Bowel Elimination (Exam 4)

sigmoid

A pt who has a colostomy in the ________ area sometimes may just need the stoma irrigated to train the bowel to empty.

1 hour after a meal

Both forms of movement in the large and small intestine is triggered by objects, so the best time to try and have a BM is?

100 million

How many nerves line the gut?

1920

If a pt has 8, 8oz glasses of water, how many ML's are they getting?

liquidly

If someone has an ileostomy, what would you expect their stool to look like?

chyme

Partially digested, semiliquid food mixed with digestive enzymes and acids in the stomach.

feces

Semisolid mass of fiber, undigested food, inorganic material, etc.

stoma

Temporary or permanent artificial opening in the abdominal wall; end of the intestine surgically brought through abdominal wall

villi

The inner wall of the small intestine is covered by millions of tiny finger-like projections called _________.

8, 10

The patient needs _______ to _________ 8oz glasses of fluid per day.

5 minutes

How long should you assess each quadrant of the abdomen of a pt who has had surgery;

3 to 5

If someone has a stoma w/frequent liquid stool (ileostomy) you should empty their skin barrier pouch several times a day and change every _______ to ________ days.

impaction

Common bowel elimination problems; results from unrelieved constipation; a collection of hardened feces wedged in the rectum that a person cannot expel -unrelieved constipation -Pts @ risk; unconscious; confused; nerve supply, CA pts (cancer patients, usually on CNS depressants which cause constipation) Tx = -prevention is the best treatment -determine presence; digital examination -enemas .Oil rentention to soften .Tap water or fleet enemas to remove and cleanse -Manual/digital removal; disimpacting -Establish bowel program to prevent recurrence.

a, e, c, b, d

Place the anatomical parts of the digestive system in the appropriate order according to how digestion occurs. a. Mastication b. ileum c. duodenum d. cecum e. stomach

double barrel

Ostomies Name this type; -Bowel is surgically severed; both ends brought through the abdomen -2 stomas; proximal functioning/distal (mucus)

7 to 10

Our GI tract deals with how many liters of water a day?

dehydrated

Our GI tract takes water in and breaks things down. If you're not having any issues that water gets reabsorbed into the body. If you are having issues, like diarrhea and youre flushing all that water out, you can then become _______________.

small intestine

The ________ ______ moves objects by peristalsis and segmentation

cecum (the cecum is the first portion of the large intestine)

Undigested food first enters the large intestine through which structure? Duodenum Cecum Rectum Sigmoid colon

iron, pepto bismol

What are two things that can make feces black and tary besides blood? Name two things

white to very light brown

What color might a patients stool be if they have had barium?

80

What percentage of your water is reabsorbed in the large intestines?

ileostomy

Which procedure produces a surgical opening in the abdomen and bypasses the large intestine entirely? Sigmoid colostomy Kock pouch Ileostomy Loop colostomy

a, d, e

Which should be included in client teaching to support normal bowel elimination? Select all that apply. a. Increase fluid intake. b. Limit fiber intake. c. Increase caffeine intake. d. Increase physical activity. e. Do not ignore the urge to defecate.

d

A client has a tendency to develop frequent constipation. Which dietary consideration should the nurse recommend? a. The client should increase iron intake. b. The client should decrease fiber intake. c. The client should increase intake of fats. d. The client should increase fiber intake.

yogurt

A client is diagnosed with an intestinal infection after traveling to a developing country. The nurse should encourage the intake of which food to optimize the gut's normal flora, creating a healthier environment? Milk Yogurt Oatmeal Bread

constipation

A nurse is auscultating bowel sounds on a client who has had recent abdominal surgery. She hears approximately 1 to 2 sounds per minute in each quadrant. Which condition should the nurse expect? Infection Diarrhea Constipation Ileus

d

A nurse is teaching wellness to a church group. How many daily 8-ounce servings of water should be encouraged for normal bowel health? a. 10 to 12 servings b. 4 to 6 servings c. 8 to 10 servings d. 6 to 8 servings

Valsalva maneuver

A person can increase the pressure to expel feces by contracting the abdominal muscles (straining) while maintaining a closed airway. This is called;

small intestine

After food/chyme leaves the stomach, it moves to the _________ _____________. This is a folded, twisted, and coiled tube that connects to the stomach and the large intestine. About 1 inch in diameter and about 20 ft long fully extended, it occupies most of the abdominal cavity. Most digestion and absorption of food occurs in the this area. Chyme travels through it slowly, by peristalis; peristalis halts periodically to allow for absorption. It consists of three segments; the duodenum, jejunum and ileum

lab test

Blood in stool: If blood loss <50cc =

melena

Blood in stool: If blood loss is > 50CC =

hemorrhoids

Common Bowel Elimination Problems; -Dilated blood vessels in the lining of anal mucosa Tx= Fluids, diet, and regular exercises are needed, sitz bath (local heat), lubricating jelly < friction

diarrhea

Common Bowel Elimination problems; -Increased frequency of loose stools -at risk for electrolyte imbalance, and Ph imbalance (acidosis) Tx = -Bowel rest, then proper dietary teaching . clear liquid .BRAT diet, bananas, rice, applesauce, toast .Foods to avoid -Fluids -If severe, may need medication to slow bowel down -Monitor for alterations in perineal skin integrity .Possibly will need a barrier ointment

incontinence

Common bowel Elimination Problems; inability to control bladder and/or bowels -involuntary passage of stool -impaired function or control; changes in frequency, volume (C-diff), consistency -Interventions

flatulence

Common bowel Elimination problems; the accumulation of gas in the alimentary canal -bloating, distension, and passage of gas -Interventions =

constipation

Common bowel elimination problems; Hard, slow stools that are difficult to eliminate; often a result of too little fiber in the diet -fewer bowel movements -hard, dry feces -Causes; lack of fiber (diet); medications; environment; inflammation -Immobility -Analgesics particuarlly opiates TX= -increase intake of high-fiber foods (dont give them all high fiber all at once: Some examples, beans, bran, prunes, pumpkin, broccoli, potato with skin, apples, bananas; fruit or veggie with skin on it, skin helps. -increase fluid intake -increase activity/exercise -provide privacy -help client to a position that facilitates defecation -allow uninterrupted time -laxatives when lifestyle changes are ineffective

MRI

Diagnostic tests Name the test; a technique that uses magnetic fields and radio waves to produce computer-generated images that distinguish among different types of soft tissue; allows us to see structures within the brain; Watch for metal, check to make sure the pt is not wearing metal.

check gag reflex

Diagnostic tests If a pt is put under conscious sedation for an upper endoscopy, what would your priority nursing intervention be once you get them back? In addition to checking respiratory;

upper endoscopy

Diagnostic tests: Name the test; visual examination of the GI tract, from esophagus to duodenum

barium swallow (upper GI series)

Diagnostic tests; Name the test; barium is taken in through the mouth and x-ray images reveal the esophagus, stomach, and small intestine

colonoscopy

Diagnostic tests; Name the test; the direct visual examination of the inner surface of the entire colon from the rectum to the cecum

conscious sedation (twilight)

Diagnostic tests; If a pt goes in for an upper endoscopy, what type of anesthesia will they get?

CT scan

Diagnostic tests; Name the test; a series of x-ray photographs taken from different angles and combined by computer into a composite representation of a slice through the body

Ultrasound

Diagnostic tests; Name the test; Used in detecting cystic structures - performed before Barium studies - NPO for gallbladder

barium enema (lower GI series)

Diagnostic tests; Name the test; barium is injected into the anus and rectum and x-ray images are taken of the colon

promote (Physical activity increases peristalsis and promotes defecation. Minimally, a client should engage in exercise three to five times a week with daily walking or light activity. Hospitalized or institutionalized clients may need assistance with activity to prevent injury. For bedbound clients, range of motion, thigh strengthening, and abdominal tightening are most beneficial to improve peristalsis)

Does the following promote or inhibit bowel movements; Crystal is in a care center and tells the nurse he has not had a bowel movement for 2 days. The nurse suggests they go for a walk later.

promote (Foods high in fiber promote peristalsis and bowel elimination. Daily fiber intake should be 25 to 30 grams of fiber to attract water to the stool. Good choices include fresh fruits, vegetables, whole-grain foods, legumes, and water.)

Does the following promote or inhibit bowel movements; Ethan is constipated and asking for a snack. The nurse offers an apple or orange.

promote (The embarrassment of the smell of flatus and stool can prevent clients from eliminating, causing them to become distended, constipated, impacted, and uncomfortable. Identifying the need for an odor-eliminating spray is the nurse's role. Next)

Does the following promote or inhibit bowel movements; Hank has a digestive disorder that causes a lot of gas. He is in a semiprivate room and mentions how disturbing it must be for his roommate. The nurse sprays an odor-reducing product and leaves it with Jeremy to use as needed.

inhibit (The most natural position for elimination is sitting upright on a toilet. When the client is not able to ambulate to the bathroom, a commode chair placed at the client's bedside can be used. A bedpan should be used only if the client is unable to get out of bed.)

Does the following promote or inhibit bowel movements; Leslie tells the nurse she needs to use the restroom. The nurse cannot find adequate help to get Bonita out of bed so she is placed on a bedpan.

inhibit (Adding fiber to try to correct opioid-induced constipation can put the client at risk for bowel obstruction due to the opioid-induced decreased peristalsis, delayed gastric emptying, and prolonged intestinal transit time of the feces. This could lead to a mechanical bowel obstruction. Next)

Does the following promote or inhibit bowel movements; Michelle is recovering from surgery and is constipated from the regular opioid pain medications she receives. The nurse requests high fiber in her diet from the dietitian.

inhibit (Water intake should be a minimum of 1,500 mL to 2,000 mL per day to keep the stool soft and aid in the production of mucus to lubricate the colon. Clay needs to drink more than 1 liter of water each day.)

Does the following promote or inhibit bowel movements; Shawn is constipated, so the nurse suggests increasing his water intake to 1 liter per day.

promote (Clients are often challenged with constipation while hospitalized as a result of medications, surgery, and inactivity. Allowing a more "natural" environment can promote normal bowel habits.)

Does the following promote or inhibit bowel movements; Stanley is recovering from knee surgery and has not had a bowel movement for 3 days. The nurse places him on the bathroom toilet rather than having him use the bedside commode or a bedpan.

inhibit (Privacy is important to promote normal bowel movements; this should include closing doors, pulling curtains, and having visitors step out of the room. Although having the door open is helpful to the nurse, it is not helpful for the client. A better alternative would be to close the door but check back often, provide a call light, or stand outside the door to hear Martha ask for help)

Does the following promote or inhibit bowel movements; The nurse assists Lisa to the restroom and leaves the door open a crack so she can be heard if she needs help.

inhibit (Timing is an important part of normal bowel function. By interrupting the meal for this procedure, the timing is poor. A better option is to discuss the order for the enema after the client has finished eating so the nurse does not disturb his or her meal or appetite.)

Does the following promote or inhibit bowel movements; The nurse has an order to deliver an enema to a constipated client. The nurse enters the room and slides the lunch tray to the side, explaining there is an order for an enema.

d (digital disimpaction can stimulate the vagus nerve, which causes a reflex slowing of the heart rate.)

During digital removal of stool, which is the most serious complication the client is at risk of developing? a. Bleeding b. Decreased blood pressure c. Hypertension d. Decreased heart rate

guaiac test

Fecal occult blood test; repeat 3 times! Name the test -a diagnostic test looking for occult blood in the stool. It is done after taking a small stool sample during a rectal examination

30ml

How many ml are in an ounce

NSAIDS

If someone is going to have a fecal occult blood test (Guaiac) , they need to avoid _________ for at least 7 days because of risk of increased chance of bleeding

a, c, d, e

In which ways can surgery or procedures contribute to sluggish bowel elimination? Select all that apply. a. Anesthesia b. Increased IV fluids c. Stress d. Decreased mobility e. Manipulation of the bowel

D

Mrs. Addie is 70 years old. While the nurse is gathering admission assessment data, the patient states, "I've taken a tablespoon of Milk of Magnesia every day for 3 years." Which nursing diagnosis is most appropriate for the nurse to use in her plan of care? A. Diarrhea B. Constipation C. Risk for Ineffective Therapeutic Regimen D. Perceived Constipation

foods, meds

On a fecal occult blood test (guaiac) there are ____ and ____ that can give false positive and false negative results; -Red meat -poultry -fish -raw veggies; apples, cauliflower, turnips, broccoli, turnips (can give a false positive) Vit. C, causes false negative

loop ostomy

Ostomies: Name this type -temporary in the transverse colon -Bowel opened (not severed) and sutured to abdominal skin -Stoma; 2 openings proximal (stool)/distal (mucus)

end ostomy

Ostomies; Name the type; -proximal end forms stoma; distal end removed or sewn closed (Hartmann's pouch)

ascending

Stool from a colostomy on the ________ side of the colon will appear softer/more watery.

decending

Stool from a colostomy on the _________ side of the colon will appear more formed/more solid.

CNS

The 100 million nerves that line the gut arose from the ________ tissue. If you have heard the gut is your second brain, this is why. For example when you get upset you might get nauseated, or you might get diarrhea.

large intestine

The ______ ____________ moves food with help of chyme by peristalsis

rectum

The ______ is approximately 6 inches long and is continuous with the anus. A high vascular folded tube, the rectum is free of waste products until just before defecation.

anus

The ______ is high vascular. It has two ring like muscles that function as sphincters; -internal sphincter involuntarily relaxes and opens when stool is present in the rectum -external sphincter is under voluntary control. voluntary relaxation of the external sphincter allows stool to be expelled from the body. -Chronic pressure on the veins within the ______ canal, as with prolonged sitting or retained feces, can cause hemorrhoids

pharynx

The ______ is the back part of the throat where food and air pass after chewing. To prevent choking and aspiration, a flap of connective tissue, called the epiglottis, closes over the trachea when food is swallowed.

duodenum

The _______ is the first section of the small intestine. It is a c-shaped tube that branches off from the stomach, about 30-60 CM (1to2ft long). It processes chyme by mixing it and adding enzymes. The bile duct and main pancreatic duct both enter the small intestine at the level of this section, providing bile from the liver and gallbladder to digest lipids and pancreatic enzymes to digest lipids, proteins and carbohydrates.

mouth

The ________ is where mechanical digestion begins, with mastication, or chewing. Food is torn into small pieces, mashed, moistened with saliva, formed into a bolus, and then swallowed into the esophagus. The _____ contains glands that secrete enzymes such as ptyalin and salivary amylase, which being the digestion of carbohydrates.

Large intestine

The _________ ________, also known as the colon, is larger in diameter than the small intestine, but shorter in length. It extends from the ileum of the small intestine to the anus. It contains seven segment's; the cecum, ascending colon, transverse colon, descending colon, sigmoid colon, rectum and anus. approx. 5-6 feet -primary organ of bowel elimination -3 functions = absorption, secretion and elimination. Rate of peristalsis effects function -most of the water and electrolytes are reabsorbed in the large intestine

stomach

The _________ is a distensible sac that extends from the esophagus to the small intestine. It stores food while it churns and mixes it, providing further mechanical breakdown. Chemical digestion continues in here, which secretes hydrochloric acid, a protein-digesting enzyme called pepsin; and gastric lipase, an enzyme that beings the digestion of lipids. The lining of this also secretes a mucous coating that protects the stomach from being corroded by HCI. Food remains here an average of four hours. Food leaves this location and enters the small intestine as a liquid called chyme.

jejunum

The _________ is the coiled midsection of the small intestine. It is about 6-8 feet long and forms the connection between the duodenum and ileum. Its major function is to absorb carbohydrates and proteins.

esophagus

The __________ is a tube of smooth muscle, which alternately contracts and relaxes in waves of peristalsis to push the bolus toward the stomach. The bolus travels the length of the ____________ in about 15 seconds. The cardiac sphincter (also called the gastroesophageal sphincter) relaxes to allow food to pass into the stomach. When the cardiac sphincter constricts, it prevents acid from the stomach from flowing back up into the _________.

ileum

The _____________ joins the small and large intestine. It is responsible for absorption of fats; bile salts; and some vitamins, minerals and water. However, nutrients are absorbed mainly in the duodenum and the jejunum.

incontinence

The following are examples of nursing interventions for a patient with ____________. -Iv fluids -NPO -possible antibiotics if its due to C-diff/bacteria -Keep them clean and dry -Diet; Nothing, then clear liquids, then the brat diet.

bowel elimination

The following are factors influencing ______________ _______________; Age Diet Position during defecation Pregnancy Diagnostic tests Fluid intake Activity Psychological factors Bowel diversions (ileostomy, colostomy) Pain Medications Surgery and anesthesia Personal habits Exercise stress

GI tract

The following are functions of the the ________ _________; -Prepare food products for use by the body's cells -Promote absorption of fluid and nutrients. If we have any issues with these it = Changes in any one are = altered body functioning****

flatulence

The following are nursing interventions to help a pt that has ___________. -simethicone, makes gas bubbles smaller so that they're easy to pass -walking -position -rocking

medications

The following describe ___________ used for short term action of emptying the bowel Cathartics and laxatives Cathartics stronger/faster Stimulants Saline or osmotic agents Bulk forming (stool softeners) lubricants

d

The nurse is assisting a client in the emergency department who needs to use the restroom for a bowel movement. Which option is best? a. Bedside commode b. Public restroom c. Bedpan d. Private restroom

c

The nurse is assisting the client in caring for her ostomy. The client states, "Oh, this is so disgusting. I'll never be able to touch this thing." The nurse's best response is; A. "I'm sure you will get used to taking care of it eventually." B. "Yes, it is pretty messy, so I'll take care of it for you today." C. "It sounds like you are really upset." D. "You sound very angry. Should I call the chaplain for you?"

a,b,c,d,e

The nurse is reviewing the medical record of a client who has not had a bowel movement for 3 days. What factors are concerning? Select all that apply. a. Client is on bedrest. b. Client is in a semiprivate room. c. Client took a laxative prior to hospitalization. d. Client is receiving an iron supplement. e. Client has not eaten for 48 hours.

D

The nurse knows that the results of a fecal occult blood test can be inaccurate if; A. The client has had an excessive intake of red meat B. The female client is menstruating C. The client takes high doses of vitamin C D.All of the above

defacation

The process by which the bowel eliminates waste is called ___________. When fecal material reaches the rectum and causes it to distend; 1. stretch receptors are stimulated to start contraction of the sigmoid colon and rectal muscles. 2. the internal anal sphincter relaxes 3. at the same time, sensory impulses transmitted to the central nervous system produce a conscious urge to defecate. We respond to this signal by voluntarily contracting our diaphragmatic and abdominal muscles to increase downward pressure, while at the same time external anal sphincter. These actions allow feces to propel through the anus.

microvilli

The villi on the inner wall of the small intestine are covered with even tinier projections, called _____________.

slows down

What does anesthesia do to peristalsis?

Enemas

What does the following describe? instillation into the rectum and sigmoid colon; promotes defecation by stimulating peristalsis; fluid volume breaks up fecal mass and stretches wall = triggers defecation reflex Cleansing= complete feces evacuation from colon -tap water (hypotonic)- do not repeat -normal saline- safest solution -hypertonic - fleet enema most common -soap solution - > irritation; pure castile soap safe Oil retention = lubricate rectum and colon

drink lots of water

What is an important thing that needs to be taught to pts who have had barium?

c

What is the effect of physical activity on normal defecation? a. Increased physical activity can increase constipation. b. Decreased physical activity can result in diarrhea. c. Increased physical activity promotes normal defecation patterns. d. Physical activity has no effect on defecation patterns. Submit

McBernie's Point

What is the point called where you find the appendix in surgery?

immune system

Whats the point of the appendix?

a,c

Which action is most appropriate for a client experiencing constipation? Select all that apply. a. Increase intake of beans and legumes b. Increase intake of lean meats c. Increase the intake of fruits and vegetables d. Increase intake of bread and pasta e.Increase the intake of milk and cheese

a, b, e

Which are common disorders that are primary causes of bowel function? Select all that apply. a.Food allergies b. Diverticulosis c. Pneumonia d. Seasonal allergies e. Food intolerance

b, c, d

Which are common gastrointestinal symptoms suggestive of food allergy? Select all that apply. a. Nausea b. Rash around the anus c. Excessive gas d. Intestinal bleeding e. Severe vomiting

a, c, d

Which are ways the nurse can promote regular defecation for clients? Select all that apply. a. Provide privacy. b. Remind the client that constipation could occur if he or she does not defecate regularly. c. Take a matter-of-fact straightforward approach. d. Control odors to prevent embarrassment. e. Accompany the client and provide encouragement while he or she is attempting defecation.

constipation

Which is the result of the passage of stool through the colon being slowed? Diarrhea Constipation Distention Ileus

d (a sigmoid colostomy is closest to the rectum. Stool is most likely to be formed and can often be controlled without the use of an appliance.

With which type of bowel diversion is the client most likely to have control over bowel elimination and not need to wear an appliance? a. Ileostomy b. Ascending colon colostomy c. Transverse colon colostomy d. Sigmoid colostomy

fleet enemas

You should avoid which type of enemas with congestive heart failure pts and renal pts?

1/3, 1/2

You should empty and change a pouch on a stoma when the pouch is ________ to _____________ full. (methods of reducing odors)

melena

black, tarry stools; feces containing digested blood;

ileostomy

creation of an artificial opening into the ileum; stool will look liquidly

Illeus

the partial or complete blockage of the small and/or large intestine

colostomy

the surgical creation of an artificial excretory opening between the colon and the body surface; stool will look different by location of the colostomy