Bowel Elimination Flashcards
(53 cards)
Functions of GI Tract
- Prepare food for absorption & use
- Absorb nutrients and fluid
- Temporary storage of waste
- Electrolyte balancing
- Remove secretions [gallbladder, pancreas]
GI Tract Parts
- Mouth
- Esophagus
- Stomach
- Small Intestine (Duodenum, Jejunum, Ileum)
- Large Intestine
- Anus
Mouth: Function and Essential Elements
Function: mechanical and chemical breakdown
Essential Elements: Saliva, teeth, tongue, swallowing
Esophagus: Function and Essential Elements
Function: to stomach, airway protection
Essential Elements: 2 sphincters- upper and lower prevent reflux
Stomach: Function and Essential Elements
Function: storage, mixing, emptying
Essential Elements: HCL, pepsin (protein breakdown), mucous (protection, intrinsic factor (B12)
Small Intestine: Function and Essential Elements
Function: digestion and absorption of most nutrients
Essential Elements:
1. Duodenum (10”) processes chyme
2. Jejunum (8”) absorbs carbs, protein
3. Ileum (12”) absorbs H2O, fat, salts, vitamins, iron
Alterations in Small Intestine
- malabsorption
- nutrient deficiency
- electrolyte imbalance
Large Intestine: Function and Essential Elements
Function: organ of elimination Essential Elements: 1. Absorption of H2O depends on SPEED 2. Bicarb exchanged for chloride, K+ excreted 3. Essential bacteria
Anus: function and Essential Elements
Function: Sphincters
Essential Element: CNS Control
Elimination relies on:
- GI function
- CNS Control
- Sensation
- Moderate Peristalsis
Factors Affecting Elimination
- Age & Development
- Diet
- Fluid [1,500-2,000 ml/day for normal stool]
- Activity: promotes peristalsis and tone
- Psychosocial
- Position [bedbound], pain or pregnancy
- Surgery, anesthesia causes decrease in peristalsis, ileus
- Medications affecting elimination, elimination also affects medications.
Factors Affecting Elimination by Age & Development
Infant- small capacity, increase speed, no control
Older adult- low efficiency/motility/sensation
low absorption, protein synthesis, constipation
Factors Affecting Elimination by Diet
- fiber, gas-producing foods increase motility
- lack of enzyme leads to food intolerance (lactose, gluten)
Factors Affecting Elimination by Psychosocial Factors
Stress, depression, access
Privacy, cleanliness and impaired ability may lead to ignoring urge, constipation.
Embarrassment may cause delay in seeking help.
Factors Affecting Elimination by Medications
Analgesics- opioids slow peristalsis
Include: NSAIDS and ASA (irritation, bleeding, low protective mucous)
Antibiotics- disrupt flora which lead to diarrhea
How Elimination Affects Medication
Motility may affect absorption, excretion; which affects timing & effectiveness, side effects
Alterations in Elimination
- Constipation
- Impaction
- Diarrhea
- Incontinence
- Flatulence
- Hemorrhoids
- Neurogenic Bowel- lack of innervation
Surgical Alterations
- G-tubes & J-tubes for feeding
- Ostomies for elimination
- name refers to site; ileostomy, colostomy
- site determines consistency of effluent, nutritional deficiencies likely
- may be reversed or permanent
Nursing Diagnosis for Elimination
- Altered Elimination: constipation/Diarrhea
- Self-Care deficit
- Knowledge deficit
- [Risk for or Actual] Fluid/ Electrolyte Imbalance
- Pain
- Nutrition: less than body requirements r/t altered digestion, elimination, absorption
Nursing Assessment
- diet and intake
- elimination pattern “usual” and new
- bowel sounds, palpation & observation
- medications
- activity
- age
- appearance of stool:
- tarry/bright red smear- blood
- pale/clay- mucous, fatty
Goals for Elimination: Overall
Return to normal elimination pattern
-patient reports passing soft, formed stool daily w/o pain
Goals for Elimination: Short Term
Short term goals support modifiable factors
- patient will increase fluid intake to 1,500ml/day
- patient will walk to end of hall and back 3x today
Goals for Altered Patterns
- pt will correctly demonstrate ostomy care by end of week
- pt will independently perform catheter care after breakfast today
- pt will choose a nutritionally balanced diet incorporating gluten-free foods from a list
Nursing Interventions
- Promote normal elimination when possible
- position, privacy, pain management, safety - Advancing diets: clear, soft, regular
- Special diets: lactose free, gluten free, high fiber, and fluid restriction
- Activity
- Medications: laxatives, softeners, fiber, cathartics, anti-diarrheals
- Enemas
- Ostomy Care
- assessment, irrigation, change bag, skin care - NG tubes: for decompression, removal of gas/secretions, feeding, taking meds
- Bowel Training
- Education: Pt and family
- vagal response [cardiac], fluid restriction, meds, diet, new Dx, post-op, when to call M.D
