Elimination (Intestinal Obstruction) Ch 59

Recommended Fluid intake for Pediatric Patients

0-10kg = 100mL/kg/day 11-20kg = 1000mL+50mLkg for each additional kg over 10kg >20kg = 1500mL + 20mL/kg/day for each additional kg over 20kg

What is an intestinal obstruction?

A common serious disorder caused by a variety of conditions and is associated with significant morbidity. They can be partial or complete and are classified as mechanical or non-mechanical.

What is Irritable Bowel Syndrome (IBS)?

A functional GI disorder that causes chronic or recurrent diarrhea, constipation, and/or abdominal pain & bloating

What symptoms would the patient with a strangulated obstruction or peritonitis experience?

A temperature greater than 100F, tachycardia, hypotension, increasing abdominal pain with or without guarding tenderness, rigid abdomen, and color change over the abdomen. Report to MD immediately

What pain assessment information should the nurse gather from the patient with an obstruction?

A thorough pain assessment with attention to onset, aggravating factors, patterns & rhythms of pain. Severe pain that stops & changes to tenderness on palpation may indicate perforation & should be reported immediately to MD

A nurse is assigned to care for a client who had a partial colectomy & ascending colostomy yesterday. What assessment findings are expected for the client? Select all that apply

A. The colostomy stoma is pinkish red & moist C. The client has pain that is controlled by analgesics

The nurse notes a bulge in a client's groin that is present when the client stands and disappears when the client lies down. Which conclusion does the nurse draw from these assessment findings? a. Reducible inguinal hernia b. Indirect umbilical hernia c. Strangulated ventral hernia d. Incarcerated femoral hernia

ANS: A In a reducible hernia, the contents of the hernial sac can be replaced into the abdominal cavity by gentle pressure or by lying flat. The contents of irreducible, strangulated, or incarcerated hernias may not be replaced into the abdomen when the client lies down.

The nurse is caring for a client who has been diagnosed with a bowel obstruction. Which assessment finding leads the nurse to conclude that the obstruction is in the small bowel? a. Potassium of 2.8 mEq/L, with a sodium value of 121 mEq/L b. Losing 15 pounds over the last month without dieting c. Reports of crampy abdominal pain across the lower quadrants d. High-pitched, hyperactive bowel sounds in all quadrants

ANS: A Small bowel obstructions often lead to severe fluid and electrolyte imbalances. The client is hypokalemic (normal range, 3.5 to 5.0 mEq/L) and hyponatremic (normal range, 136 to 145 mEq/L). Dramatic weight loss without dieting followed by bowel obstruction leads to the probable development of colon cancer. High-pitched, hyperactive bowel sounds may be noted with large and small bowel obstructions. Crampy abdominal pain across the lower quadrants is associated with large bowel obstruction.

The nurse is teaching a client how to use a truss for a femoral hernia. Which statement by the client indicates the need for further teaching? a. "I will put on the truss before I go to bed each night." b. "I will put some powder under the truss to avoid skin irritation." c. "The truss will help my hernia because I can't have surgery." d. "If I have abdominal pain, I will let my health care provider know right away." each night." b. "I will put some powder under the truss to avoid skin irritation." c. "The truss will help my hernia because I can't have surgery." d. "If I have abdominal pain, I will let my health care provider know right away"

ANS: A The client is instructed to apply the truss before arising, not before going to bed at night. The other statements show accurate knowledge in using a truss.

The nurse is caring for a client with an umbilical hernia who reports increased abdominal pain, nausea, and vomiting. The nurse notes high-pitched bowel sounds. Which conclusion does the nurse draw from these assessment findings? a. Bowel obstruction; client should be placed on NPO status. b. Perforation of the bowel; client needs emergency surgery. c. Adhesions in the hernia; client needs elective surgery. d. Hernia is dangerously enlarged; client needs a nasogastric (NG) tube.

ANS: A The client with a hernia presenting with abdominal pain, fever, tachycardia, nausea and vomiting, and hypoactive bowel sounds should be suspected of having developed strangulation. Strangulation poses a risk of intestinal obstruction. The client should be placed on NPO status, and the health care provider should be notified. The symptoms are not suggestive of enlargement of the hernia, adhesion formation, or bowel perforation.

A client tells the nurse that her husband is repulsed by her colostomy and refuses to be intimate with her after surgery. Which is the nurse's best response? a. "Let's talk to the ostomy nurse to help you and your husband work through this." b. "You could try to wear longer lingerie that will better hide the ostomy appliance." c. "You should empty the pouch first so it will be less noticeable for your husband." d. "If you are not careful, you can hurt the stoma if you engage in sexual activity."

ANS: A The nurse should collaborate with the ostomy nurse to help the client and her husband work through intimacy issues. The nurse should not minimize the client's concern about her husband with ways to hide the ostomy. The client will not hurt the stoma by becoming intimate with her husband.

The nurse is performing a physical examination on a client. Which assessment finding leads the nurse to check the client's abdomen for the presence of an acquired umbilical hernia? a. Body mass index (BMI) of 41.9 b. Cholecystectomy last year c. History of irritable bowel syndrome d. Daily dose of lansoprazole (Prevacid) 30 mg orally

ANS: A This type of hernia is associated with obesity. The other assessment findings do not place the client at increased risk for an acquired umbilical hernia.

The nurse is performing a physical assessment for a client who underwent a hemorrhoidectomy the previous day. The nurse notes that the client has lower abdominal distention accompanied by dullness to percussion over the distended area. Which is the nurse's priority action? a. Assess the client's vital signs. b. Determine the last time the client voided. c. Insert a rectal tube to facilitate passage of flatus. d. Document the findings in the client's chart.

ANS: B Assessment findings indicate that the client may have an overfull bladder. In the immediate postoperative period, the client may experience difficulty voiding owing to urinary retention. A rectal tube should not be inserted for a client who had a hemorrhoidectomy the previous day. The client's vital signs may be checked after the nurse determines the client's last void. The nurse should document all findings and actions in the client's medical record

A client has irritable bowel syndrome. Which menu selections by this client indicate good understanding of dietary teaching? a. Tuna salad on white bread, cup of applesauce, glass of diet cola b. Broiled chicken with brown rice, steamed green beans, glass of apple juice c. Grilled cheese sandwich, small ripe banana, cup of hot tea with lemon d. Grilled steak, green beans, dinner roll with butter, cup of coffee with cream

ANS: B Clients with irritable bowel syndrome are advised to eat a high-fiber diet (30 to 40 grams a day), with 8 to 10 cups of liquid daily. This selection has the highest fiber content. They should avoid alcohol, caffeine, and other gastric irritants

The nurse is caring for a client with colon cancer and a new colostomy. The client wishes to talk with someone who had a similar experience. Which is the nurse's best response? a. "Most people who have had a colostomy are reluctant to talk about it." b. "I will make a referral to the United Ostomy Associations of America." c. "You can get all the information you need from the enterostomal therapist." d. "I do not think that we have any other clients with colostomies on the unit right now."

ANS: B Nurses need to become familiar with community-based resources to assist clients better. The local chapter of the United Ostomy Associations of America has resources for clients and their families, including Ostomates (specially trained visitors who also have ostomies). Although the enterostomal therapist is an expert in ostomy care, talking with him or her is not the same as talking with someone who actually has had a colostomy.

The nurse is caring for a client who is brought to the emergency department following a motor vehicle crash. The nurse notes that the client has ecchymotic areas across the lower abdomen. Which is the priority action of the nurse? a. Measure the client's abdominal girth. b. Assess for abdominal guarding or rigidity. c. Check the client's hemoglobin and hematocrit. d. Ask whether the client was riding in the front or back seat of the car

ANS: B On noticing the ecchymotic areas, the nurse should check to see if abdominal guarding or rigidity is present; this could indicate major organ injury. The nurse should then notify the provider. Measuring abdominal girth or asking about seating in the car is not appropriate at this time. Laboratory test results can be checked after assessment for abdominal guarding or rigidity.

The nurse is providing preoperative teaching for a client who will undergo herniorrhaphy surgery. Which instruction does the nurse give to the client? a. "Eat a low-residue diet for the first week after surgery." b. "Change the dressing every day until the staples are removed." c. "Take acetaminophen (Tylenol) 1000 mg every 4 hours for pain." d. "Cough and deep breathe every 2 hours for the first week after surgery."

ANS: B The dressing should be changed every day until the staples are removed, so the client can check the incision for signs of infection. Constipation is common following hernia surgery, so clients should include adequate amounts of fiber in the diet. The maximum daily dosage of Tylenol is 4000 mg. Taking 1000 mg of Tylenol every 4 hours means that intake is 6000 mg/day, which could cause toxicity and liver damage. The client should change positions and take deep breaths to facilitate lung expansion but should avoid coughing, which can place stress on the incision line.

A client post-hemorrhoidectomy feels the need to have a bowel movement. Which action by the nurse is best? a. Have the client use the bedside commode. b. Stay with the client, providing privacy. c. Make sure toilet paper and the call light are in reach. d. Plan to send a stool sample to the laboratory.

ANS: B The first bowel movement after hemorrhoidectomy can be painful enough to induce syncope. The nurse should stay with the client. The nurse should instruct clients who are discharged the same day to have someone nearby when they have their first postoperative bowel movement. Making sure needed items are within reach is an important nursing action too, but it does not take priority over client safety. The other two actions are not needed in this situation.

A client who has had fecal occult blood testing tells the nurse that the test was negative for colon cancer and wishes to cancel a colonoscopy scheduled for the next day. Which is the nurse's best response? a. "I will call and cancel the test for tomorrow." b. "You need two negative fecal occult blood tests." c. "This does not rule out the possibility of colon cancer." d. "You should wait at least a week to have the colonoscopy."

ANS: C A negative result does not completely rule out the possibility of colon cancer. To determine whether the client has colon cancer, a colonoscopy should be performed, so the entire colon can be visualized and a tissue sample taken for biopsy. The client need not wait a week before the colonoscopy. Two negative fecal occult blood tests do not rule out the presence of colorectal cancer (CRC).

The nurse is caring for a client who just had colon resection surgery with a new colostomy. Which teaching objective does the nurse include in the client's plan of care? a. Understanding colostomy care and lifestyle implications b. Learning how to change the appliance independently c. Demonstrating the correct way to change the appliance by discharge d. Not being afraid to handle the ostomy appliance tomorrow

ANS: C Client learning goals must be measurable and objective with a time frame, so the nurse can determine whether they have been met. When the goal is to have the client demonstrate a particular skill, the nurse can easily determine whether the goal was met. The specific time frame of "by discharge" is easily measurable also. The other goals are all subjective and cannot be measured objectively. The first two options do not have time frames. "Tomorrow" is a vague time frame.

The nurse is caring for a client who is scheduled to have fecal occult blood testing. Which instructions does the nurse give to the client? a. "You must fast for 12 hours before the test." b. "You will be given a cleansing enema the morning of the test." c. "You must avoid eating meat for 48 hours before the test." d. "You will be sedated and will require someone to accompany you home."

ANS: C The client is instructed to avoid meat, aspirin, vitamin C, and anti-inflammatory drugs for 48 hours before the test. The other directions are not accurate for this test.

The nurse is caring for a client who has been newly diagnosed with colon cancer. The client has become withdrawn from family members. Which strategy does the nurse use to assist the client at this time? a. Ask the health care provider for a psychiatric consult for the client. b. Explain the improved prognosis for colon cancer with new treatment. c. Encourage the client to verbalize feelings about the diagnosis. d. Allow the client to remain withdrawn as long as he or she wishes.

ANS: C The nurse recognizes that the client may be expressing feelings of grief. The nurse should encourage the client to verbalize feelings and identify fears to move the client through the phases of the grief process. A psychiatric consult is not appropriate for the client. The nurse should not brush aside the client's feelings with a generalization about cancer prognosis and treatment. The nurse should not ignore the client's withdrawal behavior.

The nurse is performing a physical assessment of a client with a new diagnosis of colorectal cancer. The nurse notes the presence of visible peristaltic waves and, on auscultation, hears high-pitched bowel sounds. Which conclusion does the nurse draw from these findings? a. The tumor has metastasized to the liver and biliary tract. b. The tumor has caused an intussusception of the intestine. c. The growing tumor has caused a partial bowel obstruction. d. The client has developed toxic megacolon from the growing tumor.

ANS: C The presence of visible peristaltic waves, accompanied by high-pitched or tingling bowel sounds, is indicative of partial obstruction caused by the tumor. Assessment findings do not indicate metastasis to the liver, intussusception of the intestine, or toxic megacolon

A client is brought to the emergency department after being shot in the abdomen and is hemorrhaging heavily. Which action by the nurse is the priority? a. Draw blood for type and crossmatch. b. Start two large IVs for fluid resuscitation. c. Obtain vital signs and assess skin perfusion. d. Assess and maintain a patent airway. a. Draw blood for type and crossmatch. b. Start two large IVs for fluid resuscitation. c. Obtain vital signs and assess skin perfusion. d. Assess and maintain a patent airway.

ANS: D All options are important nursing actions in the care of a trauma client. However, airway always comes first. The client must have a patent airway, or other interventions will not be helpful.

The nurse is screening clients at a community health fair. Which client is at highest risk for development of colorectal cancer? a. Young adult who drinks eight cups of coffee every day b. Middle-aged client with a history of irritable bowel syndrome c. Older client with a BMI of 19.2 who works 65 hours per week d. Older client who travels extensively and eats fast food frequently

ANS: D Colon cancer is rare before the age of 40, but its incidence increases rapidly with advancing age. Fast food tends to be high in fat and low in fiber, increasing the risk for colon cancer. Irritable bowel syndrome, a heavy workload, and coffee intake do not increase the risk for colon cancer. A BMI of 19.2 is within normal limits.

Key features of Small Bowel Obstruction

Abdominal discomfort or pain possibly accompanied by visible peristalsis waves in upper/middle abdomen, Upper or epigastric abdominal distention, nausea & early profuse vomiting (may contain fetal matter), obstipation, severe f&e imbalances, Metabolic alkalosis

What are clinical manifestations of mechanical obstruction?

Abdominal pain/cramping, tenderness & rigidity, pain sporadic if not strangulated, vomiting (foul smelling with profuse bile/mucous), obstipation (no stool or flatus passage), diarrhea if partial obstruction, abdominal distention, borborygmi, absent bowel sounds

What is a late sign of mechanical obstruction?

Absent bowel sounds

What are some complementary & alternative therapies for IBS?

Acupuncture & Moxibustion (Acu-Moxa) helps by reducing flatulence & bloating & improving stool consistency

What can mechanical intestinal obstruction result from?

Adhesions (scar tissue from surgeries or pathology Benign or malignant tumor Complications of appendicitis Hernias Fecal Impactions Strictures from Crohn's or previous radiation Intussusception Volvulus (twisting of intestines) Fibrosis due to endometriosis Vascular disorders (emboli, sclerosis)

What is the patho of a non-mechanical intestinal obstruction?

Also known as a paralytic ileum or adynamic ileus. Peristalsis is decreased or absent as a result of neuromuscular disturbance, resulting in slow movement or backup of intestinal contents

What is prescribed for the treatment of IBS-D

Antidiarrheal agents such as Loperamide (Immodium) and psyllium (bulk-forming agent).

What additional health history should the nurse gather from the patient with an obstruction?

Ask about the passage of gas & time, character, & consistency of the last BM. Singultus (hiccups) are common with obstruction. Keep the patient NPO. Ask about family history for colorectal cancer (CRC), blood in stool & changes in bowel pattern.

How can septic shock occur from strangulated obstruction?

Bacteria without blood supply can form & release an endotoxin into the peritoneal or systemic circulation

Why do males need higher fluid intake compared to females?

Because men have more muscle mass and women have more fat

Hepatic Disease in elimination

Biliary Atresia, Cirrhosis

What is the early sign of mechanical obstruction?

Borborygmi (very hyperactive bowel sounds & visual movement of peristalsis)

What is prescribed for the treatment of constipation-predominant IBS (IBS-C)?

Bulk-forming laxatives such as psyllium hydrophilic mucilloid (Metamucil) generally taken at meal times with water. Amitiza (Lubiprostone) is a new drug available for women with IBS-C. This drug is not effective for men

Malabsorption Disease in elimination

Celiac Disease

What are some things that can contribute to constipation?

Cheese, bananas, dairy products (if lactose intolerant), medications, lack of mobility

What are some immunologic and genetic factors that are associated with IBS?

Cytokine genes, proinflammatory interleukins (IL), (IL-6), and Tumor Necrosis Factor (TNF)-alpha

A nurse is caring for a client 1 day after an open hernia repair surgery. Which assessment finding will the nurse report to the surgeon immediately? A. Pain in the incisional area B. Blood pressure of 130/82 C. Bronchovesicular sounds D. Rigid, board like abdomen

D. Rigid, board like abdomen

For patients with increased intestinal bacterial overgrowth, what is prescribed?

Daily probiotic supplements. Peppermint oil capsules may also be effective in reducing symptoms for IBS

What are some food intolerances that contribute to IBS?

Dairy products (lactose intolerance), raw fruits, & grains

In IBS, what are the classifications of the different types of IBS called?

Diarrhea (IBS-D) Constipation (IBS-C) Alternating diarrhea/constipation (IBS-A) Mix of diarrhea/constipation (IBS-M)

In people ages 65>, what is the most common cause ob bowel obstruction?

Diverticulitis, tumors, & fecal impaction

Teaching to Prevent Fecal Impactions

Eat high fiber foods, encourage water/fluids, no laxative abuse, encourage exercise, natural foods to stimulate peristalsis (prune juice), bulk forming products for fiber (metamucil), have the pt sit on toilet or bedside commode rather than bedpan

What are some interventions for the patient with IBS?

Health history, drug therapy, stress reduction, complementary & alternative therapies. Holistic approach to patient care is essential for positive outcomes

Obstructive diseases of elimination

Hirschsprung's, Intussusception, Small Bowel Obstruction (SBO), Pyloric Stenosis

In the patient with IBS, what would the nurse ask about in an assessment?

History of weight change, fatigue, malaise, abdominal pain, changes in bowel pattern (constipation, diarrhea, or alternating of both), consistency of stools, mucus in stools, any recent GI infections, all medications the pt is currently taking, nutrition history including caffeinated carbonated beverages, use or sorbitol or fructose (which can cause bloating/diarrhea)

What history should the nurse collect on assessment with obstruction?

History of: abdominal surgery, radiation therapy, inflammatory bowel disease, gallstones, hernias, trauma, peritonitis, tumors

Loss of control of elimination

Incontinence (injury, disease, or changes or loss of cognition) Loss of sensation

If the liver isn't functioning correctly, what manifestations will you see in the patient?

Increased bilirubin, increased ammonia, jaundice, ascites, neuro changes (hepatic encephalopathy), clotting factors will decrease and the pt will be at risk for bleeding

Key features in Large Bowel Obstruction

Intermittent lower abdominal cramping, lower abdominal distention, minimal or no vomiting, obstipation or ribbon-like stools, no major f&e imbalances, metabolic acidosis (not always present)

What is vascular insufficiency to the bowel called?

Intestinal ischemia

Alteration in motility dysfunction

Intussusception

What should you teach the patient with IBS in regard to flare-ups?

Keep a symptom diary & record triggers & bowel habits. Avoid specific foods that they cannot tolerate (caffeine, eggs, alcohol, wheat, beverages with sorbitol & fructose). They should also ingest about 30-40g of fiber each day and drink 8-10 cups of liquid & chew slowly to help promote normal bowel function

Recommended fluid intake for adult patients

Males = 3.7L Females = 2.7L

Obstruction at the end of the small intestine & lower in the intestinal tract causes a loft of alkaline fluids and can lead to...

Metabolic Acidosis

An intestinal obstruction high in the small intestine can cause a loss of gastric hydrochloride which can lead to...

Metabolic Alkalosis

Does IBS affect mostly women or men?

Mostly women except in Asian countries

Postoperative Care in Mechanical Obstruction

NGT may be in place until peristalsis resumes, clear liquid diet, monitoring, positioning, airway, inspect incisions for infection, dressing changes, drug therapy, teaching

Nonsurgical Management of Mechanical Obstruction

NPO, NGT inserted to decompress bowel by draining fluid & air. Tube attached to suction. (Salem Sump Tube to low continuous suction) , IV fluid replacement/maintenance (b/c of NPO status). Blood replacement may be needed if strangulation. VS, fluid status (I&O, turgor, mucus membranes) q2-4h. Frequent oral care. Semi-fowlers position

Inflammatory or Infections disease in elimination

Necrotizing enterocolitis (NEC), Ulcers, Inflammatory Bowel Disease (IBD), Gastroenteritis, Crohn's

What is the Diagnostic Evaluation for the patient with a small bowel obstruction?

Patient will be NPO, get good health history (When did it start? What are s/s?) to determine whether mechanical or non-mechanical. (What makes it worse? better?) They will need bowel surgery to resect. May need NG tube to compress stomach & alleviate swelling. I&O (fluid replacement). Anticipate surgery (Ostomy) pre-op/post-op care

Preoperative Care in Mechanical Obstruction

Provide teaching for pt & family & reinforce information with caregiver

Retention of elimination

Purposeful - appropriate times for elimination

Alterations in developmental R/T elimination

Pyloric Stenosis, Tracheoesophageal Fistula (TEF), Hirschsprung's

In intestinal obstruction, what happens if the hypovolemia is severe?

Renal insufficiency or death can occur or bacterial peritonitis with or without perforation

What are some diagnostic tests done IBS?

Routine lab values (CBC, serum albumin, ESR, stools for occult blood)=These are usually normal in IBS Hydrogen Breath Test (People with IBS usually exhale large amounts of hydrogen b/c excess hydrogen is produced in the small intestine with bacterial overgrowth)

What is IBS sometimes referred to?

Spastic colon, mucous colon, or nervous colon. IBS is the most common digestive disorder seen in clinical practice

What is the surgery for a Mechanical Obstruction?

Strangulated obstruction is a complete obstruction & surgery is always required. Exploratory Laparotomy is initially performed and more specific procedures depend on cause of obstruction

What are some holistic treatments for IBS?

Stress management, relaxation techniques (meditation or yoga). If the pt has work/family stress, personal counseling may be helpful. Teach the patient regular exercise is important for managing stress & promoting bowel elimination

What should you teach patients before taking Alosetron (Lotronex) for IBS-D?

Take a thorough drug history (including herbs & OTC). Report constipation, fever, increasing abdominal pain, increasing fatigue, darkened urine, bloody diarrhea, rectal bleeding & stop drug immediately

The nurse is caring for a client who has suffered abdominal trauma in a motor vehicle crash. Which laboratory finding indicates that the client's liver was injured? a. Serum lipase, 49 U/L b. Serum amylase, 68 IU/L c. Serum creatinine, 0.8 mg/dL d. Serum transaminase, 129 IU/L

The level of serum transaminase, a liver enzyme, is elevated with liver trauma. The other laboratory values are within normal limits and are not specific for the liver.

What should you teach the patient with IBS receiving the Hydrogen Breath Test?

They should be NPO (may have water) for at least 12 hours prior to the test. At the beginning of the test the patient blows into a hydrogen analyzer. Then small amounts of test sugar are ingested, depending on the purpose of the test, & additional breath samples are taken every 15 minutes for 1 hour or longer. If lactose intolerance is evaluated, lactose in ingested. If bacterial overgrowth is tested, lactose is given.

Other Diagnostic Assessments of Mechanical Obstruction

Ultrasound, endoscopy (sigmoidoscopy, colonoscopy)

Lab Assessments with mechanical obstruction

WBC normal (unless strangulated obstruction >WBC), H&H elevated, Creatinine elevated, BUN elevated (indicating dehydration). Sodium, chloride, potassium decreased b/c of f&e loss. ABG of metabolic alkalosos

How does vascular ischemia occur?

When arterial or venous thrombosis or an embolus decreases blood flow to the mesenteric vessels surrounding the intestines. Severe insufficiency of blood supply can result in bowel infarction

Which drug has been approved for "travelers diarrhea" and other illnesses?

Xifaxan (rifaximin). It has not been approved for patients with IBS

Imaging Assessment of Mechanical Obstruction

Xrays, CT scans. (x-rays are often normal when a strangulation exists in the small intestines)

What is a closed loop obstruction?

a blockage in 2 different areas

What should the nurse observe on examination on the patient with mechanical obstruction?

abdominal distention, peristaltic waves visible, auscultate for proximal high-pitched bowel sounds (borborygmi)

Function of jejunum & ileum

absorption of nutrients/vitamins (active transport), absorption of Vitamin B12 (terminal ileum)

what is a strangulated obstruction?

an obstruction with compromised blood flow (the risk for peritonitis is greatly increased)

How often should the nurse assess the NG Tube?

at least every 4 hours, assessing for proper placement, potency, & output (quality & quantity). Monitor nasal skin. Auscultate bowel sounds

What other signs/symptoms do patients with IBS experience

belching, bloating, gas, anorexia, diarrheal stools that are soft & watery, mucous present in the stool

What are some examples of environmental factors that play a role in IBS?

foods and fluid intake like caffeinated or carbonated beverages and dairy products. Infectious agents have also been identified

What are the functions of the GI tract?

ingestion, chewing, digestion, absorption, detoxification, excretion, fluid & electrolyte balance

On a physical assessment, where would the patient with IBS be experiencing pain?

lower left quadrant of the abdomen.

What are clinical manifestations with mechanical obstruction of small intestines?

mild abdominal pain/cramps. The pain can be sporadic. If strangulation present, pain becomes more localized & steady. Vomiting (may contain bile & mucous & be foul smelling), Obstipation (no passage of stool) failure to pass gas. Diarrhea may be present in partial obstruction

What are clinical manifestation of mechanical colonic obstruction?

milder, more intermittent colicky abdominal pain, low abdominal distention, obstipation, ribbon like stools, alterations in bowel patterns & blood in stools

Control of elimination

normal function (voluntary sphincter & muscle control

Causes of retention of elimination

obstructions (small bowel obstruction, tumors, hemorrhoids, etc), inflammation (Crohn's, IBS, Collitis), ineffective neuromuscular activation (Neurogenic bowel, Neurogenic bladder) (physiological especially in children)

Function of the gallbladder

store bile & secrete into duodenum

function of rectum

stores stool & allows for defecation

What is the patho of a mechanical intestinal obstruction?

the bowel is physically blocked by problems outside of the intestines (adhesions), in the bowel wall (Crohn's) or in the intestinal lumen (tumors)

What is a cognition impairment in elimination?

the inability for the person to recognize cues for elimination. The patient may not be able to let go and may hold it, or may not be able to hold it and let go

Function of cecum

water reabsorption

What is the only confirmation of proper placement of an NG Tube?

xray