Lisa Flatt, RN, MSN, CHPN

Lower GI tract The Large intestine consists of:

____________ ____________ ____________

Sigmoid Colon Rectum & Anus

Where does the majority of bowel absorption take place?_____________________

Can you voluntarily contract and relax the anal sphincters?_____________________

Is the GI tract sterile?_____________ Where is the peritoneum?_________ Is the peritoneal area sterile?_______

Surgery that involves the bowel is considered “unclean” because the bowel contents and flora contain a large amount of bacteria, that if spread to the peritoneum cause peritonitis.

How would a patient develop peritonitis if they have abdominal surgery – that does not involve the bowel? (like a C-section)

Feces/fecal matter/bowel movement /stool– what are some other terms patients may use?

“Normal stool” is soft, firm, brown and formed

Abnormal consistency: diarrhea, constipated (hard, rock-like), flakey, fulminant, frothy, liquid

“Abnormal” colors: white, yellow, green, red, black, clay-colored, chalk-colored

Constipation Diarrhea Fecal impaction Flatulence – aka fart Incontinence Helminths--worms

Kidneys Ureters Bladder Urethra

Nephron – the functional unit of the kidney Glomeruli- filters wastes; absorption,

resorption and reabsorption of fluids & electrolytes = initial production of urine

Loop of Henle – tubular system in the glomeruli (descending & ascending) that transport the urine, it starts as H2O and becomes more acidic as it moves down the loop

What is the difference between the male and female urethra?________________________

What does UTI stand for?________________ Is a UTI in a male or female considered an

emergency and very serious? _________ Why?_____________________________

Is the Urinary Tract sterile?____________ Is urinary function usually decreased as a

result of the loss of one kidney?_________

Define Pyelonephritis __________________ Can upper urinary tract infections be

considered life-threatening?_____________ Are lower UTI’s more common in men or

women?_____________________ How are they treated?______________ What are some drug classifications used

to treat UTI’s?___________

Urine/Making water/ pee pee/ wee wee – can you think of any other names?

“Normal” appearance – clear and light yellow in color

“Abnormal” findings - blood, sediment, mucus or calculi (stones), brown color, foul smelling, sluggish (thick)

What can dark colored urine indicate?_____________

What if urine is bloody/red colored?_______

Who is at the highest risk for urinary retention? ____Why?__________________

Retention Urgency Frequency Incontinence Nocturia Polyuria Enuresis

Sex Age & Developmental Level Individual Preferences and patterns

(dietary habits) Physical condition Cultural, spiritual and/or religious factors Socioeconomic factors Environmental factors Psychological factors

Meconium – dark green sticky mucousy- protects bowel in utero

Breast – yellow and seedy (colostorum) Formula – brown, formed (poop less)

Brown, formed and regular Potty trained Regression – stressors, new babies in

the house Loss of some function - activity

Soft, brown Incontinent Constipated Peristalsis – slow down (gastroparesis, biopsy) Mental – obsessed Regular – for that person Dependent on laxatives BPH- retention, difficulty start and stop Neurogenic bladder – urinary retention Caffeine is a cathartic

How do the various stages of life affect elimination?_________________________

What affect can activity have on intestinal elimination?_________________________

What affect does physical condition have on intestinal elimination?__________________

What affect does diet have on intestinal elimination?__________________________

Activity, diet, fluids, fibers all affect bowel status Using laxatives, enemas, suppositories can lead to inability

to poop on own Diuretics – rid body of excess fluid, increase urination Stool softeners – make soft NOT laxatives Sleep - regularity Stress – diarrhea or constipation Abdominal and pelvic muscle tone - continence Catheterization – sphincter muscle damage – leaking or

retention Rectal tube – for fecal elimination (diarrhea) – other systems Depression and other mental illness

How often do you have a BM? What does it look like? Do you use laxatives regularly? Stool

softeners? When was your LBM? Do you pass gas? Do you stomach pain? Does your abdomen

feel hard or distended? Bowel sounds in all quadrants?

How often do you urinate? Do you pee at night? Do you have pain with urination? Do you dribble/leak? Incontinent? What color is it? What does it smell like? Is it foul? Do you see mucus, stones or sediment?

Milky? Do you see any red? Blood streaks?

PROBLEM WHAT TO DO

Constipation Diarrhea Fecal impaction Flatulence Incontinence Helminths

Fluids, laxatives, stool softeners, activity

Clear liquids, fiber, medications, stool sample

Disimpact, enema, suppository Beano, fiber Attends, Depends, bowel and

bladder program, muscle strengthening, Kegel’s

Kill the worms!

PROBLEM WHAT TO DO

Frequency Nocturia Urgency Dysuria Enuresis – define length

of dry time Incontinence Retention Polyuria

B&B program, UTI/labs/tests B&B program, decrease

fluids prior to sleeping B&B program, UTI/labs/tests UTI/labs/tests Labs/tests B&B program, Kegel’s Labs/tests/BPH Asses fluids, diabetes,

labs/tests/UTI

DISEASE/CONDITION CAUSE AND TREATMENT

UTI – BPH – Incontinence –

Functional Overflow Reflex Total

Retention – Urinary suppression -

Urinary Tract Infection – bacteria or fungus

Prostate, aging process Varies with type BPH, sphincter valve

issues, catatonia (mental issues), spinal cord injuries

Kidneys no longer make urine

Other Stuffs

Disease: Cancer & chemotherapy use– degradation of mucosal lining, diarrhea, blood, poor absorption, constipation

Diarrhea **8 or more liquid stools in one day* Parasites, worms, medications, foods, stress,

diet, IBS, Chron’s, CDIFF!!!!!!!!! Incontinence – drugs, sphincter control,

diseases (tumors), stress, abuse, sneezing (haha)

Neurogenic bladder – full bladder does not stimulate the need to pee

Urinary Devices and Interventions

Urostomy Stents Foley catheters Coude catheters Condom catheters Urine pouches – U bags – Pee Pouches Straight catheterization Suprapubic catheters

GI Devices and Interventions

Colostomy Ileostomoy Jejunostomy Gastrostomy tube Flexible Sigmoidoscopy Upper GI Lower GI Rectal Tubes Bowel Management Systems

Enemas

Cleansing enemas “Fleets” Irrigation enemas – colonic irrigation Medicated enemas Carminative enema - flatus

expellation enema Oil retention enema

Output

Less than 30 ml of urine per hour is decreased

Monitor urine output every 6-8-12-24 hours Record BM’s Emesis NG Output Liquid stool Bed sheet soaked in perspiration

Intake

Fluids Foods with high water IV and PO Fluids Tube feedings Free water with tube feedings

Tests- GI and GU

BUN and Creatinine Urinary pH Ketones Specific Gravity Urinalysis Urine culture and sensitivity Occult Blood Blood Urobilinogen Stool tested for wormies, cdiff, bacteria, ova and parasites Xrays/CT scans/Ultrasounds/Intravenous pyelogram IVP/MRI Cystoscopy Pyelogram

The Nursing Process

Assessment – Analyze Nursing Diagnosis Planning Implementing Evaluating

Scenario

74 y/o man, daily laxative use, constipated history, medications: lasix, metformin, cholesterol, metoprolol, poor diet Analyze: hx constipation, BP, diabetic, cholesterol issues, diet issues,

decreased activity, laxative abuse Nursing Dx: Constipation related to daily laxative usage Plan: Client will: increase activity by walking 4 blocks daily, decrease

laxative use to 3 times weekly, follow diet as recommended by dietician, increase fluids to 2 liters per day, use stool softeners daily, increase fiber intake to 20 gm/day,

Implement: Obtain dietary consult; Obtain PT/OT consult; Instruct on how to measure fluid intake and healthy fluid options; Instruct on s/s of constipation; instruct on s/s normal BM; instruct of side effects of medications including: lasix, laxatives and other medications; instruct on daily walk; instruct on keeping 7 day –diet-fluid-exercise-blood sugar log -- all accomplished in two weeks

Evaluation: Patient & family verbalizes side effects of laxative use and other medications; return demonstration of exercises; Shows 7 day log and able to analyze areas that are strengths and weaknesses; compliant with diabetic diet and diet as recommended by dietician; verbalizes healthy fluid options; verbalize free of s/s constipation