NURS 1730 Lecture Notes - Lecture 4: Neurodegeneration, Geriatric Depression Scale, Colorectal Cancer
11-63-173
Week Four: January 29 - February 2, 2018
Introduction to Nursing II
Slide One
Promoting Elimination in the Older Adult
Objectives:
-Identify factors that influence fecal elimination
-Describe assessment of GI health including fecal elimination
-Differentiate common elimination problems
-Identify nursing diagnoses for elimination
-State specific evidence-based measures to promote GI health
Changes with Age
→ Fewer and smaller contractions and impairments in peristalsis due to:
- Decrease in myenteric and submucosal plexus neurons in the colon and cholinergic
myenteric activity (fewer, smaller contractions)
- Impaired relaxation and increased segmental contractions (impaired peristalsis)
- Decreased calcium influx into neurons, less calcium released in smooth muscle
- Smaller contractions, impaired peristalsis
- Increased intraabdominal pressure and formation of diverticula
Risk Factors: Chronic Disease KNOW⇒
- Neurologic: Parkinson’s disease; multiple sclerosis, CVA, dementia
- Collagen vascular: connective tissue disease
- Metabolic: diabetes mellitus, hypercalcemia, hypothyroidism
- Structural: tumors, strictures, diverticula
Other Factors
- Developmental stage
-Diet & fluid intake
-Physical activity
- Personal bowel elimination habits
- Privacy
- Psychological factors
- Cultural patterns/responses
- Lifestyle & habits
- Medications
- Travel
- Medications
- Enteral feeding
- Pelvic floor trauma
- Digestive intolerances
- Diagnostic procedures
- Surgery / Anaesthesia
- Pathologic conditions
- Pain
- Pregnancy / childbirth
- Cognitive capacity
- Access to facilities…
- Stress
- Age-related changes
- Chronic Illness (IBS, diabetes, celiac
disease)
- Infectious disease
General Health Assessment
- Nursing history
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11-63-173
Week Four: January 29 - February 2, 2018
- Physical examination – GI and GU
- Skin – hydration, integrity, edema
- Cognition
- Pain/Discomfort
- Review of data from any diagnostic tests
Assessment: Nursing History
- Elimination pattern
- Characteristics of stool routines
- Use of medications or enemas
- Patient's cognitive capacity
- Social history
- Emotional state (ie. anxiety, depression)
- Exercise patterns
- Medication history
- Environment and adaptive aids
- Hostiry of sxual abuse
Nursing History for Elimination Concerns
- Client’s normal pattern
- Recent changes
- Past problems with elimination
- Dietary intolerances (ie. twisted bowel or cancer; they may have an ostomy)
- Presence of an diversion
- Factors influencing the elimination pattern
Physical Examination
- GI assessment
- Inspection of the feces for colour, consistency, shape, amount, odour, abnormal
constituents
- Review any data obtained from relevant diagnostic tests
Assessment: Laboratory Tests
- Thyroid function tests
- Electrolytes
- Calcium
- CBC
- Screen for colorectal cancer, celiac disease
- Stool collections & analysis for fats, blood, enzymes, viruses, bacteria, giardia, parasites
(could get from pets - ask if they are a pet owner)
Characteristics of Normal and Abnormal Findings
- Colour
- (normal colour - brown. Black - indicates either blood in stool (in upper bowel) or
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11-63-173
Week Four: January 29 - February 2, 2018
on iron supplements bleeding taking place in upper bowel. - Bright red - bleeding
in lower colon).
- Consistency
- (normal: sausage like, smooth)
- Shape
- Amount
- (normal: depends on how much person eats)
- Odour
- Constituents
Screening for Colorectal Cancer
Ontario has among the highest rates of colorectal cancer in the world.⇒
- Ontario ColonCancerCheck provides free stool examination kits for home use, in private,
for three specimens
- The goal is increased participation for early detection.
- Regular screening takes place at the age of 50 and above
Colorectal Screening Guidelines
→ Depends on risk
- Average risk
- 50-74 years with no first-degree relative history
- Fecal Occult blood test (FOBT) every two years for symptomatic people
ages 50-74 without a family history of colorectal cancer.
- Increased risk
- People with a family history of colorectal cancer (one or more first-degree
relatives who have been diagnosed with colorectal cancer)
- Screening should begin at age 50 or 10 years earlier than the age their
relative was diagnosed; whichever comes first.
- Alcohol is a risk-factor for colorectal cancer; should reduce consumption if
family history.
Selected Common Fecal Elimination Problems
- Constipation
- Fecal impaction
- Diarrhea
- Bowel incontinence
- Flatulence
What is Constipation
- Rome III criteria - Any two of the following
- Decreased frequency of defecation
- Hard, dry, formed stools
- Straining at stool
- Painful defecation
- Sensation of digital maneuvers
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Document Summary
Describe assessment of gi health including fecal elimination. State specific evidence-based measures to promote gi health. Fewer and smaller contractions and impairments in peristalsis due to: Decrease in myenteric and submucosal plexus neurons in the colon and cholinergic myenteric activity (fewer, smaller contractions) Impaired relaxation and increased segmental contractions (impaired peristalsis) Decreased calcium influx into neurons, less calcium released in smooth muscle. Neurologic: parkinson"s disease; multiple sclerosis, cva, dementia. Review of data from any diagnostic tests. Dietary intolerances (ie. twisted bowel or cancer; they may have an ostomy) Inspection of the feces for colour, consistency, shape, amount, odour, abnormal constituents. Review any data obtained from relevant diagnostic tests. Stool collections & analysis for fats, blood, enzymes, viruses, bacteria, giardia, parasites (could get from pets - ask if they are a pet owner) Black - indicates either blood in stool (in upper bowel) or. Week four: january 29 - february 2, 2018 on iron supplements bleeding taking place in upper bowel.
