Nur111 Chapter 38 - Bowel Elimination Part 2

Front 1

Voluntary Contraction of abd muscles during forced exp against a closed airway?

Back 1

VALSALVA MANEUVER
-decreases bld return to heart
-cause sudden Heart attack
-increases thorax (chest) & intracranial pressure (head/eyes)

Front 2

What clients are at greater risk for Valsalva Maneuver?

Back 2

-cardiovascular disease pt
-glaucoma patients
-increased intracranial pressure
-new surgical wounds
AVOID STRAINING

Front 3

CHYME:

Back 3

-normally a soft, formed mass
-mixes w/ digestive juices (ie. bile & amylase)

Front 4

How will the stool appear if peritalsis is abnormally FAST allowing less time for water to be absorbed?

Back 4

-stool will be watery :Diarrhea

Front 5

How will the stool stool appear if peristaltic contractions SLOW down?

Back 5

-water continues to be absorbed and a Hard Mass of Stool forms, resulting in COnstipation

Front 6

______ is the beginning of the Large Intestine?

Back 6

Cecum

Front 7

Known as the "lower GI" tract?

Back 7

-Large Intestine (Colon)
length: 6-8'
-cecum, rectum, colon
-primary organ of bowel elmination

Front 8

_______ part of the Small Intestine absorbs carbs & proteins?

Back 8

Jejunum (approx 8')

Front 9

______ part of the small intestine absorbs water,fats, bile salts, and certain vitamins and irons?

Back 9

-ileum (approx 12')

Front 10

The small Intestine absorbs _______ and _________.

Back 10

-nutrients
-electrolytes

Front 11

A circular, muscular layer that prevents regurgitation?

Back 11

-ILEOCECAL VALVE

Front 12

At what age does the control of defecation occur?

Back 12

2-3 y/o

Front 13

What age group is at risk for incontinence and have difficulty controlling bowel evacuation?

Back 13

-Older Adults

Front 14

What are the 4 functions of the COLON?

Back 14

1. absorption(H2O, Na+, Cl-)
2. protection
3. secretion
4. elimination

Front 15

Abnormal opening?

Back 15

Fistula

Front 16

Name foods that cause Flatus?

Back 16

-spicy foods ( also cause indigestion & watery stools, increases peristalsis)
-onions, cauliflower & beans but also stimulate peristalis

Front 17

Nondigestible residue in the diet, provides the bulk of fecal material?

Back 17

FIBER

Front 18

Causes Constipation or Diarrhea
1. emotional stress
2. Crohns
3. colitis
4. severe depression

Back 18

1. diarrhea
2. diarrhea (also at risk for skin breakdown & dehydration
3. same as 2
4 Constipation (b/c of decreased activity

Front 19

What are the side effects of increased peristalsis?

Back 19

1. diarrhea
2. gaseous distention

Front 20

If a client is on bedrest, are they allowed to get up to go to the BR?

Back 20

-NO

Front 21

What is the daily recommeded fluid intake for an adult?

Back 21

1500-2000 mL/day:6-8oz (noncaffeinated)

Front 22

A condition that involves direct manual manipulation of the bowel that temporalily stops peristalsis is called _______ _____?

Back 22

-PARALYTIC ILEUS
-usually last about 24-48 hrs

Front 23

How does dicyclomine HCL (Bentyl) affect the GI system?

Back 23

-suppresses peristalis & decreases gastric emptying

Front 24

How does opioid analgesics affect the GI system?

Back 24

-decreases peristalis
-constipation

Front 25

*How does antichloinergic drugs( ie. Robinul, (glycopyrrolate) or atropine) affect the GI System?

Back 25

-constipation (post-op)
-urinary retention (post-op)

Front 26

How does Nonsteroidal Antiinflammatory drugs affects the GI system?

Back 26

-causes GI irritation, that increases bleeding

Front 27

How does ASA affect the GI system?

Back 27

a prostaglandin inhibitor
-causes GI bleed

Front 28

How does Histamine2 (H2) antagonists (drugs for GERD, ie. tagamet, prevacid) affects the GI system

Back 28

-suppress the secrection of HCL

Front 29

How does Fe+ affect the GI system?

Back 29

-causes black, tarry, sticky stools
-N/V
-can cause constipation
-abd cramps

Front 30

What are the signs of constipation?

Back 30

1. infrequent BM (< than q 3 days)
2. difficulty passing stool
3. excessive straining
4. inability to defecate at will
5. hard feces

Front 31

What is fecal IMPACTION?

Back 31

-results from unrlieved constipation
-collection of hardened fecs, wedged in the rectum that a person can not expel

Front 32

What client are at risk for impaction?

Back 32

-debilitated
-confused
-unconscious

Front 33

What is an obvious sign of IMPACTION?

Back 33

-inability to pass a stool for several day, despit the repeated urge to defecate

Front 34

What s/s accompany a client who is IMPACTED?

Back 34

-N/V
loss of appetite (anorexia)
-abd distention
-cramping
-rectal pain

Front 35

What chronic illness cause CONSTIPATION?

Back 35

-Parkinsons
-MS
-Rheumatoid arthritis
-Chronic bowel diseases
-severe depression
-diabetic or perpherial neuropathy
-eating d/o -paralysis

Front 36

What are some causes of constipation?

Back 36

-anxiety, depression (divorce, death of loved one), cognitive impairment
-laxative misuse
-organic illness (hypothyroidism, hypocalcemia or hypokalemia)
-low fiber diet
-spinal cord injury, tumor

Front 37

What medications cause Constipation?

Back 37

-anticholinergics
-antispasmodics
-anticonvulsants
-antidepressants
-antihistamines
-antihypertensives
-Fe+, Ca supplements
-diuretics -antacids

Front 38

What should the nurse do if bowel sounds are Not heard post-op?

Back 38

-Call MD
-if bowel sounds are absent or the pt is nausea, a NG tube may have to be inserted until bowels sounds are present
-DO NOT feed a pt who has NO bowel sounds post op!!

Front 39

In what 2 ways is Clostridium difficile acquired?

Back 39

-causes diarrhea
1. factors that cause overgrowth of C. Diff (ie. antibiotics, chemo, invasive bowel surgery, coloscopy
2. contact w/ C diff (ie. poor hand hygiene, erratic disinfection practices
-Dx test for C. diff is known as the ELISA test

Front 40

What are causes of diarrhea?

Back 40

Diarrhea INCREASES peristalsis!
-antibiotic -virus
-food allergy -IBS
-bowel surgery
-food borne pathogens (from not using proper hand hygiene, ie. handwashing after BR, storing fresh foods)

Front 41

What bowel elimination problem harms a clients Body Image & leads to social isolation?

Back 41

FECAL INCONTINENCE

Front 42

Causes of FLATULENCE?

Back 42

-beer -swallowing air
-chewing gum
-liposcopic exam (walking after exam helps expel the gas)

Front 43

Common cause of abdominal fullness, pain & cramping?

Back 43

FLATULENCE
-pt may feel like they are having a heart attack,
-pain in shoulder or chest

Front 44

1. What is a conservative meause for a patient w/ Flatulence
2. What is used as a last resort

Back 44

1. Rectal tube
2. NG tube

Front 45

Causes of HEMORRHOIDS?

Back 45

-straining at defecation
-pregnancy
-heart failure
-chronic liver disease

Front 46

How much stool is needed for a specimen
1. solid?
2. liquid?

Back 46

1. 1"
2. 15 - 30 mL

Stool C& S needs to be in a sterile container

Front 47

When are O & P specimens collected?

Back 47

-early am
-take to lab stat
-stool must be kept warm
-O&P specimen cont. (with 1 pink & 1 blue lid)

Front 48

*What type of ostomy bypasses the Entire Large intestine?

Back 48

-ILEOSTOMY

Front 49

**What is the consistency of the stool w/ an ILEOSTOMY?

Back 49

-Frequent & Liquid
-should not EVER see formed stool in bag
-rectum is sewen shut
-don't admin enteric coated tablets b/c tabs will not be absorbed (will see tab in bag)

Front 50

*What is the consistency of the stool w/ a Ascending colostomy?

Back 50

-frequent & liquid

Front 51

*What is the consistency of the stool w/ a Transverse colostomy?

Back 51

-solid, formed stool (book)
-Pasty stool (Ms. Thompson)

Front 52

*What colostomy releases near-normal stool?

Back 52

-Sigmond Colostomy

Front 53

** What part of the GI tract is used for Elimination of feces and Flatus

Back 53

Lower GI tract (large intestines)

Front 54

What is the consistency of stool w/ a Descending colostomy?

Back 54

-formed stool

Front 55

*If there was a leakage from an ileostomy, sigmond or descending colostomy bag, which one would most damaging to the skin & why?

Back 55

Ileostomy b/c uric acid is closer

Front 56

Which type of colostomy is performed in a medical emergency

Back 56

-Loop Colostomy
constructed in the Tranverse colon

Front 57

Temporary Ostomies:

Back 57

-performed for traumatic injuries
-inflammatory conditions
-allows distal end to heal & rest
-after healing has occurred, the bowel is RE-ANASTOMOSED; the pt is able to defecate normally

Front 58

1. When in a Permanent ostomies performed?
2. Name example

Back 58

1. rectum or anus is nonfunctioning
2. birth defects, rectal/stomach cancer

Front 59

the reuniting (as by surgery or healing) of a divided vessel

Back 59

reanastomosis-
will have bowel cleansing before surgery (Golytely)

Front 60

*Double Barreled Colostomy
1. what is the function of the proximal & distal stomas

Back 60

-Proximal: functioning stoma: drains stool & used if irrigated
-Distal: Don't "poop", nonfunctioning: produces mucus from stoma

Front 61

AKA as Hartmann's pouch, used as a result of colorectal cancer (rectum is removed)

Back 61

-End Colostomy (most common)
-1 stoma from the Proximal portion of the bowel
-distal end is either removed or closes off

Front 62

Stomas are part of the _____ intestine?

Back 62

-Large
-should always be pink in color or bright red

Front 63

Name 2 types of ostomies of the UPPER GI tract?

Back 63

-gastrostomy -jejunostomy
*upper GI tract=used for feeding!

Front 64

Lower GI ostomies are used for ______?

Back 64

-Elimination

Front 65

This colostomy has a stoma that is located on the lower left side of the abdomen

Back 65

Descending or sigmoid colostomy

Front 66

This colostomy has a stoma that is located in the upper abdomen towards the middle

Back 66

Transverse

Front 67

This colostomy has a stoma (opening) that is located on the right side of the abdomen

Back 67

Ascending

Front 68

an ileostomy that drains into a surgically created pouch or reservoir in the abdomen. Involuntary discharge of intestinal contents is prevented by a nipple valve created from the ileum. This method eliminates the need for the patient to wear an external pouch over the stoma. Also called Kock's pouch.

Back 68

-Continent Ileostomy

Front 69

What proceduce is occasionally used in the tx of ulcerative colitis?

Back 69

-Continent Ileostomy
-AKA "Kock" contintent

Front 70

Observable peristalsis of abdomen is a sign of?

Back 70

-intestinal obstruction

Front 71

What causes abdominal distention?

Back 71

intestinal gas
tumors
fluid in peritoneal cavity

Front 72

How often & how long do Normal Bowel sounds occur?

Back 72

-every 5 to 15 sec
-last a sec to several sec

Front 73

When Auscultating the abdomen, what sounds are heard w/ Abd Distention?

Back 73

-hear an increased in pitch or a tinkling sound

Front 74

Hypoactive bowel sounds are heard _____?

Back 74

-less than 5 sounds per min
-occur w/ paralytic ileus (ie. after abd surgery)

Front 75

1. When do high-pitched & Hyperactive bowels occur?
2. How often?

Back 75

1. small intestine obstruction & inflammatory d/o
2. 35 or more sounds per min

Front 76

Test for measuring the output of fecal fat require, how many days of stool collection?

Back 76

-3 to 5 days

Md will order: "fecal fat & bile"

Front 77

What foods & meds will cause a FOBT to have a False + reading?

Back 77

(fecal occult blood test) aka, Guaiac test
FOODS: -red meat -poultry
-fish -some raw veggies
MEDS: Vit C - ASA
-non-steriodal inflammatories

Front 78

How many FOBT test need to be done in order to confirm GI bleeding?

Back 78

3
one test does NOT confirm gi bleeding

Front 79

Can a Guaiac Fecal occult blood test(gFOBT), skill be delegated?

Back 79

Yes, however the nurse assesses for significance of findings

Front 80

-abnormal black sticky stool containing digested blood
-blood > 50 mL

Back 80

Melana

Front 81

The present of melana is indicative of ?

Back 81

Upper GI Bleeding (small intestine)

Front 82

*What is the post-test care for EDG? (esophagogastroduodenoscopy

Back 82

**NPO until gag relex returns, make sure pt can swallow before they eat, test w/ a tongue blade
-observe for bleeding, hemoptysis(coughing bld), abd pain, dysphagia (difficult swallowing), vomitng, bloody or tarry stools (coming from upper GI)

Front 83

What is part of the abd is examined w/ an Barium Swallow(SBFT)?

Back 83

-Upper GI
-examines the structure & motility of the Upper GI
-post op: increase fluids to prevent constipation, laxative (MOM)

Front 84

What part of the GI tract is examined w/ a Barium Enema?

Back 84

X-ray
lower GI tract
bowel prep w/ golytely

Front 85

DiverticulOSIS

Back 85

-small, bulging pouches (diverticula) develop in your digestive tract.
-NOT an Infection

Front 86

DiverticuliTIS

Back 86

one or more diverticula in your digestive tract become Inflamed or Infected.
-found in the large intestine
-abdominal pain, fever, nausea

Front 87

Enteroclysis:

Back 87

-X-ray: visualizes the entire small intestine (small tube goes in thru the stomach)
-requires NG placement into the jejunum
-contrast material into jejunum

Front 88

What are the warning sign for colon cancer?

Back 88

-change in bowel habits
-rectal bleeding
-sensation of incomplete bowel evacuation

Front 89

What laxatives are used as the 1st step in treating constipation in older adults?

Back 89

fiber & bulk-forming laxatives

stool softners=no longer recommended

Front 90

What type of enema is the safest, for regular use in an older adult?

Back 90

TWE
p1195

Front 91

What is the effect of digital removal of Fecal Impaction?

Back 91

-Vagal stimulation= decreases heart rate
-MD order is required

Front 92

_____ enema promotes complete evacuation of feces from the colon?

Back 92

-cleansing
ie. TWE, NS, SSE, Low-volume hypertonic saline

Front 93

Infants and children should only use _______ enema?

Back 93

Normal Saline b/c they are at risk for Fluid imbalance

Front 94

3 antidiarrheal agents?

Back 94

Imodium
Lomotil (C-IV)
Paragoric (C-

Front 95

What is the safest enema solution to use?

Back 95

**ISOTONIC: Normal Saline
"ISO" = means the same
-

Front 96

*What enema is used for a client at Risk for Electrolyte Imbalance?

Back 96

-Normal saline (isotonic)

Front 97

*What enema solution exerts the same osmotic pressure as fluids in interstitial spaces surrounding the bowel?

Back 97

ISOTONIC

Front 98

*What type of solution is used w/ TWE?

Back 98

-HYPOtonic= lower isomotic pressure than fluid in the interstitial spaces

Front 99

High probabitlity of Fluid overload if give more than 1 _____ enema?

Back 99

-TWE
fluid escapes into the interstitial spaces

Front 100

Order may read "TWE till clear"

Back 100

never give more than 3 TWE w/o consulting MD

(ATI book: TWE never repeated p 722)

Front 101

1.What are the Disadvantages is using a SSE or TWE

2. What are the sx associated w/ the disadvantages?

Back 101

1. repeated use can cause water toxicity or circulatory overload
2. edema in legs/feet
-crackles/ rhonci in lungs
-jugular vein distention
-^ hr ^b/p

Front 102

1. High enemas cleanse ____.

2. Low enemas cleanse _____.

Back 102

1. entire colon
2. only the rectum & sigmond colon

Front 103

*What solution pulls fluid OUT of interstitial spaces?

Back 103

HYPERTONIC

Front 104

*Name a hypertonic enema?

Back 104

-Fleets enema: given 4 to 6 oz:(120 to 180mL) retain for 20 -30 mins

Front 105

*1. In what type of client's are Hypertonic solutions, contraindicated ?

Back 105

-dehydrated
-young infants

Ie. Fleets enema

Front 106

What clients benefit from Hypertonic solultions?

Back 106

client who are unable to tolerate large volumes of fluid

Front 107

Oil Retention Enema:

Back 107

*Emollient Laxative
-lubricate the rectum & colon
-stool softer & easier to pass
*Use for a Fecal Impaction: followed w/ a SSE
ie. Fleet's enema (ORANGE box)

Front 108

1. Carminative Enema are used for ______.

Back 108

-( type of Retention enema)
-relief from gaseous sistention
-improve the ability to pass flatus
-Ie. MGW (30mL Mg, 60 mL glycerin & 90 mL of H2O)
*NA can give mineral oil enema
-used w/ OB pt after given birth

Front 109

*Enema used to treat clients w/ dangerously high serum K+ levels?

Back 109

-Kayexalate (pulls out the K+)
-if pt can't hold use the balloon part of a urinary catheter)
-hold 20-30 mins
(need to use TWE prior to given a medicated enema: cleanse the colon)

Front 110

What enema is used to reduce bacteria in the colon before bowel surgery?

Back 110

-Neomycin solution
-need to use TWE prior to given a medicated enema (cleanse the colon)

Front 111

Can digital removal of stool be delegated?

Back 111

-NO!

Front 112

What is the temperature of enema solution?

Back 112

-never > 102F
-but not at room temp
(test via inner wrist)

Front 113

Administering Enemas:
1. lubricate the rectal tube ____ inches?
2. position solution ____" above the rectum?
3. Position of client?
4 Amt of fluid for large volume (TWE/SSE)
5. length of insertion

Back 113

1. 2 1/2" - 3"
2. 12"-18"
3. Sim's!!
4. 750-1000mL
5. 3" - 4"

Front 114

Admin Enema:
What position is a client w/ poor sphincter control placed in ?

Back 114

-dorsal recumbent position on bedpan
-have difficulty containing enema solution

Front 115

If ___ occurs during admin of enema what should the nurse do?
1. abdomen becomes rigid or distended?
2. abdominal pain or cramping
3. bleeding occurs

Back 115

1. stop enema & call MD
2. slow rate of instillation
3. stop & call Md

Front 116

*Stool discharged from an ostomy is called?

Back 116

EFFLUENT

Front 117

NEVER use ______ to irrigate a colostomy, why?

Back 117

-enema set
-risk for perferating the bowel

Front 118

*Only a _______ ostomy can be irrigated.

Back 118

-Colostomy
-must use a cone-tipped irrigator
-muse use a two-piece system

Front 119

*Why do Left-sided colostomy (descending) need to be irrigated?

Back 119

-to regulate colon emptying
-bowel control
-it's like a pt given themselves an enema qd (gives control of BM)

Front 120

When is an urostomy bag emptied?

Back 120

-when the bag is 1/3 full

Front 121

1. What is the irrigant of choice for colostomy irrigation
2.Irrigation should take __mins
3. Takes _____ mins for solution & feces to drain out of irrigation sleeve

Back 121

1. tap water 500-750mL
2. 5-10 mins
3. 30-45 mins

Front 122

Can Pouching of an Ostomy be delegated?

Back 122

-Newly established ostomy:NO
-established ostomy:YES

Front 123

Stomas:

Back 123

-have no Nerve endings
-avoid soaps w/ lanolin
-cut bag 1/8-1/16 larger than stoma size
-moist & reddish-pink

Front 124

What type of diet is recommended for a client w/ a new ostomy?

Back 124

-low fiber diet for the 1st few weeks after surgery(breads, noodles, rice, cream cheese, eggs(not fried), strained fruit juices, lean meats, fish & poultry

Front 125

** What is the difference b/w stool softners and cathartics

Back 125

Cathartics:have a stronger effect on the intestines
-ie. Dulcolax: act w/in 30 mins

Front 126

Bowel Training:

Back 126

-for pt's w/ Neuromuscular control(Is brain working)
-give stool softner or cathartic 1/2 hour before defecation time
-offer hot drink or fruit juice
-**avoid med that increase constipation (anticholenergic, opioid, Fe+
-time limit 15-20 mins
-

Front 127

What is the nutritional consideration for clients w/ an ileostomy?

Back 127

-chew foods completely
-eat slowly
-10-12 glasses of H2O
(helps prevent blockage)

Front 128

What are high fiber foods that cause problems for clients w/ ostomies?

Back 128

-stringy meats -crab
-mushrooms -popcorn
-cherries -shrimp

Front 129

What Foods cause gas and odor (ostomies pt should avoid)?

Back 129

-broccoli -cauliflower
-dried beans -brussels sprouts