ATI Prof Nurse exam chapter 35 38 39

factors affecting bowel elimination Fluid intake

2.7 L per day for females 3.7 L per day males from fluid and food sources

REM SLEEP accounts for

20-25% of sleep time

a nurse is instructing a client who has narcolepsy. which of the following client statements indicates an understanding of the instructions

"I will take a short nap when Im sleepy"

factors affecting bowel elimination pregnancy

- growing fetus compromising intestinal space - slower peristalsis - straining increasing risk of hemorrhoids

causes of diarrhea

- viral gastroenteritis - bacterial gastroenteritis - antibiotic therapy - inflammatory bowel disease - irritable bowel syndrome

a nurse is preparing to administer a cleansing enema to a client. place the steps in order

1. Warm the enema 2. lubricate the end of the rectal tube 3. slowly insert the rectal tube into the clients rectum 4. hang the enema container 30 to 45 cm 12-18 in above clients anus 5. Ask the client to retain the solution

central

Central nervous system dysfunction in the respiratory control center of the brain that fails to trigger breathing during sleep

Hemorrhoids

Hemorrhoids are engorged dilated blood vessels in the rectal wall from difficult distention Can be itchy and painful and bloody after defecation Use moist wipes for cleansing the perineal area and apply ointment or creams as prescribed Use a SITZ bath or ice bath to promote relief from hemorrhoid discomfort

patient education for better sleep

complete exercise 3 hours before bedtime establish bedtime routine and a regular sleep pattern arrange sleep environment for comfort limit alcohol, caffeine and nicotine at least 4 hours before bedtime limit fluids 2 to 4 hours before bedtime engage in muscle relaxation if anxious or stressed

factors affecting bowel elimination AGE toddlers

bowel control at 2 to 3 years old

factors affecting bowel elimination AGE Infants

breast milk stools: watery and yellow brown Formula stools: pasty and brown

patient education for narcolepsy

exercise regularly eat small meals high in protein avoid activities that increase sleepiness (sitting too long, warm environments, drinking alcohol avoid activities that could cause injury should the client fall asleep (driving heights) take naps when drowsy or when narcoleptic events are likely take prescribed stimulants

factors affecting bowel elimination DIET

fiber requirement; 25-38 g/day difficulty digesting foods (lactose intolerance) can cause watery stools certain foods can increase gas (cabbage cauliflower, apples) have a laxativeeffect (figs, choclate) or increase the risk of constipation (pasta cheese eggs)

Urinary elimination

filtration, reabsorption, excretion kidneys are the primary organs of the urinary elimination with nephrons performing most of the functions of filtration and elimination

flatulence

flatulence occurs from distinction of the bowel from gas accumulation can cause cramping or feeling of fullness Check for abdominal distinction and the ability to pass gas through anus Encourage ambulating to promote the passage of flats

causes of constipation

frequent use of laxatives; advanced age; inadequate fluid intake; inadequate fiber intake; immobilization due to injury; a sedentary lifestyle, pregnancy, medication effects

care for diarrhea

help determine and treat cause administer medications to slow peristalsis provide perineal care after each stool and apply moisture cream after diarrhea stops suggest eating yogurt to help re establish an intestinal balance or beneficial bacteria encourage fluid intake to replace fluid loss instruct client to avoid bowl irritants such as caffeinated beverages and alcohol

A nurse is assessing a client who has had diarrhea for 3 days. which of the following findings should the nurse expect Select All Apply

hypotension elevated temperature poor skin turgor

care for constipation

increase fiber and water consumption unless contraindictated before more invasive interventions give bulk forming products before stool softeners stimulants or suppositories enemas are LAST resort for stimulating defecation encourage regular exercise

Sleep duration

infants and toddlers 9-15 hr/day this declines gradually throughout adolescents averaging to 9 to 10 hr/day and adults 7-8 hr/day

constipation

is a bowel pattern of difficult and infrequent evacuation of hard dry feces

paralytic ileus

is an intestinal obstruction caused by reduced motility following bowel manipulation during surgery, electrolyte imbalance, wound infection, or by the effects of medication

acute insomnia

lasts a few days possibly due to personal or situational stressors

chronic insomnia

lasts a month or more

factors affecting bowel elimination medications

laxatives- soften stool cathartics- promote peristalsis laxative overuse- chronic use of laxative cause a weakening of the bowels expected response to distention from feces resulting in the development of chronic constipation

patient education hyper-somnolence disorder

maintain regular sleep-wake schedule provide ample sleep opportunity take prescribed stimulants

Sleep apnea

more than 5 breathing cessations lasting longer than 10 seconds per hour during sleep. resulting in decreased arterial oxygen saturation levels. sleep apnea can be a single disorder or a mixture of central or obstructive

Insomnia

most common sleep disorder the inability to get adequate sleep and to feel rested difficulty falling asleep, staying asleep, awakening too early, not getting refreshing sleep

a nurse is administering a cleansing enema to a client who reports abdominal cramping what actions should the nurse take

nurse should slow the flow of the solution by lowering the container . Slowing down the flow of the enema should decrease cramping. if the patient is expierencing severe pain or cramping, STOP the enema assess the vital signs and notify provider

obstructive

obstructive structures in the mouth and throat relax during sleep and occlude the upper airway

fecal occult blood test

obtain a fecal sample using asepsis while wearing gloves. 3 test from three different defecations. some foods such as red meat citrus fruits and raw veggies can cause false positives results. Bleeding can be indication of cancer

Specimens for stool cultures

obtain using medical asepsis while wearing gloves - label the specimen & promptly send to laboratory

Osmotic explained

ostomies are created in either the LARGE intestine or the SMALL intestine Colostomies end in the colon Ileostomies end in the ileum End stomas are a result of colorectal cancer or some types of bowel disease Loop Colostomies help resolve a medical emergency and are temporary. a loop of bowel is supported on the abdomen with a proximal stoma draining stool and a distal stoma draining mucus. it is usually constructed in the Transverse Colon. Double barrel colostomies- consists of two abdominal stomas. one proximal and one distal. proximal stoma drains stool and the distal stoma leads to inactive intestine. after the injured area of the intestine heals, the colostomy is often reversed by reattaching two ends

the nurse is educating the client about ways to improve sleep. which of the following recommendations should the nurse include?

practice muscle relaxation techniques exercise each morning avoid heavy meals before bed time

The sleep cycle contains a period of

rapid eye movement REM

factors affecting bowel elimination personal habits

reluctance to public toilets false perception of the need for one a day bowel movements lack of privacy when hospitalized

Stage 3 NREM

slow wave sleep or delta sleep vital signs decreasing more difficult to awaken psychological rest and restoration reduced sympathetic activity

insomnia (extra notes)

some people may have intermittent insomnia might sleep well for a couple of days then have insomnia the others. women and older adults have greater risl for insomnia

factors affecting bowel elimination physical activity

stimulates intestinal activity and increases skeletal muscle tone needed for defecation

Narcolepsy

sudden attacks of sleep that are often uncontrollable can occur at inappropriate times and increase risk for injury

factors affecting bowel elimination surgery and anesthesia

temporary slowing of intestinional activity rationale for auscultating bowels before advancing diet

a nurse in an acute care facility is caring for a client who is having difficulty sleeping at night. What actions should the nurse tale to promote sleep?

try to provide a quiet hospital enviroment and limit waking the client during the night to reduce interruptions in the clients sleep. a soothing back rub and assisting the client in following their regular bedtime routine, such as taking a bath in evening might promote relaxation and sleep

sigmoidoscopy

use of a light instrument by the provider to visualize and collect tissue for biopsy or remove polyps from the colon or lower small bowel

colonscopy

use of light instrument by the provider to visualize and collect tissue samples for biopsy or remove polyps from the sigmoid colon and rectum

Stage 1 of NREM

very light sleep only last a few minutes muscle relaxtion loss of awareness of surroundings vital signs and metabolism beginning to decrease awakens easily feels relaxed and drowsy

REM

vivid dreaming about 90 mins after falling asleep, recurring every 90 mins longer with each sleep cycle average length 20 mins varying vital signs very difficult to awaken loss of skeletal muscle tone cognitive restoration

factors affecting bowel elimination AGE adolescents

-increased secretion of gastric acids -accelerated growth of the large intestine

factors affecting bowel elimination pain

-normal defecation is painless; discomfort due to conditions (hemorrhoids, fissures, perianal surgery) can lead to suppression of the urge to defecate -opioid use contributes to constipation

constipation and diarrhea

Diarrhea is normal for healthy patients. For older adult clients and clients who have existing medical problems constipation and diarrhea can have a significant impact on a clients health

A nr=urse is teaching a client about performing fecal occult blood test at home. Which of the following information should the nurse include?

Ensure the specimen does NOT include urine

Incontinence

Fecal incontinence is the inability to control defecation often caused by diarrhea Determine causes (medications, infections, impactions) Provide perineaL csre after each stool and apply moisture barrier Provider can prescribe fecal incontinence pouch or other bowel management system to collect stool and prevent it from coming in contact with skinc

a nurse is assessing a client who reports insomnia. which of the following findings can contribute to the clients insomnia

Irregular schedule stress alcohol intake

factors affecting bowel elimination positioning

NORMAL- squatting IMMOBILITY- can result in difficulty contracting gluteal muscles and defecating

The sleep cycle contains of 3 stages of

Non-rapid eye movement NREM

A nurse is preparing a presentation at a local community center about sleep hygiene. Sort the following characteristics into either rapid eye movement (REM) sleep or, non-rapid eye movement (NREM) sleep

REM Cognitive restoration occurs loss of muscle tone occurs vivid dreaming occurs NREM Light sleep 75% of time sleeping

Ostomies

Some bowel disorders prevent the expected elimination of stool from the body. bowel diversions tbrough ostomies are temporary or permanent openings (stomas) surgically created in the abdominal wall to allow fecal matter to pass

care for bowel elimination

adequate fiber in diet adequate fluid intake adequate activity walking 15-20 mins a day if not moving then pelvic tilt single leg lifts lower trunk rotation

factors affecting bowel elimination AGE older adults

decreased peristalsis relaxation and sphincters

Stage 2 NREM

deeper sleep 10-20 mins long vital signs and metabolism continuing to slow requires slightly more stimulation to awaken increased relaxation

a nurse is teaching a client who has diarrhea which of the following instructions should the nurse include?

eat yogurt when diarrhea has stopped increase fluid intake avoid caffeinated beverages

factors affecting bowel elimination psychosocial factors

emotional distress- increases peristalsis and exacerbates chronic conditions (colitis Crohns disease ulcers and IBS) Depression- can lead to decreased peristaltic activity and constipation

Hypersomnolence Disorder

excessive daytime sleepiness lasting at least 3 months impairs social and vocational activities increased risk for accident or injury related to sleepiness