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Nursing 200 Foundations > Exam 3 BM > Flashcards

Exam 3 BM Flashcards

1
Q

What GI disease kidney disease pt usually have?

A

Anorexia and GI bleed

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2
Q

List 5 causes of pt to more likely to have constipation

A
  1. Uncontrolled DM = cause gastroparesis = decrease of food from stomach to small intestines without physical obstruction
  2. HF pts condition
  3. Older pts (due to decrease mobility, fluid and fiber intake)
  4. Barium or other types of contrast IV drinking for diagnostic procedure
  5. Pt went through a surgical procedure with anesthesia and opioids intake
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3
Q

How to know if GI have any activity?

A

If auscultation hear hypoactivity GI
Can ask pt if they burped or passed any gas

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4
Q

List 12 factors affecting BM

A
  1. Age (infants - toddler - children age - adult - geriatric)
  2. Fluid and intake
  3. Physical activity
  4. Pathological conditions
  5. Pain
  6. Medications and laxatives
  7. Position during defecation
  8. Personal habits
  9. Diagnostic testing
  10. Surgical operations
  11. Psychological factors
  12. Pregnancy
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5
Q

Do infants have immature GI that causes soft stool and involuntary?

A

Yes

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6
Q

True or false: at toddler age, they have neuromuscular development, so they are aware of privacy and when having a BM but still need potty trained?

A

True

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7
Q

How is school age children vs adult in BM?

A

Same awareness and behavior as adult but still need to encourage them because they tend to be not getting up or not going on urge when playing.

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8
Q

What is the benefit of physical activity to GI?

A

Increase in GI peristalsis = Helps to eliminate waste and absorb food nutrients better

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9
Q

What 3 medications can lead to diarrhea?

A

Antibiotics, lactulose, laxatives & cathartics (if abusing because of habit forming)

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10
Q

What 4 medications can cause constipation?

A

Opioids, acids, iron meds, (antidiarrheal meds)

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11
Q

What 3 diagnostics testing can affect GI?

A

Endoscopy, barium swallowing CT scan, X-ray

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12
Q

Describe position can help better BM?

A

Knees higher than butt, pressure on the abdomen by squad sitting position slight leaning forward, thigh constricts = straighten angle of the anal canal & rectum = easier to have BM

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13
Q

Range of fiber intake?

A

24-38 g/day, depends on gender, sizer, occupation of a person

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14
Q

Does surgery and anesthesia cause decrease in GI mobility because it blocked PNS?

A

Yes

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15
Q

True or False: pt with depression = more likely to have constipation: pt with anxiety, stress = more likely to have BM or diarrhea

A

True

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16
Q

Do pregnancy at third semester tend to have constipation?

A

Yes

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17
Q

Why pain cause constipation?

A

Pt might refrain bc of pain so avoid to go. Or when using narcotics/pain meds causing hard to go bc they decrease in GI.

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18
Q

Describe constipation

A

Having less than 3 BM/week. Tend to cause excessive straining

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19
Q

When applied pressure to a closed glottis, what happened?

A

Cause vasovagal response called valsalva maneuver = cause bradycardia & syncopal episodes (fainting)

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20
Q

What do hospital give when pt having constipation?

A

Commonly laxatives or prune juice

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21
Q

List 3 effective ways for constipation implementation

A
  1. Encourage fluid, fiber intake and mobility
  2. Provide environment that is relaxing and comfortable
  3. Less narcotics intake
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22
Q

Define impaction

A

Is unrelieved constipation, hard feces that has soft oozes around it.

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23
Q

Cause of impaction (hint: give 3 causes)

A
  1. Cause of narcotics/opioids intake
  2. Decrease in fluid, fiber intake and decrease in mobility
  3. Anticholinergic, antihistamine meds (bc they decrease in GI activity)
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24
Q

2 ways to treat impaction

A

Can do enemas or manual/digital disimpaction

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25
Q

Define diarrhea

A

Involuntary spasmodic cramps that is associated with GI disease.

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26
Q

Give 4 causes of diarrhea

A
  1. Antibiotics
  2. Irritating food like spicy food; contaminated food or fluid
  3. Lactulose
  4. C.diff
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27
Q

2 implementations for treatments of diarrhea?

A

Give fluids for dehydration status
Give antidiarrheal meds

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28
Q

Define incontinence

A

It is the inability to voluntarily control the passage of feces and flatus

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29
Q

3 causes of incontinence

A

Anal sphincter problems
GI disease
Nerve impairement

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30
Q

Define flatulence

A

Accumulation of gas due to swallowing of gas or due to production of gas from bacteria in the GI tract

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31
Q

2 Treatments of flatulence

A

Antiflatulence
mobility

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32
Q

Define hemorrhoids

A

Vasodilation of the Gorge veins in the rectum that can be internal or external. It will cause discomfort/pain when having a BM.

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33
Q

3 Causes of hemorrhoids

A
  1. Straining
  2. Pregnancy
  3. Heart and liver disease
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34
Q

Treatment of hemorrhoids

A

Can give a sitz bath and give topical vasoconstriction meds like prep H (however this can cause pruritis, so can give 1% hydrocortisone cream for externally only)

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35
Q

What is bowel diversions?

A

A different passageway of feces than traditional way through surgery by creating a stoma

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36
Q

Causes of bowel diversions

A

Colon cancer, anus/rectum cancer, perforated bowel, knife/trauma to the abdomen, diverticulosis, other GI disease

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37
Q

True or false: stoma should be red, beefy, moist, no bleeding and no sensation

A

True

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38
Q

Is post op edema normal?

A

Yes. Around 1-3 cm above skin = normal

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39
Q

How long is temporary stoma?

A

6-12 months

40
Q

3 problems with stoma

A
  1. High output
  2. Ischemia of stoma
  3. Retraction, prolapse, and hernia of stoma
41
Q

3 locations of stoma

A

Jejunostomy, ileostomy, colostomy

42
Q

List 4 types of colostomy

A

End colostomy, double-barrel colostomy, loop colostomy, divided colostomy

43
Q

What is end colostomy?

A

End colostomy is a surgical procedure that is done mostly because of anal/rectum cancer or sigmoid/part of the descending colon.
Temporary = if anal/rectum is being left behind, can shut or open, can restore back.
Permanent = if anal/rectum is removed too, mostly end colostomy is permanent

44
Q

Is the proximal end always the one that has effluent out?

A

Yes

45
Q

What is loop colostomy?

A

Usually temporarily, emergency cases where there’s injury to the abdomen. There is a support structure to connect and support the two openings.
Distal end opening might or might not have discharge come out = same with might or might not have discharge come out of the anus/rectum (usually rectum/anus in loop colostomy is not shut)

46
Q

True or False: loop colostomy is bulky and easier to apply than end colostomy

A

False

47
Q

Divided colostomy define

A

2 openings separated with no connection like loop colostomy due to part of diseased/cancer of the colon.
Again, proximal end = appliance on the stoma
Distal end = might or might not have discharge out, can put appliance on if needed, but not going to have effluent out of this opening.

48
Q

What is double-barrel colostomy?

A

A surgically sewn two openings together creating something that has image like a two holes of the gun. Rare but some pt still do this.

49
Q

Is more distal the stoma is, the more formed it is going to be. This is the same way around where the more proximal stoma it is, the more stool is liquid?

A

Yes

50
Q

What equipments nurse need to wear for caring of stoma?

A

Gloves, googles (if thinking it could splash), deodorizer (do it under the bed so pt can breath easier)

51
Q

When need to change stoma?

A

Every 5 days or per policy hospital or when leaking

52
Q

When you need to empty appliance?

A

When it becomes full, but be careful to change it when it is half full = don’t want pressure on the peristomal skin.
Sometimes, it is just gas but no effluent.

53
Q

What to assess the effluent?

A

They should be recorded in mL, should assess color, and odor (usually more pungent smell than the stool comes out of the anus)

54
Q

How much you pull up when taking the clamp of the appliance off?

A

1/2 to 1 inch up.

55
Q

Which colon can nurse irrigate?

A

Only when it is sigmoid or descending colonoscopy

56
Q

Is it ok to keep the equipments of pt ostomy care in the room?

A

Yes

57
Q

What to use to compare stoma to apply for appliance called?

A

Pattern

58
Q

How many inches larger should I cut the appliance for the stoma?

A

1/8 inches larger = to prevent break down, irritation of the appliance to the stoma

59
Q

Which side nurses put for the appliance?

A

If nurse taking care of= lay on the side of the abdomen, towards the floor
If pt takes care themselves, then towards their feet = easier for them to empty the appliance.

60
Q

Types of common ostomy bags (hint: 3)

A

1 piece ostomy bag
2 piece adhesive ostomy bag
2 piece flange ostomy bag

61
Q

Steps of changing an ostomy bag?

A
  1. put towel/chucks/pads underneath the skin and the collection bag to catch any leaking falling out.
  2. Can first empty to assess effluent if needed. If need to assess, get a graduated cylinder
  3. Starting in one corner in push and pull fashion, can use adhesive wipes to slowly get the pads off. Because the stickiness can cause pain if do too quick
  4. Get gauze to catch any effluent out
  5. Use warm water towel to clean the skin and pat dry (no rubbing), then can use no-sting skin prep wipes to clean
  6. Assess and then later put in the record for physician to see
    Then use powder little bit on the peristomal skin. Then use skin barrier wipes to seal in the powder. Each pt will have different preferences.
  7. If pt like premium adhesive paste, can use that. If pt likes skin barrier strips, do that. If it is a barrier ring bc it is a two piece ostomy bag, then don’t need nothing else to secure because already have the barrier ring.
  8. Put hands in touching for 30seconds or so, to make the warmth increase the adhesive.
62
Q

What to use to remove the adhesive pads?

A

Adhesive wipes or adhesive spray for specifically peristomal care

63
Q

What to use to clean peristomal skin and get rid off the adhesiveness remained?

A
  • At hospital, can use towel soaked with warm water then pat dry (no rubbing) and then can use no-sting-skin prep wipes to clean
  • At home, can either do that or use tissues instead then use no-sting-skin prep wipes to clean
64
Q

If peristomal skin is irritating, what to do?

A

Assess and then later put in the record for physician to see
Then use powder little bit on the peristomal skin. Then use skin barrier wipes to seal in the powder. Each pt will have different preferences.

65
Q

How to secure stoma?

A

1 piece: can use skin barrier premium paste to secure and fill in the irregularities or barrier strips or
barrier ring (2 piece

66
Q

Stool that is dehydrated that cause pressure in anus describe

A
  1. Hard lump like nuts, hard to pass
  2. Sausage shape the surface very lumpy
67
Q

Is sausage stool with crackles on the surface acceptable stool normal range?

A

Yes

68
Q

Normal stool color, shape describe

A

Smooth soft sausage with variable of brown shade color

69
Q

Early signs of diarrhea, however still acceptable for some people is soft blobs with clear cut edges that is easy to pass. True or false

A

True

70
Q

Severe diarrhea stool

A

Mushy stool with ragged edges or
Even more severe is no solid piece, just liquid stool

71
Q

To make sure pt has enough nutrition to make proteins, check what?

A

Check hgb/hct level

72
Q

To check if there is GI bleeding, can do what stool diagnostic test?

A

FOBT: fecal occult blood test: need to send to the lab
Guaiac test: a test that can be done at the bedside table, must use sterile tongue depressor to scoop stool
If blue color, means positive = there is blood in stool

73
Q

What to make sure when doing ova/parasites test?

A

Make sure is still warm when sending to the lab

74
Q

Other tests to see if there’s problem with GI (hint: 6 tests)

A
  1. To see if stool is fat: can do test steatorrhea
  2. To check if liver is doing well: test ALT and AST
  3. Can look at the pancreas: test amylase and lipase
  4. CEA- carcinoembryonic antigen
  5. CT scan, ultrasound, MRI of the abdomen
  6. Upper and lower endoscopy or ERCP (endoscopic retrograde cholangiopancreatography)
75
Q

Describe steatorrhea (fatty stool)

A

Tend to be looser, smellier and paler in color like clay. And they tend to float.

76
Q

Cause of steatorrhea. Which system is affected? Give 4 systems

A

Problems with bile ducts (maybe blockage) or gallstone problems (forty, fat, fertile, female)
Problems with small intestines- malabsorption: not breaking down and absorb fats properly
Problems with liver or pancreas disease because not sending enough or the lack of digestive enzymes to the small intestines

77
Q

Brown color stool indication

A

Normal pigmentation of stool (as expected) resulting from the chemical changes of the bilirubin (breakdown of red blood cells)
Light to dark brown color is fine. Smell is aromatic not pungent, cylindrical form

78
Q

Green (some yellow shade) color stool indications

A

Eating too much vegetables like spinach
Malabsorption due to decrease in bile or food passing through too quickly so bile or other digestive enzymes don’t have time to break down

79
Q

Red color stool indication

A

Due to lower GI bleeding or rectum bleeding (fresh blood)

80
Q

What is red stool called

A

Hematochezia

81
Q

Yellow color stool indication

A

Small bowel infection like Giardia
Can mean hyperactive bowel
Malabsorption (maybe pancreatic disease)

82
Q

Blue color stool indications

A

Can indicate illnesses in babies or eating foods that contain blue dyes.

83
Q

White color stool indication

A

Intake of pesto bismol and barium at the same time
Often cause of lack of bile (can be liver or biliary tract disease, gallstones)

84
Q

Black stool indications

A

Upper GI tract bleeding that has a distinct smell to it

85
Q

Black/ coffee grounded/tarry stool name

A

Melena

86
Q

What is the regular time do you schedule BM with your pt?

A

Before or after breakfast, or after a cup of coffee

87
Q

Is pt having different trigger to have BM like hot drinks, at night, or in the morning or certain meds?

A

Yes

88
Q

Good fiber sources

A

Beans, fruits, vegetables, popcorn, oats, popcorn, almond

89
Q

Position of pt when on a bedpan in bed

A

HOB up to 90 degree. Knee gatch down all the way down.

90
Q

What to make sure before inserting the bedpan?

A

Can put powder in the edge of bedpan so it would not sticking.
Put tissue paper inside so if collect feces, it will not stuck to the surface of the bedpan

91
Q

2 examples of cathartics and what it does

A

Lactulose and sorbitol
They cause acceleration in defecation, often cause a strong pungent smell

92
Q

1 example of laxative and what it does

A

Dulcolax. It helps to ease defecation

93
Q

1 example of antidiarrheal meds and what they do

A

Lomotil. They work by slowing down the GI mobility = more time for intestines to absorb water.

94
Q

2 examples of antiflatulence and what it does

A

Simethicone, gas X. They convert larger bubbles gas into smaller gas bubbles = easier to pass

95
Q

Do we need physician order for digital removal/manual disimpaction?

A

Yes. To prevent vasovagal response and bradycardia and syncopal episodes.

Nursing 200 Foundations (17 decks)

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