Term
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Definition
- the expulsion of feces from the anus & rectum
- called a bowel movement (BM)
- frequency and amount varies from individual to individual
- peristaltic waves move feces into rectum where client becomes aware of need to defecate
- when client is on toilet or bedpan, the external sphincter relaxes and feces is expulsed
- if defecation reflux is ignored or external sphincter muscle is contracted consciously, the urge to defecate will dissapear for a few hours before occuring again
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Term
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Definition
- 75% water & 25% solid materials
- soft and formed
- normally brown
- adults usually produce 7-10L of gas every 24 hours
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Term
| Factors affecting defecation: Age (older adult) |
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Definition
- many believe they should have a BM every day and use laxatives
- educate that decreased frequency of BM's is usually a normal result of aging is important
- some lose teeth and can't chew food
- peristalsis can decrease with age
- decreased mobility-further decreases peristalsis
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Term
| Factors affecting defecation: diet |
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Definition
Bulk foods necessary to provide volume |
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Term
| Factors affecting defecation: fluids |
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Definition
| softens stool and increases peristalsis |
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Term
| Factors affecting defecation: activity |
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Definition
- stimulates peristalsis and weak muscles are innefective in controlling defecation
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Term
| Factors affecting defecation: psychologic factors |
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Definition
| anxiety and anger can cause increased peristaltic activity (nausea & diarrhea) - depression may slow peristalsis, resulting in constipation |
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Term
| Factors affecting defecation: medications |
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Definition
| check side effects that can interfere with normal elimination and/or the appearance of the stool |
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Term
| Factors affecting defecation: diagnostic procedures |
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Definition
| barium can cause constipation/diarrhea |
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Term
| Factors affecting defecation: anasthesia and surgery |
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Definition
| may cause a slowing or ceasing of normal colonic movements (listen for bowel sounds after surgery) |
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Term
| Factors affecting defecation: pain |
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Definition
| may suppress the urge to defecate if pain is experienced (constipation a result) |
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Term
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Definition
- usual defecation pattern (frequency, time of day, changes)
- client description of feces (color, texture, shape, odor)
- any bowel elimination problems (time it occurs, cause, what helps)
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Term
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Definition
- color - normally brown
- consistency - normally formed, soft, semi-solid, and moist
- shape - cylindrical, contour of rectum
- amount - varies with client
- odor - affected by ingested foods, meds
- constituents - undigested food, etc...
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Term
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Definition
- clay or white: absence of bile pigment
- black or tarry: iron, upper GI bleed or diet high in red meat & dark green veggies
- red: lower GI bleed, some foods (Beets)
- pale: diet high in milk & milk products and low in meats, malabsorption of fats
- orange or green: intestinal infection
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Term
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Definition
| pungent: infection or blood |
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Term
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Definition
- hard, dry stool: dehydration or decreased intestinal motility
- diarrhea: increased intestinal motility
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Term
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Definition
- narrow, pencil-shaped or sting-like: indicative of obstructive condition of rectum
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Term
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Definition
- Pus - bacterial infection
- Mucus - inflammatory condition
- Parasites
- blood - GI bleed
- fat - malabsorption
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Term
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Definition
- listen to bowel sounds
- palpate abdomen
- examin rectum and anus
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Term
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Definition
- contour
- stoop or sit to gaze across abdomen from side
- flat
- scaphoid
- rounded
- protuberant
- symmetry
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Term
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Definition
- bowel sounds ~ auscultation
- done out of usual sequence for assessments learned so far
- paplation may cause a change in bowel sounds, so you want to listen before you stire things up
- use diaphragm of stethoscope
- place lightly against skin
- begin in RLQ and move to all 4 quadrants
- note characteristics and frequency of bowel sounds
- normal is high - pitched gurgling, irregular, 5-30 times per minute
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Term
| Different types of bowel sounds |
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Definition
- hyperactive ~ loud, high pitched, rushing
- hypoactive ~ soft, pause between sounds
- absent ~ must wait five full minutes
- gurgling ~ rumbling
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Term
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Definition
- use a tongue blade to place a small amount of stoll on a slide
- place a few drops of reagent into smear
- observe for color changes
- blue - a guaiac positive any other color is negative
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Term
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Definition
- have a pt. defecate into clean bedpan or commode
- try to avoid contact with urine & tissue
- use tongue blade to transfer specimen to container
- usually need 1 inch or 15-30ml of liquid stool
- may need all of stool for a timed test
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Term
| promoting regular defecation |
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Definition
- privacy
- timing - go when urge recognized
- adequate fluid intake (8-10 glasses/day)
- regular exercise
- positioning - squatting & leaning forward if possible
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Term
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Definition
| a symptom, not a disease; infrequent stool and/or hard, dry, small stools that are difficult to eliminate |
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Term
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Definition
| results from unrelieved constipation; a collection of hardened feces wedged in the rectum that a person cannot expel |
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Term
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Definition
| an increase in the number of stools and the passage of liquid, unformed feces |
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Term
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Definition
| inability to control passage of feces and gas to the anus |
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Term
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Definition
| accumulation of gas in the intestines causing the wals to stretch |
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Term
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Definition
| dilated, engorged veins in the lining of the rectum |
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Term
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Definition
- mass or collection of hardened feces
- results from prolonged retention & accumulation of fecal material
- may have liquid seepage (diarrhea) around impacted mass
- may have pain in rectum
- no BM for 3-5 days
- may require enemas, laxatives, stool softeners, or manual removal
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Term
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Definition
- temporary or permanent artificial opening in the abdominal wall
- surgical opening in the ileum or colong
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Term
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Definition
- pouching ostomies
- an effective pouching system protects the skin, contains fecal material, remains odor free, and is confortabls and inconspicuous
- nutritional considerations
- consume low fiber for the first weeks
- eat slowly and chew food completely
- drink 10 - 12 glasses of water daily
- patients may choose to avoid gassy foods
- lifestyle and body image considerations
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Term
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Definition
- solution introduced into the rectum and large intestine
- promotes defecation by distending the intestine, irritating intestinal mucosa, or softening the feces (lubricating rectum) to increase peristalsis
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Term
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Definition
- draws fluid from the interstitial space into the colon
- the increased volume stimulates peristalsis
- ex. - fleets enema
- 90-120ml of fluid - works in 5-10 minutes
- caution if client is dehydrated
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Term
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Definition
- water moves from the colon into the interstitial space
- before water moves out, it stimulates peristalsis
- caution in clients with cardiac problems
- ex: tap water, soap suds
- 500-1000ml, acts in 15-20 mins
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Term
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Definition
- safest - no movement of fluid between colon and interstitial fluid
- ex. - normal saline
- 500-1000 ml's, acts in 15-20 minutes
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Term
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Definition
- oil retained for 1-3 hours
- softens feces & lubricates rectum
- 90-120 ml
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Term
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Definition
- sterile technique is unnecessary
- wear gloves
- explain the procedure, precautions to avoid discomfort, and length of time necessary to retain the solution before defecation
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Term
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Definition
- use if enemas fail to remove an impaction
- this is the last resort for constipation
- a health care provider's order is necessary to remove an impaction
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