Nursing 105

Essentials of Nursing Study Guide

©2018 Achieve Page 41 of 160 results from prolonged retention and accumulation of fecal material. Assessed by a digital exam of the rectum, a hardened mass can be palpated. This is done gently to prevent stimulation of the vagus nerve in the rectal wall that can slow the client’s heart rate. Clients who have frequent/non-productive desire to defecate may also complain of rectal pain. Abdominal assessment shows distension, nausea and vomiting. There are many possible causes; for example, physical inactivity, not eating enough (particularly of fiber), and not drinking enough water. Medications such as narcotic pain relievers (suboxone, methadone, codeine, oxycodone, hydrocodone, tramadol) and certain sedatives that reduce intestinal movement may cause fecal matter to become too large, hard, or dry toexpel. Manual removal of a fecal impaction is often required with obese patients in traction, after a barium enema, and in poorly hydrated older adults. Diarrhea Diarrhea is the passage of liquid feces and an increased frequency of defecation. Diarrhea can be caused by stress, anxiety, antibiotic use, allergy to food, fluid or drug intolerance, Malabsorption syndrome, Crohn’s disease, and surgical procedures. • Secretory diarrhea : This means that there is an increase in the active secretion, or there is an inhibition of absorption. There is little to no structural damage. The most common cause of this type of diarrhea is a cholera toxin that stimulates the secretion of anions, especially chloride ions. Therefore, to maintain a charge balance in the lumen, sodium is carried with it, along with water. In this type of diarrhea, intestinal fluid secretion is isotonic with plasma even during fasting. It continues even when there is no oral food intake. • Osmotic diarrhea: This occurs when too much water is drawn into the bowels. If a person drinks solutions with excessive sugar or excessive salt, these can draw water from the body into the bowel and cause osmotic diarrhea. Osmotic diarrhea can also be the result of maldigestion (e.g., pancreatic disease or Celiacdisease), in which the nutrients are left in the lumen to pull in water. Or it can be caused by osmotic laxatives (which work to alleviate constipation by drawing water into the bowels). In healthy individuals, too much magnesium or vitamin C or undigested lactose can produce osmotic diarrhea and distention of the bowel. A person who has lactose intolerance can have difficulty absorbing lactose after an extraordinarily high intake of dairy products. In persons who have fructose malabsorption, excess fructose intake can also cause diarrhea. High-fructose foods that also have high glucose content are more absorbable and less likely to cause diarrhea. Sugar alcohols such as sorbitol (often found in sugar-free foods) are difficult for the body to absorb and, in large amounts, may lead to osmotic diarrhea. In most of these cases, osmotic diarrhea stops when the offending agent (e.g. milk, sorbitol) is stopped. tend to have more bowel movements compared to formula-fed infants. Some breast-fed infants have a bowl movement after each feed, whereas others have only one every 2–3 days. Infants who are breast-fed rarely develop constipation. By the age of two years, a child will usually have 1–2 bowel movements per day and by four years of age a child will have one bowel movement per day. Fecal Impaction Fecal impaction