Elimination Patterns Constipation Perceived Constipation Risk for Constipation Diarrhea ... Factors

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  • PART

    III Elimination Patterns

    UNIT 7 Responses to Altered Bowel Elimination

    UNIT 8 Responses to Altered Urinary Elimination

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    HEALTH PERCEPTION-HEALTH MANAGEMENT ■ Perceived health status

    ■ Perceived health management

    ■ Healthcare behaviors: health promotion and illness prevention activities, medical treatments, follow-up care

    NUTRITIONAL-METABOLIC ■ Daily consumption of food and fluids

    ■ Favorite foods

    ■ Use of dietary supplements

    ■ Skin lesions and ability to heal

    ■ Condition of the integument

    ■ Weight, height, temperature

    VALUE-BELIEF ■ Values, goals, or beliefs (including spirituality)

    that guide choices or decisions

    ■ Perceived conflicts in values, beliefs, or expectations that are health related

    PART III ELIMINATION PATTERNS NANDA NURSING DIAGNOSES ■ Bowel Incontinence ■ Constipation ■ Perceived Constipation ■ Risk for Constipation ■ Diarrhea ■ Impaired Urinary Elimination ■ Functional Urinary Incontinence ■ Reflex Urinary Incontinence ■ Stress Urinary Incontinence ■ Total Urinary Incontinence ■ Urge Urinary Incontinence ■ Risk for Urge Urinary Incontinence ■ Urinary Retention ■ Toileting: Self-Care Deficit

    COPING-STRESS-TOLERANCE ■ Capacity to resist challenges to self-integrity

    ■ Methods of handling stress

    ■ Support systems

    ■ Perceived ability to control and manage situations

    SEXUALITY-REPRODUCTIVE ■ Satisfaction with sexuality or sexual

    relationships

    ■ Reproductive pattern

    ■ Female menstrual and perimenopausal history

    ELIMINATION ■ Patterns of bowel and urinary excretion

    ■ Perceived regularity or irregularity of elimination

    ■ Use of laxatives or routines

    ■ Changes in time, modes, quality, or quantity of excretions

    ■ Use of devices for control

    ROLE-RELATIONSHIPS ■ Perception of major roles, relationships, and

    responsibilities in current life situation

    ■ Satisfaction with or disturbances in roles and relationships

    ACTIVITY-EXERCISE ■ Patterns of personally relevant exercise,

    activity, leisure, and recreation

    ■ ADLs that require energy expenditure

    ■ Factors that interfere with the desired pattern (e.g., illness or injury)

    SLEEP-REST ■ Patterns of sleep and rest-/relaxation in a 24-h

    period

    ■ Perceptions of quality and quantity of sleep and rest

    ■ Use of sleep aids and routines

    COGNITIVE-PERCEPTUAL ■ Adequacy of vision, hearing, taste, touch,

    smell

    ■ Pain perception and management

    ■ Language, judgment, memory, decisions

    SELF-PERCEPTION–SELF-CONCEPT ■ Attitudes about self

    ■ Perceived abilities, worth, self-image, emotions

    ■ Body posture and movement, eye contact, voice and speech patterns

    Reprinted from Nursing Diagnosis: Process and Application, 3rd ed., by M. Gordon, pp. 80-96. Copyright © 1994, with permission from Elsevier Science.

    Functional Health Patterns with Related Nursing Diagnoses

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  • Responses to Altered Bowel Elimination

    CHAPTER 25 Assessing Clients with Bowel Elimination Disorders

    CHAPTER 26 Nursing Care of Clients with Bowel Disorders

    UNIT

    7

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  • Assessing Clients with Bowel Elimination Disorders

    ■ Conduct and document a health history for clients who have or are at risk for alterations in bowel elimination.

    ■ Conduct and document a physical assessment of the intestinal system.

    ■ Monitor the results of diagnostic tests and report abnormal findings.

    CHAPTER

    25 LEARNING OUTCOMES

    ■ Describe the anatomy, physiology, and functions of the intestines.

    ■ Explain the physiologic processes involved in bowel elimination.

    ■ Identify specific topics to consider during a health history assess- ment interview of the client with problems of bowel elimination.

    ■ Describe techniques used to assess bowel integrity and function.

    ■ Describe normal variations in assessment findings for the older adult.

    ■ Identify manifestations of altered intestinal function.

    CLINICAL COMPETENCIES

    EQUIPMENT NEEDED

    ■ Water-soluble lubricant

    ■ Occult blood test kit, such as Occultest or Hemoccult II

    ■ Disposable gloves

    ■ Stethoscope

    Resources for this chapter can be found on the Prentice Hall Nursing MediaLink DVD accompanying this textbook, and on the Companion Website at http://www.prenhall.com/lemone

    MEDIALINK

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  • hernia, 749 melena, 750 occult blood, 744 ostomy, 746

    peristalsis, 743 steatorrhea, 750 striae, 748 Valsalva’s maneuver, 743

    borborygmus, 748 bruits, 749 constipation, 743 diarrhea, 746 flatus, 746

    KEY TERMS

    After foods are eaten and broken down into usable elements, nu- trients are absorbed and indigestible materials are eliminated. Bowel elimination is the end process in digestion. This chapter de- scribes the structure and function of the large intestine, including the rectosigmoid region and the anus, as well as the assessment of bowel function. The anatomy and physiology of the small intestine

    are discussed in relation to nutrition in Chapter 21 ; the in- formation in this chapter is provided as a base for understanding health problems from altered bowel function. In addition, this chapter discusses the function of the small intestine in the absorp- tion of digested end products. Malabsorption (impaired absorption of nutrients) is discussed fully in Chapter 26 .

    ANATOMY, PHYSIOLOGY, AND FUNCTIONS OF THE INTESTINES The small and large intestines provide structures to absorb nu- trients and vitamins and to eliminate wastes from food ingested and processed in the upper gastrointestinal (GI) tract.

    The Small Intestine The small intestine begins at the pyloric sphincter and ends at the ileocecal junction at the entrance of the large intestine. The small intestine is about 20 feet (6 m) long, but only about 1 inch (2.5 cm) in diameter. This long tube hangs in coils in the ab- dominal cavity, suspended by the mesentery and surrounded by the large intestine.

    The small intestine has three regions: the duodenum, the je- junum, and the ileum. The duodenum begins at the pyloric sphincter and extends around the head of the pancreas for about 10 inches (25 cm). Both pancreatic enzymes and bile from the liver enter the small intestine at the duodenum. The jejunum is the middle region of the small intestine. It extends for about 8 feet (2.4 m). The ileum, the terminal end of the small intestine, is approximately 12 feet (3.6 m) long and meets the large in- testine at the ileocecal valve.

    Food is chemically digested and mostly absorbed as it moves through the small intestine. Circular folds (deep folds of the mucosa and submucosa layers), villi (finger-like projec- tions of the mucosa cells), and microvilli (tiny projections of the mucosa cells) all increase the surface area of the small in- testine to enhance absorption of food. Although up to 10 L of food, liquids, and secretions enter the gastrointestinal tract each day, most is digested and absorbed in the small intestine; less than 1 L reaches the large intestine.

    Enzymes in the small intestine break down carbohydrates, proteins, lipids, and nucleic acids as follows: ■ Pancreatic amylase acts on starches, converting them to mal-

    tose, dextrins, and oligosaccharides; the intestinal enzymes dextrinase, glucoamylase, maltase, sucrase, and lactase further break down these products into monosaccharides.

    ■ Proteins are broken down into peptides by the pancreatic en- zymes trypsin and chymotrypsin and by intestinal enzymes. Pancreatic enzymes (trypsin and chymotrypsin) and intestinal enzymes continue to break down proteins into peptides.

    ■ Pancreatic lipases break down lipids. ■ Triglycerides enter as fat globules, and are then coated by

    bile salts and emulsified. ■ Nucleic acids are hydrolyzed by pancreatic enzymes, then

    broken apart by intestinal enzymes. Both pancreatic enzymes and bile are excreted into the duo-

    denum in response to the secretion of secretin and cholecys- tokinin, hormones produced by the intestinal mucosa cells when chyme enters the small intestine.

    Nutrients are absorbed through the mucosa of the intestinal villi into the blood or lymph by active transport, facilitated transport, and passive diffusion. Almost all food products and water, as well as vitamins and most electrolytes, are absorbed in the small intestine, leaving only indigestible fibers, some water, and bacteria to enter the large intestine.

    The Large Intestine The large intestine, or colon, begins at the ileocecal valve and terminates at the anus (Figure 25–1 ■). It is about 5 feet (1.5 m) long. The large intestine frames the small intestine on three sides and includes the cecum, the appendix, the colon, the rec- tum, and the anal canal.

    Transverse colon

    Ascending colon

    Descending colon

    Ileocecal valve

    Cecum

    Sigmoid colon

    Appendix

    Rectum

    Anus

    Figure 25–1 ■ Anatomy of the