Elimination and digestion 2

Large Intestine

Last step in fecal formation and water absorption

Peristalsis

Involuntary, wave-like muscular contractions of the GI tract that propel food and digestive enzymes

Small Intestine

Food Absorption

Factors contributing to constipation

What factors do these contribute to?

- Decreased physical activity

- Opioids/Anesthesia (can cause inhibited peristalsis)

- Inadequate fluid intake

Diarrhea

The client was prescribed a broad-spectrum antibiotic. What GI situation should the nurse watch out for?

Iron Supplement

Black or tarry stool is caused by what type of supplement

Paralytic Ileus

Temporary absence of normal intestinal peristalsis that occurs after surgery, most commonly due to direct bowel manipulation during abdominal procedures

Signs of paralytic ileus

- Distended and firm abdomen

- Accumulation of gas and fluids

- Very hypoactive or absent bowel sounds

Direct manipulation of the bowel or vagus nerve stimulation

What can cause paralytic ileus

Bradycardia and syncope

What is a concern with vagus nerve stimulation?

Ask the client to bear down like passing stool

To assess for intestinal hemorrhoids or fissures how should they assess the client

How many liquid tools have you had and for how long?

What is the priority question regarding diarrhea?

Client has strained and hard stools, regardless of frequency

What is the definition of constipation?

Discard the first stool, then begin collection

What should be done first when collecting a 24-hour stool sample?

Void first

what should be done first when collecting a stool sample

Sterile

are stool collections sterile or clean?

Oral intestinal lavage (polyethylene glycol);

Completely empties the colon

First thing to anticipate for a colonoscopy?

Fecal impaction, as the barium hardens, if not completely eliminated

The client who received a barium enema is at risk of what?

EGDscopy, colonoscopy, and sigmoidoscopy

Direct Visualization GI

EGD

Directly visualizes the esophagus, stomach, and duodenum

Colonoscopy

Uses a scope to directly visualize the entire large intestine

Sigmoidoscopy

Uses a scope to directly visualize the sigmoid colon, rectum, and anal canal

Risk of constipation

The patient is 3 3-day post op client with a soft abdomen, no bowel movement, hypoactive bowel sounds, and not passing flatulence. What is he at risk of?

High-fowler's

Best position for defecation

Fall Risk, so answer the call bell immediately

When a patient has acute diarrhea, what is the main precaution to be aware of?

Risk of dependency and worsening constipation

What is the risk of using stimulant laxatives?

Left lateral sims

What is the position to be placed for a cleansing enema?

Lubricate the anal suppository and insert it past the internal anal sphincter

What is the correct way to insert an anal suppository

2-5 mins

Before labelling bowel sounds as absent, how long should you listen 4?

risk of dehydration due to lack of reabsorption

What is the risk for patients with an ileostomy bag

Reasons for cramping during large-volume (tap water) enemas

What is this

- Often caused by the bowel distending too quickly or by the solution being too cold.

Cover the patient with a clean sheet and notify the receiving department of the precautions

What is the correct way to move a patient with C. diff to another floor for CT scanning?

Liquid will drain continuously

What is the nature of the feces from an ileostomy?

Ischemia or Necrosis

What does a dark purple stoma indicate in a patient?

Red meat and NSAIDs like Aspirin

When leading up to an occult blood test, what foods or substances should be avoided before the exam?

Creams, powders, and ointments can trap moisture and lead to skin breakdown

What applications should be avoided around PEG tubes/stomas? Why?

Ventilator-Associated Pneumonia with a cuffed endotracheal Tube

What are these precautions in place to prevent?

- Performing Diligent Oral Care every 2-4 hours

- Maintaining the head of the bed at 30-45 degrees

- Using sterile technique for all tracheal suctioning

30-60mins

How long should an oil-retention enema be held?

Verify tube placement by checking the external marking and aspirating for residual.

A nurse is preparing to administer a bolus enteral feeding via a PEG tube. Which action is essential for the nurse to perform first?