Funds Elimination

Duodenum

first section of the small intestine, c shaped tube that branches off from the stomach. The duodenum processes chyme by mixing it and adding enzymes.

Jejunum

is the coiled midsection of the small intestine. Forms the connection between the duodenum and ileum. Its major function is to absorb carbohydrates and proteins.

Ileum

joins the small and large intestines. It is responsible for the absorption of fats; bile salts; and some vitamins, minerals, and water. However, nutrients is mainly absorbed mainly in the duodenum and jejunum.

Cecum

undigested food entering the first portion of the large intestine, consists mostly of cellulose and water.

Sigmoid colon

twists medially and downward to connect with the rectum and anus. 

Peristalsis

Organized wavelike movement that occurs throughout the digestive tract to propel contents forward

when does peristalsis occur

after eating

defecation occurs

as the result of peristalsis

Frequency of Poop Normal:

Daily, 2-3 times a week

Frequency of Poop Variation Hyper motility

>3 per day

Normal color of poop

brown

white or clay clotted poop

not enough bile, problem with the gallbladder, hepatitis, or use of antacids

Red poop

lower GI hemorrhoids

Yellow poop

go too quickly through the body

Pale and oily:

malabsorption of fats

Black (melena): 

upper GI tract bleed, and iron supplements

Narrow pencil shaped

intestinal obstruction or increased peristalsis

E.coli is a normal bacteria found in the

colon to protect from other bacteria

Frequency of Poop Variation Hyper motility

<1 per week

Shape Normal poop

appr. diameter of the rectum

Consistency normal poop

formed soft, moist

consistency variation poop

hard, dry-slow

liquid-fast

odor normal poop

pungent, effected by foods eaten

odor variation poop

strong foul odor

quantity normal poop

appr. 150 g/day

quantity variation poop

100-400 g/day

Examine abdomen, anus, rectum

•Observe the size, shape, and contour

•Presence of hemorrhoids

palpate abdomen

•Tenderness

•Masses

hyperactive sounds

extremely high pitch grumble more frequently, above obstruction sound

Hypoactive

are low pitched infrequent and quiet. A decrease in bowel sounds indicates decreased peristalsis, which can result in constipation.

absent

after 5 minutes of several areas

Fecal Occult Blood Test

Trying to assess if they have blood in the stool, blue positive for blood, some type of cancerous thing

Endoscopy

tub down sometime throat with a camera looking at the upper GI tract. Need to be NPO and asleep, consent , and remove dentures. Once gag reflex is back they don’t have to be NPO

Ultrasound

mass cyst edema stones, needs gel

MRI

edema hemorrhage tumor organ structures, no metal

CT:

loaf of bread cut take out a slice that’s what you are seeing, shell fish or iodine allergy don’t give , assess BUN and creatine, hold metformin 48 hours after CT scan

X-ray

see anything

Colonoscopy

going through rectum looking at the colon, or for lower GI symptoms. Put asleep, NPO, bowel prep, informed consent, sedated.

diet

what do we eat, how much do we eat. Regular diet, at specific times causes a regular bowel movement . High fiber foods causes movement which causes defecation. Yogurt with active bacteria.  Low fiber foods slow peristalsis down. Beans, broccoli, onions, spicy foods, and frequent bowel movements cause farts. Supplements.

fluid

6 to 8 glasses of water a day, fluid helps soften the stool and promote defecation. No fluid causes stool to be dry and constipation

exercise

causes bowel movements

pain

hemorrhoids, rectal surgeries, if they know it will hurt to return, they won’t return, and this will cause constipation.

Medications

opioids causes constipation, which means they need to drink more fluids. Antibiotics can cause diarrhea because it removes normal flora, this could cause c. diff, so they need to eat yogurt.

Anesthesia

  slows everything down, bowel functions and peristalsis slow down.

Paralytic ileus

  bowels stop due to surgery and then they don’t start again, which causes the stool to move up.

Absent Bowel sounds after

Paralytic ileus

Interventions for Paralytic ileus

NPO. do an NG tube with suction removes secretion that are forming. Once the bowel sounds return we remove NG tube.

Monitor: make sure the NG tube is working and assess bowel sounds.

Diarrhea

virus contaminated food medications. You have a big risk for fluid imbalance, which causes electrolytes to be imbalanced. We don’t just want you to drink water we want an electrolyte drink: Gatorade, Powerade. BRAT diet provides calories for energy and provides electrolytes. Anti-diarrheal medication are for people with chronic diarrhea >1 month

Fluctuance

foods that trigger this: fiber increase, beans, cabbage, cauliflower, onions, or spicy foods.

Incontinence

in ability to control one's bowels, could be a brain or body

GI bleed:

upper GI: dark tar, melena, smells bad. Use FOBT and a low H&H show bleeding

Hemorrhoids

veins in rectum, cause by straining, external or internal, usually treated with over the counter but they can be surgically removed.

Obstruction

bowels can twist and obstruct fecal matter. Hypoactive bowel sounds below obstruction and hyperactive above and distended.  The lining of the bowel latex's, and then the stool gets into the abdomen there is a big problem.

Fecal Impaction:

couldn’t have a bowel movement so the stool got so hard that it won’t come out anymore. My need surgery or enemas.

Valsalva maneuver

Holding breath, baring down., and tightening abdomen they could pass out

Constipation

don’t strain, hard and dry stool, fluids, good regular diet, activity help bowel movements.

Privacy

don’t wait until you get to your house six hours later. Good routine, bowel training to promote soft stool: every morning at 9am we are going to try and have a bowel movement.

Positioning for pooping

want them sitting with HOB 30-45 degrees

Bowel diversions

Surgically created opening for elimination of digestive waste products.

Output is expelled through the surgical opening, stoma.

Location determines management and fecal drainage.

Ileostomy

bypass the large intestines, output is liquid because its not going through the large intestines. Has digestive enzymes, at the end of the small intestines could be a little more consistency. Higher likely hood for skin breakdown if it touches skin.

colostomy

bring a piece of the colon out. large intestine more formed the closer to the sigmoid colon

stoma

part of the intestines that come out from the skin.

stoma temporary

allows bowels to rest and is put back in or permeant taken to much out and can’t put back.

stoma should be

moist, pink, and red, very vascular. If it is not its dying. May be swollen after the surgery but usually goes down. If it is pale dusky brown or black we need to notify the HCP because its either loosing blood and dying or necrotic and dead.

stomas surrounding tongue

make sure its clean dry and intact, not inflamed because that what keeps the stoma from retracting, clean with warm water.

stoma teaching

may decrease foods that cause gas, or foods that cause diarrhea: prune juice beer broccoli hot beverages spicy foods. Limit foods that cause odors eggs cheese. Encourage fluid intake.

Stoma Care

⚬Meticulous skin care: assess and clean

⚬Clean technique

⚬Bag must be emptied frequently and changed every 3-5 days

kidneys

filter regulate  1-2 L of urine per day

Ureters

carry urine to bladder

bladder

hold urine

urethra

expels the urine

Urine color normal

pale yellow

tea colored

severe concentrated urine

bright orange

UTI’s and phenazopyridine

blue/green

lymph node meds

urine red

colored from eating something red or blood

more fluid

less solute clearer color

urine normal odor

ammonia

urine odor variations foul

this could mean infection, also asparagus and garlic, utis

urine odor variations sweet

diabetic clients with excessively high glucose levels.

cloudy

someone's been holding the pee in, or bacteria/ infection means its thick and ——-

frothy

pouring out protein

urine output normal

50-60 mL/hr or 1500 mL/day

urine output variations

<30 mL/hour

urine c&s

see what the infection 24-hour but the results take 24-48 hours to come back. 100,000 colonies indicates infection could be altered by a clean catch and a regular one. Once urine is collected you can do a broad antibiotic and then when the results come back you can take a more specific antibiotic.

24 hour urine:

void in the morning, put your time, and then everything after that you collect, keep on ice or put in the fridge away from light, every drop has to be collected. Looking for protein levels and kidney functions

Cystoscopy

take a scope to look at your urethra bladder uterus. NPO informed consistent

bladder scanner

see how much urine is in the bladder. Post void residual

Alcohol

makes you pee a lot

caffiene

spasms

position for peeing

men stand women sit

cognition urine

Brain can’t tell bladder to release then it could cause you to be incontinent or not pee, dementia spinal cord issue. You also don’t know when you pee yourself

medication change the ——- of urine

color

urine pH

4.5-8. indicates kidneys ability to help maintain balanced hydrogen ion concentration (acid-base balance) in the blood

specific gravity

1.010-1.030 reflects the kidneys ability to concentrate urine. How many dissolved solutes are in the urine. Lower number means more fluid the less solutes. Dehydrates they’d have a high #

protein

negative, most common indicator of renal disease. some protein coming out can still show negative

glucose

negative. indicates elevated blood sugar

bilirubin

negative. occurs with liver disease, cancer, gallstones, or hepatitis.

ketones

negative. indicates impaired carbohydrate metabolism.

occult blood.

negative. trauma infection or inflammation