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74 Cards in this Set

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What is the main function of the GI system?
Functions: main function is to supply nutrients to body cells (achieved through ingestion, digestion, and absorption.Digestive systemconverts food into raw materials that build and fuel our body’s cells.Takes food in, breaks it down into nutrient molecules, absorbs them into the bloodstream, and then rids of them as indigestible remains (feces).
Name the organs of the gastrointestinal tract/gi tract: aka alimentary canal.
Organs of Digestive System
or 30 ft long continuous muscular tube or alimentary canal extends from the mouth to anus.Alimentary canal digests food (breaks it down) & absorbs (absorbs broken down fragments through its lining into the blood). Organs of alimentary canal: mouth, pharynx, esophagus, stomach, small intestine, and large intestine (leads to anus), rectum and anus.
What are the associated accessory gi organs?
Liver, pancreas, and gallbladder.
What is the digestion role and function of the liver?
Liver is largest gland in the body and has many important functions. Liver makes bile (only liver makes the bile), which is collected in the liver by the right & left hepatic ducts→ merge to form the common hepatic duct→ merge with the cystic duct (bile storage from gall bladder) to form the bile duct → goes to the duodenum of the small intestine).
Liver has many functions: METABOLISM: carbohydrate metabolism (glycogenisis), protein metabolism (synthesis of nonessential amino acids and clotting factors), and fat metabolism Synthesis of lipoproteins, breakdown of triglycerides into fatty acids and glycerol..synth & break down of cholesterol; detoxification: inactivation of drugs and harmful substances, and steroid metabolism; BILE SYNTHESIS: Formation of bile containing bile salts, bile pigments (mainly bilirubin) and cholesterol. Bile excretion (about 1 L a day); STORAGE: glucose in form of glycogen, vitamins, ADEK, and Bvit (1, 2, and 12 (cobalimin,) and folic acid) fatty acids, minerals amino acids-albumin and b-globulin antibodies ;MONONUCLEAR PHAGOCYTE SYSTEM: Kupffer cells (breakdown of old RBCs Wbcs bacteria and other particles.) Also stores fibrinogen and prothrombin for coagulation process.
What is another name for the sphincter of Oddi and what is it and what is its function?
Hepatopancreatic ampulla and sphincter: the area in the wall of the duodenum where the bile duct (carrying bile from the liver) & the pancreatic duct (carrying pancreatic juice from pancreas) unite.Then entry of bile and pancreatic juice into the duodenum is controlled by this muscular valve: hepatopancreatic sphincter (sphincter of Oddi)
The valve is shut unless food is there.
What is the digestive role of the pancreas?
Pancreas: has the pancreatic duct that delivers pancreatic juices (made in the pancreas) to the duodenum.
What is the digestive role and function of the gallbladder?
Gallbladder: Gall bladder ends up storing the bile, gall bladder contracts and squirts the bile back out to enter the duodenum (via cystic duct to bile duct).
Explain the gut brain
GI system has its own nervous system: the enteric system/intrinsic system called the “gut brain”. Gut brain contributes to the coordination from the mouth to the anus for digestion; coordinates the GI motor and secretory functions; contains many neurons (almost as many as in spinal cord) that coordinate the digestion: control movement and secretion of the GI tract.
What are the circulatory aspects of the GI tract?
Circulatory aspects: GI tract & accessory organs receive around 25-35% of cardiac output; but in times of stress, it is diverted to more vital organs (fight or flight/ sympathetic nervous system stimulates decreased gut activity; also w/ sickness gut is affected).
Explain Hirshsprung's disease and necrotizing enterocolitis, the respective treatments and outcomes.
Hirshprungs disease(Ward, 807) is GI, nervous condition (nerves don’t innervate the bowel and bowel just balloons out; lack of motility in affected portion of the bowel); usually limited to the distant colon; results in complete or partial bowel obstruction. Physical findings: vomiting, abdominal obstruction, failure to pass stool, diarrhea, flatus, or explosive bowel movments; a child w/hirshsprung disease may have h/o failure to pass meconium in 1st 48 hrs, failure to thrive, poor feeding, chronic constipation, & Down syndrome. Gets colostomy above that area, they will take out the bowel w/out nerve innervation & anastomose (reattach) the normal proximal bowel to the rectum.
Necrotizing enterocolitis: enterolcolitis is the inflammation of the small intestine and colon and is the most ominous presentation of Hirschsprung disease (ward, 807). Child may present w/abrupt onset of foul-smelling diarrhea, abdominal distention, and fever; rapid progression may indicate perforation of the bowel and sepsis; major cause of death in hirschsprung’s is from enterolcolitis and sepsis.
Name the 4 quadrants the 9 regions, and the corresponding organs.
When assessing abdomens it is good to know what organs fit in what quadrants (picture A): Lewis, p. 937/table 39-9Right upper quadrant: liver & gallbladder, pylorus, duodenum, head of pancreas, right adrenal gland, portion of right kidney, hepatic flexure of colon, portion of ascending & transverse colon. Left upper quadrant: left lobe of liver, spleen, stomach, body of pancreas, left adrenal gland, portion of left kidney, splenic flexure of colon, portion of transverse and descending colon.Right lower quadrant: lower pole of right kidney, cecum & appendix, portion of ascending colon, bladder (if distended), right ovary and salpinx, uterus (if enlarged), right spermatic cord, right ureter. Left lower quadrant: lower pole of left kidney, sigmoid flexure, portion of descending colon, bladder (if distended), left ovary and salpinx, uterus (if enlarged), left spermatic cord, left ureter. FYI: on page 930 in Lewis states that the liver lies in the "right epigastric region" Which technically is that part we'd probably be able to palpate...
What is the best way to carry out auscultation in a physical assessment of the GI tract.
When auscultating; start in RLQ cuz where lg intestine begins, up the ascending colon (RUQ 2nd ), then transverse (LUQ 3rd ), and then down descending colon & listen @ LLQ last (best order of assessment).
Explain ingestion and deglutition.
Ingestion is the intake of food. A person's appetite or desire to ingest food is a significant factor in how much food is eaten. Multiple factors are involved in the control of appetite. An appetite center is located in the hypothalamus.
Ingestion is directly or indirectly stimulated by hypoglycemia, an empty stomach, decrease in body temperature, and input from higher brain centers. The hormone ghrelin released from the stomach mucosa plays a role in appetite stimulation. Another hormone, leptin, is involved in appetite suppression. Appetite may be inhibited by stomach distention, illness (especially accompanied by fever), hyper-glycemia, nausea and vomiting, and certain drugs (e.g., amphetamines).
Deglutition (swallowing) is the mechanical component of ingestion. The organs involved in the deglutition of food are the mouth, pharynx, and esophagus.
In what ways does does the mouth help with digestion?
Mouth: the mouth mechanically & chemically breaks down nutrients into usable size and form; contains 3 pairs of salivary glands that produce saliva that dilute and soften food making it easier to swallow; saliva also contains antibacterials to prevent bacterial overgrowth in the mouth, & contains salivary amylase (digestive enzyme that breaks down starch; but is not necessary for digestion of carbohydrates.)
Salivary secretion stimulated by chewing movements & the sight, smell, thought & taste of food.
Explain the pharynx: naso, oro & laryngeal.
Pharynx: The pharynx is a musculomembranous tube that may be divided into the nasopharynx, oropharynx, and laryngeal pharynx. The mucous membrane of the pharynx is continuous with the nasal cavity, mouth, auditory tubes, and larynx. The oropharynx secretes mucus, which aids in swallowing. The epiglottis is a lid of fibrocartilage that closes over the larynx during swallowing. During ingestion the oropharynx provides a route for the food from the mouth to the esophagus. When receptors in the oropharynx are stimulated by food or liquid, the swallowing reflex is initiated.
Explain the function and structures of the esophagus.
Esophagus: The esophagus is a hollow, muscular tube that receives food from the pharynx and moves it to the stomach by peristaltic contractions. It is 9.2 to 10 inches (23 to 25 cm) long and 0.8 inch (2 cm) in diameter. The esophagus is located in the thoracic cavity, and it starts behind the trachea at the lower end of the pharynx and extends to the stomach. The upper one third of the esophagus is composed of striated skeletal muscle, and the distal two thirds are composed of smooth muscle.
With swallowing, the upper esophageal sphincter relaxes and a peristaltic wave moves the bolus into the esophagus. The muscular layers contract (peristalsis) and propel the food to the stomach. The lower esophageal sphincter (LES) at the distal end of the esophagus remains contracted except during swallowing, belching, or vomiting. The LES is an important barrier that normally prevents reflux of acidic gastric contents into the esophagus, except for instances of GERD or GER.
What is the role of the stomach in digestion and absorption? What are the parts and functions of the stomach?
Functions of stomach R to store food, mix food w/ gastric secretions, & emp t contents into the sm. int. at a rate at which digestion can occur. The stomach absorbs only sm. amnts of h20 ,alcohol, electrolytes, & certain drugs. Stomach lies obliquely in epigastric, umbilical,& lft hypochondriac regions of abd. Shape & position of the stomach wl change based on the degree of gastric distention. It always contains gastric fluid and mucus. Three main parts of the stomach R fundus, body, & antrum. Pylorus is sml portion of antrum that lies proximal to pyloric sphincter. Sphincter muscles (the LES and the pyloric sphincter) guard the entrance to and exit from the stomach. Layrs of muscle churn; sphincters (lower esophageal @ top of stomach & pyloric sphincter @ bottom of stomach) to hold food in (if functional) Pyloric sphincter is often a problem in babies (may be ineffective; food doesn’t go out of stomach, it just goes back up; projectile vomit). Reflux occurs if lower esophageal sphincter isn’t working; from stomach up into esophagus/throat (it will burn up the esophagus due to presence of digestive enzymes). Some meds affect this sphincter.The serous (outer) layer of the stomach is formed by the peritoneum. The muscular layer consists of the longitudinal (outer) layer, circular (middle) layer, and oblique (inner) layer. Mucosal layer forms folds called rugae that contain many small glands. In response to nutrient intake, these glands secrete most of the gastric juice. In the fundus the glands contain chief cells, which secrete pepsinogen, and parietal cells, which secrete hydrochloric (HCl) acid, water, and intrinsic factor. The secretion of HCl acid makes gastric juice acidic in comparison with other body fluids. This acidic pH aids in the protection against ingested organisms. Intrinsic factor promotes cobalamin (vitamin B12) absorption in the small intestine. Mucus is secreted by glands in the fundus and pyloric areas.
Explain the structure, parts and main functions of the small intestine.
Small intestine: 2 primary functions of small intestine are digestion and absorption (uptake of nutrients from the gut lumen to the bloodstream). It extends from the pylorus to the ileocecal valve; ileocecal valve separates the small and large intestine and prevents reflux of large intestine contents into the sm. intestine. Presence of villi and microvilli increases surface area for absorption; digestive enzymes on the microvilli chemically break down nutrients to allow absorption to occur. Chyme is mixed w/digestive juices (bile & amylase).Important to know where absorption is occuring; cuz when they need an ostomy, it may be jejunostomy or ileostomy (name of the part of intestine that is entered is the name of the ostomy)
Depending on the type of area determines name of ostomy. As digestive system is doing its work, it changes the texture of the chyme; fluid and electrolyte balance are HUGE. 3 parts of the sm. intestine: a total of 20-21 feet long.Duodenum: 1st part of small intestine; connects to pylorus/pyloric sphincter from stomach; 8-11” long; duodenum continues to process chyme from stomach. Location of entrance of pancreatic juices and bile to assist
Jejunum: 2nd section of small intestine; 8ft long; absorbs carbs and proteins. Ileum: 12 ft long; absorbs water, fats, and bile salts, certain vitamins, iron.
What is the physiology process of digestion beginning with the mouth and on down....
Small intestine: 2 primary functions of small intestine are digestion and absorption (uptake of nutrients from the gut lumen to the bloodstream). It extends from the pylorus to the ileocecal valve; ileocecal valve separates the small and large intestine and prevents reflux of large intestine contents into the small intestine.Presence of villi and microvilli increases surface area for absorption; digestive enzymes on the microvilli chemically break down nutrients to allow absorption to occur. Chyme is mixed w/digestive juices (bile & amylase). Important to know where absorption is occuring; cuz when they need an ostomy, it may be jejunostomy or ileostomy (name of the part of intestine that is entered is the name of the ostomy)
Depending on the type of area determines name of ostomy
As digestive system is doing its work, it changes the texture of the chyme; fluid and electrolyte balance are HUGE.3 parts of the small intestine:a total of 20-21 feet long
Duodenum: 1st part of small int.; connects to pylorus/pyloric sphincter from stomach; 8-11” long;duodenum continues to process chyme from stomach.Location of entrance of pancreatic juices and bile to assist
Jejunum: 2nd section of small int.; 8ft long; absorbs carbs and proteins
Ileum: 12 ft long; absorbs water, fats, and bile salts, certain vitamins, iron.
Explain the process of absorption in digestion.
-Absorption is the transfer of the end products of digestion across the intestinal wall to the circulation. Most absorption occurs in the sm int. The surface area of the small intestine is greatly increased by its circular folds, villi, and microvilli. The movement of the villi enables the end products of digestion to come in contact with the absorbing membrane. Monosaccharides (from carbohydrates), fatty acids (from fats), amino acids (from proteins), water, electrolytes, and vitamins are absorbed.
What nutrients are aborbed in the following organs and parts? Stomach, duodenum, jejunum, ileum and colon?
Stomach: water and alcohol; Duodenum: sugars, proteins, fats, water, iron, calcium, magnesium, sodium, and vitamins.
Jejunum: Sugars and Proteins. Ileum: bile salts, Vitamin B12, chloride. Colon: water and electrolytes.
What is the nursing intervention for TPN?
Nursing Interventions: Check the f&E balance (labs!!); total perenteral nutrition (TPN; it is total nutrition thru IV access, amino acids, glucose, multivitamins, zine trance mineral chloride acetates).
Explain bile production, storage and transport.
Liver produces bile in the hepatic cells which is secreted into the biliary canaliculi of the lobules. Then the bile drains into the interlocular bile ducts which come to unite into 2 main left and right hepatic ducts. (Biliary Tract) : Then the hepatic ducts merge as one called the common hepatic duct which then merges with the cystic duct of the gall bladder-flows into and is stored in the gall bladder. When it is needed to emulsify fats it flows out of the cystic duct back into the common hepatic duct and down into the ampulla of vater within the duodenum. Bile is a a yellow-green alkaline substance made of: Bile Salts * aids in the digestive process, emulsifying Phospholipids.
Purpose of bile salts : emulsification of fats.Fats are hard to digest, so bile salts break down fat molecules into small droplets to increase the surface area; allows enzyme to digest away fat; enzymes come from the pancreas= pancreatic lipase; without bile, it takes a long time to digest fats. Acidic fatty chyme causes the release of Cholecystokinin (CCK) from the duodenum, which causes the secretion of bile from the gall bladder.
Explain the pancreas location and digestion function.
Pancreas: gland that lies behind the stomach; pancreatic duct extends along the gland and enters the duodenum by merging with the common bile duct and into the ampula of vater (enzymes mix and mingle with bile to help in emulsification and digestion of and other substances.) Exocrine function of pancreas contributes to digestion via pancreatic enzymes. Endocrine function of pancreas is production of insulin from beta cells; glucagon from alpha cells; both are secreted directly into blood stream.
Explain Bilirubin Metabolism.
There is a breakdown of RBCs (hemoglobin) every 120 days by macrophages. Part of the breakdown is a pigment called: unconjugated or (insoluble) bilirubin. So it joins up with albumin in order to go to the liver. In the liver the unconjugatedd bilirubin combines with glucaronic acid which forms conjugated or (soluble) bilirubin which can now be secreted within bile. It is then reduced in the small intestine to urobilinogen by intestinal bacteria and either pushed out into stool or goes into systemic to make it to the kidney to be excreted. So bile is made of conjugated bilirubin along with water, cholesterol, bile salts, electrolytes, and phospholipids. The bile salts are specifically what's needed for fat emulsification and digestion.
Name the parts of the colon.
1. Cecum & appendix (RLQ)
2. Colon: bacteria in the colon synthesizes vitamin K & some B vitamins; bacteria also play role in production of flatus. Ascending (R side)Transverse (crosses abdomen)
Descending (L side)Sigmoid colon: often where cancerous lesions are found (sigmoidoscopies: to look for colon cancer).
Explain the rectum, anus and defecation.
3. Rectum: Feces in the rectum stimulate sensory nerve endings that produce the desire to defecate. The reflex center for defecation is in the sacral portion of the spinal cord (parasympathetic nerve fibers). These fibers produce contraction of the rectum and relaxation of the internal anal sphincter. Defecation is controlled voluntarily by relaxing the external anal sphincter when the desire to defecate is felt. An acceptable environment for defecation is usually necessary or the urge to defecate will be ignored. If defecation is suppressed over long periods, problems can occur, such as constipation or stool impaction.
Defecation can be facilitated by the Valsalva maneuver. This maneuver involves contraction of the chest muscles on a closed glottis with simultaneous contraction of the abdominal muscles. These actions result in increased intraabdominal pressure. The Valsalva maneuver may be contraindicated in the patient with a head injury, eye surgery, cardiac problems, hemorrhoids, abdominal surgery, or liver cirrhosis with portal hyper-tension. 4. Anus (terminal portion of large intestine).
What are all the underlying reasons for constipation in the elderly?
Constipation is common in the older adult and is due to many factors, including slower peristalsis, inactivity, decreased dietary fiber, decreased fluids, depression, constipating medications, and laxative abuse.
Explain digestion (across the lifespan) for infants.
Infants: (Ward, 786) small stomach, rapid peristalsis (why babies eat and poop quickly; infant’s stomach usually empties in 2.5 to 3 hrs, which is reason for frequent feedings), no control of defecation until age 2-3 r/t when neuromuscular development occurs (allows them to control their bowel; not going to work to potty train too early)
Liver & pancreas don’t mature until 6 months old=infants younger than 6 months don’t require solid foods.
Pancreatic lipase is needed for fat & protein metabolism but isn’t adequately secreted until 1 y/o (this limits their ability to absorb fats like those in cow’s milk; reinforces need to carefully introduce foods & limiting to foods especially prepared for an infant diet).
Explain distinction in the digestion process in the elderly. What are the causes of constipation in the elderly?
Older people: systemic changes affect digestion, absorption, cardiovascular, neurological & muscular systems.Functional ability decreases; Dental problems*
May have loss of teeth, dentures, difficulty chewing; Atrophy of gingival tissue may cause poor fitting dentures; Xerostomia/dry mouth (w/ age↓saliva production)
Dysphagia (difficulty swallowing)
↓ Taste buds, ↓ smell
↓ Appetite, acid secretion
↓ Motility, starting in theesophagus (things can get stuck, making it hard to swallow)↑ GERD, constipation, diverticuli (bowel gets outpouches that things get stuck in & it gets inflamed=diverticulosus), increased risk for fecal incontinence↓ nutrient absorption, decreased peristalsis (can lead to constipation. All of these changes are connected: if we have decreased cardiac output (almost 25%; it will affect the bowel; it is all connected)Older adults lose muscle tone in perineal floor and anal sphincter; often have difficulty controlling bowels and are @ risk for incontinence; also a slowing of nerve impulses to the anal region causing some to be less aware of the need to defecate resulting in irregularity and risk for constipation (especially in long term facilities).Constipation is common in the older adult and is due to many factors, including slower peristalsis, inactivity, decreased dietary fiber, decreased fluids, depression, constipating medications, and laxative abuse.
What can diarrhea cause in infants or elderly alike?
Hypokalemia. Because peristalsis is too quick.
What are the factors that effects normal peristalsis and normal stool formation. ?
Diet (fiber), Fluids (increase water) 1500-2000 ml, Increase physical acitivity, psych factors (not going to poop just anywhere especially if working or traveling and person doesn't respond to signal to defecate. Position: immobilization affects ability to defecate; is supine position it is impossible to contract the muscles used during defecation; if the clients condition permits, raise the head of the bed (allows client to be in a sitting postion on a bedpan enhancing the ability to defecate); Pain, Pregnancy, Meds: Opioids: slow peristalsis & segmental contraction, often resulting in constipation.Antibiotics: produce diarrhea by disrupting normal bacterial flora in the GI tract,
NSAIDS: cause GI irritation that increases incidence of bleeding w/ serious consequences for older adults; Aspirin: a prostaglandin inhibitor, it interferes w/the formation and production of protective mucus and causes GI bleeding; Iron: causes discoloration of stool, nausea, vomiting, constipation and abdominal cramps. Diagnostic Tests and Sugery.
What are some of the first health history questions a nurse would start with in a gi assessment?
Diverticulitis, abdominal surgeries effecting bowel, bowel obstructions (surgeries can leave adhesions that become a problem). Abdominal pain, nausea or vomiting, diarrhea, constipation, abdominal distention, jaundice, anemia, heartburn, dyspepsia, changes in appetite, food intolerance or allergies, indigestion, excessive gas or bloating, hemorrhoids, melena (black, tarry stools that indicate slow bleeding from upper GI source), rectal bleeding; CURRENT MEDS: acetomeniphen, nsaid, laxatives...;SURGERIES.
What would be the questions that a nurse would ask associated with the Health Perception/ Health Management category under functional health patterns?
The nurse should ask about the patient's health practices related to the GI system: maintenance of normal body weight, attention to proper dental care, maintenance of adequate nutrition, and effective elimination habits, recent foreign travel with possible exposure to hepatitis, parasitic infestation, or bacterial infestation. Past history of receiving hepatitis A and/or hepatitis B vaccination should bedocumented.
Assess consumption of alcohol (in large quantities it has detrimental effects on the mucosa of the stomach and also increases the secretion of HCl acid and pepsinogen). Chronic alcohol use can cause damage leading to cirrhosis of the liver. Obtain a history of cigarette smoking. Nicotine is irritating to the entire GI tract mucosa. Cigarette smoking is related to various GI cancers (especially mouth and esophageal cancers), esophagitis, and ulcers. Smoking will also delay the healing of ulcers.
What would a nurse ask under the nutritional-mebabolic category of functional health patterns?
A thorough nutritional assessment is essential. A dietary history should be taken and compared with the food pyramid (see Fig. 40-1 and Table 40-1). Open-ended questions will allow the patient to express beliefs and feelings about the diet. For example, the nurse can say, “Please tell me about your food and beverage intake over the past 24 hours.” A 24-hour dietary recall can be used to analyze the adequacy of the diet. Have pt recall the preceding day's food intake, including early morning and nighttime intake, as well as snacks, liquids, and vitamin supplements. If weekend eating habits vary greatly, the nurse should obtain a separate weekend diet history and assess the patient's intake for both quality and quantity of food.
Ask about use of sugar and salt substitutes, caffeine, amount of fluid & fiber intake; changes in appetite, food tolerance, weight changes; anorexia or weight loss may indicate cancer; ask about food allergies & determine what GI symptoms such allergic responses cause; lactose or gluten intolerances
What would a nurse ask under the elimination pattern category of functional health patterns?
Elimination Pattern: frequency, time of day, usual consistency of stool; changes in bowel patterns; use of enemas (including type, frequency), laxatives; assess intake of fiber (inadequate fiber contributes to constipation)
What would a nurse ask under the activity-exercise pattern category of functional health patterns?
Activity-Exercise Pattern: ambulatory status should be assessed to determine if pt is able to get & prepare food; note any limitations the pt has w/feeding self; use of and access to elimination supplies should be assessed (commode or ostomy supplies); activity & exercise affect GI motility; immobility is a risk factor for constipation.
What are some questions the nurse would ask under the sleep-rest pattern category of functional health history questions?
Sleep-Rest Pattern: Nausea, vomiting, diarrhea, indigestion, bloating, and hunger can produce sleep problems and should be investigated. The patient should be asked if GI symptoms affect sleep or rest. For example, a patient with a hiatal hernia may be awakened because of burning pain; sleep may be improved by elevating the head of the bed for this patient.
A patient often has a bedtime ritual that involves the use of a particular food or beverage. Milk is known to induce sleep through the effect of the serotonin precursor l-tryptophan. Herbal teas and melatonin are often sleep inducing. Individual routines should be noted and complied with whenever possible to avoid sleeplessness. Hunger can prevent sleep and should be relieved by a light, easily digested snack unless contraindicated.
What are some questions the nurse would ask under the cognitive/perceptual pattern category of functional health history questions?
Cognitive-Perceptual Pattern
1) Decreases in sensory adequacy can result in problems related to the acquisition, preparation, and ingestion of food. 2) Changes in taste or smell can affect appetite and eating pleasure. 3) Vertigo can make shopping and standing at a stove difficult and dangerous.4) Heat or cold sensitivity could make certain foods painful to eat. 5) Problems in expressive communication could make it difficult and frustrating for the patient to make personal desires and preferences known.
6) assess the patient in this pattern to judge the effect of deficiencies on adequate nutritional intake. If the patient has been diagnosed as having a GI disorder, the nurse should ask questions to determine the patient's understanding of the illness and its treatment.
7) Pain is another area that requires careful assessment related to its effect on the GI system and nutrition. Relevant behaviors associated with chronic pain include avoidance of activity, fatigue, and disruption of eating patterns. The possible effects of opioid pain medication related to constipation, nausea, sedation, and appetite suppression should be assessed.
What are some questions the nurse would ask under the self-perception-Self-concept pattern category of functional health history questions?
Self-Perception/Self-Concept Pattern
Overweight and underweight persons often have problems related to self-esteem and body image. Repeated attempts to achieve a personally acceptable weight can be discouraging and depressing for the patient. The manner in which a person recounts a weight history can alert the nurse to potential problems in this area.
Another potentially problematic area is the need for external devices to manage elimination, such as a colostomy or an ileostomy. The patient's willingness to engage in self-care and to discuss this situation should provide the nurse with valuable information related to body image and self-esteem.
The altered physical changes often associated with advanced liver disease can be problematic for the patient. Jaundice and ascites cause significant changes in external appearance. The patient's attitude toward these changes should be assessed.
What are some questions the nurse would ask under the self-perception-Self-concept pattern category of functional health history questions?
Role-Relationship Pattern
Problems related to the GI system such as cirrhosis, alcoholism, hepatitis, ostomies, obesity, and carcinoma can have a major impact on the patient's ability to maintain usual roles and relationships. A chronic illness may result in leaving a job/reducing the # of hours worked. Changes in body image and self-esteem can affect relationships. The availability of and satisfaction with support should be determined. It is important that the nurse be aware of these possible consequences and assess for their presence.
What are some of the questions you would ask under the Sexuality-Reproductive Pattern category of functional health patterns.
Sexuality-Reproductive Pattern: effect if have colostomy;
Changes related to sexuality and reproductive status can result from problems of the GI system (obesity, jaundice, anorexia, and ascites could decrease the acceptance of a potential sexual partner); presence of an ostomy could affect the patient's confidence related to sexual activity.
Chronic alcoholism could discourage a meaningful relationship that could develop into a sexual relationship. Sensitive questioning by the nurse could determine the presence of potential problems.
Anorexia can affect the reproductive status of a female patient. Alcoholism can affect the reproductive status of both men and women. A poor nutritional intake before and during pregnancy can result in a low-birth-weight infant.
What are some questions a nurse would ask under the Coping-stress Tolerance Pattern of functional health patterns?
Coping–Stress Tolerance Pattern:
Try to determine what is a stressor for the pt & what coping mechanisms pt uses to function w/the stressors; GI symptoms like epigastric pain, nausea, & diarrhea develop in many people in response to stressful or emotional situations; peptic ulcers and irritable bowel syndrome are aggravated by stress.
What are some questions a nurse would ask under the Value-Belief Pattern of functional health patterns?
Value-Belief Pattern:
The patient's spiritual and cultural beliefs regarding food and food preparation should be assessed. Whenever possible, these preferences should be respected by the health care provider; determine if any value or belief could interfere with planned interventions. For example, if the patient with anemia is a vegetarian, the prescription of a high-meat diet would be met with patient resistance. Thoughtful assessment and consideration of the patient's beliefs and values will usually increase patient compliance and satisfaction.
What we be part of the objective gi physical assessment of the mouth?
Mouth:
Inspection: observe for any lesions; notice breath odor; uvula should rise when client says “ah”/remain in midline; Lips should be inspected for symmetry, color, size, observe abnormalities (pallor, cyanosis, cracking, ulcers, or fissures)
Palpation: feel inside mouth for lumps and bumps, have them take out dentures to feel along gums to detect infections along gums
Pay specific attn to older adults (denture fit, ability to swallow)
What we be part of the objective gi physical assessment of the mouth?
Observe for any lesions; notice breath odor; uvula should rise when client says “ah”/remain in midline; Lips should be inspected for symmetry, color, size, observe abnormalities (pallor, cyanosis, cracking, ulcers, or fissures)
Palpation: feel inside mouth for lumps and bumps, have them take out dentures to feel along gums to detect infections along gums
Pay specific attn to older adults (denture fit, ability to swallow)Mouth
Symmetry lips: post CVA they can have asymmetry; Color: should be pink and moist. Pallor, cyanosis
Cracks, ulcers: could effect desire to eat.; Tongue:Should have Thin white coat. Should have Smooth underside
Could find thrush, lesions, lumps and bumps; Buccal mucosa
Pigmentation can change (look inside cheek); Dark skinned ppl normally have patchy areas of pigmentation; Teeth
Looking for Loose teeth, caries, dentures (ill fitting or not?), inflammation of gingiva, discoloration, distinctive breath odor.
What we be part of the objective gi physical assessment of the abdomen?
Assess the abdomen for skin changes (color, texture, scars, striae, dilated veins, rashes, and lesions), umbilicus (location and contour), symmetry, contour (flat, rounded [convex], concave, protuberant, distention), observable masses (hernias or other masses), and movement (pulsations and peristalsis). A normal aortic pulsation may be seen in the epigastric area. The nurse should look across the abdomen tangentially (across the abdomen in a line) for peristalsis. Peristalsis is not normally visible in an adult but may be visible in a thin person.;Auscultation: 1st!! So you don’t change normal bowel sounds if you were to palpate or percuss first.
2)Percussion 3)Palpation; Skin changes:Color, scars, rash, striae (stretch marks) , dilated veins (from pressure in portal system)
Symmetry; should be symmetrical.
Contour: Flat, round, concave, distended, masses. Movement: you can see pulsations. Pulsations, (may be associated w/ abdominal aneurisms). Can see peristalsis in a thin person.
What we be part of the objective gi physical assessment of the rectum/anus?
Rectum and anus:
Have to look here, test sphincter tone w/gloved hand and lubricant (insert finger to see if sphincter reacts..”squeeze my finger”); same as wink reflex
w/ babies they do it w/lubricated sterile applicator to test wink reflex.
You can vagal stimulate them, HR goes down, so have to be careful w/this.
How would you carry out an auscultation of the abdomen?
1)Includes listening for increased or decreased bowel sounds and vascular sounds. 2)Diaphragm of the stethoscope is used to auscultate bowel sounds because they are relatively high pitched. 3) The bell of the stethoscope is used to detect lower-pitched sounds. 4) Normal bowel sounds occur 5 to 35 times per minute and sound like high-pitched clicks or gurgles.4,5
5) Before auscultation, warming the stethoscope in the hands helps prevent abdominal muscle contraction.6) The nurse should listen in the epigastrium and in all four quadrants. 6)The nurse should listen for bowel sounds for 2 to 5 minutes. 7) Bowel sounds cannot be described as absent until no sound is heard for 5 minutes (in each quadrant).5 The frequency and intensity of bowel sounds will vary, depending on the phase of digestion. Normal is high pitched and gurgling. 8)Loud gurgles indicate hyperperistalsis and are termed borborygmi (stomach growling). 9)The bowel sounds will be more high pitched (rushes and tinkling) when the intestines are under tension, such as in intestinal obstruction (vomit and diarrheah might accompany) 10)The nurse should listen for decreased or absent bowel sounds.11) Terms used to describe bowel sounds include present, absent, increased, decreased, high pitched, tinkling, gurgling, and rushing. Normally no aortic bruits should be heard. A bruit (vascular sound), best heard with the bell of the stethoscope, is a swishing or buzzing sound and indicates turbulent blood flow.
Why do we percuss in gi assessment and what are we listening for?
Purpose is to determine presence of fluid (ascites) distention, or masses. Tympany* = air present
Produces higher pitch, hollow sound
Predominant percussion sound of the abdomen. Dullness = fluid or masses present (depending on amount of fluid) or mass.Percuss all 4 quadrants (assess for distribution of tympany & dullness).Percussing over anything full of fluid will sound resonant/tympanic (fluid filled abdomen).
Why and how do we palpate the abdomen gi assessment?
Light vs. deep: Light palpation used to detect: tenderness, skin sensitivity, edema, resistance (patient guards against you, or it is hard to palpate), masses. Deep palpation: Purpose for palpation is to delineate abdominal organs & masses. Note the location, size, shape, and presence of tenderness.
All 4 quadrants: Nonverbal cues: watch facial expressions. Liver size: base this on if you can feel it below the right costal margin; if you can palpate it w/deep palpation you can feel it 2-3cm below right costal margin.Shouldn’t be able to feel the liver.
What are the parts of the rectal, anal, and perianal assessment?
Inspect: color, texture, lumps, (may be start of rectal cancer) rash, scars, erythema, fissures (these are bad; may indicate tracks that go deeper into tissue, which is skin integrity issue/risk of infection), hemorrhoids
Palpate: lumps or suspicious areas with gloved lubricated finger.Rectal digital exam:Gloves, lubricant;Index finger against anus w/pt straining (produces the Valsalva maneuver); increases pressure like pushing down to have bowel movement) as sphincter relaxes.Sphincter relaxes, insert finger toward umbilicus (going up and anterior/forward toward umbilicus trying to get into right anatomical tract to get into correct part of colon).Assess for nodules, tenderness, check stool sample for occult blood.Common/ abnormal assessment findings:Lewis,Anus: thrombosed veins/ hemorrhoids (may be internal or external), ulcerations (fissures), chrones disease (caustic disease that effects GI tract). Steatorhea: fatty, frothy, foul –smelling stool; etiology of this is chronic pancreatisis, mal- obstruction problems, & biliary obstruction. Assessment will help you understand this; stool tells a Lot.
What are some of the nursing interventions we should implement
Client teaching about ways to avoid constipation (P&P, 1179 Box 46-1)
Create regular bowel habits.
Irregular habits and ignoring the urge to defectate can lead to constipation. Diet: fruits, veggies, fiber, liquids. Low-fiber diet high in animal fat (meats, dairy, eggs) & decreased fluid intake slow peristalsis and contribute to constipation. Emotional health: creating routine where there is less stress to help w/elimination.Anxiety, depression, cognitive impairment all contribute to constipation. Physical activity: increase w/things they enjoy.
Immobility, lack of exercise and lengthy bed rest all contribute to constipation. Avoid laxative dependence.Especially the elderly that may be prone to laxative misuse. Mind medications, understand effects Teach them about effects to expect; constipation is common side effect of opiods, iron supplements, antacids, diuretics, antihypertensives, antidepressants, and antihistamines. .
What are some important points on gi assessment of child?
Gi sytem matures through childhood; will start to have 1 bm a day like adults; watch for dental issues especially with the poor; listen adults report on elimination habits ...etc. Dehydration is checked w/turgor, may have no tears; use diligent hand hygeine for things like Hepa & B and c-diff. Children will call any pain "stomach" pain not able to identify well; Bowel sounds will be hyperactive w/diarrhea and w/obstruction. Clinical alert* abdominal pain in children can be referred from pneumonia, UTI, testicular torsion or can be associated w/a systemic disease; sickle cell, cystic fibrosis.
What is intussusception?
If increase pain, diarrhea, vomiting, they may have an obstruction! **one of the most common causes of obstruction in infancy is intussusception- a condition that occurs when the proximal section of the intestine and the mesentery (the peritoneal fold that encircles the small intestine an connects it to the posterior abdominal wall) “telescopes” into a distal section of the intestine. Occurs between 5-9 months. S/s of intussusception: acute abdominal pain, fever dehydration, abdominal distention, lethargy, grunting due to pain, vomiting (may or may not be present).
If a nurse is doing a bowel elimination assessment what is she going to ask?
1) Bowel History: usual bowel habits (how often, what does it look like, color, straining w/stool?); use of laxatives, presence of bowel diversions (ostomy), changes in appetite, current diet (foods they eat, fluid intake); 2) Physical assessment of mouth,abdomen,rectum; 3) Fecal characteristics; 4) Medical history (surgery-disease);5) Food/Fluid intake; 6) Medications; 7) Recent stress/anxiety; 8) Cultural aspects: African Americans have a higher incidence of colon cancer.
What are the normal characteristics of stool?
Color: Baby, yellow: Adult, brown
Odor: pungent r/t food/diet
Consistency: should be Soft, formed
Frequency: Varies, day/wk (can depend on person or culture)
Infant: 4-6x/day for breastfed or 1-3x/day bottlefed
Adult: daily or 2-3 times a week.
Amount: Adult 150 gm/day
Shape: Diameter of rectum
Constituents: Undigested food, dead bacteria, bile pigment, water, intestinal lining cells
What are the characteristics of abnormal stool?
White/clay = absence of bile
Black/tarry = UGI bleeding (melena: term for black and tarry stools) or iron indigestion; Red = LGI bleeding, hemorrhoids (have to discern if it is red blood/current or old blood); red streaks of blood on outside of stool may be related to hemorrhoids.);
Pale w/fat = indicates fat mal- absorption; Whitish mucus = spastic constipation, colitis, excessive straining.;Bloody mucus = bleeding, infection, inflammation.; Noxious odor = blood or infection.Liquid = diarrhea, consider the ↓absorption issues.;Narrow, pencil shape = obstruction (would be partial obstruction) since pencil shape is still getting through), rapid peristalsis.
Excess fat = malabsorption, r/t pancreatic or surgical issues, surgical resection of intestine.
Blood, pus, worms, foreign body = internal bleeding, infection, swallowed objects, irritation, inflammation.
What are some of the most common drugs that will have an effect and what is their effect on stool?
1) Dicyclomine : causes ↓ peristalsis and ↓ gastric emptying. Slows down bowel to help w/diarrhea. 2)Opioids: causes ↓peristalsis, decreased contractions in bowel…constipation
If they are on opioid pain meds you HAVE to check on bowel status
Part of assessment is when was last time you had BM?, are you having trouble?; important nursing implication! We could then ask doc for laxative/stool softener to make client more comfortable.Walking and increase fluids help too; peppermint tea.; 3) Atropine/anticholinergics : ↓/inhibit gastric acid secretion & ↓ GI motility that may lead to… constipation; these drugs are useful for treating hyperactive bowel disorders, but cause constipation.;
4)*Antibiotics: produce diarrhea by disrupting/kill normal bacterial flora in the GI tract…Increased use of antibiotics (especially fluoroquinolones) in recent years had contributed to the overgrowth of other bacteria (created an advantage for the epidemic, of C.diff) i.e., C-difficile…diarrhea;
5) NSAIDS/ASA (aspirin): causes GI irritation that increases incidence of bleeding w/potentially serious complications in elderly population.
have to assess how much ibuprofen or aspirin they are takingcheck stool for blood in stool; may see melena (the old blood). Elderly people admitted for NSAIDS over use
Aspirin: prostaglandin inhibitor, it interferes w/formation & production of protective mucus & causes GI bleeding. 6) Histamines: causes ↓secretion of HCl acid, ↓digestion/ interferes w/digestion of some foods.
7) Iron: black stools, N-V-D (nausea, vomiting, diarrhea), constipation, cramps.Good nsg ? Is to ask if they are on iron; could be causing these s/s. 8)Cholestyramine: goes through GI system, it is nonabsorbable drug binds w/bile acids to ↓cholesterol & LDLs (low density licoproteins; LDLs are the bad cholesterol); 9) Cathartic/Laxative: short term need; action to empty bowel. Be careful w/elderly group who can become bowel fixated if they don’t go to the bathroom; can overuse laxatives; may feel like they don’t want to go in another toilet (psychological)
Can become laxative dependent; they are knocking out normal peristaltic activity and can mess up F&E balance. 10) Antidiarrheal: opiates to ↓ intestinal muscle tone, ↓ peristalsis, (to slow down the diarrhea) ↑ water absorption
11) Enemas: ↓peristalsis, to promote defecation, helps to break up fecal mass, stretches rectal wall to initiate defecation reflex. These are last ditch effort cuz we don’t want to slow down peristalsis; we are giving enemas due to decreased peristalsis anyway. Not a delegatable task if it is a medicated enema
What does the diagnostic gi test called the upper gi series involve?
Looking @ esophagus, stomach, & small intestine.X-ray study w/use of contrast medium; looking to see peristalsis, active or inactive bowel, see lesions (pt has to assume different positions on x-ray table; used to diagnose abnormalities of espohagus, stomach, duodenum.
Nsg Responsibility: explain procedure (drink chalky barium stuff/contrast medium); & assume different positions on x-ray table; NPO for 8-12 hrs prior to procedure; tell pt to avoid smoking after midnight night b4 study (nicotine increases gastric secretions).; encourage fluids or laxative to prevent contrast medium impaction; inform pt that stool may be white up to 72 hrs after test.
What does the diagnostic gi test called the lower gi series involve?
A barium enema (contrast medium administered rectally to get x-ray of filled colon); identifies polyps, tumors, lesions of the colon.
Nsg Responsibility: bowel prep is important: administer laxatives and enemas until colon is clear of stool the evening b4 procedure (can be damaging to elderly due to F& E disturbances due to losing a lot of water from bowel; pay attn to elderly especially); Clear liquid diet evening b4; NPO for 8hr b4 test; explain about giving barium enema (may cause cramping and urge to defecate); pt will be placed in various positions on tilt table
Post procedure, give fluids, lacatives to assist barium expelling; observe stool for passage of contrast medium. Have to change positions a lot. If you lay on right side, it will drain this way (ascending colon, on right, so want them laying on the left side, where descending colon is, so it goes in and up descending to allow barium to travel best).
**side note: Lay on right side if you are too full after eating, so stomach on top so it drains faster (cuz stomach located in upper left abdomen); if you lay on left side, it prevents gastric emptying due to pressure on the stomach, which is on left side. Remember that gravity and postioning have a lot to do w/Gi tests.
What does the diagnostic gi test called the abdominal ultrasound involve?
Non invasive; used to detect abdominal masses (tumors, cysts) and assess ascites (accumulated fluid in abdomen); used to detect gallstones, cholecystitis, appendicitis;
Nsg responsibility: NPO 8-12 hr before ultrasound (air or gas can reduce quality of images)
Gall bladder studies. Esophageal studies common: Positioning is important due to issues w/GERD
What does the diagnostic gi test called the virtual colonoscopy involve?
Virtual colonoscopy: combines CT w/virtual reality software to detect colon & bowel diseases (polyps, colorectal cancer, lower GI bleeding); air introduced via tube placed in rectum to enlarge colon to enhance visualization; computer creates 2D-3D images to view on monitor. Nsg responsibility: bowel prep; no sedatives, no scope used; takes ony 15-20 minutes.
What does the diagnostic gi test called the endoscopy involve?
Direct visualization through lighted fiberoptic instrument; GI structures that can be examined include esophagus, stomach, duodenum, colon, and w/aid of fluorscopy & x-rays, the pancreas and biliary tree.; major complication is perforation through structure being scoped. Nsg responsibility: Requires informed consent; NPO for 8hr before; give preop meds if ordered; pt sedated during procedure.; explain to pt that local anesthetic may be sprayed on throat before insertion of scope.
What does the diagnostic gi test called the colonoscopy involve?
: visualizes entire colon up to ileocecal valve (junction between ileum of small intestine and cecum of large intestine) w/ flexibel fiberoptic scope; used to diagnose inflammatory bowel disease, tumors, diverticulosis. ; allows for biopsy and removal of polyps w/out laparotomy.
Nsg responsibility: bowel prep (may be on clear diet 1-2 days prior or may be given enema dependign on doc); procedure odne in sidelying position and that pt will move during procedure to assist w/advancement of scope to cecum; explain that pt will be sedated; pt may have cramps post procedure (caused by stimulation of peristalsis due to bowel inflated w/air during test); observe for rectal bleeding, VS, s/s of perforation (malaise, abdominal distention & tenesmus (painful, ineffective straining @ stool).
What does the diagnostic test called Liver Biopsy involve?
An uncomfortable procedure; needle into 6th-7th or 8th-9th ICS on right side to get specimen of hepatic tissue.Nsg responsibility: check pt’s coagulation status (prothrombin time, clotting or bleeding time); make sure pt’s blood is typed and crossmatched; baseline VS; explain to pt about holding breath after expiration when needle is inserted; informed consent is signed
After procedure: VS to detect internal bleeding q15 for 2h; 330 min for 4 hr; q1hr evey 4 hrs; keep pt lying on rt side for 2 hr minimum to splint puncture site; pt flat in bed for 12-14 hrs; assess for complication (shock, pneumothorax)
What does the diagnostic blood test called Liver Function Series (LFT) involve?
(LFT common abbreviation): may see these as blood chemistries or labs p. 947; learn these now, cuz always checking them in hospital. KNOW NORMAL VALUES; these indicate liver damage and inflammation. ALP (alkaline phophatase): highest normal value; originating in bone & liver, serum levels rise when excretion is impaired due to obstruction in biliary tract. Normal Value: 30-120 U/L
AST: Normal value: 7-40 U/L; elevated in liver damage or inflammation. ALT: normal value: 5-36 U/L: elevated in liver damage or inflammation.GGT: Normal value: 0-30 U/L; present in biliary tract (not in skeletal or cardiac muscle), increase w/hepatitis and alcoholic liver disease, more sensitive than ALP fro liver dysfuntion.
What are some other blood chemistry diagnostic gi tests that are used?
Blood chemistries p. 944
Serum amylase: important to diagnose acute pancreatitis; measures secretion of amylase by pancreas; nurse resp: obtain blood samply in acute attack of pancreatitis, explain procedure.
Serum lipase: measures secretion of lipase by pancreas; explain procedure. Alcoholics @ risk for chronic pancreatitis.
What is a fecal analysis test and and stool culture test?
Fecal analysis: form, consistency, and color are noted; specimen examined for mucus, blood, pus, parasites, and fat content; also tests for occult blood are done. Nsg responsibilty: observe pt’s stools; collect sample; keep pt diet free of red meat for 24 hr prior (could give false positive if blood is present from the meat); **if you collect stool specimens, they cannot sit on counter for long periods due to bacterial growth (invalid sample) need to get to lab asap.Stool culture: test for C diff; VERY important! Nurse collects sample.
What are the nursing implications for gi diagnostic procedures?
Explain test, explain prep, explain procedure to client, NPO & nonsmoking. Check for signed consent form *if we don’t have this, no test can happen, so we make sure consent is signed! Check for allergies to drugs and contrast medium; they will know this.
Monitor hydration/nutrition status; if people have been NPO for awhile elderly, diabetics, and young people will be @ risk for dehydration/F&E imbalance.The more dehydrated they are, they cannot get contrast medium out of system; get them take in lots of fluids to flush their system.Difficult for older adults
Monitor for diarrhea, dehydration, fluid restrictions; if someone is CHF and are on fluid restrictions, they are more prone to dehydration; can end up w/constipation, etc from not getting contrast medium out soon enough.Water soluble vs. barium media.Water soluble easier for people to tolerate.
What the various kinds of enemas?
1) Cleansing: evacuates colon, acts by ↑ peristalsis by local irritation to colon’s mucosa (creates defecation reflex; increases it locally, but decreases it systemically, which can be a risk; various solutions (never give w/out drs order; check for this and the solution he wants).Types of cleansing enemas are tap water, normal saline, soapsuds solution, and low volume hypertonic saline.
Each solution has different osmotic effect, influencing the movement of fluids between the colon and interstitial spaces beyond the intestinal wall. Infants & children should only get normal saline because they are @ risk for fluid imbalance. 2) Tap water: a hypotonic solution; exerts a ↓ osmotic pressure than fluid in interstitial spaces so it the water moves from the bowel into the interstitial spaces. Volume creates defecation reflex before the water leaves the bowel; DO NOT repeat tap water enemas due to water toxicity or circulatory overload if the body absorbs large amounts of water. F&E can be imbalanced due to this; especially an issue w/repeated enemas; if bowel is collecting too much fluid into interstitial spaces they can have fluid overload. 3) Normal saline (NS): Safest solution because it exerts the same osmotic pressure as fluids in interstitial spaces surrounding the bowel (it isotonic); bowel doesn’t absorb as much water as hypotonic enema.The volume of infused saline stimulates peristalsis; saline enemas do NOT create the danger of excess fluid absorption as in tap water/hypotonic enema. 4) Soapsuds: intestinal irritation to ↑ peristalsis; soapsuds are added to tap water or saline to create irritation to stimulate bowel. Castile soap is safe, comes in liquid form.
5) Hypertonic: exerts an ↑ osmotic pressure that pulls fluid out of interstitial space and into the bowel(this will be issue w/ppl who are already dehydrated, cuz it is removing even more fluid); colon fills w/fluid=distention that promotes defecation. Contraindicated for dehydrated pts and infants (due to removal of fluid from IS to colon)
Give to pts who cannot tolerate large volumes of fluid (like the hypotonic that causes absorption of fluid into IS from colon);hypertonic is considered a low volume enema; usually 120-180ml/4-6 ounces is effective.Commercially prepared Fleet enema is most common. Hypotonic will decrease osmotic pressure.**Health care provider may order high or low cleansing enema: terms high and low refer to the pressure the fluid is exerted.
high enemas cleanse the entire colon (after the enema is infuse, ask the client to turn from the left lateral to the dorsal recumbent, over to the right lateral position; position changes help get the fluid to reach the entire large intestine)
low enemas cleanse only the rectum and sigmoid colon. 7) Carminative: relieves gas, ↑ ability to pass gas (for ppl especially post-op, it may be good for those that are having hard time passing gas). Recommend peppermint tea or walking too.
8) Oil retention: lubricates stool, lubricates rectum & colon for easier passage; softens stool; this is for ppl who suffer constipation (ppl on longer term pain meds or elderly ppl)
To enhance action of oil, pt retains the enema for several hours if possible. 9) Other: varies depending on type of procedure; medicated
Kayexalate: a medicated enema for high K+ levels; administer to area you want bowel to get rid of extra K+
Type of medicated enema that contains a drug; used to treat pts w/dangerously high levels of potassium; drug contains resin that exchanges sodium ions for potassium in the large intestine.
Neomycin: antibiotic enema used to ↓ bacteria in colon prior to bowel surgery.
What is the best position and procedure for giving an enema?
**Lay on left side in lateral sims position for enema; this allows water to go into bowel most easily (descending colon on left side of body, so allows it to enter and be flushed better); nsg consideration, let them know you will do little at a time to be effective; don’t just insert tube and put all water in..ask them to hold it in as long as they can (tell them that the further up in the bowel it gets, the better it will work..especially elderly, they can’t hold it very long); have pt tell you if they are getting abdominal pain/cramping to see if you need to let the go to the bathroom instead of continuing.

**enemas don’t affect the amount of bacteria in the bowel.
What are the generalities and fundamentals of ostomies?
1) An artificial opening (stoma) in abdominal wall to treat a condition in which feces can’t pass from rectum (cancer, Crohn’s, NEC necrotizing enterocolitis); due to a damaged portion of the bowel; to get it to heal, they cut it, and create a stoma to allow the reset of the bowel to heal; later go back and reanastamose (put back together).
2) Stoma is piece of bowel that has been cut through and pulled out through abd wall to use as a passage for feces. 3) Location of ostomy names it; i.e., ileostomy, jejunostomy, colostomy. 4) Duodenostomy: still want them to eat, but if that close @ duodenum, nutrients won’t be absorbed anyway, but TPN (total perenteral nutrition) is damaging to the liver; keeps ppl alive but is damaging to the liver.
5) Depends on what part of bowel is damaged as to where ostomy will be located.6) Location also determines type of stool: Ileostomy: drainage thin and green ; the entire large intestine is bypassed, so stools are frequent and liquid; Jejunostomy: color?Colostomy: brown drainage, w/particles/lumps of stool. Some ostomies are reversed once condition heals.Stoma has blood supply, it should be pink, moist (healthy looking; never want to see dark stoma=lack of blood flow to that portion of bowel; maybe disease is progressing=may need more surgery and get new stoma).
Drainage that comes out of stoma usually has digestive enzymes in it (enzymes are very powerful/caustic; leaking can result in digesting the skin around the stoma; VERY important to keep skin around stoma protected). See fundies 1182 for stomas and care of them.Bowel sounds: Increased bowel sounds can indicate an obstruction (bowel working too hard to get passed the obstruction; can result in diarrhea stool due to water only getting passed). Decreased bowel sounds: paralyzed ileus & peritonitis
Feeding versus elimination
Double barrel ostomies in babies:
Absorption below the damaged area.
What are the ostomy nursing considerations?
Assessment: Pink, healthy tissue vs. darkened, lack of circulation, necrosis, etc. Skin:redness, breakdown, etc.; make sure to clean off stool and dry completely; repeated wiping can aggravate skin breakdown.Can protect anal areas w/petrolatum, zinc oxide or other ointment that holds moisture in the skin preventing drying & cracking.
Psych: Major body image issue, disfiguring. Self-care: Can I do this?
Sexual relations? Embarrassing
Social embarrassment: Odor, visibility, spillage. Bags can fall off which is HUGE embarrassment.
Self-esteem.