(Starting with Lower left box)

1. appendix
2. cecum
3. ascending colon
4. gallbladder
5. esophagus
6. liver
7. spleen
8. stomach
9. transverse colon
10. descending colon
11. small intestines
12. rectum

• Food is mixed with salivary enzymes beginning the process of digestion
• The bolus of food is propelled to the pharynx and down the esophagus
• Food enters the stomach where secretions from the stomach break down and digest food
• The food then enters the small intestine
• contents then enter the large intestine
• travels to rectum and then anus

The anus, the last portion of the large intestine, has two sphincters: the ______ sphincter (_____ muscle that is under _______ neural control) and the _______ sphincter (______ muslce under _____ control).

Choices: voluntary, involuntary, smooth, striated, external, internal

internal sphincter is smooth muscle under involuntary control

external sphincter is striated muscle under voluntary control

• completion of absorption
• manufacture of some vitamins
• formation of feces
• expulsion of feces from the body

Peristalsis is under control of the ____ ______.

Contractions occur every __ to __ minutes.

Mass peristalsis sweeps occur __ to __ times each 24-hour period.

___ to ___ of food waste is excreted in stool w/in 24 hrs.

nervous system

3 to 12 minutes

1 to 4

1/3 to 1/2

Characteristics of Normal and Abnormal Feces

Characteristic             Normal          Abnormal

Frequency

Color

Consistency

Shape

Amount

Odor 

Frequency N: 1-2/day to 1 every 2-3 days

Ab:>3/day;<1 every 3 days

Color N: Brown, Ab: Black, tarry; reddish-brn, maroon; clay colored; yellow-green

Consistency  N: soft, formed, Ab: Hard, Loose, liquid, high mucus content

Shape N: Cylindrical, Ab: Narrow, pencil thin

Amount: N: 100-300g/day, Ab: <100g/day, >300g/day

Odor: N: aromatic, pungent, Ab: Foul, objectionable

Developmental Considerations

formula or breast feedings

toilet training

constipation

Which of the following foods are constipating, have laxative effects, or are gas-producing?

onions, fruits and vegetables, chocolate, lean meat, cheese, cabbage, coffee, cauliflower, beans, pasta, eggs, alcohol, bran

Constipating: lean meat, cheese, pasta, eggs

Laxative effect: fruits and vegetables, chocolate, coffee, alcohol, bran

gas-producing: onions, cabbage, cauliflower, beans

Effect of medications on stool (color)

Aspirin, anticoagulants:

Iron salts:

Antacids:

Antibiotics:

Aspirin, anticoagulants: pink to red to black stool

Iron salts: black stool

Antacids: white discoloration or speckling in stool

Antibiotics: green-grey 

Physical Assessment of the Anus and Rectum

Examine anal area for:

Insert gloved finger into anus to assess _____ _____ and smoothness of _____ _____.

Inspect perineal area for _____ _____ secondary to diarrhea

cracks, nodules, distended veins, masses or polyps, fecal mass

sphincter tone and smoothness of mucosal lining

skin irritation

Inspection

Auscultation

Percussion

Palpation

Nutrition

Fluid Intake

Activity and Exercise

Body Position

Ignoring the urge to defecate

lifestyle

Pregnancy (constipation due to hormonal changes)

Medications

Diagnostic procedures

surgery

fecal diversion

Which quadrent do you start with to auscultate the abdomen?

If the patient complains of pain in the abdomen, do you auscultate that area first, last or in the normal pattern?

Normal bowel sounds are heard in each quadrant within ___ to ____ seconds.

Lower right

last

5 to 15 seconds

A patient who has undergone abdominal surgery may have________ or ______ bowel sounds for 1 to 3 days postoperatively.

Continuous bowel sounds or sounds heard more than every 5 seconds can be termed ______. Which patients usually exhibit these sounds?

hypoactive or absent

hyper active; patients w/diarrhea

hypoactive

hyperactive

Which quadrant of the abdoment would you be most likely to hear tympanic sounds?

What is the normal sounds heard in the other three quadrants?

When an abdomen is abnormally distended with air (or gas), which sounds may be heard throughout the abdomen?

upper left quadrant where b/c the stomach is there

hollow sounds

tympanic

An accumulation of fluid in the peritoneum, usually from liver failure

What assessement is particularly helpful in assessing this?

Ascites

abdominal girth

fecal occult blood test, or Hemoccult test

Stool culture

Radiologic procedures

endoscopic examination

What does the fecal occult blood test test for in the stool.

What is the usual source for blood found on the surface of the stool verses blood found mixed in the stool mass itself?

blood in the stool

hemorrhoids/intestinal

Choose: Esophagogastroduodenoscopy, sigmoidoscopy, colonoscopy, UGI series

1. visualizes the rectum, colon, and bowel using a lighted scope
2. examines the distal sigmoid colon, rectum, and anal canal through a flexible or rigid scope
3. involves fluoroscopic examinationof the esophagus, stomach and small intestine after ingestion of barium sulfate
4. examines the esophagus, stomach, and upper duodenum through an optic scope 

1. colonoscopy
2. sigmoidoscopy
3. UGI series
4. esophagogastroduodenoscopy

patients on bed rest taking constipating medicines

patients with reduced fluids or bulk in their diet

patients who are depressed

patients with CNS disease or local lesions that cause pain

Bulk - fibercon, metamucil

Emollient (stool softeners) - colace, surfak, dialose, doss

Saline - milk of magnesia, fleet enema

Stimulant - castor oil, dulcolax, ex-lax, correctol, senokot

absorbents: kaolin/pectin, kaopectate, bismuth

Bulk-forming agents: metamucil

Opiates and synthetic opiates (imodium, lomotil)

Antispasmodics: atropine

Small volume enemas usually contain ____mL

Large volume enemas contain up to _____mL for the adult

A _____ _____ enema is administered to promote the expulsion of flatus.

150mL

1000mL

return flow

What are the indications for administration of a cleansing enema?

Which solutions would be used to administer a large volume enema? sm volume?

Which position for enema administration is recommended by some authorities?

relief of constipation, prepare the bowel for tests

LG - tap water, soap suds, saline, SM - saline or oil

sims position

105-110 F

When it's too cold, cramping can occur

When it's too hot, bowel mucosa may be injured

The rectal tip of an enema should be lubricated and instered how many inches into the adult?

Insert the rectal tip toward the client's _____.

How many inches should the solution be held above the anus?

3-4 inches

umbilicus

12 to 18 inches

Discontinue the enema if the client exhibits:

If more than ____ tap water enemas are necessary, consult the doctor before giving them. Why?

diaphoresis, pallor, rectal bleeding

3, because it may create an electrolyte imbalance

Fecal impaction is an emergency

To relieve constipation, you can consume prune joice, but not milk or bananas

In the older adult, weakened pelvic muscles leads to constipation. Getting up and walking around and increasing fluids can help relieve some.

Paralytic ileus or an abdominal tumor can cause abdominal distention

Constipation

Decrease in activity such as bed rest after surgery

Low suction is 20 to 40 mm Hg.  High suction is 80 to 120 mm Hg.

If the nasogastric tube has a vent, continuous suction may be used.  Intermittent suction is required when there is no vent.

Where are some vitamins and iron absorbed along with a sm amount of fluid?

Where is most fluid absorbed? 

Where are Electrolytes predominately absorbed?

ileum

large intestine

Duodenum, jejunum, and large intestine

T or F

1. All older adults should use laxatives to promote normal defecation
2. Oral laxatives take longer to effect change than laxatives administered rectally
3. Olderadults are at particular risk for laxative abuse
4. Rectal suppositories tend to work within 60 minutes of administration 

1. False
2. True
3. True
4. True