bowel elimination Flashcards
(47 cards)
the large intestine
Primary organ of bowel elimination
Extends from the ileocecal valve to the
anus
About 5 feet long
Functions
o Absorption of water
o Formation of feces
o Expulsion of feces from the body
the small intestine
- The small intestine
(small bowel) is about 20
feet long and about an
inch in diameter. - Its job is to absorb
most of the nutrients
from what we eat and
drink.
assessment of the gi system
Health history:
o Information about abdominal pain, dyspepsia,
gas, nausea and vomiting, diarrhea,
constipation, fecal incontinence, jaundice, and
previous GI disease is obtained
Pain:
o Character, duration, pattern, frequency,
location, distribution of referred abdominal
pain, and time of the pain vary greatly
depending on the underlying cause
Pediatrics:
o Subjective: Lifestyle & Family history, Diet and
Elimination patterns
bowel habits and family history
Change in bowel habits and stool
characteristics
o May signal colonic dysfunction or
disease
o Constipation, diarrhea
Past health, family and social history
o Oral care and dental visits
o Lesions in mouth
o Discomfort with certain foods
o Use of alcohol and tobacco
o Dentures
physical assessment of the abdomen
The sequence for abdominal assessment proceeds from
inspection, auscultation, and percussion to
palpation. Auscultation must be completed before manipulation
of the abdomen because it has an impact on motility
Inspection: observe contour, any masses, scars, or
distention
Auscultation: listen for bowel sounds in all quadrants
o Note frequency and character, audible clicks, and
flatus.
o Describe bowel sounds as hypoactive, hyperactive,
absent or infrequent. (be sure to listen 2 min or longer for
absent bowel sounds)
Percussion and palpations: performed by advanced
practice professionals
inspection and palpation
Inspection and palpation
o Lesions, ulcers, fissures (linear break on the
margin of the anus), inflammation, and external
hemorrhoids
o Ask the patient to bear down as though having a
bowel movement. Assess for the appearance of
internal hemorrhoids or fissures and fecal masses.
o Inspect perineal area for skin irritation secondary
to diarrhea or fecal incontinence.
process of peristalsis
Process of Peristalsis
Peristalsis is under control of the
nervous system.
Contractions occur every 3 to 12
minutes.
Mass peristalsis sweeps occur one to
four times each 24-hour period.
One-third to one-half of food waste is
excreted in stool within 24 hours.
Intestinal gas (flatus) may occur
how much fluid should you drink per day
~2,000-3,000
ml’s of fluid
per day
variables influencing bowel inflammation
Developmental considerations
Daily patterns
Food (high fiber foods 25-30 grams) and fluid intake
o Fiber good to help lower cholesterol
Activity and muscle tone
Lifestyle
Psychological variables
Pathologic conditions
Medications
Diagnostic studies
Surgery and anesthesia
manifestations of chronic constipation
Fewer than three bowel movements per week
Abdominal distention, pain, and bloating
A sensation of incomplete evacuation
Straining at stool
Elimination of small-volume, hard, dry stools
Chronic constipation: 3-6 months or greater
complications of constipation
Decreased cardiac output
Fecal impaction
Hemorrhoids
Fissures (torn skin around anus)
Rectal prolapse
Megacolon
patient learning needs for constipation
Normal variations of bowel patterns
Establishment of normal pattern
Dietary fiber and fluid intake
Responding to the urge to defecate
Exercise and activity
Laxative use
Increase daily intake of water as a first line of prevention
foods affecting bowel elimination
Constipating foods: cheese,
lean meat, eggs, pasta
Foods with laxative effect:
fruits and vegetables, bran,
chocolate, alcohol, coffee
Gas-producing foods: onions,
cabbage, beans, cauliflower
Lactose Intolerant: cannot
tolerate dairy/milk products
o Symptoms: cramping,
diarrhea, bloating, flatulence
infants stool
Infants: Characteristics of stool and frequency depend on
formula or breast feedings.
o Stools may be yellow and loose during breastfeeding
toddlers stool
Toddler: Physiologic maturity is the first priority for bowel
training.
child adolescent and adult considerations
Child, adolescent, adult: Defecation patterns vary in
quantity, frequency, and rhythmicity.
Older adult: Constipation is often a chronic problem;
diarrhea and fecal incontinence may result from physiologic
or lifestyle changes.
older adult considerations
Test Your Knowledge!
Which food is a recommended for an
older adult who is constipated?
A. Cheese
B. Fruit
C. Cabbage
D. Eggs
Answer: B. Fruit
Rationale: Fruits and vegetables have a laxative
effect on the system. Cheese and eggs have a
constipating effect and cabbage, although a
vegetable, produces gas in the system.
preventing food poisoning
Never buy food with damaged packaging.
Take items requiring refrigeration home immediately.
Wash hands and surfaces often.
Use separate cutting boards for foods.
Thoroughly wash all fruits and vegetables before eating.
Do not wash meat, poultry, or eggs to prevent spreading
microorganisms to sink and other kitchen surfaces.
Never use raw eggs in any form.
Do not eat seafood raw or if it has an unpleasant odor.
Use a food thermometer to ensure cooking food to safe internal
temperature.
Keep food hot after cooking; maintain safe temperature of 140°F or
above.
Give only pasteurized fruit juices to small children.
effects of medications on stool
Aspirin, anticoagulants:
o pink to red to black stool
Iron salts:
o black stool
Bismuth subsalicylate used to treat diarrhea
o can also cause black stools.
Antacids:
o white discoloration or speckling in stool
Antibiotics:
o green-gray color
diarrheas affects on stool
Increased frequency of bowel
movements (more than three per day)
with altered consistency (i.e., increased
liquidity) of stool
Usually associated with urgency,
perianal discomfort, incontinence, or a
combination of these factors
May be acute, persistent, or chronic
Causes include infections, medications,
tube feeding formulas, metabolic and
endocrine disorders, and various
disease processes
manifestations of diarrhea
Increased frequency and fluid
content of stools
Abdominal cramps
Distention
Borborygmus
Anorexia and thirst
Painful spasmodic contractions of
the anus
Tenesmus (cramping rectal pain)
complications of diarrhea
Fluid and electrolyte imbalances
o Infants are most at risk
Dehydration
Cardiac dysrhythmias
Chronic diarrhea can result in skin
care issues related to irritant
dermatitis
Weight loss
assessment and diagnostic findings
Complete Blood Count (CBC)- helps to check for anemia or infection
Serum chemistries (Ex: Phosphate level)
o Results are usually normal or mildly elevated; abnormal results early in the disease are generally due to vomiting
or dehydration
Urinalysis
Stool examination
Endoscopy (EGD) or barium enema
o Helps to evaluate upper abdominal pain, nausea, vomiting, bleeding, or
difficulty swallowing
