Fundamentals Theory Exam 3 PART 1

Bowel, and NG care

What factors affect bowel elimination

• age

• diet/fluid intake

• activity

• medication/anesthesia

• surgery

• psychological factors

Peristalsis

Muscular contractions that move GI contents through the digestive tract

Fast peristalsis associated with…

Looser stool/diarrhea (faster movement of intestinal contents, less time for water absorption)

Slow peristalsis associated with…

Harder stool/constipation (more time for water absorption)

Role of the rectum

Stores feces before defecation

Incontinent bowel meaning

Loss of voluntary control over bowel elimination

What is constipation

Difficult, infrequent, or incomplete passage of stool (usually hard)

What factors can contribute to constipation

• Slow peristalsis

• Low fluid intake

• Low fiber intake

• Inactivity

• Surgery/anesthesia

• Certain medication

Important nursing intervention for constipation

• Fluids

• Fibers

• Activity

What is diarrhea

Frequent passage of loose/watery stool

Major nursing concerns with diarrhea

• Fluid loss

• Electrolyte imbalance

• Infection/transmission

• Skin breakdown

Fecal impaction

Mass of hardened stool that becomes lodged in the rectum/colon and cannot be expelled normally

Hemorrhoids

Swollen/enlarged veins in the rectal/anal area

What can contribute to hemorrhoids

Straining with bowel movements/constipation

Flatulence

Excess intestinal gas

Diverticulitis

Inflammation of diverticula in the intestinal tract

What is the Valsalva maneuver

Holding the breath while straining

Why is Valsalva maneuver dangerous

Straining while holding the breath can cause significant cardiovascular changes or syncope

What should patients to instead of excessive straining

Bear down appropriately without holding breath/straining excessively

What is a stool occult blood test

A test that detects hidden blood in stool

What is another name for a stool occult blood test

Guaiac or hemoccult

Why is an occult blood testing important

It can help detect GI bleeding and is relevant to colorectal cancer screening

What can cause a false-positive result

Certain foods/medications

What is an ova and parasite stool test used for?

detecting intestinal parasites

What does stool culture and sensitivity look for?

Infectious organisms in stool and their antibiotic sensitivity

Examples of ova & parasites detected in stool

• Giardia

• Cryptosporidium

Examples of organisms detected in stool

• C. diff

• H. pylori

Do fecal management devices require an order?

Yes

Why are fecal management devices used?

• Manage fecal incontinence

• Help prevent skin breakdown

• Commonly used with C. diff infections

What diagnostic tests are used to evaluate bowel problems?

• Ultrasound

• CT

• Colonic transit study

• Endoscopy/colonoscopy

• MRI

• Anorectal manometry

• Barium-related tests

• Abdominal flat plate x-ray

What does anorectal manometry evaluate?

Function of the rectum / anal sphincter

Colostomy procedure

Portion of intestine is removed and brought through the abdominal wall to the surface of the body

Most important concern when applying an ostomy appliance?

Protecting the peristomal skin

How should the wafer opening fit around the stoma?

Approximately 1/8 - ¼ inch larger than the stoma

What characteristics should the nurse document about stool?

• Amount

• Frequency

• Color

• Consistency

What does black, tarry stool suggest?

Possible GI bleeding (melena)

What does red stool indicate?

Possible blood, particularly lower GI bleeding

What can gray/white stool indicate?

Lack of bile reaching the intestine

What is docusate sodium (colace)

Stool softner

What is bisacodyl (dulcolax)

simulant laxative

Cathartics vs laxatives

Cathartics are stronger and used to empty the bowel

What do anti-diarrheal medications do?

Decrease intestinal / abdominal muscle activity to slow down diarrhea

What is loperamide?

Imodium, an anti-diarrheal

Purpose of enema

• Stimulate peristalsis

• Help break down / remove hard stool

What is the maximum volume of enema fluid at one time

Never more than 1,000 mL at one time

What is the tonicity of a tap-water enema?

Hypotonic

What major complication can occur from enemas?

Water intoxication syndrome

What is the tonicity of a soap-suds enema?

Hypertonic

What is the purpose of an oil-retention enema?

Provides lubrication and helps soften hard stool

How long should a mineral oil retention enema be retained according to the practice question?

30 minutes

What is the goal of bowel training?

Establish a predictable/habitual routine for defecation

What interventions promote bowel training?

• Establish a habitual daily routine

• Provide privacy

• Collaborate with nutritionist/dietitian

• Appropriate foods

• Bear down but do not strain

What position is anatomically most efficient for bowel movements?

Squatting, because it straightens the rectum and facilitates elimination

What happens to peristalsis with aging?

Slows down

What happens to gastric emptying with aging?

It becomes delayed

What bowel problems become more common with aging?

• Constipation

• Diarrhea

• Constipation

True or false: Enemas/laxatives commonly used in children?

False- rarely used

What pH do you want when someone has a NG tube

5 or less (higher than 5 means tube may have migrated)

What may a provider order for a constipated child?

Glycerin suppository

Function of the diaphragm

• Dome-shaped muscle that separates chest from abdomen

• Contracts to create pressure with breathing

• Increased abdominal pressure to help with vomiting, coughing, urination, and defecation

Function of the stomach

Muscular organ that stores food; mixes food with gastric juices and begins digestion of proteins

Pyloric sphincter function

Acts as a valve between stomach and duodenum, controls rate at which chyme leaves the stomach; prevents back flow of intestinal contents into stomach

Two major goals when managing oral intake

• Promote independence

• Prevent aspiration

What should be assessed before oral feeding?

• Assess for aspiration risk

• Can they chew?

• Can they swallow?

• Feeding assistance or independent?

• Diet restrictions / requirements?

What increases aspiration risk?

• Altered level of consciousness

• Impaired gag

• Issues with saliva/swallowing

Ideal HOB angle during feeding

45-90º

How can you help orient the patient to food?

Describe the plate using a clock

4 reasons for a gastric tube

1. Decompression (drain)

2. Gavage (give nutrition)

3. Compression (control bleeding)

4. Lavage (wash)

What is gastric decompression

Removal of stomach contents using suction (air, fluid)

What should be assessed before gastric decompression

• Abdominal distention

• Increased abdominal girth

• Bowel sounds

• Nausea/vomiting

What does coffee-ground gastric drainage suggest?

Blood (GI bleed)

What tube is commonly used for decompression?

Salem sump tube (less common: levine tube)

What special feature does the salem sump have?

Pigtail vent

What is gavage

Feeding through a tube directly into the GI tract (enteral feeding)

When is enteral nutrition appropriate?

When patient can digest food, but cannot ear orally

What tubes can provide enteral feeding

• NJ

• NG

• G tube

• J tube

What tube is usually used for NG feeding

Levin tube

Salmen sump tube is for continuous or intermittent suction

low continuous

Levine tube is for continuous or intermittent suction

intermittent

Main purpose of salem sump tube

gastric decompression- removing fluid, air, and unwanted contents from the stomach via suctio

Compression (reason for gastric tube)

Apply pressure to bleeding

Suction setting for NG tube

Low suction (ideal: 80)

What is gastric compression used for?

Applying pressure to a hemorrhaging site, such as esophageal varices

What tube is associated with compression of esophageal varices

Blakemore tube

Salem sump tube has one lumen or two?

2

Levin tube has one lumen or two?

1

Does a levin tube have an air vent?

No

What is a levin tube typically used for?

• Feeding

• Medication administration

What is a salem sump tube typically used for?

• gastric decompression

• suction

What is gastric lavage used for?

Removing…
- poison
- drugs
- blood

What tube is commonly used for gastric lavage?

Salem sump

What medication may be used first for certain poisonings?

Activated charcoal

Tubes for short term use

• NG (naso-gastric)

• NJ (naso-jejunal / naso-enteric)

Characteristics of NG tubes

• Large bore

• Short term use

• RN may insert depending on presentation

Characteristics of NJ tubes

• Small bore

• Short term use

• Required trained/advanced provider

Characteristics of G tubes and J tubes

• Large bore

• Long term

• Inserted by advanced provider

What tube size should be used for NG tube

16-20 French

Method for measuring NG tube insertion length

Nose, Ear, Xiphoid process

Steps of NG tube insertion

1. Lube tube

2. Head back (for 4 inches)

3. Insert tube and advance

4. Head forward

5. Have patient sip water while advancing

What to do if you meet resistance when inserting NG tube

Pull back tube a little bit, then advance further- do not take out