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Elimination Bowel
chapter 33 potter and perrry
| Question | Answer |
|---|---|
| What is Zestril and what is it used for? | An Ace inhibitor (Lisenopril). It lowers BP. |
| Where is the cardiac sphincter and what is its function? | Between the esophagus and the upper end of the stomach, prevents reflux of stomach contents back in to the esophagus. |
| ______ and _______ in the stomach facilitate the digestion of protein. | Pepsin and HCl |
| What ingredient in stomach juices is necessary for the absorption of Vitamin B12? | Intrinsic factor |
| What is an average amount of chyme moving through the small intestine in a day? | 7-10 Liters |
| By the time 7-10 liters of chyme reaches the end of the small intestine how much has it been reduced to? | 600-800mL |
| What are the three sections of the small intestine? | duodenum, jejunum, ileum |
| The ______ is 2 feet long and continues to process chyme from the stomach. | Duodenum |
| The _______ is 9 feet long and has the primary function of absorbing carbohydrates. | Jejunum |
| The _______ is 12 feet long and specializes in the absorption of water, fats, and bile salts. | Ileum |
| Which two sections of the small intestine absorb most nutrients and electrolytes? | duodenum and jejunum |
| Which section of the small intestine absorbs certain vitamins, iron, and bile salts? | Ileum |
| What affect would surgical resection, inflammation, or obstruction of the small intestine have? | disrupted peristalsis, reduced area for reabsorption, blocked passage of chyme resulting in electrolyte and nutritional deficiencies |
| About how long is the large intestine? | 1.5 -1.6 meters or 5-6 feet |
| What names of the three parts of the large intestine? | cecum, colon, rectum |
| What is the name of the passage way from the small intestine to the large? | ileocecal valve |
| What are the four segments of the colon? | ascending, transverse, descending, sigmoid |
| What are the three functions of the colon? | absorption, secretion, and elimination |
| What does the amount of time spent in the colon have to do with a stools consistency? | The amount of water absorbed from chyme depends on the amount of time spent in the colon. Fast peristalsis = watery stool. Slow = hard stool |
| Name a couple of electrolytes secreted in the colon. | bicarbonate and potassium |
| What kind of peristalsis moves undigested food toward the rectum? | Mass peristalsis |
| About how many times a day do we have mass peristalsis and when is usually the strongest? | 3-4 times a day, strongest about an hour after mealtime |
| What are distended veins in the rectum caused by straining during defecation? | Hemorrhoids |
| What is the voluntary contraction of abdominal muscles while maintaining forced expiration against a closed airway in order to expel feces called? | Valsalva maneuver |
| Which patients should avoid straining? | patients with hypertension, abnormal cardiac rhythm or other cardiovascular diseases, glaucoma, increased intracranial pressure, or new surgical wound. |
| Describe normal defecation. | Painless passage of soft formed stool |
| Continuous oozing diarrhea, anorexia, abdominal distention, cramping, N&V, and rectal pain are signs and symptoms associated with what condition? | Fecal impaction |
| What is the aim of treatment for a patient with diarrhea? | adequate hydration, correct causative factors, antispasmodic or anti-diarrheal medications, protect skin integrity |
| What kind of stool consistency would be formed by an ostomy of the sigmoid colon? | a nearly normal stool consistency |
| What kind of stool consistency would be formed by an ostomy of the ileum? | watery stool (foregoes the whole large intestine) |
| What are loop colostomies and when are they performed? | Loop colostomies are usually emergency situations. They are large temporary stomas of the transverse colon that is looped over a bridge to prevent it from slipping back in. |
| What kind of colostomy is used as surgical treatment for colorectal cancer? | end colostomy |
| What patients often have a temporary end colostomy with a Hartmann’s pouch? | patients with diverticulitis |
| What is an advantage to a patient with a colostomy of the sigmoid colon? | They could train the bowel to empty at a certain time of day and not have to where a bag throughout the day. |
| What is it called when a portion of ileum is used to create a new rectum and connected to the anus? | ileoanal pouch anastomosis |
| What procedure creates a pouch of ileum that the patient catheterizes and empties several times a day? | Kock continent ileostomy |
| What would elevated levels of amylase in feces indicate? | Pancreas disorder |
| What would elevated levels of carcinoembryonic antigen in feces indicate? | It is typically elevated in persons with cancers of the GI tract or hepatobiliary organs |
| What could cause elevated levels of biliruben in feces? | hepatobiliary disease |
| Elevated levels of what may indicate obstructive hepatobiliary diseases and carcinomas, or healing fractures? | Alkaline phosphate |
| If feces is white or clay what’s missing? | bile |
| What could black or tarry stool indicate? | Upper GI bleeding or Iron ingestion |
| What could red in the stool indicate? | lower GI bleeding, hemorrhoids, or beets |
| What is the stool is pale with fat in it? | Malabsorption of fat |
| What is the normal stool frequency for infants? Bottle? Breast? | Variable - Breast-fed 4-6 times a day, Bottle fed 1-3 times a day |
| What is the normal stool frequency for adults? | Variable – daily or 2-3 times a week |
| What is FOBT and FIT and how often should people over 50 have it? | Fecal Occult Blood Test, Fecal immunochemical test – Yearly |
| What are the test people over 50 should have every 5 years? | Flexible Sigmoidoscopy (FSIG) , double contrast barium edema |
| What test should people over 50 have every 10 years? | colonscopy |
| Patients on what medication should be regularly screened with a FOBT? | patients on an anticoagulant for intestinal bleeding |
| The American Cancer Society recommends yearly _______ and _________every 5 years. | FOBT and flexible sigmoidoscopy |
| Name four factors that affect the character of feces. | Mechanical breakdown of food, GI motility, Selective absorption, Secretion of substances in the large intestine |
| Two factors that make for nice, soft stool consistency | Fiber and fluid intake |
| Greatest danger from diarrhea | fluid and electrolyte imbalance |
| What factors are included in an elimination assessment (4 things) | bowel habits, analysis of factors that normally influence defecation, review of recent changes, physical examination |
| 2 dangers during digital removal of stool | trauma to rectal mucosa, vagal stimulation |
| Add questions about primary, secondary, and tertiary health care. When to complete a full assessment. Enema volume, when and why stop an enema | |
| What is the best time to administer an enema? | shortly before a patient’s normal time to defecate or immediately after a meal |
| What are some harmful effects related to overuse of laxatives (3)? | permanent bowl damage, osteomalacia, electrolyte imbalance |
| How are cathartics classified? | by the way they promote defecation |
| How do stimulant cathartics cause defecation? | irritate local mucosa, increase motility, inhibit reabsorption of water |
| What is the time frame of action for a stimulant cathartic? | 6-8 hours |
| What kind of cathartic agents work by increasing fecal mass and lubrication by osmosis caused by a substance that the intestines cannot absorb? | saline or osmotic cathartics |
| What is the time frame of action for saline or osmotic cathartics? | 1-3 hours |
| What kind of cathartic agents soften and lower the surface tension of the stool by allowing water and fat to penetrate and block absorption of water into the intestines and works in 12-24 hours? | emollient or wetting agents |
| What kind of laxatives are the least irritating and safest? | Bulk forming laxatives |
| How do bulk forming laxatives work? | Fecal bulk stretches intestinal walls stimulating peristalsis. |
| Which patients could benefit from mineral oil laxatives? | patient’s with painful hemorrhoids |
| What are the problems associated with regular use of mineral oil? | interferes with absorption of A, D, E, K ; causes a dangerous form of pneumonia if aspirated |
| What is the only safe type of enema for infants and children due to potential fluid imbalance? | normal saline |
| What is the normal volume of a cleansing enema for an adult? | 750-1000mL |
| What kind of enema is for patients who cannot tolerate large amounts of fluid? | Hypertonic fluid |
| How many milliliters are included in a hypertonic solution enema? | 120ml to 180ml |
| Which psychological factors cause diarrhea and constipation? | Depression decreases peristalsis and leads to constipation. Anxiety, stress, or fear can increase peristalsis leading to diarrhea. |
| How do narcotic analgesics, opiates, and anticholinergics affect elimination? | they depress peristalsis and cause constipation |
| How do antibiotics affect elimination? | They destroy normal intestinal flora and produce diarrhea |
| How does general anesthesia affect elimination? | slows or stops peristalsis |
| How does pregnancy affect elimination? | Constipation due to extra pressure on the rectum is common |
| What causes lactose intolerance and what are the signs and symptoms? | Patients that are lactose intolerant lack lactase and experience cramping and diarrhea when they ingest milk products. |
| What do broccoli, cauliflower, onions, and dried beans have in common? | They produce gas and stimulate peristalsis. |
| Emotional stress initially _______ peristalsis to evacuate the bowel for “fight” response. | Increases |
| What is the correct temperature for and enema and why? | 105 to 110 degrees to relax muscles. Colder causes muscle spasm. Hotter injures mucosa. |
| Intrathoracic pressure _________ during straining to defecate. | increases |
| How come people can have heart attacks from going to the rest room? | Raised intra-thoracic pressure during straining cuts of venous return to the heart. It returns forcefully causing tachycardia and ^BP followed by reflex bradycardia |
| Which side should a person be lying on for an enema and why? | the left side because that is where the sigmoid colon is located |
| How does leaning forward promote defecation? | by raising intra-abdominal pressure |
| What is the purpose of a rectal tube? | Promote passage of flatus decreasing abdominal pressure |
| What is the function of soap in a soapsuds enema? | to irritate the bowel resulting in peristalsis |
| How far in is an enema tube inserted? | 3-4 inches |
| Excessive use of what weakens the natural response to defecation? | laxatives |
| Stool from what part of the colon is liquid? | Ascending colon |
| Stool from what part of the colon is pasty? | transverse colon |
| Stool from what part of the colon is dry, solid, and formed? | descending |
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Perseverandovercome
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