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25 Cards in this Set

  • Front
  • Back
what is normal output from an ileostomy once bowel adaptation has occured?
500-800CC IN 24 HOURS
What would the RN watch for if the output was over 1000 cc/ day
dehydration, sodium and potassium depleation,
where is enzymatic activity most likely to cause damage to the patient's skin?
Ileum
will nutritional supplements be necessary?
90% of nutrients are absorbed in first 100 cm of small bowl.

As long as mucosa and length of jejunum are intact.
Where is Vitamin B12 absorbed from and why is this a problem?
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.
how long is the anal canal
3 cm
what is the transition zone?
columnar epithelium that line the small bowl and colon transition to squamous epithelium within the transition zone.
What is the importance of the Transition zone?
Contents are 'sampled' here.
Anal Verge
actual visual opening of the anal canal at skin level.

Used to indicate location of a rectal tumor
How is the rectum divided
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
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?
abdonimoperineal resection( APR)
Permanent colostomy
If a tumor is 7 cm above what surgery and ostomy will be placed?
low anterior resection (LAR)
no permanent ostomy needed.
Define Dentate line
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.
What problems can the skin below the dentate line cause to some patients?
Ileoanal Reservior( IAR) or Ileal Pouch anal anastomosis (IPAA) may experiencing itching that is not visible as it is in the anal canal itself.
Internal sphincter is involuntary muscle and is composed of ______ muscle and is ____ cm long
1. smooth

2. 3
Internal sphincter ____ the anorectal junction and proximal ____ cm of the _____
1. encircles
2. 2
3. anal canal
Internal sphincter is ____ contrated. which maintains a ____ anal canal
1. tonically
2.closed
Internal sphincter ____ _____ ( automatically, without cognitve input) when the rectum fills
1. relaxes
2. involuntarily
External sphincter is composed of what type of muscle?
1. smooth (involuntary)
2 striated (voluntary)
What nerve innervate the external sphincter?
Pundental nerve, exits spinal cord at the sacral 2-4 level
what is the job of the pudental nerve?
voluntary,increase contraction to prevent passage of contents or

relax and allow passage of contents
Explained the 'resting state' of the external sphincter
always contracted but can contract more when consciously desirable
What if the pudental nerve is damaged in a patient?
The exteral sphincter will not function and the patient will be incontinent.
NOTE ON TRAUMA TO SPHINCTERS
ANY TRAUMA THAT CAN NOT BE REPAIRED WILL RENDER THE PATIENT INCONTIENT AND A PERMANENT COLOSTOMY WILL SIMPLIFY BOWEL MANAGEMENT
What happens when the internal sphincter relaxes?
squamous epithelia cells in anal canal distal to dentate line come in contact with bowel content, allows for samplings reflex.