chapter 47-1

chapter 47-1

1. physical assessment: look,listen, and feel, describe sounds as audible, hyperactive, hypoactive, or inaudible

   • stool cultures: suspect infectious agent. get culture before starting antibiotics
     • fecal occult blood test (FOBT): measures microscopic blood in feces, hamatest and guiac test, colorectal cancer
       • guidelines for occult blood test: avoid red meat x4 days
         • avoid ASA greater than 325mg, NSAIDs, and iron
           • preparation x7days
             • avoid vitamin Cx3days
               • No laxatives, enemas, or suppositories for 3 days
                 • bleeding hemorrhoids and hematuria, epistaxis=postpone test
                   • avoid mixing stool sample with urine
                     • use medical asepsis
                       • no toilet tissue in specimen
                         • obtain 3 different samples from different bowel movements
                           • positive test: results require follow-up with colonoscopy or flexible sigmoidoscopy

2. constipation: infrequent stool/or hard, dry small stools that are difficult to eliminate

   • is a symptom not a disease
     • causes: diet, lack of exercise,medications(opioids)
       • can lead to fecal impaction

3. diarrhea: 3 or more loose stools in a day, associated with intestinal cramps, N/V, protective response

   • causes: viral. bacterial, IBS, hyperthyroidism, medications, malabsorption syndrome

4. impaction: occurs from unrelieved constipation

   • hardened feces wedged in rectum that person cannot expel

5. incontinence: inability to control passage of feces and gas to the anus. can be urine or stool

6. flatulence: accumulation of gas in intestines causing walls stretch

7. hemorrhoids: dilated, engorged veins in the lining of the rectum

   • 2 types: internal and external
     • causes: increased venous pressure, straining, pregnancy

8. bowel diversions: temporary or permanent artificial opening in the abdominal wall(stoma)

   • surgical opening in the ileum in the ileum or colon (ileostomy or colostomy)

9. colostomy and ileostomy care: empty often, assess stoma regularly(stoma color dark pink or red/moist, size 1/2-1 inch from abdominal surface

   • keep peristomal rea clean and dry, monitor intake and output
     • patient education critical, pouching, colostomy irrigation

10. colostomy irrigation: promotes regular bowel evacuation

11. nursing interventions to promote regular bowel elimination: exercise, nutrition, time and privacy(routine)

    • positioning: upright, bed rest-place patient bedpan, 30-45 degrees

12. cathartics and laxatives: medications that promote peristalsis and emptying of GI tract. overuse causes impaired bowel motility and decreased sensory stimulus

    • types: bulk forming-increases intestinal bulk, emollient-soften stool, osmotic-water drawing agents into intestines, stimulating peristalsis

13. enemas: cleansing tap water=1000ml of water

    • normal saline=safest
      • hypertonic solutions=small amount 120-180ml or so soapsuds
        • oil retention=lubricate feces, easier to pass
          • carminative=relief from gaseous distention MGW
            • kayexalate=medicated enemas for hyperkalemia

14. enema administration: sterile technique is unnecessary, wear gloves, explain procedure, positioning, precautions to avoid, discomfort and length of time necessary to retain the solution before defecation

15. digital removal of stool:use enemas fail to remove impaction, last resort in managing severe constipation