DEFECATION<br /><ul><li>Defecation is the expulsion of feces from the anus and rectum.
Also known as bowel movement</li></li></ul><li>Defecation reflex<br /><ul><li>Intrinsic defecation reflex
Feces enter rectum distension of rectal walls initiates signal through mesenteric plexus initiate peristaltic waves (descending, sigmoid colon, rectum)anus internal sphincter inhibited from closing relaxed external sphincter defecation
Parasympathetic defecation reflex</li></li></ul><li>Common Bowel Elimination Problems<br />Constipation. Decreased frequency of bowel movements accompanied by prolonged or difficult passage of dry hard stool<br />Impaction. Collection of hardened feces wedged in the rectum<br />Diarrhea. Increase in number of stools and the passage of liquid, unformed feces.<br />Incontinence<br /> Flatulence<br /> Hemorrhoids<br />
Emotional state.</li></li></ul><li>Assessment of the GIT<br />MTCAT '09<br />Nursing History : Subjective Data<br />1. General Data<br />presence of dental prosthesis, comfort of usage<br />difficulty eating or digesting food<br />nausea or vomiting<br />weight loss<br />pain – may be caused by distention or sudden contraction of any part of the GIT<br /> - specify the area, describe the pain<br />2. Specific data if symptoms are present<br />situations or events that effect symptoms<br />onset, possible cause, location, duration, character of symptoms<br />relationship of specific foods, smoking or alcohol to severity of symptoms<br />how the symptoms was managed before seeking medical help<br />
Assessment of the GIT<br />MTCAT '09<br />3. Normal pattern of bowel elimination<br />frequency and character of stool<br />use of laxatives, enemas<br />4. Recent changes in normal patterns<br />changes in character of stool (constipation, diarrhea, or alternating constipation and diarrhea)<br />changes in color of stool <br />melena - black tarry stool (upper GI bleeding)<br />hematochezia – fresh blood in the stool (lower GI bleeding)<br />c. drugs /medications being taken<br />d. measures taken to relieve symptoms<br />
Assessment of the GIT<br />MTCAT '09<br />B. Physical Examination : Objective Data<br />a.) Mouth and Pharynx<br />lips – color, moisture, swelling, cracks or lesions<br />teeth – completeness (20 in children, 32 in adults), caries, loose teeth, absence of teeth impair adequate chewing<br />gums – color, redness, swelling, bleeding, pain (gingivitis)<br />mucosa – color (light pink)<br /><ul><li>examine for moisture, white spots or patches, areas of bleeding, or ulcers
white patches – due to candidiasis (oral thrush)
white plaques w/in red patches may be malignant lesions</li></ul>tongue – color, mobility, symmetry, ulcerations / lesions or nodules<br />pharynx – observe the uvula, soft palate, tonsils, posterior pharynx <br /><ul><li> signs of inflammation (redness, edema, ulceration, thick yellowish secretions), assess also for symmetry of uvula and palate</li></li></ul><li>Assessment of the GIT<br />MTCAT '09<br />b.) Abdomen<br /> - assess for the presence or absence of tenderness, organ enlargement, masses, spasm or rigidity of the abdominal muscles, fluid or air in the abdominal cavity<br />Anatomic Location of Organs<br />RUQ – liver, gallbladder, duodenum, right kidney, hepatic flexure of colon<br />RLQ - cecum, appendix, right ovary and fallopian tube<br />LUQ – stomach, spleen, left kidney, pancreas, splenic flexure of colon<br />LLQ – sigmoid colon, left ovary and tube<br />
Assessment of the GIT<br />MTCAT '09<br />
Assessment of the GIT<br />MTCAT '09<br />1. Inspection<br /><ul><li>assess the skin for color, texture, scars, striae, engorged veins, visible peristalsis (intestinal obstruction), visible pulsations (abdominal aorta), visible masses (hernia)
abdominal distension, measure abdominal girth or circumference at the level of umbilicus or 2-5 cm. below</li></li></ul><li>Assessment of the GIT<br />MTCAT '09<br />2. Auscultation<br /><ul><li>presence or absence of peristalsis or bowel sounds
Absent – no sounds in 3-5 mins.</li></ul> peritonitis, paralytic ileus, <br /><ul><li>Hyperactive – 5-6 sounds in less than 30 sec.</li></ul> diarrhea, gastroenteritis, early intestinal <br /> obstruction<br />
Assessment of the GIT<br />MTCAT '09<br />3. Percussion<br /><ul><li>done to confirm the size of various organs
to determine presence of excessive amounts of air or fluid
dullness or flatness – area of liver and spleen, solid structure </li></ul> – tumor<br />4. Palpation<br /><ul><li>to determine size of liver, spleen, uterus, kidneys – if enlarged
determine presence and chac. of abdominal masses
determine degree of tenderness and muscle rigidity (rebound or direct)</li></ul>c.) Rectum<br /><ul><li>perineal skin and perianal skin
assess for presence of pruritus, fissures, external</li></ul> hemorrhoids, rectal prolapse<br />
FECAL STUDIES<br />For blood, fat, infectious organisms<br /><ul><li>A freshly passed, warm stool is the best specimen.
From fat or infections organisms, collect three separate specimens and label day # 1, day #2, day # 3.</li></li></ul><li>Stool examination (fecalysis)<br /><ul><li>Stool for occult blood(Guaiac Test)
proper collection of specimen should not be mixed with water or urine, should be sent immediately to the laboratory</li></li></ul><li>UPPER GI SERIES (BARIUM SWALLOW)<br /><ul><li>Fluoroscopic examination of upper GI tract to determine structural problems and gastric emptying time.
Sequential films taken as it moves through the system.</li></ul>Barium – is a radiopaque substance that when ingested or given by enema in solution, outlines the passage ways of the GIT for viewing by x-ray or fluoroscopy<br />
UPPER GI SERIES (BARIUM SWALLOW)<br /><ul><li>for identification disorders of esophagus, stomach, duodenum – esophageal lesions, hiatal hernia, esophageal reflux, tumors, ulcers, inflammation
Pt. swallows a flavored barium solution and the radiologist observes the progress of the barium through the esophagus and take x-ray films
Observe for: impaction, distended abdomen, constipation</li></li></ul><li>LOWER GI SERIES (BARIUM ENEMA)<br /><ul><li>Barium is instilled into the colon by enema
Client retains the contrast medium while x-rays are taken to identify structural abnormalities of the large intestine or the colon.</li></li></ul><li>Nursing care: pretest<br /><ul><li>NPO for 8 hours pretest
Give enemas until clear the morning of the test.
Explain that a local anesthetic will be used to ease comfort and that speaking during the procedure will not be possible; the client should expect hoarseness and a sore throat for several days.</li></li></ul><li>Nursing care: posttest<br /><ul><li>NPO until return of gag reflex.
Assess vital signs and for pain, dysphagia, bleeding
Administer warm normal saline gargles for relief of sore throat.</li></li></ul><li>COLONOSCOPY<br /><ul><li> to visualize the colon
useful to identify tumors, colonic cancer, colonic polyps
not done when there is active bleeding or inflammatory disease </li></li></ul><li>Colonoscopy<br />Preparation : <br /><ul><li>clear liquid diet 24 hrs. before fleet or cleansing enema
SIGMOIDOSCOPY<br />Sigmoidoscopy– examination of sigmoid colon, rectum and anus<br />Proctoscopy– examination of rectum and anus<br /><ul><li> used as a screening test for persons 40 yrs old and above, with history of colonic cancer
used for pt with lower GI bleeding or inflammatory disease</li></ul>Preparation : <br /><ul><li>light dinner and light breakfast -
Steatorrhea. Greasy, bulky, foul smelling stool. Presence of undigested fats like in hepatobiliary-pancreatic obstruction/disorders</li></li></ul><li>Foods & meds that alter stool color <br /><ul><li>Meat protein - dark brown
Avoid raw fruits and vegetables, fried foods, spices coffee.</li></li></ul><li>Nursing Care<br />Directed toward identifying the cause, relieving symptoms, preventing complications and if infectious, preventing the spread of infection to others.<br />RISK FOR FLUID VOLUME DEFICIT<br /><ul><li>RECORD I & O
Monitor v/s and record including orthostatic hypotension
Provide fluid and electrolyte replacement solutions as indicated- increase OFI as tolerated</li></li></ul><li>NURSING DIAGNOSIS<br /><ul><li>Altered nutrition less than body requirements R/T
Apply protective ointment to the perianal area</li></li></ul><li>Flatulence<br />Presence of excessive gas or tympanites in the intestines.<br />COMMON CAUSES OF FLATULENCE<br /><ul><li>Constipation
Chewing gum, candy sucking, smoking</li></li></ul><li>DECREASING FLATULENCE <br />One method of treating flatulence involves the insertion of a rectal tube.<br />Guidelines: <br /><ul><li>Use rectal tube (Fr 22-30) for adults and a smaller size for children.
Have the client assume a side-lying position.
Lubricate the rectal tube to reduce mucous membrane irritation.
Expose the anus and insert the rectal tube into the rectum 10cm (4in). The rectal tube will stimulate peristalsis. If no flatus is expelled, insert the tube another inch or so. Do not force the tube if it does not insert easily.
Wrap an abdominal or incontinence pad around the end of the rectal tube to catch any liquid that may be expelled. Or, placing the end of the tube into a receptacle filled with fluid.
Leave the tube in no longer than 3 minutes to avoid irritation of the rectal mucosa. If abdominal distention is not relieved, the tube may be inserted every 2 to 3 hours.
Encourage the client to assume various positions in bed. </li></li></ul><li>TEACHING ABOUT MEDICATIONS <br />Cathartics and Laxatives <br /><ul><li>Cathartics are drugs that induce defecation. They can have strong, purgative effect. A laxative is mild in comparison to a cathartic, and it produces soft or liquid stools that are sometimes accompanied by abdominal cramps.
Cathartics: Castor oil, cascara, phenolphthalein and bisacodyl.
Laxatives are contraindicated in the client who has nausea, cramps. Colic, vomiting, or undiagnosed abdominal pain. Clients need to be informed about the dangers of laxative use. </li></li></ul><li>TYPES OF LAXATIVES <br />
Critical Thinking Exercise<br /> Adam, 1 year old infant was admitted in the hospital due to fever with temperature of 38 C, vomiting and diarrhea for 2 days duration. The nurse reported that the infant defecated 3 times as many stool as usual with watery consistency. Initially, it is apparent that the child is mildly dehydrated because of stool losses secondary to acute infectious diarrhea. <br />What appropriate nursing care plans could you formulate for Adam. Supplement necessary assessment findings significant to the patient’s case.<br /> Eve, 15 year old rider, was admitted in the hospital due to vehicular accident. She reportedly loss her consciousness when she was brought to ER thus upon admission, she was placed initially on NPO. After a few days, on a balance skeletal traction to treat fracture. She does not want to eat because according to her, she lost her appetite every time she sees other patients. She had not defecated also for 5 days already.<br />Formulate appropriate nursing care plan for Eve. Supplement necessary assessment findings significant to the patient’s case.<br />