseous discharges through anal sphincter.

60% of elderly affects

Leads to social isolation

Skin breakdown

Goal

Establish regular pattern of elimination

experience BM twice daily when placed on commode, toilet, bedpan.

decease freq. of incontinent episodes

Front 54

Diarrhea

Back 54

Passage of liquid feces and increase i amount & frequency of defecation.

Less time for fluids and electrolytes to be absorbed. Can lead to incontinence, embarrassment.

Assessment

Dehydration

Cramping

Abdominal Pain

Front 55

Causes of diarrhea

Back 55

ANXIETY- increased GI motility and mucus secretion

MEDS- antibiotics, iron, cathartics

Food allergy

incomplete food digestion

Food/drug intolerance-increased motility and mucus secretion

Colon disease, malabsorption, crohns disease, surgery.

Infection, viral, bacterial, parasitic

Front 56

Clostridium Difficile

C-diff

Back 56

2-3 stool samples out for testing (only 1 cause of diarrhea)

Very contagious

Precautions

Travels on shoes

Up to 30 watery stools per day

GI flora disturbance, long term ATB, enteral feds, NG suction

HRF Dehydration

Pain and discomfort

Skin breakdown

Front 57

BRAT DIET

Back 57

BANNA

RICE

APPLE

TOAST

Front 58

Alternative treatments for diarrhea

Back 58

Herbs-garlic, claves

Probiotics

Front 59

Laxatives

Back 59

promotes soft stool

osmotics (saline)

Acute- constipation, chronic constipation, bowel preps for surgery.

Action-pulls water into intestine. Salts and saline products, contain sodium or magnesium

Example- Lactulose, glycerin

2. Stimulants

Action- Promotes peristalsis results in 6 -12 hours. Ex: Castor oil, Cascara Senna

3. Bulk-forming

Natural fibrous substances

Action Takes up to 8-24 hours up to 3 days to work.

Ex: Fiber-con, Metamucil

Mix with glass of water or juice

4. Emollients

Lubricants & stool softeners

Action lowers surface tension and promotes water in intestine and stool.

Ex Mineral oil, Docusate calcium

Front 60

Suppository

Back 60

Meltable tablet

Constipation stool in rectum

Stimulate nerve ending in intestine, release gas

Dulcolax

Patient must hold butt cheeks together and take deep breath.

Front 61

Enemas

Back 61

Cleansing (fluid into rectum) Stimulates peristalsis by distending colon, softens feces. Tap water 15-20 or Soap suds 10-15

Front 62

Retention

Back 62

Oil instilled

Constipation, dry stool

Sofents feces

Olive, mineral oil

Front 63

Carminative

Back 63

Glycerin, magnesium, water

Herbal oils

Gas & Constipation

Relieve flatus

Soft-burgative effect

Front 64

Hypertonic

Back 64

Constipation

Pulls water into rectum to stimulate peristalses and evacuation

Fleets 5-10 min

Front 65

Care Of Ostomy bowel/bladder

Back 65

Emptying pouch

Standard precaution

Open clip, drain, record color, ant

Cleanse

Front 66

Osmotic

Back 66

pulls water into intestine

Front 67

Wetting Agents

Back 67

lower feces surface tension soil wetter/less dry

Front 68

Docusate Sodium

Back 68

Slow acting

Front 69

Saline

Back 69

increase fluid bulk magnesium citrate, salts

Front 70

Stimulates

Back 70

promotes peristalsis by iterating sensory nerve ending.