Basic Human Needs Bowel Elimination Care of Nasogastric - PowerPoint PPT Presentation

1 / 70
About This Presentation
Title:

Basic Human Needs Bowel Elimination Care of Nasogastric

Description:

Basic Human Needs Bowel Elimination Care of Nasogastric Tubes Confirm placement after insertion HOB at 30 degrees unless ordered otherwise Mark point where tube exits ... – PowerPoint PPT presentation

Number of Views:401
Avg rating:3.0/5.0
Slides: 71
Provided by: mcccEdum
Category:

less

Transcript and Presenter's Notes

Title: Basic Human Needs Bowel Elimination Care of Nasogastric


1
Basic Human NeedsBowel Elimination
2
Bowel Elimination
  • GI Tract is a series of hollow mucous membrane
    lined muscular organs
  • Purpose is to absorb fluids nutrients, prepare
    food for absorption provide storage for feces

3
GI Tract Anatomy
  • Mouth
  • Esophagus
  • Stomach
  • Small Intestine
  • Large Intestine
  • Rectum

4
(No Transcript)
5
Mouth
  • Digestion begins here
  • Mechanical, chemical breakdown of nutrients
  • Teeth-Mastication
  • Salivary secretions-enzymes
  • Food Bolus

6
Esophagus
  • Hollow, muscular tube for passage of food to
    stomach
  • Peristaltic waves, contraction and relaxation of
    smooth muscle moves food down to stomach
  • Sphincter control to prevent reflux

7
(No Transcript)
8
Stomach
  • Food is temporarily stored and mechanically and
    chemically broken down
  • Secretes HCL, mucus, pepsin, intrinsic
    factor(Needed for Vitamin B12 absorption)
  • Food is converted into chyme

9
Small Intestine
  • 1 inch in diameter
  • 20 feet long
  • Three divisions Duodenum, Jejunum, Ileum
  • Enzymes in small intestine (amylase, lipase,
    bile) break down fats, proteins carbs into
    basic elements
  • Nutrients absorbed in duodenum jejunum, ileum
    absorbs vitamins, iron, bile salts

10
Large Intestine
  • Lower GI tract
  • Larger diameter, 5-6 feet in length
  • 3 divisions cecum, colon, rectum
  • Responsible for absorption of water
  • Primary organ of bowel elimination
  • Cecum-chyme enters cecum via the ileocecal valve,
    valve prevents regurg back to small intestine,
    cecum ends with appendix

11
Colon
  • 3 Divisions Ascending, Transverse, Descending
  • Colon Functions Absorption, Protection,
    Secretion, Elimination (stool and flatus)

12
(No Transcript)
13
Flatus Formation
  • Air swallowing
  • Diffusion of gas from bloodstream into intestines
  • Bacterial action on unabsorbable CHO (Beans)
  • Fermentation of CHO (cabbage, onions
  • Can stimulate peristalsis
  • Adult forms 400-700 ml of flatus daily

14
Rectum
  • Sigmoid colon
  • Storage of feces
  • Length varies with age
  • When fecal mass or flatus moves into rectum, it
    distends and defecation begins
  • Process involves involuntary (Internal sphincter)
    and voluntary control (external sphincter)
  • Valsalva Maneuver- voluntary contraction of
    abdominal muscles

15
Factors Affecting Bowel Elimination
  • Age
  • Infection
  • Diet
  • Fluid Intake
  • Physical Activity
  • Psychological factors
  • Personal Habits

16
Factors Affecting Bowel Elimination
  • Position during Defecation
  • Pain
  • Surgery and Anesthesia
  • Medications

17
Common Bowel Elimination Problems
  • Constipation
  • Impaction
  • Diarrhea
  • Incontinence
  • Flatulence
  • Hemorrhoids

18
Constipation
  • More of a symptom than a disorder
  • Decrease in frequency of BM
  • Straining pain on defecation is associated
    symptoms(Valsalva maneuver)
  • Can be significant heath hazard (increase ICP,
    IOP, reopen surgical wounds, cause trauma,
    cardiac arrhythmias)

19
(No Transcript)
20
(No Transcript)
21
Impaction
  • Results from unrelieved constipation
  • Collection of hardened feces wedged into rectum
  • Can extend up to sigmoid colon
  • Most at risk depilated, confused, unconscious
    (all are at risk for dehydration)

22
Impaction
  • When a continuous ooze of diarrheal stool
    develops, impaction should be suspected
  • Associated S/S Loss of appetite, abdominal
    distention, cramping, rectal pain

23
(No Transcript)
24
Diarrhea
  • Increase in number of stools the passage of
    liquid, unformed stool
  • Symptom of disorders affecting digestion,
    absorption, secretion of GI tract
  • Intestinal contents pass through small large
    intestines too quickly to allow for usual
    absorption of water nutrients

25
Diarrhea
  • Irritation can result in increased mucus
    secretion, feces become too watery, unable to
    control defecation
  • Excess loss of colonic fluid can result in
    acid-base imbalances or fluid/electrolyte
    imbalances
  • Can also result in skin breakdown

26
Conditions that cause Diarrhea
  • Emotional Stress
  • Intestinal Infection (Clostridium difficile)
  • Food Allergies
  • Food Intolerance
  • Tube Feedings (Enteral)
  • Medications
  • Laxatives
  • Colon Disease
  • Surgery

27
(No Transcript)
28
Incontinence
  • Inability to control passage of feces and gas
    from the anus
  • Caused by conditions that create frequent, loose,
    large volume, watery stools or conditions that
    impair sphincter control or function

29
Flatulence
  • Gas accumulation in the lumen of intestines
  • Bowel wall stretches and distends
  • Common cause of abdominal fullness, pain,
    cramping
  • Gas escapes through mouth (belching), or anus
    (flatus)

30
Hemorrhoids
  • Dilated, engorged veins in the lining of the
    rectum
  • External (Clearly visible) or Internal
  • Caused by straining, pregnancy, CHF, chronic
    liver disease

31
Clicker Question
  • 1. A newly admitted client states that he has
    recently had a change in medications and reports
    that stools are now dry and hard to pass. This
    type of bowel pattern is consistent with
  • A. Abnormal defecation
  • B. Constipation
  • C. Fecal impaction
  • D. Fecal incontinence

46 - 31
32
Bowel Diversions
  • Certain diseases cause conditions that prevent
    normal passage of feces through rectum
  • Creates need for temporary or permanent
    artificial opening (stoma) in the abdominal wall

33
Bowel Diversions
  • Surgical openings (ostomy) are most commonly
    formed in the ileum (ileostomy) or the colon
    (colostomy)
  • Incontinent ostomy- need to wear appliance pouch
  • Continent ostomy- have control through use of
    ostomy cap

34
(No Transcript)
35
(No Transcript)
36
(No Transcript)
37
Incontinent Ostomy
  • Location of ostomy determines consistency of
    stool
  • Ileostomy bypasses the entire large intestine,
    stools are frequent watery
  • Ascending colostomy- liquid stool
  • Sigmoid colostomy-most like normal stool

38
(No Transcript)
39
Incontinent Ostomies
  • Loop colostomy- temporary, usually done on
    transverse colon
  • 2 openings through stoma, proximal loop for
    stool, distal loop for mucus
  • End colostomy- one stoma formed from the proximal
    end of the bowel with the distal portion removed
    or sewn shut (Hartmanns Pouch)

40
Incontinent Ostomies
  • End colostomy usually done for colorectal cancer
  • Ruptured diverticulum- temporary end colostomy
    with a Hartmanns Pouch
  • Double barrel colostomy- Bowel is surgically
    severed, 2 ends are brought out onto abdomen with
    2 distinct stomas (proximal distal)

41
(No Transcript)
42
(No Transcript)
43
(No Transcript)
44
Continent Diversions
  • Ileoanal reservoir- restorative proctocolectomy,
    no outward stoma, no pouch wearing, clients have
    internal pouch created from the ileum
  • Ileal pouches constructed in various
    configurations (S,J,W)
  • End of the pouch is sewn or anastamosed to the
    anus

45
Continent DiversionsIleoanal Reservoir
  • Several stages to surgery to create pouch
  • May need temporary ostomy to allow time for pouch
    to heal
  • Kegel exercises to increase pelvic floor muscle
    tone

46
(No Transcript)
47
Continent Diversions
  • Kock Continent Ileostomy-Internal reservoir or
    pouch is created using piece of small intestine
  • Stoma brought out low on abdomen, end of internal
    part in pouch is a one way nipple valve to
    promote continence
  • Valve only allows fecal contents to drain when an
    external catheter is place in stoma, no pouch
    required

48
(No Transcript)
49
Ostomy Nursing Considerations
  • Patient Education
  • Care of stoma, appliance selection and use
  • Body Image considerations
  • Support groups (UOA)
  • Enterostomal nursing- specialty within profession

50
Nursing ProcessAssessment
  • Nursing History
  • Physical Assessment
  • Lab Tests
  • Fecal characteristics
  • Diagnostic evaluation- Endoscopy, Colonoscopy

51
(No Transcript)
52
(No Transcript)
53
(No Transcript)
54
Nursing Diagnosis
  • Bowel Incontinence
  • Constipation
  • Diarrhea
  • Impaired Skin Integrity
  • Body Image Disturbance
  • Altered bowel elimination
  • Pain

55
ImplementationPromoting Normal Defecation and
Acute Care Management
  • Positioning of patient-squatting
  • Positioning on bedpan
  • Use of cathartics, laxatives
  • Anti-diarrheal agents
  • Enemas
  • Digital removal of stool
  • Ostomy care
  • Fecal Incontinence Devices

56
(No Transcript)
57
(No Transcript)
58
(No Transcript)
59
(No Transcript)
60
Common Laxatives Cathartics
  • Metamucil-bulk forming
  • Colace, Surfak-emollient or wetting agent
  • Fleets, MOM. Mag Sulfate-saline agent
  • Dulcolax, Ex-Lax, Castor oil- stimulant cathartic
  • Haleys MO, mineral oil- Lubricant

61
Enemas
  • Cleansing enema
  • Tap water
  • Normal saline
  • Hypertonic Solutions (Fleets enema)
  • Soapsuds
  • Oil Retention
  • Medicated enemas (Kayexalate, Lactulose)
  • Administering a Cleansing enema PP pg. 1200-1201

62
Nasogastric Tubes
  • Decompress GI tract in surgery, infection of GI
    tract, trauma to GI tract, conditions where
    peristalsis is absent
  • N/G tube purposes- decompression, feeding,
    compression, lavage
  • Pliable tube inserted through nasopharynx into
    stomach
  • Uncomfortable insertion

63
Nasogastric Tubes
  • Types Levin single lumen, different sizes used
    for feeding or decompression
  • Salem Sump Most preferable for decompression,
    dual lumen, one for removal of gastric contents,
    one as an air vent, hooked to suction to achieve
    decompression

64
(No Transcript)
65
(No Transcript)
66
Care of Nasogastric Tubes
  • Confirm placement after insertion
  • HOB at 30 degrees unless ordered otherwise
  • Mark point where tube exits nose (AACN 2005)
  • Tape tube securely to nose
  • Tube Irrigation
  • Nasal skin care
  • Frequent oral hygeine
  • Assess for abdominal distention
  • Suction settings

67
(No Transcript)
68
(No Transcript)
69
Restorative Care
  • Bowel training
  • Maintenance of proper fluid food intake
  • Promotion of regular exercise
  • Promotion of Comfort
  • Maintenance of skin integrity
  • Promotion of self concept

70
Clicker Question
  • 2. To maintain normal elimination patterns in the
    hospitalized client, you should instruct the
    client to defecate 1 hour after meals because
  • A. The presence of food stimulates peristalsis.
  • B. Mass colonic peristalsis occurs at this time.
  • C. Irregularity helps to develop a habitual
    pattern.
  • D. Neglecting the urge to defecate can cause
    diarrhea.

46 - 70
Write a Comment
User Comments (0)
About PowerShow.com