L5+6 Fecal Flashcards by Chun Wing Wong

Physiology of faecal elimination
Large intestine
Rectum…

Large intestine
1.Absorb water and nutrient
2.Fecal eliminate

Rectum+canal
1.Internal muscle—) involuntary muscle
2.External muscle—) voluntary muscle
3.Defecation—) expulse feces from rectum

External sphincter relax—) expulsion of faeces( contraction of abdominal muscle)

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Faeces physiology

1.Soft but formed (75% water)
2. Brown colour due to bilirubin
3.microorganism’s action in faeces leads to odour
4.normally fart 13-21/day

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Adult faeces normal abnormal

Adult
1.colour brown vs clay or white
2. Consistency formed, soft, moist vs hard & dry
3.shape cylindrical vs narrow, pen shape
4.amount 100-400g
5. Aromatic: depends on food vs pungent(勁）

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Factors affecting defecation

1.development
2.Activity
3.Diet
4.fluid intake/ output
5.psychological factors
6.daefecation habit
7. Medication
8.diagnostic procedures
9.surgery
10.pathologic conditions
11.pain

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Development of faeces

Infant:
1.Meconium: first stool after born <24h
Transition stool: after a week— greenish yellow
2.Immature intestine: cannot well absorb water: watery stool, soft and liquid
3.Breast feed: light yellow to golden feces
Formula: dark yellow to yellow green feces
Less frequent and dryer after intestine mature
4.control of daefecation starts at 1.5-2
5. 17% older adult suffer from constipation

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Activity factors affect daefecation

1.activity stimulate peristalsis
2.weak abdominal and pelvic muscle are often ineffective in defecation

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Diet affecting daefecation

1.insoluble fibre promotes movement of faeces thru digestive system.
2.drink enough water as fibre work best with water
3. Regular diet helps in regulating peristalsis action in colon
4. Spicy food can produce Diarrhea and flatus
5.constipation-food: egg, pizza, lean meat
6.laxative food: sugar, chocolate, alcohol
7.hard feces with less water intake or excessive output
8.move too quick=watery

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Psychological factors

Anxious or angry: diarrhea
Depress: contipation

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Defecation habit related defecation

1.Early bowel training can establish the habit of defecating at a regular time.
2.person ignore urge to defecate—) water continue to dry up—) dry stool
3. Reflex to shit is weaken when keep ignore

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Medication related to shit

Drugs cause constipation: morphine, codeine
Drugs cause diarrhea
Laxatives: stimulate bowel
Lomotil: suppress peristalic activity
D rug cause GI bleeding will cause red stool, black

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Surgery

Surgery related to GI tract can cause stopped bowel movement which last 24-48hr

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Pathological

1.Spinal cord & brain injury can decrease stimulation of defecation
2.impaired mobility may decrease the urge of defecation—) constipation

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Pain

Feeling of pain( hemorrhoid injury) will suppress shit

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Constipation
Cause of defecation

Headache
Anorexia, nausea
Abdominal pain, cramp
Decreased defecation
Hard dry stool
Painful defecation

Cause:
1.insuffcient fluid intake
2.insufficient fibre intake
3.insufficient activity/ mobility
4.irregular defecation habit
5.ignoring urge to defecate
6.lack of privacy
7.depression

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Fecal impaction(積屎）
factors
Treatment

Too much hard shit
Abdominal distend
Anorexia, nausea, vomiting

Treatment
Oil retension enema
Suppositories
Manual removal

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Diarrhea

Fatigue, weakness
Hard or impossible to control the urge of defecation
Spasmodic cramp
Increase bowel sound
Unformed stool or liquid

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Bowel incontinence

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Loss of ability to control fecal
Partial incontinence: cannot control flatus or minor soiling
Major incontinence: inability to control feces
Reason: impaired functioning of anal sphincter

Flatulence

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Action of bacteria in chyme
Air defuse in blood stream
Air swallowed

Food
Infection
Medication
Surgery

Ostomy

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Jejunostomy
Colonostomy

Temporary colonostomy: related to traumatic injury
Allow distal diseased colon rest and heal

Permanent colonostomy: outlet of colon as colon itself loss function

Fecal elimination assesment

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Nursing history
Physical examination
Inspection of feces
Diagnosis

Nursing history- assesment

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Usual feces?
Recent bowel change?
Elimination problem?
Have ostomy?
Any factors affecting elimination pattern?
When usually have bowel movement?
Any change recently?
Describe feces: colour, texture, amount

Diagnositic study-
direct visualisation techniques
X-ray
Lab test

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Colonoscopy-viewing colon
Anoscopy- anal canal
X-ray at GI tract
Lab test: need 1” faeces
Wear clean glove
—) fecal occult blood testing

Fecal elimination problems may lead to …

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Risk of dehydration/ electrolyte imbalance

Impaired skin integrity( prolonged Diarrhea, incontinence)

Low esteem related to ostomy, fecal incontinence
Low body-image
Anxiety related to lack of control of fecal elimination

Planing related to fecal elimination

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1.promote regular defecation
2.teaching about medication
3.reduce flatulence
4.administating enemas灌腸
5.digital removal of fecal impaction
6.bowel training programs

Promote regular defecation

1.privacy 2.timing 3.nutrient & liquid 4.exercise 5.positioning

5 factors of promoting regular defecation

1. Privacy: stay with them if need Provide wiping tools for them 2.timing: request not to ignore urge of defecation 3.nutrients: less carb high fibre, less gas-producing food e.g. cabbage Constipation: increase water intake, hot or warm water Diarrhea: 8 cups of water to prevent dehydration Electrolyte drinks Potassium and sodium intake e.g. grape juice Limit fat and spicy food 4.exercise: strengthen abdominal muscle 5.positioning: difficult to sit—) elevated toilet Commode chair Bedpan from restricted client

Teaching about medication

1.Laxative CANNOT give nausea, cramp, vomiting clients 2. Inform the danger of laxatives 3.suppository best effects with 30min b4 shit and wait super want shit 4. Antidiarrheal drug 3-4 day no ok then need find cause Long term usage of OTC will cause dependence Lomotil will cause drowsiness

Administering enemas

1. Introduce and verify client 2.provide privacy 3. Explain what going on 4,explain will feel full when solution is being administered 5.request to hold shit 6.assist to hold left lateral position 7.clean glove 8.insert tube smoothly into rectum 9.ask to take deep breath when have resistance 10. Compress the container in hand 11.lying down for 5-10min

Administering suppository

1.unwrap the suppository 2.lubricate the tip of suppository 3.lubricate gloved index finger 4.encourage relax by deep breath 5.insert suppostory along the rectal wall 6. Avoid suppository embed to feces 7.remain in position from at least 5min, ard 30min then sin shit 8.assisit to bedpan or commode chair 9. Remove glove 10. Documentation

Bowel training program

1. Give suppository 2.urge then assist to bedpan or commode chair 3.provide privacy 4.teach to lean forward 5.positive feedback if successfully shitted

Setting goals

1. Fluid intake output appropriate? 2.activity level appropriate? 3.physical and emotional support provided? 4.client and family understand the medicine to comply therapy?

Physiology of urinary

250-400mL Stretch receptor transmit impulse to spinal cord when been stimulate by pressure of bladder Voluntary control of urine when 1. Nerve supplying the bladder. & urethra 2. Motor area of cerebrum works normally

Factors affecting urinary

Development Fluid intake Muscle tone Medication Pathological Surgical Psychological

Oliguria, anuria

<500 per day

Frequency of urinary

4 types of urinary incontinence

Stress urinary incontinence Urge urinary incontinence Mixed urinary incontinence Overflow urinary inconitinence

Stress urinary incontinence

Stress urinary incontinence 1. Weak pelvic floor muscle—) urine leakage when laughing, coughing or sneezing To women: 1. Shorter urethra 2. Trauma to pelvic floor e.g. childbirth 3. Change related to menopause To men: Prostatectomy切咗前列腺

Urge urinary incontinence

Reason drink too much coffee or alcohol Constipation UTI or tumour in bladder

Mixed urinary incontinence

Both stress and urgency

Overflow urinary incontinence

Cause: Neurogenic blsdder (not feeling bladder fullness) —) not anle to control sphincter when full—) involuntary urination

L5+6 Fecal Flashcards

(40 cards)