Quiz - Bowel Management Flashcards Preview

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Flashcards in Quiz - Bowel Management Deck (34)
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1
Q

autorhythmicity

A

Rhythmic smooth muscle contraction without nervous input

nervous input is required for controlled coordination

2
Q

Describe the intrinsic nervous system of the GI tract.

A

Extends from esophagus to anus; can act independent of the nervous system.

(nervous input is required for controlled coordination)

3
Q

Which two reflexes are part of the intrinsic nervous system?

A

Gastrocolic reflex and peristaltic reflex

4
Q

What is the gastrocolic reflex?

A

Food or warm fluid entering the stomach causes reflexive evacuation of the colon (response is strongest after 1st meal of the day)

5
Q

What is the peristaltic reflex?

A

Distention initiates reflexive contraction propelling food mass down

6
Q

What is the role of the autonomic system?

A

Coordinates the bowel with the rest of the body

7
Q

Which two innervation systems make up. the autonomic system?

A

Sympathetic and parasympathetic innervation

8
Q

sympathetic innervation

A

Arises from T8-L2 and inhibits digestive functions

9
Q

parasympathetic innervation

A

Cranial and sacral (S2-4) innervation that stimulates digestive functions

10
Q

Somatic nervous system

A

Voluntary control of external anal sphincter & pelvic floor m.

11
Q

Where is the somatic nervous system innervated?

A

S2-4

12
Q

What are the two reflexes that are involved in defecation?

A

Intrinsic defecation reflex and the parasympathetic defecation reflex

13
Q

Intrinsic defecation reflex

A

Mediated by the intrinsic system that when elicited by feces entering the rectum causes relaxation of the internal sphincter and increased peristalsis in the descending colon, sigmoid, and rectum

*Not usually strong enough to cause defecation

14
Q

Parasympathetic defecation reflex

A

Required for normal defecation and is activated by a sacral spinal reflex

Once activated by filling of the rectum, it causes relaxation of the internal anal sphincter and an intensification of peristalsis in the descending colon, sigmoid, and rectum

15
Q

What is the pathway for defecation

A

Internal anal sphincter is active at rest
–>
Feces enters the rectum and the internal sphincter relaxes

At the same time, the external anal sphincter contracts to prevent unwanted defecation (not a good time, hold it!) This contraction, caused by a sacral cord reflex, is brief.
–>
Decide whether to continue or discontinue the contraction
–>
Voluntary control is dependent on sensory input and motor output (between S2-4 and cerebral cortex)
–>
Defecation involves voluntary relaxation of the external anal sphincter and pelvic floor m., close the glottis, contract the abdominals
–>
Stimulates the defecation reflex

16
Q

Bowel function after SCI

A

Acute SCI–> spinal shock 6-12 weeks –> areflexive bowel –> paralytic ileus

(risk for blockage, must be NPO until bowels cleared)

17
Q

What is paralytic ileus?

A

Build up of pressure in the small intestine due to loss of peristalsis

18
Q

What are the symptoms of paralytic ileus?

A

Absence of normal bowel sounds causing visible swelling of the abdomen and possible vomiting (can force the stomach contents up into the airways)

19
Q

What are the treatment options for paralytic ileus?

A

Nasogastric suction, NPO status (nothing by mouth), IV fluids and electrolytes

20
Q

For long-term bowl function after spinal cord injury, which of the following is/are intact: autorhythmicity, intrinsic system, autonomic system and somatic system?

A

Autorhythmicity and intrinsic system = YES
Somatic system = NO
Autonomic system = sometimes

21
Q

Describe reflexive long-term bowel function after SCI.

A

S2-4 reflex arc intact, typically SCI above T12

Defecation occurs normally via reflexes

No volitional control over timing

May not fully empty

22
Q

Describe areflexive long-term bowel function after SCI.

A

S2-4 reflex arc impaired, typically SCI below T12

Without the stronger parasympathetic defecation reflex, the bowel will not empty reflexively

High risk for feces to become impacted in the rectum

Incontinence when stool passes unhindered from the rectum

23
Q

What is the key factor that determines bowel control?

A

The integrity of the sacral arc reflexes

24
Q

GOALS FOR BOWEL MANAGEMENT

A

To condition the bowel to empty at scheduled intervals

Prevent constipation and impaction

Prevent AD

Minimize incontinence

25
Q

Describe bowel management for a reflexive bowel.

A

Accidents via reflexes

Manual removal, suppository, digit stimulation

Want stool to be formed and soft

26
Q

Describe bowel management for an areflexive bowel.

A

Impaction or accidents via mechanical means

Suppository sometimes, manual removal, abdominal contraction, laxative sometimes

Want stool firm but not hard

27
Q

What are the indications and advantages for colostomy or ileostomy?

A

Indications: severe constipation, incontinent, perianal pressure ulcers

Advantages: less manual dexterity required, decreased time for care, eliminates incontinence

28
Q

How is a colostomy or an ileostomy accessed?

A

Via a stoma that needs to be kept clean and dry

29
Q

What are the two options for FES?

A

Surgically implanted electrodes or surface electrodes on abdominal muscles

30
Q

What are some tips for a successful bowel program?

A
  1. Perform bowel program at the same time each day
  2. Large meal promotes movement via gastrocolic reflex
  3. Physical activity promotes bowel motility
  4. Use gravity and or straining if possible
  5. Lie on LEFT side (no bedpan) or sit up (preferable)
  6. Massage abdomen in direction of large intestine
  7. Good stool consistency via adequate fluid intake, high fiber diet, stool softeners, laxatives, meds
31
Q

What do OT’s have to do with bowel care?

A

Empathy, timing/schedule formation, positioning, transitional movements/transfers, manipulation skills, equipment recs, home mods, patient and caregiver education, emphasize importance of sin care

32
Q

What are some pieces of adaptive equipment that can be used for toilet transfers?

A

Drop-arm BSC (padded = better), digital stimulation commode, transfer board, shower commode w/c

33
Q

What are some assistive devices for hand function during bowel program?

A

Digital stimulator with u-cuff, suppository inserter with u-cuff

34
Q

Who else can have neurogenic bladder/bowel issues?

A

Alzheimer’s, diabetic neuropathy, MS, neuropathy, nervous system tumor, stroke recovery