colostomy
a surgical operation that creates an opening from the colon to the surface of the body to function as an anus
constipation
irregular and infrequent or difficult evacuation of the bowels. EX. can be a symptom of intestinal obstruction or diverticulitis
defecation
the elimination of fecal waste through the anus
diarrhea
frequent and watery bowel movements occurring three or more times a day. EX. can be a symptom of infection or food poisoning or colitis or a gastrointestinal tumor
distention
stretching out of the intestinal walls and making them appear inflated
fecal incontinence
loss of voluntary control of rectal sphincters
flatus
gas in the digestive tract or expelled through the anus
Guaiac test
a test performed to look for occult (hidden) blood to detect gastrointestinal bleeding not visible to the eye
Ileostomy
surgical procedure that creates an opening from the ileum through the abdominal wall to function as an anus
impaction
Presence of large or hard fecal mass in the rectum or colon.
Kayexalate enema
used to treat pts with dangerously high serum potassium levels. lowers that level
Melena
abnormally dark, tarry feces containing blood and has old blood odor (usually from gastrointestinal bleeding)
Normal flora
Microorganisms that reside in or on the body without causing disease. Colon is one place where normal flora prevent infection and maintain health.
occult blood
hidden blood
peristalsis
the process of wave-like muscle contractions of the alimentary tract that moves food along. Begins in esophagus and continues to rectum.
siphon enema
aka Return flow enema OR Harris flush. Administered to remove gas and not specifically for the removal of stool.
steatorrhea
the presence of greater than normal amounts of fat in the feces which are frothy and foul smelling and floating. EX. a symptom of disorders of fat metabolism and malabsorption syndrome such as Crohn's disease.
stoma
a mouth or mouthlike opening (in reference to ostomy here)
tenesmus
cramping identified by increased rectal pressure and a feeling of the need to defecate.
pyloric sphincter
the sphincter muscle of the pylorus that separates the stomach from the duodenum. Chyme passes through and into small intestine
chyme
a semiliquid mass of partially digested food that passes from the stomach through the pyloric sphincter into the duodenum
Bowel Sounds
Gurgles, clicks, and tinkling sounds in bowel.
defecation reflex
normal response to the presence of feces in the rectum. Under voluntary control of the individual.
Characteristics of feces
color, shape, consistency, odor, and frequency
Normal characteristics of feces
soft, formed, light yellowish-brown to dark brown, and slightly odiferous, and falls into a slightly curved shaped
Meconium
black, shiny, sticky stools from newborns
Breastfed infants
usually have bright yellow, pasty, seedy-appearing stool
Formula or cow's milk fed infants
usually have a darker yellow-ish brown or tan colored stool that is much more firm and formed
Stool - consitency
NORMAL - soft, formed consistency
ABNORMAL - liquid or semiliquid, watery, unformed, very hard and dry
Stool - shape
NORMAL - longer curved shape, cylindrical
ABNORMAL - balls, clumps, or broken off chunks, flat or ribbon like, pencil like
Stool - Color
NORMAL - Yellow in infants, Light brown to dark brown in others
ABNORMAL - Bright red blood, black, coffee grounds appearence, pale, white, gray, or clay color
Stool - Presence of infection
NORMAL - absence of pus, mucous, fat
ABNORMAL - presence of pus, excessive mucous, foamy, or floating on water
Stool - Presence of parasites
NORMAL - absence of parasites
ABNORMAL - presence of worms or eggs
Stool - Odor
NORMAL - slight odor
ABNORMAL - foul odor, strongly odiferous, bloody or old blood smell, metallic smell
Frank blood
Blood that is bright red and visible to the naked eye
small intestine bleeding
often result in a maroon colored stool
anorexia
loss of appetite
Possible causes of constipation and diarrhea
-change in activity level
-change in dietary and fluid intake
-side effects of medication
-side effects of surgery
-pregnancy
-high stress levels and emotional problems
-laxative abuse
-aging process
-structural changes
-chemical changes
-food allergies
too much fiber
can cause flatus and constipation
Lactose intolerance
congenital disorder consisting of an inability to digest milk and milk products. Their ingestion can cause diarrhea
opportunistic infection
When the level of normal flora decreases, other microorganisms such as fungi are allowed to grow disproportionately. Affects bowel by taking control and causing diarrhea. Clostridium difficile is one the more severe opportunistic infections.
diverticulosis
condition occurs when the muscular wall of the colon weakens and separates, allowing small pouches or pockets of the inner wall to protrude outward. Pouches easily trap fecal material and become inflamed.
diverticulum
Singular is Diverticuli. They are the pouches formed in diverticulosis. Have been known to rupture allowing fecal material and bacteria to enter the sterile peritoneum and cause peritonitis
diverticulitis
Name for when pouches in diverticulosis become inflamed. They can cause diarrhea and severe cramping.
Perforate
rupture
common signs and symptoms of peritonitis
-malaise
-anorexia
-nausea
-vomiting
-abdominal distention
-decreased or absent bowel sounds
-fever
classic sign is constant intense pain that worsens with movement
gastroenteritis
common name for bacterial or viral infections of the GI tract
edentia
lack of teeth
continence
voluntary control over urinary and fecal discharge
Independent Nursing interventions to promote bowel elimination
-determine pt normal BM frequency pattern
-track and document pt feces characteristics
-assess bowel sounds at least once a shift
-pt on bedrest. reposition q2h and ROM
-pt ambulatory. walk 3-4x daily and eat in chair
-encourage fluids as allowed by physi
hypoactive bowel sounds
fewer than 5 per minute
hyperactive bowel sounds
More than 30 per minute or continuous
borborygmi bowel sounds
excessively loud and gurgling, with a noise like splashing
absent bowel sounds
Listen in EACH of the four quadrants for 3-5 minutes
Daily fluid intake
maintain between 1,500 and 2,500 mL/day in most adults
debilitated, elderly, or confused patient
may not be able to drink more than a few sips at a time. Provide a drink every 15-20 minutes
adequate fiber intake
25-35 g/day
Foods high in fiber content
-apples, unpeeled
-artichokes
-beans
-blueberries
-broccoli
-cabbage
-carrots
-cauliflower
-cherries
-corn
-dried fruits
-flaxseed
-legumes
-nuts
-oatmeal
-oranges
-pears, unpeeled
-plums
-popcorn
-prunes
-raisins
-raspberries
-strawberries
-sunflower see
diarrhea lasting longer than 24-36 hours
pt can be given full liquids, cooked fruit and vegetables such as applesauce or carrots. Also bananas and aged cheeses.
apple pectin
common treatment for diarrhea and primary ingredient found in over the counter antidiarrheal medications such as Kaopectate.
diarrhea due to loss of normal flora
Yogurt containing active bacteria helps replace normal flora and promote healing. Same yogurt can also be used while taking antibiotics to prevent loss of normal flora.
Lactobacillus acidophilus
supplement that comes in several forms and can be used to replace normal flora or prevent its loss while taking antibiotics. Its also used to treat diarrhea caused by virus known as Rotavirus
enema
injection of a liquid through the anus to stimulate evacuation of feces. Water temp should be between 105-110 F to avoid burning intestinal mucosa. Too cold will cause abdominal cramping. Sims' or left lateral side lying position.
enema tube insertion
insert tip of tubing 3 to 4 inches
high enema
starts same as regular enema. After instilling half of enema solution, reposition pt first to supine postion and then to the right lateral side lying position to administer remaining solution
visualization
Radiological tests as prep for colon surgery
enemas til clear
enemas are administerd until the expelled solution no longer contains feces and is relatively clear. LIMIT OF 3000 mL (three 1000 ml or large volume solution)
large volume of solution
500 to 1000 mL for an adult
Tap water emema
VOLUME - 500 to 1000 mL
PURPOSE - cleaning
RESTRICTIONS - hypotonic. Do not use for infants, children, or patients with congestive heart failure. Could result in fluid volume overload
Normal saline (NS) (0.9%) enema
VOLUME - 500 to 1000 mL
PURPOSE - cleaning
RESTRICTIONS - Isotonic. Safe for use in children and congestive heart failure patients. Infants: use 50-150 mL
Toddlers: use 150-350 mL
School-age children: use 350-500 mL
Soapsuds (use castile soap only)
VOLUME - add to tap water or NS at a ratio of 5 mL soapsuds per 1000 mL
PURPOSE - cleaning
RESTRICTIONS - Mix castile soap in saline, not tap water, for infants, children, or patients with congestive heart failure.
Hypertonic sodium phosphate enema
VOLUME - 120 mL
PURPOSE - cleaning
RESTRICTIONS - Normally used only for adults
Oil retention enema
VOLUME - 120 mL
PURPOSE - softens stool
RESTRICTIONS - Normally used only for adults
milk and molasses enema
hypertonic solution sometimes used for persistent constipation and impaction removal. Extremely effective but messy to administer.
Contradictions to enemas
-rectal surgery
-severe bleeding hemorrhoids
-ulcerative colitis or Crohn's disease
-rectal fissure
-rectal cancer
-excessive bleeding potential due to disease or medication
-certain heart conditions such as myocardial infarction or unstable angina
enema inducing vagal response
IMMEDIATELY
-Stop enema
-Remove tube
-Put pt supine
-Assess pulse, skin color, and whether pt diaphoretic
-Call for assisstance, but dont leave pt
-Pulse below 60, then place pt in shock position, with head lower than feet
-Assess BP as soon as cuff is av
Vagus Nerve stimulation symptoms
Complaints of
-chest pain
-chest heaviness or pressure
-shortness of breath or inability to breathe
-dizziness
-feeling like he or she is going to faint
-nausea
Only one sign or symptom required to stop and remove enema.
Vagus nerve stimulation signs
-pallor
-clammy skin
-pulse rate under 60 bpm
Only one sign or symptom required to stop and remove enema.
substances to avoid prior to stool occult blood testing
48 hours before testing. Including anything with red dye or food coloring.
-alcohol
-antacids
-antidiarrheals
-gastric irritants such as NSAIDs or steroids
-red jello
-red meats
-red popsicles
-vegetables and fruits high in peroxidase, an enzyme found in
ostomy
surgical procedure that creates an artificial opening for the elimination of bodily wastes
effluent
fecal material emptying from ostomy
Need for bowel diversion
-cancerous tumor
-infarcted area in which the bowel walls have become ischemic and died
-desease process such as Crohn's disease
-ruptured diverticulum
-ulcerative colitis
-traumatic abdominal injury
single barreled colostomy stoma
aka end stoma. Term for the single opening present in a colostomy stoma.
double barreled colostomy stoma
Both ends of the dissected colon are brought to the surface and two stomas are formed. Proximal and distal stoma.
Anastomosed
Surgically reconnected. Ex - after distal portion of the colon heals, loop is reconnected and placed back into the abdominal cavity. Referring to double barreled colostomy stoma.
loop stoma
Loop of bowel, usually the transverse colon, is brought to the surface of the abdomen
Bridge
aka Stay. A plastic rod positioned under loop of colon to keep it outside the body. Its stitched to the abdominal wall.
Stool consistency - ascending colon
effluent will be liquid to mushy with a foul odor
Stool consistency - right transverse stoma
mushy to semiformed effluent
Stool consistency - left transverse stoma
effluent semiformed to soft
Stool consistency - descending or sigmoid colon
effluent soft to hard formed stools
Stool consistency - ileostomy
liquid due to majority of water not being absorbed until it reaches the large bowel. Effluent is continuous and contains enzymes making it corrosive to skin surrounding stoma
kock pouch
diversion that uses the terminal portion of the ileum to form an internal pouch to collect and store the effluent prior to evacuation from the body. Drained with a catheter
peristomal skin
skin surrounding the stoma
New Stoma look
should be pink to red, shiny, and moist.Pallor, cyanosis, or a dusky color indicates impaired blood supply. Black depicts necrosis.