Elimination - Assessment r/t lower gastro-intestinal

GI tract from mouth to anus

mouth, teeth, pharynx, esphogas, pyloric sphincter, small intestine (duodenum, jejunum, ileum), cecum, appendix, ascending colon, transverse colon, descending colon, sigmoid, rectum, anus

Water is absorbed from the large intestine causing

feces to be more formed and less watery as it progresses through the colon

Valsalva's manuever

taking a deep breath and trying to expel this air against a closed glottis (Valsalva maneuver). This contraction of expiratory chest muscles, diaphragm, abdominal wall muscles, and pelvic diaphragm exert pressure on the digestive tract

Superior mesenteric artery

supplies blood which carries O2 and nutrients to the ascending and transverse colon, if supply cut off intestine would die

Valsalva's maneuver contraindicated in pt with

heart problems, hemmorhoids, head trauma

Inferior mesenteric artery

supplies blood which carries O2 and nutrients to the descending colon, sigmoid and rectum, if supply cut off, intestine would die

During assessment r/t lower GI tract you get a nursing hx which includes

subjective data (pt's own words), pain, indigestion, gas, N/V, bowel habits

Also do physical exam for assessment r/t lower GI tract which includes

1. Inspection (look before you touch, observe for scars, lesions, lumps, bumps, contour maybe symmetrical, round, flat; peristalsis, wounds, ostomies)
2. Auscultation (listen for 3-5 minutes in each quadrant starting with RLQ where the cecum dumps into th

Decreased mobility (lack of movement) =

decreased motility (slowed peristalsis)

Normal BM

anywhere from 3 per day to one every four days (must know bowel hx to determine extent of reported constipation)

Causes of constipation

lack of activity, dietary(low fiber), drugs, large bowel problems, psychogenic, systemic, chronic laxative or enema use

Drugs affecting constipation

anatacids containing aluminum or calcium, salts, narcotic analgesics, anticholinergics, many antidepressants, tranquilizers, sedatives, antihypertensives, iron salts

Psychogenic affecting constipation

voluntary suppression of urge, percieved need to defecate on schedule, depression

Systemic affecting constipation

advanced age, pregnancy, neurologic conditions (trauma, MS, tumors, CVA, parkinsonism), endocrine and metabolism disorders

Complication of Constipation

1. Arterial hypertension = pushing causing decreased BP and decreased CO, then release causing increase in BP
2. Fecal Impaction = chronic constipation could lead to perforation leading to infection (could still have runny stool b/c seeping around the imp

Harris flush

use of repeated enema to break away at fecal impaction

Medication to promote elimination***

1. stool softeners - docusate sodium (colace)
2. Peristalsis stimulators - senna, ex-lax, correctal, bisucodyl, dulocolax
3. bulk formers - metamucil, citracel, fiber con (encourage fluids)
4. suppositories - glycerin
5. enemas

Many causes of diarrhea including

1. bacteria, parasites, and viral
2. e. coli
3. staphyloccocal (food poisoning)
4. Vibrio cholerae
5. Salmonella
6. Shigella
7. C. difficile

Prolonged diarrhea

requires a culture to determine cause

Tx of diarrhea

1. give frequent small amounts of fluid (stay hydrated),
2. if caused by infection discourage antidiarrheal to allow infection to be excreted,
3. BRAT diet (bananas, rice, apple sauce, toast)
4. Meds- Immodium to stop diarrhea, Lomoto to slow peristalsis

Foods that aggravate diarrhea

1. milk products
2. apple juice, pear juice, grapes, honey, dates, nuts, figs, fruit-flavored soft drinks
3. table sugar
4. sugarless gum and mints
5. antacids
6. coffee, tea, cola drinks, OTC analgesics

Diagnostic tests include

1. lower GI or barium enema
2. flexible proctoscopy or sigmoidoscopy
3. colonscopy

Lower GI or barium enema (x-ray exam) used for inflammatory bowel, diverticulosis, and strictures

1. allows visualization of the position, filling, and movement of contrast medium
2. detects diverticulitis, lesions, polyps, colitis, obstruction, bleeding
3. Barium instilled thru rectal tube and x-rays are taken
4. clear colon required prior to procedu

Flexible proctoscopy and sigmoidoscopy used for rectal bleeding and cancer screening

1. exam of rectum, anus, and sigmoid with flexible scope
2. lay in left lateral position (Sim's) to use gravity in colon
3. no fasting required, enemas common pre-procedure

Colonoscopy

1. Enable MD to visualize the entire large intestine
2. Recommended every 10 yrs starting at age 50 if no risk, at age 40 if risk factors, and if family hx of colorectal cancer or precancerous polyps then have done 10 yrs before age of family members diag

Preparation for colonoscopy

1. Day before drink barium electrolyte lavage soln and take laxatives
2. Clear liquid diet
3. No ASA two weeks before procedure
4. NPO after midnight
5. Check with MD about meds esp blood thinners and insulin b/c will be NPO

Normal expectations of colonscopy

1. prep is worst b/c tastes bad and causes lots of diarrhea
2. will be under conscious sedation (will be able to follow directions but will not remember after)
3. may experience cramping, bloating, pressure
4. laxative after to remove Barium b/c will soli