Alterations in elimination are early signs of gastrointestinal problems
purpose of GI organs: absorb fluid and nutrients, prepare food for absorption, temporary storage of feces
Gastrointestinal (GI) tract
series of hollow mucous membrane-lined muscular organs
Digestion begins in the mouth and ends in the small intestine
Mouth- Esophagus- Stomach- Small Intestine
Mouth function
* mechanically, chemically break down nutrients
-Masticate: breaking down into a size suitable for swallowing
-Salivary glands: dilutes and softens food
Esophagus function
* passage of food from mouth to stomach
-esophageal sphincter: circular muscle that prevents air from entering the esophagus and food from refluxing into throat
Bolus
round mass of chewed food
Peristalsis
propels/pushes food through GI via wavelike movement
Stomach function
*Storing swallowed food and liquid; mixing food, liquid and digestive juices; emptying contents into small intestine
Stomach secretes
Hydrochloric Acid (HCL), Mucus, enzyme pepsin, intrinsic factor
Pepsin and HCL facilitate digestion of
Protein
Mucus protects stomach mucosa from acidity and enzyme activity
Intrinsic factor essential for absorption of vitamin B12
Small Intestine
Segmentation and peristaltic movement facilities digestion and absorption
Chyme
pulpy acidic fluid that passes from the stomach to the small intestine, consisting of gastric juices and partly digested food.
Three sections of small intestine
Duodenum, j�junum and ileum
Duodenum
Processes chyme from stomach
Jejunum
Absorbs carbohydrates and proteins
Ileum
Absorbs water, fats and bile salts
Small intestine (Duodenum/Jejunum)
Absorbs most of the nutrients and electrolytes
Small Intestine (Ileum)
Absorbs certain vitamins, iron and bile salts
Nutrients are absorbed into lymph fluids or blood vessels in the intestinal wall
Undigested food from small intestine emptied in Cecum (beginning of large intestine)
Large Intestine- primary organ of bowel elimination
Cecum, colon and rectum
Ileocecal Valve
circular muscular layer that prevents regurgitation (when chyme enters large Int.)
Chyme enters large intestine by wave of peristalsis through ileocecal valve
Colon: ascending, transverse, descending and sigmoid colon
Colon's (large intestine) three functions
absorption
secretion
elimination
Colon absorbs
water sodium and chlorine from digested food
If peristalsis is abnormally fast
less time for water to be absorbed so stool is watery
If peristalsis is abnormally slow
water continues to be absorbed which causes constipation
Secretory function of the colon aids in electrolyte balance
Bicarbonate secreted w/ exchange of chlorine
colon secretes 4 - 9 mEq potassium daily
Intestinal contents stimulates the peristaltic contractions
S
Slow peristalsis pushes content through colon
Fast (mass) peristalsis pushes undigested food toward rectum *4x a day, strongest after mealtime
Bacteria in the rectum convert fecal matter into its final form
Rectum usually empty until the urge is present to go (defecate)
Defecation
discharge of feces from the body
There are fold in the rectum and each fold contains an artery and vein
Hemorrhoid: when artery or vein in rectum becomes distended
*local heat temporarily relieves
Anus
expels feces and flatus; contraction and relaxation aid in controlling defecation
Physiological factors critical to bowel function and defection
-normal GI trat function
-sensory awareness of rectal distention and continence
-voluntary sphincter control
-adequate rectal capacity and compliance
Normal defecation begins
with movement in the left colon (moving stool to rectum)
At the time of defecation
external sphincter relaxes and abdominal muscles contract> increasing intrarectal pressure
Valsalva maneuver
assits in stool passage
Factors affecting Bowel elimination
Age, diet, Fluid intake
Physical activity, Psychological factors
Personal habits, Position during defection
Pain, Pregnancy, Surgery/Anesthesia
Rx, Diagnostic tests
Age (Affects on bowels)
-Babies experience fast peristalsis (incontinence)
-Elderly loose muscle in perineal floor and anal sphincter (incontinence)
Diet (Affects on bowels)
Fiber (non-digestable) provides bulk of real material; promotes peristalsis ex: whole grains, veggies
Lactose Intolerance
Lack the enzyme to break down lactose
Physical activity promotes peristalsis
emotional stress accelerates peristalsis
Colitis
inflammation of lining of colon; irritable bowl syndrome
Crohn's disease
a chronic inflammatory disease of the intestines, esp. the colon and ileum, associated with ulcers and fistulae.
Depression slows down peristalsis
causing Constipation
Pregnancy: As fetus grows it obstructs rectum
Causes slowing of peristalsis > constipation
Paralytic ileus
Paralysis of ileus; usually after surgery or anesthesia; causes constipation
Laxatives, Cathartics
Soften stool and promote peristalsis *Cathartics stinger than laxatives
Endoscopy
an instrument that can be introduced into the body to give a view of its internal parts.
Opioid analgesics (pain Rx)
slows peristalsis > constipation
Antibiotics
disrupts normal bacteria > Produce diarrhea
Aspirin
Interferes with formation of mucus > causes GI bleeding
Iron
Causes discoloration, nausea, vomiting, abdominal cramps > constipation
Constipation
symptoms where there's difficulty emptying bowels
Fecal Impaction
results from unrelieved contraption; collection of hardened feces in rectum that cannot be expelled (several days)
When continuous oozing of diarrhea stool occurs suspect impaction
Excess loss of colonic fluid results in serious fluid and electrolyte (acid-base) imbalance
Diarrhea
increase in number of stools and passage of liquid, unformed feces
Fecal incontinence
inability to control passage of feces and gas from anus (harms clients body image)
Flatulence
accumulation of gas in lumen of intestines; stretching and distention of bowl awl
Thrombosis
purplish discoloration of vein (decreased circulation)
Stoma
temporary or permanent artificial open in in abdominal wall
Bowel Diversion: Ileostomy
Surgical opening created in Ileum (brought through abdominal wall)
Bowel Diversion: Colostomy
Surgical opening created in colon (brought through abdominal wall)
Ostomy (bowel consistency)
Ileostomy: liquid
ascending colon: liquid
transverse colon: slushy
descending colon: pasty
sigmoid: near normal stool
No bowel sounds with paralytic ileus
Gas or flatulence create tympanic note
Masses/tumors/ fluid creates dull note
25% of solid portion of stool is bacteria from the colon
Cannot mix feces with urine/water when getting sample
Fecal Occult Blood Testing (FOBT)
measures microscopic amounts of blood in feces; useful for screening for colon cancer
*blue is positive for blood
One of the most important habits to teach
Take time to defecate (set routine)
Encourage 20g of fiber a day
*Fiber and bulk-forming laxatives first step in treatment for constipation in older adults
Stool softeners no longer recommended for constipation
*Osmotic laxatives
Enema
Promote defecation by stimulating peristalsis
Cleansing enema (complete evac from colon)
tap water, normal saline, soapsuds solution, low volume hypertonic saline
Tap water enema: Hypotonic
Normal Saline enema: isotonic *safest
Hypertonic solution enema: pull fluids out (fleet enema)
Soapsuds enema: castile soap
High/Low enema
Low enema only cleanses sigmoid colon
High enema cleanses entire colon
Digital removal of stool: LAST resort (cannot be delegated)
Move fingers in "scissor" motion when in anus
Purposes of Nasogastric Intubation
Decompression: remove secretions from GI
Enteral feeding
Compression
Lavage
Nasogastric tube (NG)
pliable hollow tube that's inserted through client's nose (nasopharynx) into stomach
12 F NG tube: used for decompression
Salem sump NG tube: has a blue pigtail for air vent
NG tube: burning sensation as tube passes through nare
change tape on nose everyday to reduce irritation
-frequent mouth care (2 hrs)
excoriation
damage of the skin
Turning a client regularly with NG tube promotes emptying of stomach contents
Ostomy and bowel retraining initiated in acute care setting
Effluent
stool discharged from an ostomy
Only a colostomy can be irrigated
Never use an enema, use a cone tipped irrigator
Wound ostomy continence nurse (WOCN)
nurse specially educated to care for ostomy clients
Clean peristomal skin with warm tap water
Do NOT use soap to clean stoma (skin around)
Minimum of 1500 ml of liquid help constipation in older adults
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