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NURS 106 Exam 2
Bowel Elimination (W & VL)
| Question | Answer |
|---|---|
| What are the main functions of the GI tract? | digest and absorb nutrients and eliminate food waste |
| What are the structures of the GI tract? | mouth, esophagus, stomach, sm. intestine, lg intestine, rectum, anus |
| What is the main purpose of the jejunum? | to absorb carbs and protein |
| What is the main purpose of the ileum? | absorption of fat, bile salts, some vitamins, minerals and water |
| Where does the majority of absorption occur in the digestive system? | duodenum and jejunum |
| What is the large intestine also known as? | the colon |
| Name structures of the large intestine? | ascending colon, hepatic flexure, transverse colon, splenic flexure, descending colon |
| Approximately what % of fluid enters the colon is reabsorbed along its passage? | 80% |
| gastrocolic reflex | triggered by food entering the stomach and sm intestine... causes most of the propulsions of the contents into the transverse and sigmoid colon |
| hemorrhoids | distended blood vessels within or protruding from the anus |
| Defecation | the process by which bowel eliminates waste |
| Valsalva Maneuver | Contraction of the abdominal muscles while maintaining a closed airway to increase the pressure to expel feces |
| Who should not use the valsalva maneuver? Why? | people with heart disease, glaucoma, increased intracranial pressure or new surgical wounds as it may increase blood pressure, increase pressure in the abdominal cavity and is associated with cardiac arrhythmias |
| What is a normal frequency for BMs? | Anywhere from couple times a day to once a week |
| How do you know when your BMs are normal? | If the person passes stool without excessive urgency (needing to rush to the toilet) and with minimal effort and no straining without blood loss and without the use of laxatives |
| Meconium | green black tarry and sticky substance that new borns pass due to swallowed amniotic fluid. |
| What color stools do breastfed babies pass? | golden yellow stools |
| What color stools do formula babies pass? | tan stools |
| When does the ability to control defecation develop? | 2 to 3 years of age |
| What is the primary risk factor for irritable bowel syndrome? | Stress |
| What is irritable bowel syndrome? | disorder with bloating, pain and altered bowel function |
| What does calcium supplements cause? | constipation |
| What does magnesium cause in the digestive system? | loosen stool |
| What does vitamin C do to stool? | softens it and can cause diarrhea in sensitive patients or if over consumed |
| How many glasses should a person drink to promote healthful bowel function? | Min of 6-8 glasses |
| What do antacids do? | neutralizes stomach acids but may slow peristalsis |
| Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen do what to the digestive system? | irritate the stomach and if used a lot lead to ulceration of the stomach or duodenum |
| What mineral supplement is notorious for causing constipation? | Iron |
| Paralytic ileus | a cessation of bowel peristalsis but the bowel still makes secretions causing distention and discomfort |
| Food allergy | a true immune system reaction promopted by the presence in the body of an allergenic such as constipation, diarrhea, rashes, anaphylatic shock, bloating, intestinal bleeding |
| Food intolerance | not a food allergy - it produces symptoms like GI discomfort, pain, gas, bloating, diarrhea or constipation that is NOT CAUSED BY A IMMUNE RESPONSE |
| Diverticulosis | A balloon out between the muscles of the colon that forms pouches in which fecal material is trapped. |
| Diverticulitis | When the diverticulosis becomes infected |
| Bowel diversion | surgically created opening for elimination of digestive waste products |
| effluent | output |
| stoma or ostomy | a surgically created opening in the abdominal wall |
| What kind of output or effluent would a bowel diversion have that was located close to the ileocecal valve (between the sm and lg intestines)? | liquid effluent |
| Reanastomosis | reconnection of the bowel |
| ileostomy | brings a portion of the ileum through a surgical opening in the abdomen bypassing the large intestine |
| Kock pouch | continent ileostomy, creates an internal pouch the patient inserts a tube through the external stoma into the pouch so the pt is free of an ostomy appliance |
| total colectomy ileaoanal reserve | removes the colon, creates a pouch from the ileum and connects the ileum to the rectum |
| colostomy | brings a portion of the colon through a surgical opening in the abdomen, can be located anywhere on the colon (lg intestines) |
| What kind of drainage would be produced from a colostomy close to the sigmoid colon? | solid feces |
| Double barreled colostomy | 2 separate stomas that externalize the bowel on both sides of the portion that has been removed one side drains fecal material and one side drains mucus (distal stoma) |
| Loop colostomy | segment of bowel brought out the abdominal wall with a plastic rod wedged under the bowel to keep it from slipping back into the abdomen. |
| What should be part of your assessment when learning about a pt's digestive system? | normal bowel patterns, appearance of stool, changes in bowel habits/stool appearance, history of elimination problems, use of bowel elimination aids including diet, exercise, meds and remedies |
| What do you examine when doing a physical assessment for bowel elimination? | abdomen, rectum, anus look at the size, shape, contour of abdomen, listen to bowel sounds and u can palpate the anus and rectum for the presence of stool or masses |
| What do normal bowel sounds like? | high pitched with approx 5-35 gurgles every minute |
| What do hyperactive bowel sounds like? | very high pitched |
| What do hypoactive bowel sounds like? | low pitched and quiet |
| What does it mean if after 3-5 minutes you hear no bowel sounds? | absent bowel sounds |
| Normal quantity of stool produced a day? | 100-400g |
| What does narrow pencil shaped stool indicate? | intestinal obstruction or constriction or rapid peristalsis |
| What do hard stools indicate? | constipation |
| Liquid stool indicate? | rapid peristalsis (i.e. from infection) |
| Normal pH of stool? | neutral or slightly alkaline |
| What do stools with strong foul odors indicate? | blood in the stool, especially in the upper GI tract or infection |
| What are indirect visualization studies? | radiographic views of the lower GI tract |
| Why are stool specimen analyzed? | detect blood, infection or parasite infestation |
| To obtain a stool specimen what must the client first do? | Void and then defecate in a clean dry bedpan/bedside commode or special container (half hat) |
| How much stool do you need for a stool specimen? | 20 or 30 mL of liquid stool |
| Occult? | Hidden |
| What does the fecal occult blood test, test? | for blood hidden in the stool |
| What does the fecal occult blood test require? | special reagent that detects the presence of peroxidase ( an enzyme present in hemoglobin) |
| What is peroxidase | an enzyme in hemoglobin |
| What food should be restricted when a fecal occult test is required? | red meat, chicken, fish, horseradish, some raw fruits, vegies as they may cause false positives |
| What meds should a pt avoid if a fecal occult test is required? | salicylates (aspirin), steroids, iron preparations, or anticoagulants as they cause false positives |
| What supplement should a pt avoid if a fecal occult test is required? | vitamin C as it can produce a false negative |
| How many days should the pt not eat contraindicated meds before the fecal occult test? | 7 days |
| How many days should the pt avoid contraindicated foods before a fecal occult test? | 3 days |
| What color is a positive fecal occult result | Blue |
| How long should a pt hold the solution of an enema? | 5-15 minutes depending on the type of enema |
| Prior to removing stool digitally what should you do? | obtain a baseline vital signs and determine whether the pt has a history of cardiac problems or other contraindications |
| Why are baseline vital signs obtain prior to removing stool digitally? | because the digits may stimulate the vagus nerve |
| How often should the ostomy pouch should be changed? | 3-5 days |
| What are common nursing diagnosis related to bowel elimination? | bowel incontinence, constipation, risk for constipation, perceived constipation, diarrhea, toileting self care deficit |
| Constipation | decrease frequency of bowel movement resulting in hard dry stool |
| Subjective characteristics of constipation | abdominal pain, feeling of rectal fullness, straining or pain with defecation |
| fecal impaction | hard dry stool is lodged in the rectum and cannot be passed |
| risk for constipation can be caused by | bedrest, meds such as opioids or surgery |
| Perceived constipation | for clients who make a self diagnosis of constipation and uses laxatives, suppositories or enemas to ensure daily bowel movement |
| Toileting self care deficit | impaired ability to preform or complete own toileting activities examples include: those who can't carryout proper toilet hygiene, flush the toilet, get to the toilet |
| Is toileting self care deficit a bowel problem? | no |
| How can a nurse promote normal or regular defecation? | privacy, positioning, timing of defecation, fluids and nutrition, exercise |
| How much should nurses encourage pt to intake of fiber? | 25-30 grams |
| What is a BRAT diet | bananas,rice (white), applesauce, toast |
| What are bulking agents? | fiber in a nonfood source |
| What are the preferred medications for treating constipation? | bulking agents |
| What occurs with habitual laxative use (not including bulking agents) | lead to further constipation |
| What is the fecal impaction cycle? | impaction blocks the normal stool and then more stool is hardened |
| How do you treat fecal impaction | enemas or digital removal of stool |
| What is an enema? | the introduction of a solution into the rectum to soften feces, distend the colon and stimulate peristalsis and the evacuation of feces |
| What kind of enemas are there? | cleansing, retention or return flow |
| cleansing enema? | promote removal of feces from the colon |
| Retention enemas? | introduces a solution into the colon that is meant to be retained for a prolonged period |
| What are carminative enemas? | used to help expel flatus and relieve bloating and distention |
| Medicated enemas? | used to instill antibiotics to treat infections in the rectum or anus or to introduce anthelminthic agents for treatment of intestinal worms or parasites |
| nutritive enemas | administer fluid and nutrition for pt's that are dehydrated and frail |
| What are return flow enemas? | used to help patient expel flatus and relieve abdominal distention |
| hypertonic enemas are ______ to the intestinal mucosa? | irritating and cause rapid evacuation |
| where should a solution container for an enema be placed? | no higher than 30 cm or 12 inches above the rectum for an adult or 7.5 cm or 3 inches for children |
| What is digital removal? | breaking up the hardened mass into pieces and manually extracting the pieces with your fingers |
| What occurs when the vagus nerve is stimulated? | heart rate slows |
| flatulence | when gas is excessive or leads to complaints of abdominal distention, cramping or discomfort |
| In severe flatulence what can a nurse do? | insert a rectal tube to aid in elimination |
| bowel incontinence | inability to control discharge of feces and flatulence |
| When should the fecal pouch be changed? | when it is 1/3 to 1/2 full |
| What clients should go through bowel training? | people with chronic constipation, impaction or bowel incontinence |
| What is bowel training? | gradually increase fiber, increase fluids, initiate a designated uninterrupted time for pooping, provide privacy, develop a staged treatment plan |
| What is the goal of ostomy care? | for the patient to assume self care |
| Healthy stoma should be: | PMS Pink, Moist, Shinny |
| What does a black stoma mean | necrosis |
| What does a blue stoma mean? | ischemia |
| Can stomas in the descending colon be controlled? | No, as they are liquid |
| Can stomas in the descending or sigmoid colon be controlled? | Yes, and colostomy irrigation is a means to control evacuation and possibly eliminate the need to wear a ostomy pouch |
| colostomy irrigation | similar to an enema, a tube is put into the stoma and evaluate poop |
Created by:
lydia.koo
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