fundamentals test 4 ch 38

plan with patient monitor for frequency, consistency, shape, volume, color monitor bowel sounds teach about specifc foods that help regularity ensure privacy ensure adequate fluid intake

bowel training program

"bearing down" causes increased intrabdominal and thoracic pressure; larger amount of blood returns to heart once pressure lessens; can cause heart rate to slow resulting in syncope in pt; valsalva may be contraindicated in pt with cardiovascular problems

dangers of valsalva maneuver

indirect visualization

detect obstruciton, strictures, inflammation, tumors, ulcers

deficient fluid volume related to prolonged diarhhea impaired skin integrity related to prolonged diarhea, fecal incontinence ineffective coping related to inability to accept ostomy

diagnosis with bowel elimination as the cause/etiology

various endoscopy

direct visualization; diagnose inflammatory, ulcerative, infectious, benign or malignant neoplasm, lesions of mucosa

clostridium difficile

disruption with normal intestinal flora as a result of broad spectrum antibiotics; cause intestinal mucosal damage and inflammation

developmental considerations daily pattern food and fluid activity and muscle tone lifestyle psychological variables pathologic conditions medication diagnostic studies surgery and anesthesia

factors effecting bowel elimination

bean cabbage carrot celery corn dried fuir nuts spinach

foods cause stomal blockage

applesauce banana creamy PB oatmeal potatoe rice/pasta

foods tha help control diarhea

alcohol/beer/carbonated eggs beans/peas/lentils onions most fruit

foods that can cause gas

absorption of water; formation of feces; expulsion of feces

function of large intestine

25-30g fiber; daily fluid of 2-3k mL

ideal intake

bowel incontinence

inability of the anal sphincter to control the discharge of fecal and gaseous material

500-750mL/day; monitor electrolytes closely

increased fluid intake for long term ostomy

stool culture

indicated for suspected infection from bacteria, virus, fungi, parasites

breastfed: more frequent, yellow-golden, loose, little odor formula: yellow-brown, paste like, strong odor due to decomposing protein anywhere from 1-10; much more in breastfed (by 12 months 1-2/day)

infant defecation

fecal incontinence

involuntary or inappropriate passing of stool or flatus

opiod decrease antacid with aluminum and iron sulfate decrease anticholinergic decrease some antiobiotics increase otc antacid with magensium increase metformin(type 2 diabetes) increase

medication effect

diarrhea bowel incontunece risk for constipation

nurse diagnosis

promote regular bowel habits (timing, positioning, privacy, nutrition, exercise) provide comfort measures prevent and treat constipation (teach about nutrion, laxatives, food safety)

nurse interventions

small, frequent meals discourage heavy activity after eating high fiber, low fat, adequate fluid develop dialy routine (2 hours after wake and after a meal ideal) avoid regular laxative easy access and assistence encourage regular exercise and not to ignore urge

nursing strategies

constipation often common chronic issue

older adults

2-4 hours

oral hygiene for NG tubes

deodenum jejunum ileum

order of small intestine

keep pt free od odors drain when 1/3 -1/2 full inspect regulary; should be dark pink to red and moist ( pale=anemia, dark=compromised circulation) minimal bleeding note size; stabilizes in 6-8 weeks, most protrude 1/2-1inch keep clean monitor I/O; record every 4 hours for first 3 days explain self care adn encourage looking

ostomy care

paralytic ileus

paralysis of intestinal peristalsis

stimulates movement inhibits movement

parasympathetic effect of colon sympathetic

diarrhea

passage of more than 3 loose stools in a day

sit upright; encourage toilet or bedside commode avoid bedban; elevate 30 degrees if required

positioning for elimination

immediately before and after defecation

rectum is empty except

inspection auscultation percussion palpation palpation may disturb normal peristalsis and bowel motility

sequence for abdominal physical assessment

void urine first to not alter defecate in bedpan; not toilet bc dont want water no toilet paper

stool collection

postop paralytic ileus; opiod can exacerbate

temporary stoppage of persistalsis caused by direct manupilation of the bowel during abdominal surgery; lasts 3-5 days

occult blood

to detect intestinal bleeding resulting from ulcer disease, inflammatory bowel disorders, colon cancer

voluntary control possible; normally by 30 months but varies discoruage punishment/ shame individual based on maturity hospital stay may regress

toddler 18-24 months

rectal bleeding change in elimination pattern blood in stool cramping pain in lower abdomen

warning signs of colon cancer

1-4x per day; after food has been consumed 1/3 to 1/2 of ingested food exreted in stool within 24 hours, the rest in the next 24-48 hours

when does mass peristalsis occur