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what physiological conditions are critical for normal bowel function and defecation?
- Normal GI Tract Function
- Adequate Capacity
- Sensory Awareness of distension to the rectum and contents
- Voluntary Sphincter Control
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Describe factors that affect bowel elimination
- development
- Diet
- Activity
- Psychological Factors
- Personal Habits
- Medications
- Pathological Conditions
- Pain
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what is the impact of Narcotics in fecal elimination
slows peristalsis and segmental contractions often resulting in constipation
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how does antibiotic affect fecal elimination
may produce diarrhea by disrupting normal bacteria in GI tract
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hoe does ASA affect fecal elimination
- can interfere with formation of protective mucous covering the stomach
- resulting in gastritis or bleeding
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how do NSAIDS affect fecal elimination
- promote GI tract irritation
- ranges from epigastric pain to flank hemorrhage
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how does Iron affect fecal elimination
- can discolor stool ( Black)
- can lead to constipation
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how do laxatives affect fecal elimination
- 3 mechanisms
- chemical - act to stimulate peristalsis (Dulcolax)
- mechanical - increase bulk, fiber (Metamucil)
- Softener- lubricate (mineral oil or ducosates)
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what are carthartics
- stronger than laxative
- used as colonoscopy prep
- (GoLytly)
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what are the risks of diarrhea
- rapid passage reduces the time that the large intestines can reabsorb fluid
- can cause serious electrolyte and fluid losses in the body.
- Can Happen very Fast In Children and Older Adults
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teach about diarrhea
- drink 8 glasses or water a day/few electrolye replacements
- eat foods with sodium and potassium
- increase Soluble Fiber (skinless fruit, potatoes, oatmeal, rice)
- No alcohol, or caffeine
- Limit insoluble fiber (cereal, whole wheat)
- Clean Perineal Area
- After eat yogurt to reestablish flora into the stomach
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What foods migt act as a laxative
- Bran
- Prunes
- Figs
- Chocolate
- alcohol
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What foods cause constipation
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What foods produce Gas
- Apples
- Bananas
- Cauliflower
- Onions
- Cabbage
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describe Valsalva Maneuver
- Straining against closed epiglottis
- this builds up pressure on the large veins in the thorax and interferes with return bood flow to the heart and coronary arteries.
- When client releases pressure the epiglottis opens and a surge of blood flows to the heart
- May cause arrythmias
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When NOT to give laxative or Carthartic
- Nausea
- Cramps
- Colic
- Vomitting
- undiagnosed Abdominal Pian
- Diarrhea
- Ask Doctor first risk rupturing bowel
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What are causes of constipation
- insufficient fiber
- insufficient activity or immobility
- insufficient fluid intake
- irregular defecation habits
- change of dailt routines
- chronic use of laxatives
- IBS"
- Lack of Privacy
- Pelvic Floor Dysfunction or muscle damage
- Meds (iron, antihistamine, opioids, antacids)
- Ignoring urge (holding it)
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how to recognize constipation
- fewr than 3 BM per week
- Dry Passage of stool
- Passage of No Stool
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Causses of diarrhea
- stress/anxiety
- fluid and electrolyte imbalance
- tube feedings
- changes in diet
- changes in neurological system
- impaired nerve intervention
- Parasites
- Drugs, antibiotics
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what are the possible locations of ostomies
- Cecostomy/Ileostomy
- Ascending Colostomy
- Transverse Colostomy
- Descending Colostomy
- Sigmoid Colostomy
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sigmoid colostomy
- normal formed consistency and freq
- discharge can be regulated
- does not need appliance
- most common permenant ostomy
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Descending colostomy
- produces increasingly formed fecal drainage
- Some people have control
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Transverse colostomy
- malodorous
- mushy drainage some liquid has been reabsorbed
- Usually no Control Must Wear Bag
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Ascending Colostomy
- liquid drainage cannot be regulated
- digestive enzymes are present
- Odor has to be controlled
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Cecostomy/Ileostomy
- produces liquid drainage
- drainage is constant
- odor is minimal no bacteria present
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what is normal hourly urine output
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Kidney begin to excrete between 11-12th seek
ability to concentrate urine is minimal
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life Span development/changes in urinary elimination
- Ability to concentrate urine is minimal
- Urine is slightly yellow
- Voluntary control is absent
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life span development /changes children urinary elimination
- between 18-24 months start to recognize bladder is full
- between 2 1/2 and 3 years recognize fullness and able to communicate and hold it
- Full night time control occurs 4-5 daytime 3
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lifespan urinary elimination
Adults
- Kidney reach maximum size between 35-40
- after 50 kidey begins to diminish in size and function
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lifespan development/changes
urinary elimination
Older Adults
- estimated 30% of Nephrons lost by 80
- Renal blood flow decreases because vascular changes and decreased cardiac output
- ability to concentrate urine decreases
- bladder muscle control decreases
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what are signs and symptoms of UTI?
- urine becomes dark and cloudy
- u/o decreases
- GFR decreases
- Facial and periorbital edema occurs
- Malaise
- Fever
- headache
- anorexia
- nausea
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why are UTI more common in females than males
Urethra is shorter, and is in close proximity to the vagina and the anus
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what is residual urine
urine left in the bladder after you go to the bathroom
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what are the health risks associated with residual urine
- urinary stasis
- UTI
- infection into the Kidneys and the body
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what tests are used to evaluate Renal Function
- BUN
- Creatinine Clearance (24 hr)
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what is the relationship between BP and Renal Function?
- Kidney Function is down, BP is up
- when BP/blood flow in afferent arterioles decreases for any reason the Renin Angiotension Aldsterone is stimulated.
- Angiosterone increases vasoconstriction and stimulates aldosterone
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What are some factors that affect urinary elimination
- developmental factors
- muscle tone
- medications
- Fluid I/O
- enlarged prostate
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straight catheter
- straight
- no balloon
- used to check for residual urine or client use at home every 4-6
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irrigation catheter
- stays in bladder (indwelling)
- 3 lumen 1 drain urine, 2fill balloon, 3 irrigation
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coude' catheter
- rigid, with curve on the end
- used mostly for males that have had prostate surgery
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retention catheter
- foley, most common
- double lumen, 1 drain 2 balloon
- indwelling
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suprapubic catheter
surgically inserted above pubic bone
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what supplies are needed for indwelling catheter
- gt catheter and kit
- sterile gloves
- drape under butt, and drape goes over thighs
- antiseptic solution
- cotton balls
- lubrication
- forceps/tweezers
- syringe filled with sterile water
- collection bag and tubing
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what are different types of enemas?
- cleansing
- carminative
- retention
- return flow
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cleansing enema
- hypertonic - pulls fluid from body(fleet-small bottle)
- hypotonic -body absorbs fluid (tap water-big bag)
- istonic-equal, no fluid movement
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carminative
used to expel gas
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retention enema
- introduces oil or medication into rectum and sigmoid colon
- stays in 1-3 hours softens feces
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Return flow enema
alterate between 100-200mL, stimulates peristalsis eliminates gas
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urinary diversions
- ureterostomy
- nephrostomy
- veciostomy
- ileal conduit
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