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organ responsible for completing absorption
secretion of bicarbonates
formation/expulsion of feces
protectiong of lining with mucus
the large intestine
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What are the 7 sections of the large intestine?
- cecum
- ascending colon
- transverse colon
- descending colon
- sigmoid
- rectum
- anus
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waste products of digestion
chyme
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Factors that affect elimination
- developmental age
- food and fluids
- activity and muscle tone
- lifestyle
- psychological variables
- pathological conditions
- medications
- diagnostic tests
- surgery and anesthesia
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Why does psychological variables affect elimination?
- emotional stress increases GI motility
- depression may cause constipation
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How do medications affect elimination?
- narcotic analgesics and tranqulizers, iron supplements increase constipation
- antibiotics - diarrhea
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What are pathological conditions that affect elimination and why?
- diverticulitis- Crohns disease cause diarrhea leading to malabsorption
- spinal cord injuries/ head injuries decreased sensory stimulation.
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What ares some common bowel elimination problems?
- constipation
- impaction
- diarrhea
- incontinence
- flatulence
- hemorrhoids
- bowel diversions
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fewer bowel movements than normal with the difficult passage of hard dry feces.
constipation
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What are common causes of constipation?
- changes in diet/lack of fiber
- medications
- environmental factors
- continued laxative use
- aging process
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What are some complications/consequences of constipation
- "valsalva maneuver"
- stimulates vagus nerve, may decrease HR
- straining is contraindicated
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results from unrelieved constipation
collection of hardened feces, wedged in the rectum and can't be expelled
impaction
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increased passage of loose stools
most common causes include food intolerance, colon disease, and meds.
fatigua, weakness,abdominal cramping
fluid and electrolyte imbalance and skin breakdown
diarrhea
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defined as involuntary passage of stool
caused by any condition that impairs anal sphincter control and conditions creating diarrhea
skin break down and feelings of shame or guilt
fecal incontinence
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defined as sensation of bloating and abdominal distention that is acoompanied by excess gas
complications include shame, embarrassment, discomfort due to distention
flatulence
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caused by increased venous pressure resulting from straining at defecation, pregnancy, CHF, chronic liver disease.
manifested by itching, burning, mass
hemorrhoids
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defined as masses of dilated vessels that lie beneath the lining of the skin of the anal mucosa
hemorrhoids
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creating an opening into the abdominal wall for fecal elimination
may result in temporary or permanent artificial opening in the abdominal wall
bowel diversions
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allow intestine to repair itself after inflammatory disease
as a result of cancer
temporary ostomy
permanent ostomy
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surgical openings with the ends of the intestine brought through the abdominal wall
colostomies
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What does stool color signify?
- brown: normal
- black/tarry: upper GI bleeding, iron, diet high in red meat
- red: lower GI bleeding, hemorrhoids
- clay/white: absence of bile, barium ingestion
- orange or green: intestinal infection
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how often does slow peristaltic contractions occur?
every 3-12 minutes.
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how often does mass peristalsis occur?
3-4 times within 24 hours. being strongest after meals
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What is the first stool called?
meconium.
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age group where water is not absorbed so there is an increase in BM
infants
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age group that has decreased motility, decreased peristalsis and therefore decreased BM
elders
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gas producing foods?
onions, cabbage, and beans
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foods with laxative effects
prunes, bran, alcohol, coffee, spicy foods
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what does narcotic analgesics, tranquilizers, and iron supplements cause?
constipation
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what do antibiotics cause
diarrhea
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what does a bowel prep and barium cause
- bowel prep=diarrhea
- barium=constipation
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manifest by inability to pass stool for several days despite a repeated oozing of diarrheal stool plus abdominal distention, anorexia, or rectal pain.
impaction
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symptoms of diarrhea
fatigue, weakness, and abdominal cramping
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what is usual bowel frequency?
daily to 2-3x a week
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what should you find during a bowel inspection?
- abdomen symmetical and soft
- no distension
- no visible peristaltic waves
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waht do you find during a bowel auscultation
- 5-35 gurgles/min
- due to surgery= paralytic ileus
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what should you find during a bowel palpation
non-tender , no masses/nodules
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What should you hear during a bowel percussion?
- dull over sold masses (impaction)
- tympanic/hyperresonant (flatulence)
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why is stool brown?
due to the break down of bilirubin by bacteria
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what does it signify when stool odor is pungent or noxious?
blood or infection
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what is the normal amount of daily stool
150g but can very between 100-400
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What causes false positives in stool exam tests?
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Certain foods such as red meat, raw fruits and vegetables and medications that irritate the GI tract like Aspirin, NSAIDS, and iron or when patient has taken more than 250 mg of Vitamin C in the 3 days prior to the test.
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direct visualizatoin of the of the large intestine with a flexible endoscope
colonoscopy
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viewing the rectum with a protoscope
proctoscopy
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examination of the sigmoid using a flexible instrument/tube
flexible sigmoidoscopy
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what are diet/fluid recommendations for ostomies?
- low fiber diet to start- gradually introduce hi fiber
- 2000-3000ml fluid/24hrs
- avoid food that may cause blockage(popcorn)
- general rule is eat as tolerated
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what are ways to promote healthy defecation?
- its most likely to occur 1 hours aftermeals so do not ignore the urge
- take time to do your tthangg
- assume squatting position, use elevated seat, lean forward
- provide privacy
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describe dulcolax?
stimulate laxative that causes local irritation to the intestinal mucosa, stimulates peristalsis and work relatively fast but can cause cramps and loss of fluid in stools. can cause fluid and electrolyte imbalance with prolonged use.
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describe saline or osmotic laxatives
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draw water into the fecal mass by osmosis, stimulate peristalsis. MOM and citrate of magnesia and Sodium phosphate or a fleets enema, are osmotic laxatives. These are rapid acting and can cause fluid and electrolyte imbalance. They should not be used by the elderly.
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describe colace?
stool softener that inhibits reabsorption of water. it may take several days to work.
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describe metamucil
bulk forming laxatives absorb water and increase bulk. can take up to 12 hours
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describe mineral oil
lubricant that softens fecal mass. but it interferes with absorption of fat soluble vitamins (A,D,E,K) if aspirated it can cause pneumonia.
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What are the speeds of laxatives?
- stimulant- fastest, 6-8 hours. dulcolax rectal suppository takes 30 mins.
- stool softeners- slowest 12-24 hours.
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what are the most effect antidiarrheal medication?
opiates. because they slow GI motility and excess fluid can be absorbed
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why should yo not give a patient anitdiarrheals if they are positive for clostridium difficile
it is best for them to continue excreting the toxin.
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simethicone is often combined with antacids for what purpose?
antiflatulent
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What is the purpose of enemas?
- to relieve constipation/gas/fecal impaction
- to administer drugs (neomycin, kayexalate)
- to promote visualization of the intestinal tract
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Describe the different types of enemas
- tape water: hypotonic, should not be repeated because of water toxicity or circulatory overload.
- normal saline enemas: safest b/c its isotonic
- soap solution: castile soap 1tsp:1000ml water, irritates intestinal mucosa
- hypertonic saline enema: small amount of fluid 120 ml that draws water into bowel such as Fleet’s sodium phosphate enema
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More types of enemas?
- oil retention: to lubricate rectum/colon; retain for several hours (fleets mineral oil)
- carminative enema: provides relief from gas by stimulating peristalsis(MGW:magnesium-glycride-water solution 60-80mls)
- return flow enema- expel flatus 100-200 ml (harris flush)
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what is the correct temperature of an enema?
40-43C (105-110 F)
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What is the force of flow of an enema controlled by?
- heigh of enema
- size of tubing
- type of liquid given
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What can happen during fecal impaction removal. (digital removal)
- mucosal irritation or bleeding
- stimulation of vagus nerve, may lead to bradycardia, cardia arrest.
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why is skin care so important with liquid stool?
it contains digestive enzymes and is very acidic. It can lead to skin breakdown, so to protect use petroleum jelly, zin oxide or orther barrier ointments.
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what areas of the colon does a colostomy irrigation work.
in the descending or sigmoid colon
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how long can a rectal tube be inserted?
up to 30 mins.
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what does the nephron do?
filters blood and removes metabolic wast products and regulate fluida and electrolyte balance.
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how is blood delivered to the glomerulus?
by the afferent arterioles.
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what happens in teh proximal tubule.
water and solutes are reabsorbed.
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what happens in the loop of henle
reabsorption of other solutes and glucose
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what happens in the distal tubule
water and sodium reabsorbed under the control of ADH and aldosterone.
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how much blood passes through teh kidneys in a minute
21% of total cardiac output, 1200 ml of blood
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how much can the bladder hold?
- 600ml normally
- 1000ml distended.
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describe the location of the bladder and the 4 layers
when empy it sits behind the symphysis pubis but distended it can reach to the umbilicus. innermost layer mucous membrane, connective layer, muscular layer (deltrusor muscle) and outer serous layer.
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how does micturation work?
when bladder fills (250ml-450ml) it stimulate the stretch receptors which send impulses to the spinal cord and stimulate the internal sphincter to relax and stimulate the urge to urinate.
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production of abnormally large amounts of urine
polyuria
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increased intake of fluids
polydipsia
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excretion of large amounts of urine usually to due to meds like diuretics
diuresis
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low urine output <500ml/day or 30ml/hr which is necessary for kidney function. result of decreased blood flow to to kidneys
oliguria
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lack of urine output.
anuria
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voiding 2 or more time a night
nocturia
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feeling that you have to void immediately
urgency
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voiding at more ferquent intervals than normal(4-6xday)
frequency
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either painful urination or difficulty urinating
dysuria
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difficulty in starting to urinate
hesistancy
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involuntary passage of urine in children.
enuresis
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bed wetting
noctural enuresis
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presence of blood in the urine
hematuria
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inability of the bladder to to partially or completely empty
urinary retention
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not able to concentrate urine or reabsorb water. 20x a day.
cognitive impairment may not be aware or bladder fullness=incontinence
infants
elders
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why does beer or caffeinated beverages increase urine production?
food and fluids high in sodium cause?
inhibits ADH
urinary retention to maintain normal electrolyte concentrations.
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anticholinergic
suppress the urge to urinate
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atropine, antihistamines, opiod analgesics are?
anticholingerics
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complication that can occur from the spread of organisms from the urinary tract in to the blood leading to a systemic infection.
urosepsis
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causes of lower UTIs?
- stasis of urine from urinary retention
- blocked urinary catheter- retention
- poor perineal hygiene
- sexual intercourse
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signs and symptoms of a UTI
- dysuria- burning
- fever/chills
- n/v
- hematuria, cloudy foul smelling concentrated urine
- acute confusion delirium in elderly
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differ between flaccid and spastic
flaccid retains urine and spastic leads to incontinence.
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normal /abnormal urine colors
- pale straw, amber
- dark yellow, bright red
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cloudy urine means?
bacteria infection.
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why does urine turn darker yellow
concentrated indicating fluid volume deficit
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what is the specific grabity of urine
1.01-1.025
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low specific gravity associated with?
high specific gravity associated with?
- over hydration
- dehydration
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