FIN exam 2: Elimination GI

GI elimination

The excretion of waste product

Bowel elimination

The process of expelling stool

Functions of GI (2)

• Breakdown and absorption of nutrients from foods ingested

• Elimination of waste

Upper GI tract function

Involved in digestion and absorption of nutrients

Upper GI tract parts (4)

• Mouth

• Esophagus

• Stomach

• Small intestine

Upper GI tract accessory digestive organs (3)

• Liver

• Gallbladder

• Pancreas

Lower GI tract function

Involves the process of waste formation

Lower GI tract part

Colon

Peristalsis

movement of fecal matter

What stimulates peristalsis?

Smooth muscles

Label layers of GI tract

Elimination is involuntary or involuntary?

Both

What does pressure stimulate during elimination?

Stimulates parasympathetic nerve fibers (sacral + spinal cord)

Steps of elimination

1. pressure

2. parasympathetic nerve fibers stimulated

3. rectum contracts

4. internal anal sphincter relaxes

5. voluntary relaxation of external anal sphincter

6. Stool passage

Pressure stimulates ________ nerve fibers, allowing for…

Passage of stool

Voluntary relaxation of external anal sphincter allows for…

Passage of stool

Nursing skills for elimination

• Assessment

• Enema (last resort)

• Nastrogastric tube for gastric decompression

• Ostomy care

• Medication administration (must give correct med, e.g. do not use stool softeners for those with diarrhea)

• Nutrition education

Ostomy care and when is it used?

surgically created opening on the abdomen for the elimination of body waste

• Used for someone who has chronic inflammatory disease

• Must ensure it’s clean and secured

GI assessments

• X-ray

• Endoscopy

• Colonoscopy

• NG tube sucks out stomach contents — can assess contents of stomach

• CAT scan

• Readi-cad (drink 1hr before CAT scan to help with imaging; oral contrast)

Invasive procedures/surgical interventions

Colectomy

Colon resection

• Removing portion of bowel, for treatment r/t cancerous tumor, or traumatic injury

• Ends can remain ‘reanastmosed’

  • surgical procedure to reconnect two previously separated sections of a bodily structure

Colonoscopy/ileostomy

Diversion of the intestine (colon or sm intestine) through a stoma on the skin

• Temporary or permanent

Rectal prolapse repair

Rectal prolapse is when the rectum falls though anal opening

• requires surgery to put it back in

Hemorrhiodectomy

Excision of internal or external hemorrhoids

• only for patients who have severe pain/discomfort

Fecal collection system

flexible tube inserted into rectum, which collects liquid stool

• in cases of c. Diff or extreme diarrhea

• Helps to prevent skin breakdown

Why do people with c. Diff get a fecal collection system?

because the infection causes frequent, watery diarrhea

Ostomy

urgically created opening on the abdomen that allows bodily waste to exit the body when the usual path is blocked or cannot function properly

• Example: ileostomy

Bowel regimen medications (9)

• Senna

• Polyethylene Glycol (MiraLAX)

• Bisacodyl

• Docusate (colase)

• Lactulose

• Magnesium citrate

• Fleet enema

• Psyllium (metamucil)

• Glycerin suppository

Senna class and form

• Stimulant laxative

• Tablet/liquid

When is senna used?

when someone hasn’t had bowel movements in a few days

Senna side effects (3)

• Abdominal cramping

• Diarrhea

• Nausea

Polyethylene glycol (miralax) class and form

• Osmotic laxative

• Powder/packet

Polyethylene side effects (5)

• Bloating

• Cramping

• Gas

• Nausea

• Diarrhea

Milk of Magnesia (MOM) class and form

• Osmotic laxative

• Liquid form

MOM side effects (3)

• Abd cramping

• Diarrhea

• Nausea

Bisacodyl class and form

• Stimulant laxative

• Po/suppository form (solid med into rectum)

Bisacodyl side effects (5)

• Abd cramping

• Diarrhea

• Nausea

• Dehydration

• Laxative dependence

Dosustate (colace) class and form

• Stool softener (emollient laxative)

• Capsule/liquid

Docusate side effects (2)

• Mild cramping

• Diarrhea

Lactulose

• Osmotic laxative

• Liquid form

Lactulose side effects (4)

• Bloating

• Gas

• Cramping

• Diarrhea

Magnesium citrate class and form

• Osmotic laxative

• Liquid

Mg citrate side effects (4)

• Diarrhea

• Cramping

• Electrolyte imbalance (w/ excessive use)

Fleet enema class and form

• Saline laxative

• Rectal enema

Fleet enema side effects (4)

• Cramping

• Diarrhea

• Rectal irritation

• Electrolyte imbalance

How is fleet enema administered?

patient lies on left side for liquid to be inserted into their rectum

• they try to hold the liquid in for at least 15 minutes

Psyllium (Metamucil) class and form

• bulk forming laxative — increases peristalsis

• Powder/packet — mix with liquid

Psyllium side effects (1)

• Loose stool

Glycerine suppository class and form

• Hyperosmotic properties (provides rectal stimulation and lubrication)

• Suppository (bowel movement in 15-60 mins)

Constipation

Difficulty passing stool

Constipation consistency (3)

• Hard

• Dry

• Formed

Clinical constipation presentation (5)

• Abdominal bloating

• Gas

• Cramping

• Pain

• Nausea/vomiting

Possible causes of chronic constipation (3)

• lack of dietary fiber

• medications (e.g., opiods or iron supplements)

• decreased fluid drinking

Diet to alleviate constipation (3)

• High fiber meals

• Increase fluid intake

• Encourage movement

Diarrhea

frequent passing of watery stool, loose stools

• >3 /day or volume of 200g/day

Acute vs Persistent vs Chronic Diarrhea

• Acute: associated with bacterial/viral illness and usually resolves within a few days

• Persistent: days to weeks

• Chronic: can persist for weeks

What is the primary concern with diarrhea?

Dehydration and electrolyte imbalance can occur quickly

• must be monitored

• Hyperkalemia (K+ excess in blood)

Diarrhea causes (9)

• Medication effect

• Intestinal obstruction

• Tube feeding

• Dumping syndrome (food moves too quickly from the stomach into the small intestine)

• GI disease — IBS

• IBD

• Infection (viral/bacterial)

• AIDS

• Parasitic

What labs/imaging should be ordered for diarrhea?

Why should you wait to give patients medications when they have diarrhea?

since it can possibly be caused by infectious processes, you do not want to give medications until after you determine if the patient doesn’t have an infection

Constipation and diarrhea are usually not a huge problem, but they can become _____

Deadly

• Blood flow to bowels can be cut off

• Constipation can lead to blockage and infection

• Diarrhea can lead to extreme dehydration and electrolyte loss

Crohn’s Disease

chronic inflammatory bowel disease (IBD) that can affect any part of the digestive tract

What parts of the GI tract does Crohn’s affect?

ANY part of the GI tract

• Mouth to anus

What part of the bowel walls does Crohn’s affect?

All parts

• transmural inflammation

Transmural inflammation

Inflammation of the entire bowel wall

Skip lesions

areas of inflammation or tissue damage in the gastrointestinal tract that are separated by healthy tissue

What labs/imaging should be ordered for Crohn’s disease?

Labs

• ????

Scans

• MRI

• CT

• Ultrasound

What does imaging show with Crohn’s disease?

Inflammation that gives the mucosal tissue a cobblestone-like appearance

Symptoms of Crohn’s

• Abdominal pain

• Diarrhea (not bloody)

• Weigh loss

• Fatigue

Crohn’s has risks of developing… (2)

• Malnutrition

• Dehydration

Crohn’s medications (2)

• Antiinflammatories

• Immunosuppresants

Ulcerative Colitis

IBD that primarily affects colon, causing inflammation and ulcers in the lining of these organs

Place that Ulcerative colitis affects

Colon

Location of inflammation for Ulcerative colitis

Mucosa and submucosa of the colon wall

Ulcerative colitis continuous lesions

continuous inflammation throughout area

Symotoms of Ulcerative colitis

• Bloody diarrhea

• Urgency

• Abdominal cramping

Must monitor _____ and _____ with Ulcerative colitis

fluid and electrolytes

Provide _____ and _____ support for patients with Crohn’s and Ulcerative colitis

Emotional and psychological support

***Ulcerative colitis vs Crohn’s location

• UC is only in the colon

• Crohn’s can be present anywhere in the digestive tract

***UC vs Crohn’s inflammation pattern

• UC: limited to the mucosa and submucosa

• Crohn’s: has skip lesions and is transmural

**UC vs Crohn’s symptoms

• UC: bloody diarrhea, urgency, abd cramping

• Crohn’s: non-bloody diarrhea, abd pain, weight loss, fatigue

IBD medications for Crohn’s vs Ulcerative colitis

• Crohn’s: Animosalicylates, corticosteroids, immunosupressants, anti-TNF, anti-integrin, nutrition therapy, antibiotics

• UC: Animosalicylates, corticosteroids, immunosupressants, anti-TNF, anti-integrin

  • abx and nutrition therapy not typically used

IBD medications (4)

1. Anti-inflammatories — MOST COMMON

2. Cortical steroids

3. Immunosuppressants

4. Biological agents (for severe cases)

Indicators of bowel obstructions (3)

• Severe pain

• Vomiting (stool could be in there)

• Absent bowel sounds

What is the technical term for the movement of fecal matter through the GI tract?

A. Digestion

B. Peristalsis

C. Defecation

D. Constipation

B. Peristalsis

Name a commonly used bowel regimen medication that can be mixed with water for administration?

A. Senna

B. Colace

C. Miralax

D. Ducolax

C. Miralax

Which bowel disorder is characterized by ulcerations from mouth to anus?
A. Diarrhea
B. Chronic Constipation
C. Crohn's Disease
D. Ulcerative Colitis

C. Crohn's Dx

Electrolyte abnormalities are commonly associated with which elimination disorder?
A. Constipation
B. Crohn's Disease
C. Diarrhea
D. Colorectal Cancer

C. Diarrhea

Which dietary advice is most appropriate during an acute flare of ulcerative colitis?
A. High-fiber to promote bowel motility
B. High-protein, low-residue diet to reduce stool frequency
C. Encourage carbonated beverages for hydration
D. Strict fasting for 72 hours

B. High-protein, low-residue diet to reduce stool frequency

Which chronic complication is a patient with ulcerative colitis at increased risk for?
A. Pancreatic Cancer
B. Colon Cancer
C. Renal Cell Carcinoma
D. Esophageal Cancer

B. Colon Cancer

Which clinical sign would indicate a complication of ulcerative colitis requiring immediate intervention?
A. Mild abd cramping with 2-3 stool/day
B. Abdominal distention with decreased bowel sounds
C. Fatigue and mild anemia on lab work
D. Weight loss of 5lbs over one month

B. Abdominal distention with decreased bowel sounds

• Toxic megacolon — inflammation becomes so bad that it paralyzes the colon muscles

Which area of the GI tract is commonly affected by Crohn's Dx?
A. Sigmoid Colon
B. Rectum
C. Terminal Ileum and colon
D. Esophagus

C. Terminal Ileum and colon

Which of the following statements would be an appropriate nursing education point for a patient with
Crohn's Disease?
A. Smoking reduces the frequency of flares
B. A high-fiber diet is recommended during a flare
C. Continue medications even if you feel well
D. Limit fluid intake during diarrhea

C. Continue medications even if you feel well

• A: smoking worsens it

• B: high fiber can irritate inflamed bowel

• D: fluid should be increased since so much fluid is being lost to diarrhea

Key takeaways:

• differentiate btwn diarrhea and constipation

• understand Crohn’s vs UC

• Review key nursing interventions and common treatments for GI elimination concepts