NSG 310 TEST PREP

NSG 310 TEST PREP Discuss factors that affect bowel elimination (p.973) ● Stress, privacy, immobility, bed bound, surgery, food, fluid, ect Identify common alterations in elimination & interventions for patients w them. ● Causative agent? ● Constipation- fluid/fiber/exercise, prune juice, coffee or hot bev, medications ○ Watch for laxative abuse, can cause cycle of dependence ○ Abnormal to use laxative to move bowels ○ Valsalva maneuver (bearing down) can stimulate vagus nerve and cause them to pass out - not okay for cardiac patients, bowel surgery, fissions in ab, episiotomy surgery ○ Criteria for constipation is 2 or more of following in 12 weeks (2 weeks for children): straining, hard or lumpy stools, sensation of blockage or incomplete elimination for more than 25% of BM’s Formulate nursing diagnosis associated with altered bowel elimination ● Stool occult blood diagnostic test - aka hemoccult ○ Need 3 samples of different occasions ○ Stick samples 2 diff parts of specimen ○ Positive = blue color, guaiac positive ○ Nurses don’t do this anymore, lab techs ○ Can send some w patient ○ Iron, red meat, nsaids, menses or hemorrhoids can cause false pos ○ Send home w hat for collection ○ Ova & parasites collection has to be in container ○ No urine or tp in specimen ● Barium - enema or ingested ○ Have to make sure we get it out of them ○ Will turn to concrete in system ● KUB - kidneys ureter bladder ○ Looking at bowels ● Ct scans - with or without contrast ○ Assess for allergies to iodine, can be nephrotoxic ● Abdominal ultrasound - painless, KY jelly, transducer ● Endoscopies - EGD - mouth to duodenum ○ Need sedation, consent, NPO ○ F & E is concern ○ Bowel prep can cause fatal dehydration ○ Remove dentures ● Complications - over sedation, perforation, aspiration, hemorrhage List and describe nursing interventions that promote normal bowel elimination ● Prune juice with butter ● Valsalva maneuver is harmful b/c decreased CO ● Stool softeners ● Enemas- “fleets” small volume, tap water enema large volume up to 500ml; retention enema to give medication, kayexalate, barium (contrast medium) ○ Retention - oil or medication in enema (hold one to 3 hours) ○ Small volume - fleets (100 ml) ○ Large volume - tap water (500 - 1000) ○ Barium contrast medium enema to see bowel outline ○ Return enema - evacuate gas out of colon ● Fecal impaction digital removal- more common in older adults ○ Need an order because associated risk w bleeding, low platelet count ○ Be generous with lube on finger, side lying position on left, gloved hand ○ Assess for bleeding, light-headed ○ Digital disimpaction should not be performed in high risk pts ● Exercise, timing, positioning, privacy ● Hemorrhoids - painful and itchy, can cause rectal bleeding ○ Try to decrease the inflammation w cold compress, TUCKS (medicated pad), hydrocortisone topically, sitz bath ● Diarrhea- loose stool. Ask follow up q’s ○ Caused by inflammation, abx, infection, tube feeding, anxiety ○ Dehydration, anxious about having an accident, urgency, clear pathway to the bathroom, are they mobile? Find causative agent ○ C diff- they need to get bacteria out, don’t stop the diarrhea ○ Keep clean, dry, use soft agents on skin, monitor for excoriation ○ Can use metamucil, bulking agent ○ Bananas, rice, applesauce, toast ○ Fecal microbiota transplant ● Fecal incontinence- privacy, emotional support, good skin care, toilet regimen ○ Fecal management system/rectal tube- an inserted balloon, monitor for internal skin breakdown, can’t leave in too long, need an order ○ May be partial or complete ○ Good skin care is essential ● Fecal microbiota transplant - stool transplant from healthy stool to someone w c diff. Looking at gut flora w great biodiversity ● Flatulence - use rectal tube, return enema w water, anti-gas meds, limit gas producing foods like carbonation, gum ● Bowel training - food/exercise, certain time of day Differentiate among the various types of bowel diversions and key nursing care. ● Temporary or loop stoma - mucus still comes out ● Permanent or end stoma - take bowel to surface sow down toward edges of skin ○ Proximal end forms stoma and distal end is removed or sewn closed ● Take down- re-anastomosis of the bowel is done ○ Smell- charcoal filters can be added to reduce smell ● Ileostomy - spouted shape, needs to be monitored more closely ○ 500 ml a day of watery stool ○ Some bleeding is normal, edema should go away ○ Look at peristomal skin, digestive enzymes in small intestine are caustic ○ “Affluent” aka what is coming out of ostomy ○ Empty 4-6 times / day ○ Change every 3-5 days ● Colostomy - flat or flush with skin, semi solid poop, smaller amount per day ○ 200-300 ml per day ○ Empty 1-3 times / day ○ Change 5-7 days ● Nursing care: reach out to Wound Care Nurse if necessary ○ Burp the pouch - open top slightly, get gas out before bedtime ○ Smell is biggest concern for pt ○ Help normalize for patient, give charcoal filter ○ Understand this is incredibly embarrassing for pt ○ Teach how to empty pouch - standing up or sitting on toilet ■ After discarding, wipe side end w dry toilet paper ■ Roll up and keep closed Describe the indications for nasogastric intubation, the technique and key safety considerations. Decompression = suctioning, removal Lavage = irrigation Gastric feeding = giving food ● Tubes- salem sump, double lumen ● Contraindicated w head injury! ● Accurate placement- pre-procedure measurement, post procedure measurement ○ X-ray confirms placement ○ Pre procedure- nose ear mid umbilicus ■ Document NG tube measurement ○ Post - ● Check patency, is it flowing well? Suction or irrigate, no too much b/c it can change electrolyte balance in body. ○ LIWS - low intermittent wall suction, color coded ○ LWS - continuous or low wall ○ 80-120 mmHG ○ Oral and mouth care every 2 hrs ○ Don’t forget to turn off suction when listening to bowel sounds