Bowel elimination Ch 40 PDF

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Summary

Miriam Walter was professor. Used course objectives outlined for each section as well as study guides given prior to major exam....

Description

Bowel elimination Ch 40 BM “norm” 1-3/day or 2-3/week Assessment Subjective: last BM? Abd pain? Gas? Appetite? Objective  Inspect-distension?  auscultate  palpate  assess abnormals-stoma Common Bowl Normal activity Problems Important to assess-post op, abd pain complaint, N/V 1. Flatulence Rectal tube 2. Constipation Interventions

3. Impaction Interventions

4. Diarrhea

Contributing factors

5. Incontinence

Activity, fluid, fiber (bulk and stim peristalsis) Don’t suppress urge to defecate Admin laxative per order Edu Bowel program R/T dec fluids, hypercalcemia, hypokalemia, slow GI motility, anxiety, depression, BR, meds, age Hardened fecal mass from unresolved const. s/sx passage of liq stool, rectal pain, anorexia, N/V, distension May need to be removed  warm liqs  fiber  ambulation Acute-3 or+ loose stools/day Chronic >14 days s/sx abd cramps, hyperactive BS, mucus, blood, N/V, fatigue, weakness, wt loss fluid/electrolyte imbalances  emotional stress  intestinal infection  food allergy/intolerance  food borne pathogen  enteral nutrition  laxatives  meds (antibiotics)  IBD-Chron’s, UC Interventions  tx causative factor  bulk up  anti diarrhea meds (pepto bismal, kaopectate, @modium, lomotil)  maintain fluid balance Contributing factors-age, LOC, impaired sphincter fx/ability to

Interventions

6. Bowl diversions Temporary or perm artificial opening in abd wall via stoma

7. Hemorrhoids

Factors affecting elimination 1. Aging 2. Diet

3. Physical activity 4. Patho 5. Positioning 6. Pain 7. Pregnancy 8. Surgery/anest hesia

get to toilet/innervation  routine toileting  skin care (barrier cream) Types of ostomies-location determines effluent  ileostomy-liquids, continuous drainage  colostomy-more formed stool, more distal-more formed, may be irrigated to est bowel pattern  ileoanal pouch-pouch est from SI, attached to anus (serves as rectum), continent  kock continent ileostomy-reservoir from SI with continent stoma and valve, can be drained with intermittent cath assessment  color, size, shape, stoma bleeding  healthy stoma-beefy red, moist and shiny  0.5-1 inch protrusion  6-8 wks for final size  surrounding skin  drainage Norm/abnormal findings Interventions  applying, emptying, changing pouch  control odors  skin care  client teaching for self care, diet  psych support Engorged, dilated blood vessels in rectal wall Predisposing factors-straining, pregnancy, chronic const., heart failure, chronic liver disease Tx-alleviate const, topical med, excised thrombosed  dec peristalsis, esophageal emptying, absorption  dec muscle tone in perineal floor/sphincter  dec awareness of BM need (dementia) Fiber 25-30g/day Fluids 1.5-2 L Intolerance

squatting hemorrhoids Pressure on rectum impairs passage, straining, leads to hemorrhoids Slowing or stopping of peristalsis post op Paralytic ileus after direct manipulation 24-48 hrs s/sx absent

BS, const. 9. Meds Small bowel obstruction-Ileus

Volvulus

Laxatives (types)

Enemas

Pharm (mechanisms of action)

Tests

Obstruction, inability of intestine to contract occurs in SI s/sx severe abd pain, N/V, liq stool can be d/t adhesions, Chron’s, hernia Bowel twists around itself/mesentery causing obstruction, blood flow’s blocked Can occur secondary to constipation Surgery required s/sx pain, bloating, nausea, bloody stools, const. Indications-bowel prep, hemorrhoids, CV disease, modification of effluent from ostomies, pregnancy, prevent impaction for bed bound, opioid use, tx of parasitic infections, lactulose for liver disease, kayexalate for hyperkalemia  bulk forming-first line of defense, same action as dietary fiber, absorbs water to inc bulk (Metamucil)  surfactant/stool softeners-(docusate sodium-colace) softer stool for easier passage, draws water into stool, doesn’t stim peristalsis, onset can take days  stimulants-stim peristalsis (bisacodyl-dulcolax po/supp), (sennosides), sup act faster  osmotic laxatives-draws water into intestine, distends wall stim peristalsis (mira lax)  misc-lubricant, glycerin sup stim rectum and lubes, polyethylene glycol Fleet Mineral oil Tap water Soap suds Kayexelate for high K levels Iron, opioid (const.) AnticholingergicsLaxatives Diphenoxylate/atropine (imodium) NSAIDs cause GI bleeds after ext. use Reglan (GERD) Dicylclomine-antispasmodic (IBS) Stool specimen  C&S, O&P Upper/lower GI  barium swallow/enema  can cause const/wet stool  UGI-NPO 4-8 hrs  LGI-liq diet 2 days, cl liq 24 hrs, enema/laxative

GI bleeding

Shades

S/SX of GI problems IBD Chron’s IBS UC C diff

Risk factors

Complications

 upper endoscopy  colonoscopy/sigmoidoscopy Occult blood-tests for invisible blood in stool, helps find etiology if anemia, can be used for any abd pain complaint Colon studies  cl liq diet 1-3 days  laxatives, enema  NPO sev hrs prior  no red/purple dyes in food  prep til clear Wireless capsule endoscopy CT, MRI Breathalyzer-lactose intolerance, bacterial overgrowth, fungal infection Bright red-LGI Black, tarry-UGI Coffee ground emesis Hemorrhoids-blood outside of stool Hemoatchizia-passage of fresh blood through anus Melena-dark sticky feces containing partly digested blood (internal bleeding, swallowing blood) Fe suppl  Brown  Green-moving through too quickly, lots of greens  yellow-excess fat, mal absoprtion (celiac)  black-internal bleeding, iron  white-bile duct obstruction, meds  blood stained, red-cancer

Gram+ anaerobic spore forming bacteria Community/HAI s/sx watery diarrhea, foul smell, fever, anorexia, belly pain, tenderness  age >65  comorbidity  exposure to antibiotics/healthcare  immunosuppressive conditions (chemo, HIV)  manipulation of GI system (feeding tubes, surg) Stool spores survive up to 70 days Dehydration from diarrhea, fluid/electrolyte imbalance Rupture of toxic megacolon-peritonitis, sepsis, death...