bowel elimenation

gastric lavage

irrigation of the stomach

colostomy

opening a part of the colon onto the abdominal skin surface

ascites

accumulation of serous fluid in the peritoneum. Measurement of abdominal girth is an important assessment in the client with ascites. Comparison of abdominal girth measurements over time is an objective way of determining whether abdominal distention is increasing, decreasing, or remaining unchanged.

how much fluid

75% of feces is water need water 2000ml, 2500ml-3000ml a day for healthy stool

a barium and what happens

A susbstance you drink or is given via enema so doc can see xray info. if barium is administered as a test agent, the stools after the procedure will appear chalky white or tan until all of the barium has been eliminated from the gastrointestinal tract. If barium remains in the colon, it hardens and can cause impaction of stool. Therefore, laxatives are commonly ordered after the diagnostic test to facilitate barium removal.

upon discharge with a colostomy

After surgery may delay bowel movement for 1-2 days. general anesthesia can almost paralyze gi motility (peristalsis) abdominal surgery 3-4 days. sometimes exposed to air and can become "bashfull" air causes them to be difficult to get moving narcotics and long hospital stays slow down gi motility During the first six to eight weeks after surgery, the nurse should encourage the client with an ostomy to avoid foods high in fiber (e.g., foods with skins, seeds, and shells) as well as any other foods that cause diarrhea or excessive flatus. By gradually adding new foods, the ostomy client can progress to a normal diet. The nurse should urge clients to drink at least two quarts of fluids, preferably water, daily. The use of liquid, chewable, or injectable forms rather than long-acting, enteric-coated, or sustained-release medications is recommended. Laxatives and enemas are dangerous because they may cause severe fluid and electrolyte imbalance.

applying a fecal incontinence pouch

Cleanse entire perianal area and pat dry. Apply skin protectant and allow it to dry. Separate buttocks and apply the pouch to the anal area. Attach the pouch to a urinary drainage bag. Hang the drainage bag below the patient.

valsalva maneuver

Defecation is assisted by taking a deep breath against a closed glottis (to move the diaphragm down), contracting the abdominal muscles (to increase intra-abdominal pressure), and contracting the pelvic floor muscles (to push the feces downward). These actions are called When an individual bears down to defecate, the increased pressures in the abdominal and thoracic cavities result in a decreased blood flow and a temporary decrease in cardiac output. Once the bearing down ceases, the pressure is lessened, and a larger than normal amount of blood returns to the heart; this act elevates the client's blood pressure.

prolapse

During prolapse, the stoma is protruding into the bag. The nurse should have the client rest for 30 minutes and, if stoma is not back to normal size within that time, notify the physician. If stoma stays prolapsed, it may twist, resulting in impaired circulation to the stoma

2 types of movements

SEGMENTATION alternating contractions of the intestine smooth muscle, it slows the passage of content so absorption and digestion can happen PERISTALSIS= also called bowel motility. propels content along intestines both small and large, mostly at the duodendum. sympathetic system slows peristalsis

what to do in preparing a patient for a rectal exam

Tap water and normal saline solution is preferred for cleansing the bowel in preparation for a rectal examination because of its non-irritating effects

nutrition in stool

The 25% of feces that are solid comes chiefly from the intake of food that has a high cellulose or fiber content. Cellulose or fiber is contained in plant foods. Foods in the high-fiber category include fresh fruits and vegetables with the skins and intact outer coverings and cereal grains with the outer covering of bran in place. A person who consumes approximately 25 to 30 g of dietary fiber from fruits, vegetables, and grains will most likely have sufficient bulk in the stools

toddlers bowels

The duodenocolic reflex is strong in toddlers and preschoolers. Any ingestion of food may stimulate a bowel movement, and toddlers and preschoolers may normally have more than one bowel movement per day. Toddlers are curious about the products their bodies produce. It is not unusual that, at some time during toddlerhood, smearing or playing with feces will occur. In a matter-of-fact manner that does not threaten the child's self-esteem, parents and caregivers should let the toddler know that smearing feces is unacceptable. During toddlerhood, usually between 22 and 36 months, children are ready to learn voluntary control of bowel elimination normally not trained until after 22 months. normally trained by 4

irrigation of a colostomy

The purpose of irrigation is to remove formed stool and, in some cases, to regulate the timing of bowel movements. Irrigation does not affect the osmolarity of stool.

stomas

Washing the stoma and surrounding skin with mild soap and water, and patting it dry can preserve skin integrity. Another way to protect the skin is to apply barrier substances such as karaya, a plant substance that becomes gelatinous when moistened, and commercial skin preparations around the stoma. stomas should be dark pink to red and moist. Pallor may suggest anemia and a dark appearance may indicate ischemia. the wafer should be tight around the stoma without restricting blood flow bleeding may occur in small amounts due to stoma tissue fragile change ostomy when 1/4 to 1/3 full

what to do if the catheter is plugged when draining a continent ileostomy

When the catheter becomes plugged with stool or mucus, the nurse should try to rotate the catheter tip inside the stoma to clear the obstruction. The nurse could also try to milk the catheter in order to clear it. However, the nurse or client should not wait longer than 6 hours without obtaining drainage as it could lead to further complications. If all the above actions fail, the nurse should simply remove the catheter, rinse it, and try again.

gluten intolerance

a protein found in wheat, rye, barley, and buckwheat. For these people, ingestion of gluten-containing food results in the retention of carbohydrates and fats, which cannot be digested and absorbed through the intestine. can't digest gluten, The person experiences abdominal distention and a bloated feeling, along with a diarrhea of bulky, greasy stools.

diagnostic tests

at age 50 yearly colorectal screening, fecal occult tests yearly also get a flexible endoscopy every 5 years and a colonoscopy every 10 years. Fecal occult blood test, barium studies, and endoscopic examination is the correct order of the exams and tests Nurses are commonly involved in scheduling diagnostic studies when a client is to undergo multiple studies. They should follow a logical sequence when more than one test is required for accurate diagnosis; fecal occult blood tests to detect gastrointestinal bleeding. guaiac stool sample via hemoccult slide. first, apply smear of stool then close the slide over and wait 3-5 min. then open the reverse side flap and apply 2 drops of hemoccult solution onto each window and then one onto the control window. then document, if a positive guaiac comes back there is blood in stool, it is an abnormal finding hollow tympanic sounds are normal percussion sounds over the left upper quadrant., dull sounds would be abnormal. a convex/symmetric shape abnoman is normal barium studies to visualize gastrointestinal structures and reveal any inflammation, ulcers, tumors, strictures, or other lesions; normally give laxatives after a barium to keep barium moving and becoming hard in gi tract, as patients are at risk for an intestinal obstruction if barium is not moved. endoscopic examinations colonoscopy sigmoidoscopy EGD esophagogastroduodenoscopy patients are prept by enema, NPO, maybe special diet then procedure happens, the procedure it to visualize inside of gi for any abnormality, locate a source of bleeding, and if necessary, provide biopsy tissue samples. hematest will test for unseen blood in a stool

paralytic ileus

bowel is temporarily paralyzed and distention occurs

lactose intollerant

cant digest lactose,(the sugar contained in milk products) gas pain, cramping and diarhhea

constipation

constipation is present when patients normal defication pattern involves a change in stool consistency and frequency. the book says fewer than 3 bowel movements in a week, mostly women. chronic constipation can happen with habitual use of laxatives. Opioids have a very high potential to cause constipation. use digital removal as a last resort as it may cause parasympathetic stimulation which could lead to lowering the heart rate and synapse could occur contipation puts patient at risk of pain, nausea, fecal impaction,

abnormal bowels

constipation more than 3xday or less than 1 every 3 days color black, tarry, reddish brown, maroon, clay colored, yellow green consistency, hard, lose liquid, high mucous content. shape, narraw pencil thin odor foul, or objectionable Occult blood in the stool is blood that is hidden in the specimen or cannot be seen on gross examination. It can be detected with simple screening tests, such as a Hematest flatulence= accumulation of gas in the intestinal tract, can lead to distention. distention = accumulation of gas or liquid or solid intestinal content in the intestinal tract. could be a tumor or paralytic illeous.

digital removal info

contraindication of digital removal Digital removal of stool should not be performed on patients who have bowel inflammation or bowel infection, or after rectal, prostate, and colon surgery.

sigmoidoscopy

diagnostic examination of the rectum and sigmoid colon

normal feces

feces consist of 75% water and 25% solids. The solids include bacteria, undigested fiber, fat, inorganic matter, and some protein. CELLULOSE is the major undigested fiber left in the feces after digestion and absorption have occurred. If dietary fiber intake is small, less stool is produced daily. The normal color of feces is brown, resulting from the chemical conversion of bilirubin, an orange or dark yellow bile pigment, into urobilin and stercobilin (brown pigments) by intestinal bacteria and enzymes. The food ingested can affect the color (e.g., beets may give stool a reddish color). Ingestion of certain medications can also affect the stool's color and consistency. Between 150 and 300 g of feces is produced daily Frequency is 1-2 day to 1 every 2-3 days color brown consistency soft and formed shape cylinder amount 100-300g odor aromatic/pungent

meconium

first feces of a newborn

enemas

for medication hold for at least 30 min RETURN FLOW ENEMAS, relieves accumulated flatus 300-500ml water, procedure takes 15-20 min when patient uncomfortable lower enema and you will see water and bubbles, air being removed. LARGE VOLUME ENEMAS LIMIT TO 3 up to 1000ml tap water enema (TWE) normal saline, isotonic soapsuds enema (SSE) often to remove potassium. cleansing prior to a procedure and constipation The nurse would slowly and gently insert the enema tube 3 to 4 inches for an adult. The nurse would position client on the left side in the Sims' position. This position aids in the client's ability to retain the solution. The nurse would not introduce the solution quickly, as this will result in the client cramping. The nurse would administer the solution over 5-10 minutes, depending on the volume. The nurse would encourage the client to hold the solution for 5 to 15 minutes when the urge to defecate becomes strong. after an enema you should hear increased bowel sounds due to increased peristalsis. SMALL VOLUME ENEMAS for constipation, if laxitive fails. fleets, hypertonic in nature oil retention. retain 5-10min also retention mineral enemas Mineral, olive, or cottonseed oil are used to lubricate the stool and intestinal mucosa without distending the intestine.

ng tubes

gastric decompression/aspirating = removing contents from the stomach like fluid or air to relieve pressure. if someone has a bowel obstruction or paralytic ileus, or stomach surgery. abdominal distention is relieved. gastric lavage= irrigation of the stomach, say if a person od gastric feeding for oral feeding bypassing orac cavity,

fecal diversion

ileostomy, transverse (loop) colostomy, sigmoid colostomy, ileostomy liquid because it doesnt go to large intestines for reabsorption of water, loose electrolytes Colostomy soft and will have daily colostomy irrigation ileoanal reservoir also called J pouch involves construction of an internal pouch by removal of the colon and attachment of a segment of ileum to the anus. Fecal material goes directly from the small intestine out the anus. A Kock pouch or continent ileostomy is another development in fecal diversions. A pouch is made from 30 cm of ileum and an outlet valve is constructed. Although this procedure requires a stoma, feces can be drained at the patient's convenience rather than having it continually draining into an external pouch, as occurs in the traditional ileostomy. The nurse should monitor the client for rectal bleeding after a colonoscopy. The nurse should provide rest and offer food and fluids as allowed. The evening before the procedure, solid foods are avoided and liquids are encouraged. Laxatives are also given before the procedure

perirectal exam

inspection and finger in anus check for impaired skin integrity with diarrhea check for hemeroids when diarrhea or constipation are present. The RN performs digital exam to decifer for fecal impaction then report to doctor for further orders.

defecation reflex

involuntary response of intestinal contraction and anal sphincter relaxation to rectal distention

flatus

lots of gas in intestinal tract

borborygmi

loud rumbling sounds, normal movement of gas "stomach growling"

newborns

meconium. first stool within 24-48 hours softly formed and dark greenish, it is partially dried intestinal secretion stored prior to birth, at 3rd day looks like the milk they drink: breastfed=bright yellow, soft, loose unformed and unobjectionable odor sometimes only poop 1 every 3 days formula=dark yellow or tan. slightly more formed stronger odor infants sometimes pass stool at every feeding, or once a day, or once every 3 days

absorption

mostly happens in the duodenum and jejunum. Final absorption is in the large intestine mostly fluid and electrolytes. In the assending colon it is liquid, by the time they leave the transverse colon, they are semisolid, and this is called feces. should excrete 100-300g/day

structure of gastrointestinal tract

mouth to esohagus to stomach to small intestines: duodenum, jejunum, ileum, this takes 3-10 hours. then through to the large intestines, the colon is the major portion of the large intestine. cecum to the ileocecal valve to the large intestines. Large intestine includes ascending, transverse, descending, and sigmoid, then to the rectum. The rectum is the portion that immediatley follows the sigmoid colon. The rectum is normally empty but can really stretch. the anus is the last portion of the large intestines and has 2 sphincters, the internal sphincter is smooth muscle it is involuntary and external sphincter, striated muscle, voluntary control.

medications

opioids and iron cause constipation. antibiotics diahrrea due to irritating the gi mucosa or by inhibitting growth of normal flora antacids constipation or diahrrea antidiarrheal agents slow the bowel motility or to absorb excess fluid in the bowel. antiflatulence relieve gas

nursing interventions for bowel elimination

outcome will be for patient to demonstrate a normal bowel movement/pattern of bowel elimination. laxatives for constipation oral laxitives offer a gradual onset of action. RN fecal impaction rectal tube, 4 inches 15-20 min, this allows gas to get out. use this before going to meds. bowel training schedule, stool softners 2xday, bulking agent and suppositary, usually after breakfast. go to toilet and digital stimulation. takes weeks to months fecal collection during incontinence

paralytic ileous

post op not emergency. regular it is. the patient will have abdominal distention, no bowel sounds, and have pain. Best objective measurement is to note abdominal girth,

why have an enema

stimulates peristalsis so there is: medication administration relief from constipation remove impaction prior to and after a diagnosis, ie a barium study certain surgery procedures like abdominal so that there is no contamination to the wound site.

assessment

• The nurse places the patient in the supine position with the abdomen exposed. • The nurse uses a warmed stethoscope to listen for bowel sounds in all abdominal quadrants. • The nurse notes the character of bowel sounds, which are normally high-pitched, gurgling, and soft.