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25 Cards in this Set
- Front
- Back
what is normal output from an ileostomy once bowel adaptation has occured?
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500-800CC IN 24 HOURS
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What would the RN watch for if the output was over 1000 cc/ day
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dehydration, sodium and potassium depleation,
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where is enzymatic activity most likely to cause damage to the patient's skin?
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Ileum
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will nutritional supplements be necessary?
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90% of nutrients are absorbed in first 100 cm of small bowl.
As long as mucosa and length of jejunum are intact. |
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Where is Vitamin B12 absorbed from and why is this a problem?
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1. terminal 15 cm of ileum and then stored in liver 2 YEARS.
2 Problem if terminal end is used to create reservoir, patient at r/f long term B12 deficiency that may not show for 2 YEARS--leads to anemia and neurlogic disorders. |
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how long is the anal canal
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3 cm
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what is the transition zone?
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columnar epithelium that line the small bowl and colon transition to squamous epithelium within the transition zone.
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What is the importance of the Transition zone?
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Contents are 'sampled' here.
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Anal Verge
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actual visual opening of the anal canal at skin level.
Used to indicate location of a rectal tumor |
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How is the rectum divided
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Thirds
lower third is from anal verge to 7 cm middle third is 7 cm- 11cm uppoer third extends from 11-15 cm from anal verge |
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If a tumor is located 7 cm or less above the anal verge what procedure will be performed and what type of ostomy will be placed?
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abdonimoperineal resection( APR)
Permanent colostomy |
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If a tumor is 7 cm above what surgery and ostomy will be placed?
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low anterior resection (LAR)
no permanent ostomy needed. |
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Define Dentate line
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anatomical marker within the transition zone, located above the anal verge.
Below the dentate line epithelial cells are squamous and the submucosa contains free sensory nerve endings. |
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What problems can the skin below the dentate line cause to some patients?
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Ileoanal Reservior( IAR) or Ileal Pouch anal anastomosis (IPAA) may experiencing itching that is not visible as it is in the anal canal itself.
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Internal sphincter is involuntary muscle and is composed of ______ muscle and is ____ cm long
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1. smooth
2. 3 |
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Internal sphincter ____ the anorectal junction and proximal ____ cm of the _____
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1. encircles
2. 2 3. anal canal |
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Internal sphincter is ____ contrated. which maintains a ____ anal canal
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1. tonically
2.closed |
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Internal sphincter ____ _____ ( automatically, without cognitve input) when the rectum fills
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1. relaxes
2. involuntarily |
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External sphincter is composed of what type of muscle?
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1. smooth (involuntary)
2 striated (voluntary) |
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What nerve innervate the external sphincter?
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Pundental nerve, exits spinal cord at the sacral 2-4 level
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what is the job of the pudental nerve?
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voluntary,increase contraction to prevent passage of contents or
relax and allow passage of contents |
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Explained the 'resting state' of the external sphincter
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always contracted but can contract more when consciously desirable
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What if the pudental nerve is damaged in a patient?
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The exteral sphincter will not function and the patient will be incontinent.
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NOTE ON TRAUMA TO SPHINCTERS
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ANY TRAUMA THAT CAN NOT BE REPAIRED WILL RENDER THE PATIENT INCONTIENT AND A PERMANENT COLOSTOMY WILL SIMPLIFY BOWEL MANAGEMENT
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What happens when the internal sphincter relaxes?
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squamous epithelia cells in anal canal distal to dentate line come in contact with bowel content, allows for samplings reflex.
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