Elimination Flashcards
Bowel How waste is eliminated?
1
Q
atony
A
lack of normal tone or strength
2
Q
borborygmi
A
a gurgling /splashing sound normally heard over large intestine
3
Q
bowel diversion (ostomy)
A
divert the bowel to an opening in the abdomen where a stoma is created.
4
Q
carminative
A
a agent that helps to prevent gas formation in the gastrointestinal tract
5
Q
cathartic (purge hint)
A
an agent that causes catharsis evacuation of the bowel.
promotes soft to watery stool with cramping
6
Q
chyme
A
the mixture of partly digested food and disgestive secretions found in the stomach and small intestine during digestion of a meal.
7
Q
constipation
A
decrease in normal frequency of defecation accompanied by difficult or incomplete .
8
Q
defecation
A
evacuation of the bowels
9
Q
diarrhea
A
passage of loose, unformed stools.
10
Q
enema
A
the introduction of solution into the rectum and colon to stimulate bowel activity and cause emptying of lower intestines.
11
Q
flatulence
A
excessive gas in the stomach and intestines
12
Q
flatus
A
gas in the digestive tract
13
Q
haustra
A
one of the sacculations of the colon caused by longitudinal bands of smooth muscle that are shorter than the gut
14
Q
hemmorrhoids
A
veins of the internal or external hemorrhoidal plexus and the immediately surrounding tissues.
15
Q
impaction (fetal)
A
constipation caused by a firm mass of feces in the distal colon or rectum
16
Q
Incontinence
A
loss of self control of urine/feces/semen
17
Q
Laxative
A
a food/chemical substance that acts to loosen the bowels and prevent or treat constipation.
18
Q
Melena
A
Black tarry feces caused by the digestion of blood in the gastrointestinal tract.
19
Q
Purgative
A
an agent that will stimulate the production of bowel movements
20
Q
Stool
A
Evacuation of the bowels,
21
Q
Tympany purpose
A
abdominal tention with gas.
22
Q
Elimination occurs through…… (4)
A
-Skin: Perspiration
* Lungs: Water Vapor
* Bowels: Feces
* Kidneys: Urine
23
Q
_______________ relaxes to allow the food to pass into the stomach. It prevents acidic stomach contents from flowing back into the esophagus.
A
The cardiac sphincter (also called the gastroesophageal sphincter)
24
Q
The small intestine purpose :
A
digestion and absorption of food occur in the small intestine
25
The_____________ is the ________ section of the small intestine. Its main job is....
The ______________ is the _____________ of the small intestine. Its major function is to.......
The ___________ joins the _____________. It is responsible ......
duodenum / first/ processes chyme by mixing it and adding enzymes.
jejunum/ midsection/ Its major function is to absorb carbohydrates and proteins. Its major function is to absorb carbohydrates and proteins.
ileum/ small + large intestine/ for the absorption of fats; bile salts; and some vitamins, minerals, and water.
26
The colon ....
secretes mucus, which facilitates smooth passage of stool, and absorbs water, some vitamins, and minerals. Approximately 80% of the fluid that enters the colon is reabsorbed along its passage.
26
Haustra
normal pouches of colon that occur when longitudinal
26
Peristalsis
continues throughout the length of the large intestine, where it propels intestinal contents toward the rectum and anus.
26
Hemorrhoids
Chronic pressure on the veins within the anal canal, as with prolonged sitting or retained feces, can cause hemorrhoids (distended blood vessels within or protruding from the anus).
27
During the first few days of life, the term newborn passes __________
meconium; Meconium is green-black, tarry, sticky, and odorless
28
Valsalva maneuver
increase the pressure to expel feces by contracting the abdominal muscles (straining) while maintaining a closed airway
29
If passage through the colon is slowed, _________ is reabsorbed from the feces. The stool becomes dry and hard, requiring more effort to pass.
If passage through the colon is faster than normal,
_________ is reabsorbed, and stools are watery.
more water
less water
30
Children Stages to defacate (3 key points)
-must be aware of the urge to defecate.
-be able to maintain closure of the external anal sphincter while getting to the toilet,
- be able to remove clothing.
31
When the colon must repeatedly move highly compacted fecal material, the longitudinal and circular muscles enlarge over time. This increases force on the mucosal tissues, causing them to “balloon” out between the muscles and to form small sac-like pouches in the mucosa, in which fecal matter becomes trapped is callled_________
Diverticulosis
32
An ileostomy
brings a portion of the ileum through a surgical opening in the abdomen, bypassing the large intestine entirely.
Because most of the water is absorbed from the feces in the large intestine, drainage at this level is liquid and continuous. The patient must wear an ostomy appliance at all times to collect the drainage.
33
bowel diversion:
a surgically created opening for elimination of digestive waste products. A client with a bowel diversion does not eliminate via the anus
34
A colostomy
is a surgical procedure that brings a portion of the colon through a surgical opening in the abdomen
35
The closer the colostomy is to the ascending colon and the ileocecal valve , the more____________
Colostomy close to the sigmoid colon will produce ____________.
liquid and continuous the drainage will be.
solid feces.
36
Normal bowel sounds :
Hyperactive bowel sounds are :
Hypoactive bowel sounds are:
Absent bowel sounds:
high pitched, with approximately 5 to 15 gurgles every minute.
VERY high pitched and more frequent than normal. They may occur with small bowel obstruction and inflammatory disorders. They indicate hyperperistalsis, which can result in diarrhea.
sounds are low pitched, infrequent, and quiet. A decrease in bowel sounds indicates decreased peristalsis, which can result in constipation.
If you hear no bowel sounds after listening in a quadrant for 3 to 5 minutes, you should listen in several areas before describing them as absent. Absent bowel sounds indicate a lack of intestinal activity, which may occur after abdominal surgery and may indicate a paralytic ileus.
37
Describe the sound you would hear for a client with constipation.
Hypoactive bowel sounds
38
The nurse knows that most nutrients are absorbed in which portion of the digestive tract?
a. Stomach
b. Duodenum
c. Ileum
d. Cecum
ANS: B
Most nutrients are absorbed in the duodenum with the exception of certain vitamins, iron, and salt (which are absorbed in the ileum). Food is broken down in the stomach. The cecum is the beginning of the large intestine
39
Where should the nurse begin auscultating bowel sounds?
RLQ
40
order of abdomen assessments?
IAPP
41
Peroxidase
an enzyme present in hemoglobin.
42
Bowel Incontinence
Objective Data:
Subjective Data:
Objective Data:Patient soiling linen or clothes.
Subjective Data:Patient may or may not recognize the occurrence of bowel movement due to mental status.
43
List assessment findings indicate that the patient has hyperactive bowel sounds? ( 4)
-Occurs greater than 30 gurgles/min
-Loud growling.
-High-pitched.
- They may occur with small bowel obstruction and inflammatory disorders. (They indicate hyperperistalsis, which can result in diarrhea.)
44
Bowel Elimination (subjective)
Subjective data:Ask the client about:
a. Normal bowel habits, diet, sufficient fiber/fluids? Exercise? Weight: loss or gain? Perceived constipation -- client self-prescribes the use of laxatives, enemas, etc. to ensure a daily BM.
b. Change in bowel habits:
* c/o pain, distention
* flatus (gas)
* eructation (burping)
* stools: description, frequency
* pruritus (itching) in rectal area
c.Appetite changes
* Anorexia or NPO, nausea, vomiting, dyspepsia or pyrosis (indigestion or heartburn).
* odynophagia (painful swallowing), dysphagia (difficulty swallowing)
d.Note medications: Rx & OTC
e.Travel history (See table in Lewis text for good questions to ask R/T GI health history.)
45
Objective data for bowel elimination (6)
a. Height & weight
b. Condition of oral cavity: lesions, thrush, condition of teeth & gums, mouth odor, sordes (crusts), taste
sensations, ability to swallow & move tongue, dysphagia
c.Altered means of ingestion: G-tube, J-tube, N/G, Gastrostomy, etc.
d.Abdominal assessment: Refer to SLWB, abd girth
e. Note stool size, shape, amount, color, consistency (watery, formed, soft, hard, containing mucous), and frequency
f. Examine rectal area for lesions -- Hemorrhoids, anal fissures or slits; rashes
46
distinguish between constipation and perceived constipation.
....
47
Constipation ....
Because frequency of bowel elimination varies, constipation is usually defined as a decrease in the frequency of BMs resulting in the passage of hard, dry stool. Constipation can be a temporary problem wherein symptoms resolve in a short time. Nearly everyone experiences constipation at some point.
48
Nursing Interventions
a. asesses
b. adminstier anti-diarrheal
c. Replacement fluids
d. assess peri/anal area
e. HT stress reduction / diet restrictions
f. weekly weight
g. prune juice, hot liquids
49
Assist With Positioning Ways (five ways)
1. An upright seated or squatting position is the most comfortable for defecation and decreases the need to strain.
2. When possible, assist the patient to the bathroom to use the toilet.
3. Place a bedside commode next to the bed for patients who are unable to ambulate to the bathroom.
4. A patient who must remain in bed should assume a semi-Fowler position to use the bedpan. Patients who are unable to assume this position because of surgery, trauma, or other medical conditions must use supine or side-lying positions. These positions are unnatural for bowel elimination and place the patient at risk for constipation.
5.Raise the siderails or provide an overhead trapeze so that the patient can grip them to maneuver on and off the bedpan.
50
Adding fiber does not help to relieve opioid-induced constipation unless the patient’s current intake is actually deficient.
T or F
T
51
Support Healthful Intake of Food and Fluids ( 4)
1. Diet teaching. Teach clients the importance of a balanced diet in promoting soft, formed, regular BMs.
2. Ample fiber. Encourage fiber to attract water into the stool, and promote peristalsis. The diet should be rich in fresh fruits and vegetables (especially raw), whole-grain foods, flaxseeds, popcorn, dried beans, peas, and legumes.
3. Adequate fluid. Without adequate fluid intake, a high-fiber diet can actually cause constipation. . I
4. Water is preferred. Water is the preferred fluid because soda, coffee, and tea often contain caffeine or additives that promote diuresis. However, because the diuretic effect of these fluids is minimal, they are acceptable for clients who simply will not drink enough plain water.
52
Use the following interventions to help clients manage flatulence:
Teach clients to be aware of and avoid foods that trigger flatulence.
Teach clients to follow self-care strategies (identified earlier) for maintaining regular BMs.
Encourage patients who have had surgery with gaseous anesthesia to ambulate and perform bed exercises to stimulate peristalsis and the passage of gas.
In severe cases, you may need to insert a rectal tube to aid in the elimination of flatus
53
Teach clients to see their primary care provider for the following reasons if a symptom lasts longer than 3 weeks or is disabling: (4)
Blood in the stool (unless they have hemorrhoids and this is not an unusual occurrence for them)
Severe stomach pain
Change in bowel habits
Unintended weight loss
Constipation that is not relieved after trying fiber, fluids, and exercise
54
The BRAT
bananas, rice, apples, toast) diet is often recommended for patients suffering from diarrhea or the stomach flu. In addition to these foods, you may also consume other mild foods that ease the GI tract such as saltines, oatmeal, or boiled potatoes.
55
C diff
micro organism/ very contagious
56
A “high” enema .
attempts to clear as much of the large intestine as possible.
With a “high” enema, the client receives initial instillation of the fluid in the left lateral position. The client then moves to the dorsal recumbent position and then the right lateral position for the remainder of the instillation. This turning process allows the fluid to follow the shape of the large intestine.
57
Medicated enemas may be used to :
Nutritive enemas administer:
instill antibiotics to treat infections in the rectum or anus or to introduce anthelminthic agents for treatment of intestinal worms and parasites.
fluid and nutrition through the rectum for patients who are dehydrated and frail. They are most commonly used in hospice care as a means to provide hydration for dying patients.
58
Medicated enemas
Nutritive enemas
instill antibiotics to treat infections in the rectum or anus or to introduce anthelminthic agents for treatment of intestinal worms and parasites.
administer fluid and nutrition through the rectum for patients who are dehydrated and frail. They are most commonly used in hospice care as a means to provide hydration for dying patients.
59
Cleansing enemas
promote removal of feces from the colon
60
A return-flow enema__________
For adults:
used to remove intestinal gas and stimulate peristalsis.
approximately 100 to 200 mL (3 to 7 oz) of tap water or saline is instilled into the rectum
61
Hypotonic Enema :
a. What's the mixture
b. action
c. how long does it take
d. effects (think about solutions)
a.500–1,000 mL of tap water/ soap suds use luke warm water
b.Large volume distends the colon, thereby stimulating peristalsis; Water also softens stool.
c.15 minutes until bowel movements
d. Fluid and electrolyte imbalance, especially water intoxication, is possible if enema is not expelled.
&
Large-volume solutions may be contraindicated in patients who have weakened intestinal walls.
62
Isotonic
EXAMPLES
ACTION
TIME UNTIL BOWEL MOVEMENT
ADVERSE EFFECTS
500–1,000 mL of normal saline (0.9% NaCl solution)
Large volume distends the colon, thereby stimulating peristalsis; some softening of stool also occurs.
15 minutes
Fluid and electrolyte imbalance, especially sodium retention
63
Hypertonic
EXAMPLES/Uses
ACTION
TIME UNTIL BOWEL MOVEMENT
ADVERSE EFFECTS
90–120 mL, (3–4 oz), of sodium phosphate (e.g., Fleet) for adults; available as a commercially prepared solution/ constipation
pulls water into rectum, to stimulate peristalsis and defecation.
Rapid acting: 5–10 minutes
Sodium retention
Hypertonic solutions may be contraindicated for patients who tend to retain sodium or water (e.g., those with renal failure and congestive heart failure).
64
identify the factors that affect bowel elimination.
● Age
● Stress
● Dietary intake
● Fluid intake
● Activity
● Medications
● Surgery
● Anesthesia
● Pregnancy
● Pathological conditions (e.g., food allergies and intolerances, diverticulosis, diverticulitis)
65
What should you discuss with your client when performing a nursing history focused on bowel elimination?
● Normal bowel pattern
● Appearance of stool
● Changes in bowel habits or stool appearance
● History of elimination problems
● Use of bowel elimination aids, including diet, exercise, medications, and remedies
66
Identify at least five independent nursing actions that you could take to encourage regular elimination in a well client.
● Provide privacy when using the bathroom
● Allow for uninterrupted time to defecate, especially after meals
● Teach the client to do the following:
● Assume a seated or squatting position when attempting to have a BM
● Drink at least 1,500 mL (preferably 8 to 10 glasses, or 2,000 to 2,400 mL) of fluid per day
● Exercise 3 to 5 times per week
67
How do hypotonic and isotonic enemas differ from hypertonic enemas?
● Hypotonic and isotonic enemas are large-volume enemas. The volume causes intestinal distention and leads to rapid evacuation of stool.
● Hypertonic enemas are smaller volume. The hypertonic solution attracts water into the colon, causing distention and stimulating peristalsis and defecation. Patients are usually able to retain hypotonic and isotonic longer than hypertonic solutions. Hypertonic solutions are more irritating to the mucosa.
68
What actions can you take to make the patient more comfortable when he receives an enema?
● Explain the purpose of the enema and what the patient can expect.
● Always provide privacy when administering an enema.
● Reassure the patient that you will be immediately available to help the patient to the restroom or onto the bedpan.
● Lubricate the tip of the enema and administer the solution slowly.
● Have the patient breathe slowly through the mouth.
69
Osmotic Laxatives
a. uses
b. action
c. example
a.acute constipation, chronic consipation/bowel preps for surgery
b.pulls water into bowel/intestines. salts and saline products , contain sodiumm or mg
c. lactulose
70
Stimulant laxatives
b.action
c. example
a. Irritate sensory nerve endings ...are bowel irritants. They irritate the intestinal wall, stimulating intense peristalsis. ( 6-12 hrs)
b. castor oil /bisacodyl cascara
71
Bulking agents (examples)
are nonfoods, high in fiber. They must be combined with sufficient fluid intake to be effective. The fiber attracts fluid into the colon, and the increased bulk of the stool stimulates the urge to evacuate.
Examples: Metamucil, Citrucel, psyllium, FiberCon.
72
Emollients Laxative:
a. uses
b. action/ issues if there
c. examples
a. Lubricant laxatives
b. coat the stool and the GI tract with a thin waterproof layer. Because the lubricant coats the entire GI tract, it may interfere with the absorption of nutrients.
c. Mineral oil , Docusate Calcium + sodium and casantharnol
73
Psyllium (Metamucil)
__________Forming
Bulk
74
Methylcellulose (Citrucel)
_______ Forming
Bulk
75
catharsis
a prompt, fluid evacuation of the bowel
76
*What is the primary mechanism of action of bulk-forming laxatives? Why is transit through the intestine hastened?
agents swell in water to form a viscous solution or gel, thereby softening the fecal masss and increasing its bulk. Fecal volume may be further enlarged by growth of colonic bacteria.
swelling of the fecal mass stretches the intestinal wall, thereby stimulating peristalsis.
77
The nurse is preparing to provide the patient with methylcellulose (Citrucel). The patient asks the nurse how this type of laxative works. The nurse correctly states that this laxative is known as a(n) _________________ laxative and works by __________________.
a. bulk-forming; functioning as dietary fiber
b. osmotic; retaining water and softening the feces
c. stimulant; stimulating peristalsis
d. surfactant; softening the feces
a
78
What is the main mechanism of action of surfactant laxatives?
alter stool consistency by lowering surface tension, which facilitates penetration of water into the feces
79
The nurse is providing education for a patient taking bisacodyl (Dulcolax) tablets daily. Which statement by the patient best demonstrates the need for further teaching?
a. "I should swallow the pill intact."
b. "I should take the pills with milk or dairy products."
c. "Most people take the pill at bedtime, with good results in the morning."
d. "The pill will be effective within 6 to 12 hours."
b
80
Name a common brand of the laxative salt, magnesium hydroxide ( think about evaluation )
Dulcolax milk of magnesia
81
Carminative
Provides relief from abdominal distention caused by flatus.
82
A nurse is preparing an older adult patient for an enema. The nurse should assist the patient to which of the following positions?
Left lateral with right leg flexed
83
While a nurse is administering a cleansing enema, the patient reports abdominal cramping. Which of the following is the appropriate intervention?
Lower the enema fluid container
84
Clay color poop indicates
lack of bile
85
Black/tarry poop indicates
UPPER GI BLEEDING
86
Bloody (bright red) indicates (REMEMBER PATHO)
LOWER GI Bleeding
87
PUS POOP indicates
infection
88
Higher fiber diet consists of and helps with :
fruits/veggies/whole grains/beans
helps with bulking up stool.
89
Bulkier Foods feces help..........
help increases pressure on intestinal wall. Moving it more quickly.
90
Medications that can cause constipation .... (3)
Opioids / iron/ aluminum
91
C -Diff (Define/S&S/ Steps)
results following treatment with broad spectrum ATB
ATB kills/disruption the normal flora of colon, causing C-Diff organism to flourish.
S&S: diaherra/ mucous/ EXTERMELY FOUL/ cramping
can lead to dehydration and death.
Steps: wash hands with soap and water, cleanses all surfaces wth disinfects.
92
Foods and Drugs to avoid before occult test
at least four days prior to the test include red meat, liver, salmon, and tuna.
like aspirin or iron should be avoided for seven days before obtaining a stool specimen for occult blood.
93
When testing for occult blood:
we are looking for blood that is hidden in the stool and cannot be visibly seen
94
Suppositories:
designed to melt at body temperature, should be inserted with a gloved hand, lubricated, and placed into the rectum.
95
Bowel incontinence (define)
*Patients with bowel incontinence should be___________
is the inability to retain bowel in the rectum, often related to aging or neurologic diseases.
placed on bedpans during predicted incontinent times and have a strict skin regimen.
96
Feces percetnage
75% water, 25% solid materials
97
dyspepsia (PEP)
pyrosis
odynophagia ( OWWW)
dysphagia (DDDD)
indigestion
heartburn
painful swallowing
difficulty swallowing
98
