NURS 220 Exam 3 Study Guide with Complete Solutions.

NURS 220 Exam 3 Study Guide with Complete Solutions. Bowel Elimination Process of Bowel Elimination -Defecation: process of elimination of waste -Feces: semisolid mass of fiber, undigested food, inorganic material Anatomy and Physiology of the Gastrointestinal Tract -Mouth -Esophagus -Stomach -Small intestine: 3 Sections -duodenum, jejunum, ileum -Large intestine -cecum, colon, rectum -Anus -Defecation: dependent on sensory awareness, voluntary sphincter control -Functions Process of Bowel Elimination -Fecal material reaches rectum -Stretch receptors initiate contraction of sigmoid colon/rectal muscles -Internal anal sphincter relaxes -Sensory impulses cause voluntary “bearing down” -External sphincter relaxes -Developmental stage -Personal factors -Sociocultural factors- stress is one of the factors that cause diarrhea -Nutrition/hydration-put on potty after eat Know place of small intestine, especially jejunum and ileum 1 -Medications-it does cause some constipation -Procedures -Culture- it fixated on drugs Absence of bowel sounds-hypoactive onesdistention, hardness, tenderness Factor Affecting Bowel Elimination -Pregnancy- pregnant women are always compensated -Pathological conditions -Bowel diversions -Ileostomy -Colostomy Characteristics of Feces -Color -Consistency -Shape -Amount -Odor -Constituents Common Diagnostic Tests -Direct visualization -Colonoscopy –does the whole tract -this one needs sedation -Sigmoidoscopy – it goes lower GI tract but not the whole colon -don’t necessary have sedation -Radiographic views -Flat plate of the abdomen ***KNOW difference between these*** -Both tests need permit and bowel prep -They do a lot of flat plate or X-ray to see if you have an obstruction -Laboratory studies (of feces) -Stool for occult blood -Stool for fecal fat -Stool for ova and parasites -Be aware of nursing responsibilities/patient preparation for all tests -Take sample from two different areas -If come out blue, it is positive for blood -This is screening then you need to do more for further evaluation -Red meat can give you positive result or women on period Question The nurse knows that the results of a fecal occult blood test can be inaccurate if a. - The female client is menstruating 2 Promoting Regular Defecation -Provide privacy -Correct position -Seated upright -Timing -Often occurs after meals -Some clients may need assistance -Allow patients to do hand hygiene -Don’t put bed pan on bedside table, or on the floor -Cardiac patients- don’t want them to strain -most ppl if they have a bowel movement you hold your breath, for cardiac patients, it cause them to increase pressure in chest and cause the reflex to go down -make sure they eliminating routinely so they don’t get restrained, hold breath too much not good -Encourage fluids -entourage fluids, the softer the stool is the easier to get out -don’t pick caffeinated fluid -Proper diet -Fresh fruits, vegetables, whole grains, fiber -Exercise -Three to five times a week -Range of motion for clients on bedrest -help to get stool out, get patients moving Types of Bedpans Proper and Improper Position on a Bedpan When use bedpan make sure there is chuck under it and always have gloves on Proper position: Elevate the patient -provide patient privacy -hand hygiene afterwards 3 Common Alternations in Defecation -Diarrhea- Increased number of liquid stools, frequently liquid stool -Constipation-difficult pass stols -Fecal impaction-little stool like diarrhea -abdomen is hard -urge to go to bathroom but can’t -Bowel diversions -patient develop it are ones at constant bed rest -older folks at nursing home Managing Diarrhea -Monitor stools to quantify diarrhea. -Assess and monitor for fluid imbalance. -Monitor for alterations in perineal skin integrity. -Diarrhea-fluid imbalance -Skin integrity -As soon patient has Bowel movement, make sure they are cleaned up -Proper dietary teaching -Clear liquid -Bananas, rice, applesauce, toast (BRAT)-very bland food, doesn’t taste good -Foods to avoid -Antidiarrheal medications -Not recommended for acute diarrhea -Lomotil, immodium -Teach clients about over-the-counter aids -Nobody should take a lot GI medication for a long time Managing Constipation -Increase intake of high-fiber foods. -Increase fluid intake. -Increase activity/exercise. -Provide privacy. -Help client to a position that facilitates defecation. -Allow uninterrupted time. -Offer laxatives when lifestyle changes are ineffective. -you want to encourage more bowel function -offer laxative is the last to do -try to encourage patients good diet 4 Acute Care: Enemas -Cleansing -Tap water -hypotonic so not same osmotic pressure as other -Normal saline -Hypertonic solutions -cause fluid shift due to electrolyte imbalances -have higher osmotic pressure than solution in GI -Soapsuds -Oil retention -if you have a lot stool and you want to soft it up, that’s what you take -Carminative -Medication -Kayexalate enema -give to patients with lots of potassium such as renal patients -Administration -When to give enemas? -the night b/4 surgery -When doing enema -have your patient on left side -lobercate enema more -have a lot chucks on bed and open cap and control the flow in -patient should instruct to hold it as long as possible -make sure the bathroom is free at the time -DON’T do Enema on toilet -too close for comfort -won’t be able to hold it, it will come right out -can do some damage to rectal area Question Mrs. Addie is 70 years old. While the nurse is gathering admission assessment data, the patient states, “I’ve taken a tablespoon of Milk of Magnesia every day for 3 years.” Which nursing diagnosis is most appropriate for the nurse to use in her plan of care? Perceived Constipation -subjective data, the patient has been taking milk of magnesia bc she knows she has constipation.