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B260 Week 5

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by

Greg Carter

on 3 February 2016

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Transcript of B260 Week 5

B260 Week 5
Bowel Elimination
The GI Track
Series of hollow mucous membrane lines muscular organs

Absorbs fluid and nutrients
Prepares food for absorption
Absorbs large volumes of fluids
Making fluid and electrolyte balance a KEY function
Components:
Mouth
Esophagus
Stomach
Small intestine
Large intestine
Anus
Mouth
Mechanically and chemically breaks down food
Esophagus
food enters esophagus
passes through upper esophageal sphincter
sphincter prevents air from entering esophagus
prevents food from refluxing into throat
What happens during aspiration?
Stomach
Produces and secretes hydrochloric acid, mucus, pepsin, and the intrinsic factor
Intrinsic factor: glycoprotien essential for the absorption of B12
Intestines
Small Intestine
3 Sections:
duodenum
jejunum
ileum
Duodenum
processes chyme from stomach
Jejunum
absorbs carbs and protein
ileum
absorbs water, fats, some vitamins, iron, and bile salts
Large Intestine
"lower GI track"
Healthy adults absorb more than a gallon of water and an ounce of salt every 4 hours
Factors influencing bowel elimination
Age
Diet
Fluid intake
Physical activity
Psychological factors
Personal habits
Positioning
Pain
Pregnancy
Surgery
Medications

Constipation
Review box of types with therapies..
S/S include infrequent bowel movements (less than every 3 days), difficulty passing stool, excessive straining, hard feces.
What is the valsalva maneuver?
in what patient populations would this be a contraindication?
Impaction
results from unrelieved constipation

collection of hardened feces wedged in the rectum that cannot be expelled.
If not resolved often results in an obstruction
When would you suspect impaction?
(what are the s/s of impaction?)
Bowel Diversions
Why?
temporary or permanent?
an artificial opening in the abdominal wall: Stoma
Created in the ileum
-ileostomy
or colon
-colostomy
ileostomy
bypasses the entire large intestine
Stools are frequent and liquid
colostomy
ascending colon: frequent and liquid
transverse colon:
more solid, formed stool
Sigmoid:
near-normal stool
Care of Bowel Diversions
Why is skin care around stoma important?
Dietary Considerations
First few weeks after surgery: low fiber diet, particularly with ileostomies
eat slowly, chew food completely, drink 10-12 glasses of water daily unless contraindicated
High fiber foods that may cause problems: stringy meat, mushrooms, popcorn, shrimp, crab
Foods that cause gas and odor:
broccoli
cauliflower
dried beans
brussel sprouts
Questions
A patient is admitted for a lower GI bleed. What color does the nurse expect the stool to be?

A. Red
B. Black
C. Green
D. Orange
you are taking a health history of a patient newly admitted to rule out bowel obstruction. Which of the following is a priority question?

A. Describe your BM
B. How often do you have a BM
C. When was your last BM
D. Do you routinely use stool softeners?
you are caring for a 78 yo with diarrhea. of the following problems, which is the most important to consider?

A. Malnutrition
B. Dehydration
C. Skin Breakdown
D. Incontinence

Enemas
Cleansing
Promote complete emptying of feces from colon via large volume of solution/local irritation to stimulate peristalsis
Tap Water
Hypotonic. goes from bowel into interstitial spaces. DO NOT repeat tap water enema due to water toxicity or circulatory overload
NS
Safest to use, exerts the same osmotic pressure as fluids in interstitial space surrounding bowel.
Hypertonic
exerts osmotic pressure pulling fluids OUT of interstitial space. Colon fills with fluid. good for patients who cannot tolerate large amounts of fluid. BAD for dehydration and young infants!!
Soapsuds
Castiel soap. use with caution in pregnant women and older adults, may cause electrolyte imbalance
Oil Retention
lubricate the rectum and colon. feces absorb the oil and become softer/easier to pass.. retain for several hours if possible (wow).
Caution
May take 3 times to be "clear"
Caution against more than 3
depletes fluids and electrolytes
giving an enema sitting on toilet is not safe
Full transcript