Shared Flashcard Set

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Elimination
Basics
50
Nursing
Undergraduate 1
11/23/2013

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Cards

Term
Older Adult
Definition
Decreased peristalsis

Lose muscle tone in perineal floor and anal sphincter

Often have difficulty controlling bowel
elimination with an intact external sphincter

Become less aware of need to defecate

Bowel consciousness
Term
Diet (Fiber)
Definition
provides bulk of fecal matter
 Need 20-35 grams of fiber/day

Risk for polyps with no fiber in diet
Term
Diet (Bulk forming foods)
Definition
help flush fats and wastes
from body

Whole grains, fresh fruits and vegetables
Term
Diet (Good)
Definition
Bowel walls stretch, creating peristalsis and initiate defecation reflex
Term
Fluid Intake
Definition
1100-1400 mL fluid daily

Fluids and fruit juice soften stool and 5 peristalsis

Risk for constipation with diminished fluid intake
Term
Physical Activity
Definition
Promotes peristalsis

Weakened abdominal and pelvic floor muscles impair ability to increase intraabdominal pressure and to control the external sphincter

Encourage early ambulation
Term
Psychological Factors
Definition
Stress increases

peristalsis
 Diarrhea
 Gaseous distention
Term
Personal Factors
Definition
Maintain privacy
 Prefer own toilet

 Embarrassment
ignore urge

 Convenient time
 Busy work schedule
ignore urge
Term
Position During Defecation
Definition
Leaning forward

Intraabdominal pressure

Contract thigh muscles

Bedridden
client…raise HOB 30º
or more while on
bedpan
Term
Pain
Definition
Hemorrhoids
 Rectal surgery
 Rectal fistulas
 Abdominal surgery
 Suppress urge to defecate
 Develop constipation
Term
Surgery & Anesthesia
Definition
General anesthesia
 Temporarily stop peristalsis

Local or regional anesthesia
 Minimally or does not affect bowel activity

Direct manipulation of bowel temporarily stops peristalsis (paralytic ileus) for 24 to 48 hours
Term
Constipation
Definition
Infrequent bowel movements- < every 3 days

Inability to defecate at will
Difficulty passing stools
Excessive straining
Hard feces
Term
Health hazards from straining
Definition
Increased intracranial pressure

Increased intraocular pressure with possible fainting

Bradycardia (Valsalva maneuver)

Suture and wound separation
Term
CONSTIPATION COMMON CAUSES
Definition
Ignoring urge to defecate
Low fiber diet
Low fluid intake
Anxiety, depression or cognitive impairment
Lack of regular exercise
Laxative misuse
Medications
 Opioid analgesics
 Diuretics
Term
FECAL IMPACTION
Definition
Results from ongoing constipation
Term
Fecal Impaction (Signs and symptoms)
Definition
Inability to pass hardened stool for several days despite repeated urge with intestinal obstruction

Continuous oozing of diarrhea stool around impaction

Loss of appetite
Nausea and/or vomiting
Abdominal distention and cramping
Rectal pain
Can extend into sigmoid colon
Term
Incontinence
Definition
Inability to control passage of feces and gas from anus due to imparment of anal sphincter control.
Term
Promoting normal defecation
Definition
Sitting position

Positioning on bedpan – raise HOB 30 degrees or greater after bedpan placement unless contraindicated

Privacy
Term
Normal Fecal Characteristics
Definition
Color –brown
Odor – Pungent; affected by food type
Consistency – soft, formed
Frequency – 2-3 times per week
Shape – resembles diameter of rectum
Constituents – undigested food, dead bacteria, fat, bile pigments, cells lining intestinal mucosa, water
Term
Stool Specimen Collection
Definition
Gather supplies

Explain reason for specimen collection

Wear gloves

Ask to void before stool collection

Have defecate in a clean bedpan, bed side commode or hat in toilet

Teach to not contaminate specimen with urine or menstrual discharge

Teach to not place tissue in bedpan, commode or hat

Use clean tongue depressor to transfer specimen (sterile if for bacteria/viral study)

1 inch formed stool or 15-30 mL of liquid diarrhea stool for most tests

Some specimens are temperature sensitive and must be sent to lab immediately
Term
Performing a Hemoccult/Guaiac test on stool for occult blood (microscopic amounts of blood)preparation
Definition
Preparation: No red meat, any blood containing food, cantaloupe, uncooked broccoli, turnip, radish or horseradish 3 days before test
Term
Performing a Hemoccult/Guaiac test on stool for occult blood (microscopic amounts of blood)
Definition
Requires 3 consecutive samples

If directed by MD stop taking meds that interfere with test –vit C, aspirin, NSAID, steroids, iron, anticoagulants that irritate gastric mucosa & cause bleeding

Label card on front with patient identifying info

Thin smear from 2 portions of the stool

Close cover flap & turn over

Wait 3-5 minutes. Open flap. Apply 2 drops of developing solution on each smear. Interpret within 60 seconds. Blue is positive & no color is negative
Term
OVA & Parasite Test on stool
Definition
Transport immediately to lab while warm

3 stool specimens over a period of days
Term
Fecal Fat Test
Definition
3-5 day collection of stool

Save all of the stool for this test
Term
Enemas
Definition
Purposes:
Temporary relief of constipation

Removal of impacted feces

Empty bowel before diagnostic tests or surgery

Beginning a program of bowel training
Term
Cleansing Enemas
Definition
Low volume hypertonic solutions.

120-180 ml solution.

Pull fluid out of interstitial spaces into the intestine and stimulate peristalsis.

Contraindicated for hydrated clients.
Term
Cleansing Enemas (Tap Water)
Definition
Stimulates defecation

Water moves from intestines into interstitial spaces

Risk of circulatory overload if repeated – avoid this
Term
Cleansing Enemas (Normal Saline)
Definition
Safest solution

Stimulates defecation without movement into interstitial spaces
Term
Cleansing Enemas (Soapsuds)
Definition
Use pure castile soap (comes in kit)

Intestinal irritation to stimulate peristalsis

Use cautiously in elderly – damage intestinal mucosa; fluid and electrolyte imbalance
Term
Cleansing Enemas (Oil Retention)
Definition
Lubricates rectum and colon

Softens stool

Usually retained for 30 minutes up to several hours if possible
Term
Cleansing Enemas (Carminative(to relieve gas)
Definition
MGW solution – 30 mL magnesium, 60 mL glycerin & 90 mL water

Medicated

Kayexalate (for clients with high potassium)

Neomycin solution – to reduce bacteria in colon before bowel surgery
Term
Digital removal for impacted stool (per MD order)…it is the nurse’s responsibilities!!
Definition
Provide for privacy

Assist to left side lying position with knees flexed and back toward nurse

Place bed pad below buttocks, and bedpan nearby for stool

Nurse wears clean gloves with index finger well lubricated

Gently insert gloved index finger along the length of the rectum

Loosen and dislodge stool by gently massaging around it. Break up the stool and remove in small pieces

Assess throughout for facial pallor, diaphoresis or change in pulse rate

Assist onto bedpan or commode

Document responses & results
Term
Enema Administration Key Points When Using Solution Administration Bag
Definition
Water proof pad under client

Position client onto left side lying (Sims) position with right knee flexed

Use warm solution

Raise solution bag above anus on hanging pole

12-18 inches for high enema – for entire colon
12 inches for regular enema
3 inches for low enema – for rectum and sigmoid areas

Insert lubricated tip in direction of clients umbilicus 3-4 inches

Open regulating clamp and allow solution to enter slowly

Clamp tubing for cramping or fluid leakage around rectal tube

After enema infused turn from left lateral to dorsal recumbent to right lateral to reach entire colon for high enema
Term
Prepackaged Bottle Disposable Container
Definition
Once inserted roll up container to instill the solution

Retain solution until urge to defecate (2-5 minutes)

Exception: mineral oil
Term
Diarrhea
Definition
Increase in the number of stools and passage of liquid, unformed feces
Term
Diarrhea (Common Causes)
Definition
Antibiotic use and other causes of over of clostridium difficule (c.difficilie)

Enteral nutrition

Food allergies and intolerance
Term
Overgrowth of Clostridium difficile (Causes) (C. difficile)
Definition
Antibiotics – cephalosporins, ampicillan, amoxicillin, clindamycin

Chemotherapy

Invasive bowel procedures
Term
Prevention of C. difficule
Definition
Good hand washing

Probiotics e.g. culturell

Stool specimens for c. difficile
Term
Enteral nutrition (prevention of diarrhea)
Definition
Canned formulas at room temp

Strict sanitation during preparation

Initial feedings at half strength and gradually increase volume

Increase rate slowly and at rate tolerated by client

Dietician for assistance
Term
Enteral nutrition (Food-borne pathogens prevention)
Definition
Good hand washing
Term
Diarrhea Nursing History
Definition
Usual elimination pattern (frequency & time of day)

Description of usual stool characteristics

Routines to promote normal elimination
-drinking hot liquids
-eating specific foods
- taking time to defecate

Use of artificial aids
-enemas, laxatives &
bulk forming additives

Presence of bowel diversion (ostomy)

Changes in appetite
Diet history
Description of daily fluid intake

Surgeries or illnesses affecting GI tract

Medication history (laxatives, antacids, iron supplements, analgesics)

Emotional state

Exercise

Pain or discomfort

Living arrangements

Mobility and dexterity
Term
Physical Assessment (Diarrhea)
Definition
• Mouth
Abdomen

Rectum

Characteristics of feces
Term
Acute Care: Client Goals(Diarrhea)
Definition
Restore normal elimination

Restore normal stool consistency

Prevent associated Risks
-Fluid Balance & Electrolyte
imbalances
-Skin Breakdown
-Abdominal Distention
-Pain
Term
Acute Care: Nursing Order & Implementation
(Diarrhea)
Definition
Assess for causative factors

Assess for fecal impaction

Eliminate causative factors

Maintain hydration & fluid/electrolyte balance

Avoid caffeine, high fiber or spicy foods

Maintain skin integrity

Promote wellness
Term
Nursing History (Constipation)
Definition
• Usual elimination pattern (frequency & time of day)
• Description of usual stool characteristics
• Routines to promote normal elimination
-drinking hot liquids
-eating specific foods
- taking time to defecate
• Use of artificial aids
-enemas, laxatives &
bulk forming additives
• Presence of bowel diversion (ostomy)
• Changes in appetite
• Diet history
• Description of daily fluid intake
• Surgeries or illnesses affecting GI tract
• Medication history (laxatives, antacids, iron supplements, analgesics)
• Emotional state
• Exercise
• Pain or discomfort
• Living arrangements
• Mobility and dexterity
Term
Physical Assessment (Constipation)
Definition
Mouth

Abdomen

Rectum

Characteristics of feces
Term
Acute Care: Client Goals (Constipation)
Definition
Restore normal elimination

Restore normal stool consistency

Prevent associated Risks
-Abdominal distention
-Pain
Term
Acute Care: Nursing Order & Implementation (Constipation)
Definition
Provide privacy & uninterrupted time

Timing – when urge is recognized, after breakfast

Positioning- lean forward on toilet.

Discourage straining.

Diet – high fiber & fluids

Exercise
Term
Fecal Impaction (Acute Care)
Definition
Enemas
Cleansing promote complete evaluation (tap water, normal saline, soapsuds, low vol hypertonic solution)

Oil retention

Other
Term
Medication
Definition
promote defecation by softening stool & promoting peristalsis

laxatives

*cathartics

*chronic -use-lg intestines loses muscle tone & less responsive to stimulation by laxatives

control diarrhea
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