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When should a person be cautious doing the valsalva maneuver?
CV disease, glaucoma, increased IC pressure, new surgical wounds
Why is CV disease a cause for concern while doing the valsalva maneuver?
Can cause cardiac overload and cardiac arrhythmias. Basovagal response (stimulation of vagus nerve leads to a drop in BP) can cause a person to faint
Intestine has completely stopped (can occur temporarily [24-48 hrs] after anesthesia). Area dies (necrosis) and needs to be surgically removed quickly. Reason why monitoring bowel sounds every shift is important!
Individuals at High Risk for Constipation
Patients on bed rest taking constipating meds, patients with reduced fluids or bulk in their diet, depressed patients, and patients with a CNS disease or local lesions that cause pain
Abdominal Assessment (needs to be done in this order)
Skin, contour, shape, note any distention, auscultate in each quadrant
Order of listening in quadrents
Needs to listen in right lower quadrant first, then move up to right upper quadrant, across to left upper quadrant, and down to left lower quadrant
Tap on finger and note sound. Attempting to locate and determine what you're percussing over.
Bottle Fed (formula) Babies
Stool is yellow to brown, paste-like, stronger odor due to decomposition of protein, and usually occur 1-2 times/day
A high ____ diet and daily fluid intake of ____ to ____mL/day facilitate bowel elimination
Fiber, 2000, 3000
Pathologic Conditions that may cause Diarrhea
Diverticulitis, infection, malabsorption syndromes, neoplastic diseases (tumors), diabetic neuropathy, hyperthyroidism, and uremia (retention of urea in the blood)
Conditions that may cause Constipation
Diseases within the colon or rectum. Injury to, or degeneration of the spinal cord and megacolon
Opioids, antacids (not containing Mg), and anticholinergic meds ____ GI motility and can cause ____
Who is at risk of contracting C. difficile?
Patients on antibiotics, normal flora is disrupted making it easier to grow. Usually a HAC
Recommendations for a patient preparing to take a fecal occult blood test
Avoid the foods (for 4 days) and drugs (7 days) that may alter the results, postpone test until 3 days after menstruation, postpone test if hematuria or hemorrhoids are present, postpone if patient has had a recent nose/throat bleed
Examples of Cathartics
Stronger effect on intestine than laxatives. Castor oil, cascara, senna, phenolphthalein, biscodyl (dulcolax) act chemically by stimulating peristalsis. Others such as Metamucil act by increasing intestinal bulk. Mineral oil and Colace soften fecal material
The most common types of solutions used for cleansing enemas (4)
Tap water, normal saline solution, soap solution, hypertonic solution
Large Volume Enemas that result in Rapid Colonic Emptying
Hypotonic (tap water) and isotonic (normal saline solution)
Oil Retention Enemas
lubricate stool and intestinal mucosa making defecation easier. 150-200mL for adults
help to expel flatus from rectum and provide relief from gaseous distention (milk of molasses, magnesium sulfate-glycerin-water enema)
Carbon Dioxide Suppositories
Liberate about 200mL of gas which causes distention, causing stimulation and elimination impulses
How can using a suppository or daily cleansing enema be helpful in bowel incontinence?
Empty lower colon regularly and often help decrease incontinence
When are temporary ostomies used?
To allow the intestine to repair itself after inflammatory disease, some types of intestinal surgery, or injury
Internal pouch created that patient accesses through a nipple-like valve constructed from the ileum on the abdominal wall. Doesn't have to wear an external collection device, but the valve malfunctions frequently so this procedure has limited use
Terminal ileum is sutured directly to anus, pouch is created, and patient is able to control expulsion of feces through the intact anal sphincter. Has complications, candidates are carefully selected
Pouch that can be Drained (when is it emptied and replaced?)
Emptied when 1/3 full, replaced every 3-7 days
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