bowel elimination
Terms
undefined, object
copy deck
- use laxatives cautiously with patients who are
- pregnancy, breast feeding, anemia or after sugery on anus or perineum.
- safest least irritating laxative
- bulk forming laxative
- agent used for chronic constipation and to relieve mild watery diarrhea, in ibs, diverticular disease
- bulk forming laxative
- can cause esophageal or bowell obstruction if not mixed with at leaset 240cc's of water or juice and swallowed quickly.
- bulk forming laxatives
- types of bulk forming laxatives include
-
Psyliium ( metamucil, naturacil)
methlcellulose (cologel, hydrolose)
polycarbophil calcium (mitrolan) - Laxative that can not be mixed through a tube because it forms a gelatin
- bulk forming laxative
- Lower surface tension of feces, allowing water and fat to penetrate' also increase secretion of water by intestine
- stool softner
- when are stool softners used
- short term therapy to relieve stranin on defecation (hemmorioids perianal or prostate surgery pregnancy)
- names of stool softners
-
colace docusate Na
surfak docusate Ca
dialose docusate K+ - Emollient or fecal mositening agent is also know as
- Stool softners
- dilute stool softners with
- milk or fruit juice to decrease throat irritation
- used to empty bowel for endoscopic exam, suspected poisoning, stool specimen
- Saline cathartics
- Contraindicated in clients with kidney dysfunction
- saline cathartics
- contain salt prepartion not absorbed by intestines that creates an osmotic effect that draws water into intestinal luman producing fluid distention leading to peristalsis.
- saline cathartics
- saline cathartics include
- milk of magnesia, fleet enema
- on contact with mucosa of colon, irritates mucosa to increase motility. Decreases absorption in small bowel and colon.
- Stimulant cathartics.
- what Cathartic is used for acute constipation, preparation of radiologic exam?
- stimulant cathartic
- Side effects of stimulant cathartics.
- nausea, cramping loose stools, fluid and electrolyte imbalance, rectal irritation.
- Not to be taken with milk or antacids because it dissolves the tabs coating.
- stimulant cathartics.
-
kinds of stimulant cathartics are
and when not to take them -
doxidan, correctol, exlax,
at bed time. the take 2-6 hours to work. - penetrates and coats fecal mass and prevets excessive absorption of water
- lubricant laxatives
- Down side of lubricant laxatives
- can leak and seep from rectum causing anal pruritis.
-
colonic bacteria metabolized galactose and fructose to organic acids.
increased fluid accumulation distion peristalisis with in 24 to 72 hours. - lactulose
- decreased blood ammonia level in chronic liver disease
- lactulose
- side effects of lactulose
- gas cramps belching flatulence.
- mix lactulose with
- water juice or milk
- cleans bowls for colonscopy with low incidence of N,m V or bloating
- polyethylene glycol
- isotonic solution so fluids and electrolytes are neikther absorbed nor secreted in gi tract.
- polyethylene glycol
- defining characteristics of constipation
- dry hard stool, straining, painful defecation, abd distention, palpable abd mass rectal pain.
- causes of constipation
-
low fiber diet. hi animal fats and refind sugars
irregular bowel habits, ignoring urge
fluid intake less than 1500cc - assessments for constipation
-
monitor bowel elimination
asculate bowel sounds
palpate abdomen - diagnostic tests for constipation
- Stool for occult blood, guiac
- things not to do before occult blood test that give false +
- no rare red meat. horsradish, iron anticoagulants, asa, nsaid 3 days before can give false +
- things that give a false neg to occult blood test
- vitamine c 24h before, do not mix stook and urine.
- Tests UGI series is NPO when
- After 12am and MOM after test to ecacuate barium.
- TESTS THAT CAN BE DONE FOR CONSTIPATION
- CAT SCAN OF ABD, COLONSCOPY, OSMOTIC LAXATIVE, ENCOURAGE PT TO EXPEL FLATULANCE.
- INTERVENTIONS FOR CONSTIPATION
-
exercise, activity
1500cc2000cc fluids
high fiber diet use RR after eating when duodenocolic reflex works best - Enema types 5
-
fleet
saline
soap suds
tap water
oil retention - enema that is made from hypertonic solution
- FLEETS
- enema that is the safest. 2 tsp salt in 500 ccs water
- saline
-
Emema that irritates bowel mucosa
5ml of castile soap in 1L water - Soap Suds
- enema that is hypotonic with potential for water intoxication so never give to children , alters cardica or renal funcion patients
- Tap water
- Enema that Softens feces, caots rectal mucosa to facilitate expulsion and specifically given for impaction
- Oil Retention
- bowel traning includes
-
stool softners, buling agent, suppositorys, rehab for spinal coard injury, planned time for using rr
client leans forward. massaging stomach - inability to evacuate stool voluntarily
- fecal impaction
- evidence of fecal impaction
- no stool for 3-5 days, followed by liquid stool. may be incontinent and not perceive urge.
- Risk of fecal impaction is greater with people who are
- cognitive impaired, immobilized
- Fecal impactions defining characteristics are
- rectal/abd fullness, bloating, urge to defecate but no stool, n,v
- interventions for fecal impaction are
-
oil enemas
digital removal
change in bowel habits
review meds, add buling agent - frequent evacuation of water stools with loss of fluid and electrolytes increased mucus.
- diarrhea
- Defining characteristics of diarrhea
-
abd cramps
urge to evacuate
increased stools
change in color
increased BS 30per min
burning at anus due to irritation - causes of diarrhea
-
emotional stress
intestinal infection
food allergies
greasy spicey food
tube feeding with inadequate water
antibiotics, magnesium antacids, laxatives
colitis chrons disease gastrectomy, colon resection - interventions for diarrhea
-
balanced electrolyte/glucose solutions
if diarrhea 3-4 days no milk
no spicey fatty foods
antidiarrheal meds given for longer then 2 days. - over the counter meds for diarrhea
-
immodium
pepto bismol
kaopectate magnesium -
immodium (loperamide)
does what? side effect? dose -
-opiod that decreases gi motility by stopping movements in the gut.
side effects are dizzy, dry mouth , skin rash.
no more then 8mg with 2-3 mg as inital. - kaopectate (attopulgite) does what?
- Gi absorbent and protective agent
-
pepto bismol does what?
dose?
enhances what? -
inhibits gi secretions and syntheses of prostaglandin that produces intestinal inflamation and hypermotility. supresses growth of helicobactor pylori that causes ulcers.
Dose is 30 ccs or 2 tbsp. q30-60min
enhances effect of anticoagulant. - prescription antidiarrheals are
-
synthetic opiods
opiods - antidiarrheal opids work by
-
lowering bowel motility.
reduce pain and rectal spasms
increase reabsorption of water - synthetic opiods for diarrhea are
- lomotil (diphenoxylate & atropine)
-
inhibits intestinal propulsive motility thus decreasing transit time
S.E. drowsiness, dizy rash dry mouth abd distress - Lomotil
- take up or attach to another substance and coats wall of gi tract.
- absorbents
- absorbs bacteria or toxins and passes them out with stool.
- absorbents
- questran (cholestyramine) absorbs bile acids to reat increased cholestrol and also used to treat diarrhea
- absorbents
- involuntary elimination of bowel contents associated with neurologic mental or emotional impairments
- fecal incontinence
- causes of fecal incontinence
-
cerevral cortx or scaral cord injury or disease.
tube feeding/diet changes
fecal impaction
gi disorgers
infectious disease - interventions for fecal incontinence
-
bowel management programs
briefs
bulk forming agents to normalize stool
andidiarrheal agent if ordered
maintain hydration
treat infectious disease if cause
precent impaction. - accumulation of gas in GI tract
- Flatulence
- causes for flatulence
-
swolling air
smoking, carbonated bevs.gum chewing
rapid food ingestion or drink ingestion
colonic irritationi
hi fber goods. onions cabbage lugumes - interventions for flatulence
-
increase activity
alter diet
simethicone
rectal dube
return flow enema - abdominal distention is from
- accumulation of excessive amounts of flatus or liquid or solid intestinal contents
- causes for abdominal distention
- inactivity, constipation, fecal impactioin, tumors
- interventions for abd distention
- activity, give reglan, ng decopression for ileus
- Colostomy is a
- diversion of the colon
- ileostomy is a
- diversion of the ileum that produces liquid stool
- Stomas should be?
-
beefy red, not being serous red
be above skin level
not tucked inward - if stoma is tucked inward or is syanotic, what do you do
- call surgeon immediatly