Term
| Function of the Gastrointestinal Tract |
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Definition
-Motility
peristalsis
-Absorption
-Defecation
Defecation reflex
Valsalva’s maneuver |
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Term
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Definition
| Gas produced during digestion. Mostly bacterial fermentation but also some swallowed air. Important to ask if post surgical, no BM, hypo BS |
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Term
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Definition
| Bradycardia as a result of stimulation of the vagus nerve and inhibition of heart rate. |
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Term
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Definition
| Contraction of the stomach muscles while maintaining a closed airway (bearing down). Increases pressure within the abdominal cavity, and can affect blood pressure and heart rhythm. Contraindicated in people with heart disease, glaucoma, intracranial pressure or new surgical wounds. Sometimes used when someone is having a very fast heart rate. |
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Term
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Definition
| Remember anus and rectum are highly vascular. That’s why nutrition and medications given. Hemorrhoids are caused by chronic pressure on the veins within the anal canal. = Distended blood vessels within or protruding from the anus. |
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Term
| Bowel Elimination/Defecation |
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Definition
| A normal process by which waste products are eliminated from the body. This involves voluntarily contracting diaphramatic and abdominal muscles and relaxing external sphincter. |
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Term
| Feces/Stool/Bowel Movement: |
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Definition
: mixture of fiber and undigested food mixed with water
Flatus: Gas produced during digestion. Mostly bacterial fermentation but also some swallowed air. Important to ask if post surgical, no BM, hypo BS |
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Term
| Characteristics of Normal Feces (normal amount?, color, shape, etc) |
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Definition
-Wide normal range of frequency: from 1 -2 BM’s daily to 2 – 3 times a week.
-Soft, Formed, Semi – Solid, -Cylindrical
-Brown
-Pungent Odor
-Passed without urgency or excessive straining/effort |
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Term
| Factors Affecting Bowel Elimination in the older adult |
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Definition
-Slowed Gastrointestinal Motility
-Weakened Pelvic Muscles
-Decreased sphincter muscle strength
-Decreased Activity
-Chronic Illnesses which affect gut transit times and delay evacuation.
-Medications
-Laxative Abuse |
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Term
| Other Factors Affecting Bowel Elimination |
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Definition
-Cultural Considerations
-Nutrition
-Fluid Intake
-Activity and Exercise
-Body Position
-Ignoring the Urge to Defecate
-Lifestyle
-Medications
-Diagnostic Procedures
-Anesthesia/Surgery
Paralytic Ileus
-Infection
-Tube Feedings |
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Term
| Advanced Age affects bowel elimination? |
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Definition
| causes a decrease in intestinal muscle tone, perineal muscle tone and relaxation of the relaxation or decreased tone of the anal sphincters>> Combined with low fiber and inactivity – leads to bowel elimination problems |
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Term
| PSYCHOSOCIAL FACTORS effects bowel elimination? |
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Definition
| : Stress: can cause constipation, diarrhea. Stress is the primary risk factor in the development of Irritable Bowel Syndrome (bloating, pain, and altered bowel function) and can exacerbate other conditions such as chrone’s disease, ulcerative colitis, and ulcers |
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Term
| PERSONAL FACTORS: effects bowel elimination? |
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Definition
| : Lack of privacy, time, positioning (squat is best) Immobilized patients may not be able to sit. Bedpan is uncomfortable and embarrassing. Even commode./ Pain – if defecation causes pain, may suppress urge |
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Term
| Nutrition effects bowel elimination? |
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Definition
-irregular eating causes irregular bowel elimination
-A varied diet is best
-Fiber adds bulk to the stool which causes it to absorb water and increase in mass, causing peristalsis.
-Need water too – too much fiber without water can actually cause constipation)
-Water is best: Too many sugary beverages can lead to soft or watery stools
-Milk can cause constipation, unless the person is lactose intolerant
-Coffee may promote peristalsis , but may is thought to be a diuretic.
-Therapeutic Diets (hospital) |
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Term
| T/F In the presence of the defecation reflex, the external anal sphincter remains relaxed. |
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Definition
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Term
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Definition
| This reflex is not under voluntary control and the internal sphincter relaxes |
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Term
| ACTIVITY effects bowel elimination? |
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Definition
| promotes peristalsis and strenghtens abdominal muscles |
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Term
| PATHOLOGIES effects bowel elimination? |
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Definition
| food allergies or intolerances, Diverticulosis, UC, Chrones |
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Term
| ANESTHESIA/SURGERY effects bowel elimination? |
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Definition
-General anesthesia slows everything including bowels.
-paralytic ileus: cessation of peristalsis after bowel manipulation –keep NPO
-Perineal surgery or childbirth: trauma to area
-Decreased mobility after surgery due to dizziness/pain |
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Term
| MEDICATIONS effects on bowel elimination? |
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Definition
-Antacids (slow peristalsis)…….NSAIDS( irritate stomach – can lead to ulceration
-Antibiotics – destroy normal flora, causing diarrhea
-Iron – turns stool black, causes constipation/ Ca++ constipation
-+Magnesium and Vitamin C – can cause diarrhea – Vit C may also cause false negative for guaic |
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Term
| Opiates effects on bowel elimination? |
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Definition
decreased peristalsis, delayed gastric emptying and prolonged intestinal transit time
There’s a whole list in your book of meds that cause constipation |
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Term
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Definition
entire colon (large intestine)removed then brought to surface.
-stool very watery |
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Term
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Definition
| middle of colon (large intestine) brought to top |
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Term
| Sigmoid colostomy? stool? |
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Definition
| Only rectum removed. (solid stool) |
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Term
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Definition
| an opening which connects a portion of the body cavity to the outside environment |
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Term
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Definition
| surgical procedure in which a stoma is formed by drawing the healthy end of the large intestine or colon through an incision in the anterior abdominal wall and suturing it into place. |
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Term
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Definition
| removes a part of the colon and uses the ileum (a small section of the small intestine) to form a new reservoir for waste that can be expelled through the anus. |
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Term
| Altered Bowel Function: Constipation (Perceived or Actual) Associated with? Complications for constipation? |
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Definition
-A decrease in the frequency of BMs and the passage of dry, hard stool that requires more effort to pass.
-constipation is often associated with bloating, cramping and straining
-hemorrhoids, rectal fissure and impaction and….
Straining (valsalva maneover) increases pressure or stimulates vagal response: bradycardia, hypotension, syncopy |
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Term
| What meds or supplements can cause constipation? |
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Definition
| Opioids and Calcium supplements ,antihistamines, anticholinergics. |
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Term
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Definition
-Constipation
-Fecal Impaction
-Diarrhea
=C-diff
-Fecal Incontinence
-Flatulence
=Flatus
-Distension |
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Term
| Issues with frequency of stool? |
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Definition
More than 3 stools a day
fewer than once a week |
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Term
| Color? (colors, causes by) (foods that effect color?) |
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Definition
-Black – Tarry (Melena): Upper abdominal bleeding. (usually soft)
-Frank blood: lower tract or hemorrhoids
-White or pale stools can be indicative of disease
-Iron can also cause stool to become black. Look for other s/s.
-Foods can affect color: beets, spinach |
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Term
Normal shape?
Shape issues? |
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Definition
-Should be shaped like rectum,
narrow and pencil shaped can mean obstruction
-small and marble shaped: dehydration/constipation |
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Term
CONSISTENCY: Dry and hard or Watery ( “loose” )
-What causes this? |
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Definition
-If passage through the colon is slowed, more water is absorbed and the stool becomes dry and hard.
-If it passes quickly, less water absorbed, stool is watery or “Loose” |
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Term
| Strong, foul ODOR can mean? |
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Definition
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Term
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Definition
-Is acquired through the ingestion of spores usually transmitted from other patients through the hospital environment or the hands of healthcare personnel
-Alteration of the intestinal flora by antibiotics leads to proliferation of the organism
-Elderly have highest risk
-Causes diarrhea with a foul odor
-Stool culture confirms
-Need antibiotics to treat
-Patient placed on contact precautions/hand sanitizers ineffective against spores |
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Term
| Clostridium difficile other facts? |
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Definition
Gram positive spore forming anaerobic bacillus
is found throughout enviroment – in soil, air, water and human and animal feces
Antibiotics kill the normal flora which protects against infection of GI tract
Young, healthy people don’t usually get sick from it
Symptoms may not appear for weeks or months after abx treatment
Watery diarrhea 10 – 15 times/day, cramping, weight loss, fever, blood in stool
Ironically abx used to treat – flagyl and vancomycin. Recurrence is common. Probiotics like Yogurt and Acidophillus helps
Do not give antidiarrheals |
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Term
| Foods that Affect Bowel Elimination? |
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Definition
-High Fiber
=Fresh Fruit and Berries
=Dried Fruit
=Vegetables (especially leafy or raw)
=Whole Grain Cereal Products
=Flaxseed
=Dried beans, peas and legumes
-Foods that slow peristalsis
=Simple carbohydrates, lean meats
-Foods that produce Gas
=Cabbage Family
=Onions
=Legumes
-Probiotics
=Yogurt
=Acidophillus
-Spicy Foods
=may cause gas and more frequent bowel movements |
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Term
| How much fiber eat a day? What has most fiber? |
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Definition
-We should get 25 – 30 g/fiber/day so you should know foods high in fiber.
-Artichokes have the most fiber, followed by peas and broccoli. Carrots have the least.
-Beans have between 10 and 16 grams of fiber per cup
-Raspberries top the list of fruits with 8 grams per cup |
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Term
Percent of plate should be fruits and veggies?
Percent of grains should be whole grains? |
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Definition
-Make half your plate fruits and vegies
-Half your grains whole grains |
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Term
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Definition
Live microbial foods or supplements that improve microbial balance in stomach.
HEALING
Yogurt/Acidophillus _ Probiotics; Maintain “healthy” bacteria in intestines. Promotes healing for people with intestinal infections, and antibiotic induced diarrhea (kills normal flora) . W&T says: stimulates peristalsis so also good for constipation
Also been found to controls gas and odor for people with ostomies. (Lutz says do not take abx and yogurt w/in 2 hrs of each other.) |
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Term
| Stool blood test, what causes false positive? negative? |
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Definition
-red meat or iron = pos
-vitamin C = neg. |
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Term
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Definition
| examination of large intestine from the rectum through the last part of the colon |
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Term
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Definition
| look inside the rectum and entire colon |
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Term
| Esophagogastroduodenoscopy |
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Definition
| shows the upper part of the gastrointestinal tract up to the duodenum. |
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Term
An elderly woman who is incontinent of stool following a cerebrovascular accident will have the following nursing diagnosis?
A. Bowel incontinence related to loss of sphincter control as evidenced by inability to delay the urge to defecate
B. Diarrhea related to tube feedings as evidenced by hyperactive bowel sounds and urgency
C. Constipation related to physiologic condition involving the deficit in neurologic innervation as evidenced by fecal incontinence
D. Fecal retention related to loss of sphincter control and diminished spinal cord innervation related to hemiparesis |
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Definition
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