Bowel Elimination Fundamentals Of Nursing Craven Ch 42

Front 1

During _______ alternative contraction and relaxation of the intestinal smooth muscle occur. Slows the passage of intestinal content to permit more complete digestion and absorption of nutrients.

Back 1

Segmentation

Front 2

_______ propels the intestinal content along the entire length of the small and large intestines.

Back 2

Peristalsis

Front 3

_______ Nervous system input affects the rate of intestinal motility.

Back 3

Autonomic

Front 4

_______ stimulation slows the peristalsis and delays the passage through the intestine.

Back 4

Sympathetic

Front 5

______ stimulation increases bowel motility and emptying.

Back 5

Parasympathetic

Front 6

Partially digested food (also known as _____ empties from the small intestine, where digestive process is completed and the absorption of nutrients and fluids begins.

Back 6

chyme

Front 7

Most nutrient and electrolyte absorption occurs in the _____ and _____.

Back 7

duodenum & jejunum

Front 8

Some vitamins, iron, and fluid are absorbed in the _______.

Back 8

ileum

Front 9

Final absorption of nutrients, especially the absorption of fluid and electrolytes, occurs in the _____ intestine.

Back 9

Large

Front 10

Although, the distal ______ principle function is storage of feces, some sodium, chloride, and water continue to be absorbed during storage.

Back 10

colon's

Front 11

The process of ______ begins when peristalsis propels feces into the rectum and causes rectal distention.

Back 11

defecation

Front 12

When stool distends the rectum, parasympathetic afferent nerve fibers in the sacral segment of the spinal cord are stimulated, causing contraction of the descending and sigmoid colon, rectum, and anus and relaxation of the internal anal sphincter. This stimulus response sequence is a sacral reflex, not under voluntary control. It is called the _______ _______.

Back 12

defecation reflex

Front 13

Defecation will automatically follow unless the external anal sphincter (a striated muscle under voluntary control) remains _______.

Back 13

contracted

Front 14

Defecation is assisted by taking a deep breath against a closed glottis (to move the diaphragm down), contracting the abdominal muscles (to increase intra-abdominal pressure), and contracting the pelvic floor muscles (to push the feces downward.) These actions are called the _____ _______.

Back 14

Valsalva maneuver

Front 15

Feces consists of _____% water and _____% solids.

Back 15

75% & 25%

Front 16

_______ is the major undigested fiber left in the feces after digestion and absorption have occurred.

Back 16

Cellulose

Front 17

between _____ and 300g of feces is produced daily.

Back 17

150

Front 18

The 25% of feces that is solid comes chiefly from the intake of food that has a high ____ or _____ content.

Back 18

cellulose or fiber

Front 19

Cellulose or fiber is contained in _______ foods.

Back 19

plant

Front 20

_____ are enlarged or varicose veins in the anal canal. Pain and rectal bleeding are sometimes associated with _______ and may lead to frequent denial of the defecation reflex to avoid pain.

Back 20

hemorrhoids

Front 21

An ______ _______ is an ulcerous crack or split in the anal mucosa. Bleeding and pain occur as the stool passes.

Back 21

Anal fissure.

Front 22

Medications:
Narcotics & Iron (constipation)
Antibiotics (diarrhea)
Antacids (Diarrhea or constipation)

Back 22

Laxatives & Stool softener, and enemas administered to promote stool evacuation.

Antidiarrheal medications may be given to decrease stool frequency.

Front 23

Surgery:
general anesthetics may slow gastrointestinal motility, causing client to experience a period of decreased bowel functioning for 1-2 days.

Back 23

GI tract with require 3-4 days for bowel activity to return to normal. Preoperative laxatives or enemas may be prescribed. Narcotic analgesics, reduce activity, and fear of pain.

Front 24

The portion of the intestine brought through the abdominal wall is known as a _______.

Back 24

stoma

Front 25

A bowel diversion surgery that brings a segment of the large colon out to the abdominal skin is called a ________.

Back 25

colostomy

Front 26

When a portion of the ileum is used to make the stoma on the abdomen, the procedure is called an __________.

Back 26

ileostomy

Front 27

stool produced from an ileostomy is __________ and contains large quantities of electrolytes

Back 27

liquid

Front 28

In a person with a descending colostomy, in which only the rectum has been removed, stool is ______ in consistency, and elimination may be controlled with daily colostomy irrigation.

Back 28

soft

Front 29

A _____ pouch involves construction of an internal pouch by removal of the colon and attachment of a limb of ileum to the anus.

Back 29

J pouch

Front 30

A ______ pouch is made from 30 cm of ileum and an outlet valve is constructed. Client can drain at their convenience rather than continuous draining from stoma.

Back 30

Kock pouch

Front 31

______ is the infrequent, sometimes painful passage of hard, dry stool. It occurs when stool moves through the large intestine too slowly or remains in the large intestine too long.

Back 31

Constipation

Front 32

A ____ ______ is the accumulation of hardened feces in the rectum.

Back 32

Fecal Impaction: suspect impaction when there is a history of absence of regular bowel movements for several days. Followed by passage of liquid or semi liquid stool.

Front 33

_______ is manifested by frequent evacuation of watery stools. Stool may have increased mucus.

Back 33

Diarrhea-stool is highly acidic

Front 34

Medications, inappropriate use of laxative can cause diarrhea. Antacids especially those containing ______ cause diarrhea. Antibiotics can promote diarrhea by irritating the GI mucosa or inhibiting normal growth of intestinal flora

Back 34

Magnesium.

Front 35

Normal intestinal flora inhibit the growth of ______ ______.When broad spectrum antibiotics especially third generation cephalosporins, normal flora is altered.

Back 35

Clostridium difficile (C-Diff)

Front 36

When traveling some people experience diarrhea after ingesting food or water from unfamiliar locale. A waterborne foreign strain of ____ _____. causes intestinal inflammation.

Back 36

Escherichia coli

Front 37

The _______ of parenteral tube feedings may precipitate a diarrheal response.

Back 37

hyperosmolality

Front 38

______ is the accumulation of gas in the GI tract. Swallowed air, bacterial action in the large intestine, and diffusion from the blood.

Back 38

Flatus

Front 39

certain foods eg. cabbage, onions, legumes often increase the amount of flatus produced. ____ _____ foods that are recommended to promote normal bowel elimination can cause excess flatus.

Back 39

High fiber foods

Front 40

An accumulation of excessive amounts of flatus or liquid or solid intestinal contents cause ____ _____.

Back 40

abdominal distention

Front 41

_____ _____ and ____ ______ are types of bowel obstruction that produce distention

Back 41

Paralytic ileus & abdominal tumors

Front 42

Long periods of bed rest or relative inactivity can slow peristalsis and lead to accumulated flatus in the large intestine. Peristalsis also slows after surgery with general _______.

Back 42

anesthesia

Front 43

Inspection:
an abdomen that appears more than slightly rounded is called _____ or distended; and abdomen may be ______ because of excess subcutaneous fat, pregnancy, or accumulated fluid or gas.

Back 43

protuberant

Front 44

Auscultation:
bowel sounds, which are a result of peristalsis throughout the intestine, are heard as a _____ or ____ noise.

Back 44

bubbling or gurgling

Front 45

Stomach "growl", these loud bowel sounds are termed __________.

Back 45

borborygmi

Front 46

Auscultation:
Starting in the ______ lower quadrant, because bowel sounds are heard best at the ileocecal junction.

Back 46

right

Front 47

Normal bowel sounds are hear in each quadrant within 5-_____ seconds.

Back 47

15

Front 48

A continued absence of bowel sounds beyond 72 hours may signal _____ _____, a condition in which bowel is temporarily paralyzed and distention occurs.

Back 48

paralytic ileus

Front 49

Continuous bowel sounds or sounds heard more frequently than every 5 seconds can be termed ______.

Back 49

Hyperactive

Front 50

Clients with diarrhea usually have hyperactive, _____-pitched bowel sounds indicating hypermotility in the intestine.

Back 50

High-pitched

Front 51

A client with a ____ ___ may have a combination of hypoactive and hyperactive bowel sounds.

Back 51

bowel obstruction: hypoactive sounds below the level of obstruction and hyperactive sounds above the level.

Front 52

Percussion:
Is used to identify ___, fluid, or solid masses in the abdomen.

Back 52

Air

Front 53

begin percussion in the quadrant that was first auscultated. It is normal to hear a high pitched, hollow sound, called _______, over the left upper quadrant (LUQ)

Back 53

tympany

Front 54

The normal percussion sound heard in the other 3 quadrants is a hollow sound that is not quite as high-pitched as tympany

Back 54

reflecting a mixture of air and fluid in the intestines.

Front 55

When an abdomen contains and excess fluid accumulation, ______, low-pitched sounds are heard over the fluid-filled areas.

Back 55

duller

Front 56

Palpation:
It is recommended that beginning nursing students _____ perform palpation independently

Back 56

Not perform, this can be highly dangerous.

Front 57

An assessment technique that nurses can perform independently is the measurement of abdominal girth. For the comparison of abdominal girth measurements to be valid, measure the same abdominal circumference each time.

Back 57

Mark "X" with a marking pen on the client's abdomen at the point of greatest distention, ensuring that any subsequent measurement will be made from the same location.

Front 58

Abdominal girth is especially helpful in assessing _____, an accumulation of fluid in the peritoneum, usually from liver failure

Back 58

ascites

Front 59

Perirectal Examination:
Place client in a _____ _____ position with one or both knees flexed.

Back 59

side-lying

Front 60

Fecal Occult Blood Test (FOBT)
hidden blood in the stool is called a ______ or Hemoccult test.

Back 60

guaiac; blue is a positive diagnostic finding, indicating the presence of blood in the stool sample.

Front 61

If blood is on the surface of the stool, it is likely to be caused by bleeding from hemorrhoids and is not occult. If blood is mixed in the stool mass itself,

Back 61

its likely source is intestinal. When collecting a stool specimen for occult blood, a stool sample obviously contaminated by hemorrhoidal or menstrual blood should not be used.

Front 62

Items that can provide a False Positive or negative for FOBT

Back 62

False + red meat, iron preparations, broccoli, cauliflower, turnips, aspirin, bismuth compounds, steroids, nonsteroidal antiinflamatory drugs (NSAIDs)

False - Vitamin C may cause a false negative

Front 63

Stool Culture:
Salmonella & Shigella-cause diarrhea
C. Difficile-diarrhea

Back 63

Ova (eggs) and parasites, Giardia lamblia or Entamoeba histolytica.

Front 64

Radiologic Procedures
Purpose is to visualize the segments of the small and large bowel and detect abnormalities in the shape,

Back 64

motility, and functioning. Barium enema is used, can cause constipation so laxative is often prescribed. Monitor BM and Bowel Sounds after procedure

Front 65

Proctoscopy or ________ examines the rectum and sigmoid colon using a flexible, fiberoptic instrument.

Back 65

sigmoidoscopy

Front 66

_____ can visualize the colon up to the ileocecal valve. More painful, client is often given IV pain medications

Back 66

Colonoscopy

Front 67

The _________ is an endoscopic procedure that visualizes the esophagus, stomach, and duodenum.

Back 67

esophagogastroduodenoscopy

Front 68

A ______ (retrieval of a small piece of mucosa or tumor for analysis) or _____ (complete surgical removal of a colonic lesion) can be done during endoscopy.

Back 68

Biopsy & polypectomy. Monitor for signs of rectal bleeding or the onset of continuous dull abdominal pain, possibly indicating colonic perforation.

Front 69

Common Meds for Constipation:
Bulk=Fibercon, Metamucil
Emollient=Colace, Surfak, Dialose, DOSS

Saline=Milk of Magnesia (MOM), magnesium citrate, Fleet enema

Back 69

Stimulant=Castor oil, Dulcolax (bisacodyl), Pericolace (casanthranol), Ex-Lax, Correctol (phenolphthalein, Senokot (senna)

Front 70

Absorbents:
Kaolin/pectin (Donnagel)
Attapulgite (Kaopectate)
Bismuth subsalicylate (Pepto-Bismol)

Back 70

Absorbs, excess fluid and bowel irritants; provides soothing effect to irritated bowel.

Front 71

Bulk-Forming Agent
Psyllium (Metamucil, Effer-syllium)

Back 71

Attracts water to absorb excess fluid

Front 72

Opiates
Paregoric
Codeine

Back 72

Decrease Intestinal motility
Increase Intestinal water and electrolyte absorption

Front 73

Synthetic Opiates
Loperamide (Imodium)
Diphenoxylate/atropine

Back 73

Decrease Intestinal motility
Increase Intestinal water and electrolyte absorption

Front 74

Antispasmodics
Atropine
Tincture of belladonna

Back 74

Decrease Intestinal motility

Front 75

Antiflatulence agents, such as simethicone, are used to relieve gas.

Back 75

Antiflatulence medication is usually given in combination with an antacid.

Front 76

An ______ is the cleansing of a portion of the large bowel by insertion of fluid rectally

Back 76

enema

Front 77

Narcotic analgesics ______ intestinal motility

Back 77

slow

Front 78

____ _____ is the irrigation of the stomach

Back 78

Gastric lavage

Front 79

For clients who cannot obtain adequate nourishment orally, liquid food can be instilled into the stomach through the nasogastric or nasointestinal tube. This type of feeding is also called______

Back 79

enteral nutrition or gastric gavage