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68 terms

NURS 302: Ch. 38 Bowel Elimination

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How often do peristalsis contractions occur?
Every 3 to 12 minutes
How many times in a 24 hour period do mass peristalsis sweeps occur?
1-4 times
How much food waste is excreted in stool within 24 hrs?
1/3 to 1/2
3 Things the Large Intestine Absorbs
Water, sodium, and chloride
Valsalva Maneuver
Voluntary contraction of abdominal muscles to promote defecation.
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
Paralytic Ileus
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!
Constipating Foods
Cheese, lean meat, eggs, pasta
Foods with Laxative Effect
Fruits, veggies, bran, chocolate, alcohol, coffee
Gas-Producing Foods
Onions, cabbage, beans, cauliflower
____ ____ are a big problem with constipation
narcotic analgesics
If enteral tube feeding is too fast it can lead to ____
Diarrhea
Acute Diarrhea
Virus, food cause
Chronic Diarrhea
Brought on by disease
Common Bowel Elimination Problems
Incontinence, flatulence, hemorrhoids
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
Ileostomy
Bypasses large intestine, stools are frequent and liquid.
Transverse and Sigmoid Colostomy
Further down in the large intestine, stools are more solid
Size of stoma should stabilize within ____ to ____ weeks
6, 8
Normal bowel sounds occur every ____ to ____ seconds
5, 15
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
Bowel Sounds: Absent
Problem unless it's right after surgery
Bowel Sounds: Hypoactive
< 5 sounds/minute. Could be NPO or old.
Bowel Sounds: Hyperactive
35+ sounds/minute. Not feeling well
Bowel Sounds: Borborygmous
Constant churning and sounds. N&V
Palpate
Light touch, dominant hand on top and push. Ask if it hurts, same order as auscultation.
Percuss
Tap on finger and note sound. Attempting to locate and determine what you're percussing over.
Tympanic Noise during Percussion
Empty
Dull Sound during Percussion
Mass (tumor), fecal material, bone
Hyperresonance Sound during Percussion
Gas
Occult
Blood present but not visible
Guaiac Testing
Detects microscopic (occult) blood
Who should you never give a fleet enema to?
End-stage renal patient (electrolyte issues)
If medication is causing diarrhea what should you do?
Remove the med and attempt a different med
How much liquid is absorbed daily by the intestinal tract?
800-1000mL
Daytime Bowel Control is Normally Attained by ____ months of age
30
Breastfed Babies
Stool is yellow to golden, loose, little odor, and frequent (2-10 times/day)
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
What is the number 1 cause of constipation?
Overuse of laxatives
Frequent, bulky, greasy, and foul smelling stools in a child may indicate ____ ____
Cystic fibrosis
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 ____
Decrease, constipation
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
Carminative Enemas
help to expel flatus from rectum and provide relief from gaseous distention (milk of molasses, magnesium sulfate-glycerin-water enema)
Medicated Enemas
provides meds that are absorbed through the rectal mucosa
Anthelmintic Enemas
destroy intestinal parasites
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
When are permanent ostomies used?
For debilitating intestinal diseases or cancer of colon/rectum
Continent Ileostomy
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
Ileoanal Reservoir
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
Pale Stoma
Anemia
Dark or Purple/Blue Stoma
Compromised circulation, ishemia
Pouch that can be Drained (when is it emptied and replaced?)
Emptied when 1/3 full, replaced every 3-7 days
Nondrainable Pouches (when emptied?)
1/2 full
Are ileostomies irrigated?
No, fecal content is liquid and can't be controlled
Fiber Blockages in ileostomies
Foul-smelling watery output, abdominal cramping, distention, N&V
What should you encourage a patient with an ostomy to eat to control odor?
Dark green leafy veggies (chlorophyll deodorizes)