400 EXAM 2--Chapter 48 Flashcards
1
Q
ϖ An abnormal infrequency or irregularity of defecation, abnormal hardening of stools that makes their passage difficult and sometimes painful, a decrease in stool volume, or retention of stool in the rectum for a prolonged period often with a sense of incomplete evacuation after defecation
A
constipation
2
Q
what qualifies a patient to have constipation
A
less than 3 BM per week
3
Q
how to treat constipation
A
increase fiber and fluids
4
Q
complications of constipation?
A
fecal impaction
hemorrhoids
fissures
5
Q
o Test used to determine whether symptoms result from spasm or narrowing of the bowels:
♣ pressure studies such as balloon expulsion test
A
anorectal manometry
6
Q
daily dietary intake of ____ to ____ g/day of fiber to prevent constipation
A
25-30 g/day
7
Q
ϖ Increased frequency of bowel movements (more than 3 per day), and increased amount of stool (more than 200 g/day), and altered consistency (increased liquidity) of stool
A
diarrhea
8
Q
diarrhea can be?
A
ϖ acute, chronic, inflammatory, noninflammatory, viral or bacterial or due to ATB therapy.
9
Q
most often associated with infection and is usually self limiting, lasting up to 7 to 14 days
A
acute diarrhea
10
Q
persist for more than 2 to 3 weeks and may return sporadically
A
chronic diarrhea
11
Q
c. diff can be caused from?
A
long term IV ATB
12
Q
sx of diarrhea
A
abdominal cramps
distention
anorexia
thirst
13
Q
o Potential for _____ ______ d/t significant fluid and electrolyte loss (especially potassium) can lead to dehydration with diarrhea.
A
cardiac dysrhythmias
14
Q
med of choice for diarrhea
A
loperamide (immodium)
15
Q
ϖ Involuntary passage of stool from the rectum
A
fecal incontinence
16
Q
cause of fecal incontinence
A
something impairing the neurological system
interference with motor or sensory control
out of control diarrhea
17
Q
o Rectal examination and endoscopic examination such as a flexible signoidoscopy are performed to rule out ? with fecal incontinence
A
tumors, inflammation, or fissure
18
Q
surgical procedures for fecal incontinence
A
surgical reconstruction, artificial sphincter implants, sphincter repair or fecal diversion with colostomy
19
Q
nursing interventions for fecal incontinence?
A
bowel training
regular pattern of elimination
20
Q
if there is a neurological fecal incontinence what may be required?
A
digital stimulation
21
Q
if incontinence is r/t fecal impaction?
A
normal function will resume after impaction is removed and the rectum is cleansed
22
Q
o If incontinence is d/t neurologic condition:
A
♣ Encourage high fiber diet and increased fluids
♣ Promote regular pattern of elimination
Do bowel training
23
Q
o If incontinence is d/t diarrhea:
A
♣ Foods that thicken stool (applesauce) and fiber products (psyllium) help improve incontinence
24
Q
new fecal and bowel management systems (fecal pouch)
A
o Flexi-Seal Management System—
25
♣ Consist of a tube with a low-pressure balloon that conforms to the internal rectal area, may be used for up to 29 consecutive days – do not inflate more than 30 ml Saline into baloon
Flexi-Seal
26
ϖ Most common GI condition (12% of population)—leading cause of workforce absenteeism
IRRITABLE BOWEL SYNDROME (AKA SPASTIC COLON)
27
ϖ Chronic disorder with no identifiable organic cause—more inconvenient than harmful
o No anatomic or biochemical abnormalities have been found that account for its common symptoms
IBS
28
dx of IBS
o Diagnosis is made only after test confirm the absence of structural or other disorders
29
o Main symptoms of IBS
alteration in bowel patterns: alternating constipation, diarrhea, or a combination of both
Pain (over sigmoid colon),
30
o With IBS: Abdominal pain sometimes precipitated by _____ and its frequently relieved by _____/
eating; defecation
31
Criteria for IBS include:
recurrent abdominal pain or discomfort for at least three days a month in the past 3 months
32
IBS also needs two or more of the following:
o Improvement with defecation
o Onset associated with change in frequency of stool
o Onset associated with change in appearance (form) of stool
33
medical management of IBS
Restriction and then gradual reintroduction of foods that are possible irritating may help determine what types of food are acting as irritants
34
changes for IBS patients
o High fiber diet, exercise, stress reduction or behavioral modification therapy programs
35
may be prescribed to decrease smooth muscle spasms decrease cramping & constipation for IBS patients
o Anticholinergics or antispasmodics (propantheline)
36
o Fluid should not be taken with meals because this results in abdominal distention with what patients?
IBS
37
o Can’t absorb fats very well
o Can’t tolerate food containing gluten
Usually identified in childhood
celiac disease
38
o Classic symptoms of celiac disease
Small stature person and steatorrhea(oily & fatty stools)
39
other sx of celiac disease
o Diarrhea, & frequently loose, foul smelling stools (pale, grey, or clay colored)
40
diet for celiac disease
gluten free
41
what is gluten in?
barley, rye, oats, wheat
42
celiac disease has an increased risk for ?
osteoporosis
43
ϖ Surgical emergency!—The most common cause of acute surgical abdomen in the United States
appendicitis
44
SX of appendicitis BEGIN like?
o Begins as vague epigastric or periumbilical pain (visceral, dull, and poorly localized) that is intermittent
45
pain migrates to _____ ____ (midway b/w umbillicus and anterior iliac crest in the RLQ)
McBurney's point
46
♣ It is the usual site for localized pain and rebound tenderness (pain when pressure is released)
McBurney's point
47
sx of appendicitis?
low grade fever, loss of appetite, N/V, elevated WBCs
48
appendicitis patients can not have _____ or ____.
laxatives or enemas
49
diagnosis of appendicitis
Elevated WBCs with elevated neutrophils
Abd. x-ray
ultrasound
CT scans
50
Perforation of the appendix can lead to
peritonitis
abscess formation
portal pylephlebitis
51
o , which is septic thrombosis or the portal vein caused by vegetative emboli that arise from septic intestine
portal pylephlebitis
52
a complication of appendicitis when the bowels go to sleep
paralytic ileus
53
a complication of appendicitis when something is twisting or obstructing
mechanical bowel obstruction
54
performed as soon as possible to decrease risk of perforation
o Appendectomy
55
safe and effective in the treatment of appendicitis with perforation
laparoscopy
56
o If abscess forms or appendix ruptures, then an _____ procedure is performed
open
57
if pt comes in with abdominal pain?!?!
place them NPO
draw CBC for WBC count
put on IV fluids and ATB
hold pain meds
ice pack RLQ
58
semipermeable membrane that allows water and electrolytes to flow between the peritoneal cavity and the blood stream
peritoneum
59
Inflammation of the peritoneum, the serous membrane lining the abdominal cavity and covering the viscera
ϖ Peritonitis
60
o Peritonitis fluid in response to inflammation can shift into the abdominal cavity instead of the blood stream at ____-____mL/hr
300-500
61
peritonitis patients have a high risk for?
F/E imbalances
62
causes of peritonitis
bacterial infection
inflammation
appendicitis
perforared ulcer
diverticulitis
bowel perforation
abd. surgery
peritoneal dialysis
63
sx of peritonitis
♣ Affected area of abdomen extremely tender and distended muscles become rigid; guarding may be present
rebound tenderness and paralytic ileus
hypoactive or absent bowel sound
anorexia N/V
diminished peristalsis
64
with peritonitis a temperature of ___-____ can be expected along with increased pulse.
100-101
65
o Hypotensive with progression of peritonitis If not corrected will lead to?
hypovolemic shock (oliguria, BP down, HR up, restless, pale)
66
assessment and diagnostic studies of peritonitis
CT scan of abd.
WBC count over 20,000
altered potassium, sodium, potassium, and chloride (low levels)
abd x-ray
67
what does the abd. X-ray show with peritonitis
shows air
68
medical management for peritonitis
IV fluids, colloid and electrolyte replacement (potassium especially)
bed rest
intestinal decompression --NG tube
69
when will surgery be recommended with peritonitis?
when bowel is perforated or gangrenous
70
if they had surgery for peritonitis they will likely have what after?
lavage
71
nursing management for peritonitis
```
NPO
I&Os
admin and monitor IV fluids
NG feedings
aseptic techniques
```
72
how to now if peritonitis patient is improving?
```
check vitals
stable HR and BP
balanced electrolytes
softening abdomen with bowel sounds returning
passing gas
```
73
ϖ herniatiation (out pouching) of the lining of the bowel that extends through a defect in the muscle layer
o May occur anywhere in the small intestine or colon
diverticulum
74
diverticulum is most common where?
sigmoid colon
75
single outputting of the bowel
diverticula
76
o Doesn’t present with any symptoms at all unless an infection occurs—usually harmless
diverticula
77
—(the condition) exists when multiple diverticula are present without inflammation, symptoms, or infection
diverticulosis
78
how is diverticulosis usually found?
colonoscopy
79
dietary risk factors for diverticulosis?
refined foods
high fat meats
low fiber
80
most patients with diverticulosis remain symptom free until ____ occurs
inflammation
81
sx of diverticulosis
abdominal cramping over LLQ over sigmoid colon
82
o results when food and bacteria retained in a diverticulum produce infection and inflammation that can impede drainage and can lead to perforation or abscess formation
diverticulitis
83
complications of diverticulitis
```
abscess
fistula formulation
bowel or urethra obstruction
perforation
peritonitis
rupture and hemorrhage
```
84
sx of diverticulitis
♣ Acute onset of mild to severe pain in the left lower quadrant relieved by bowel movement or farts.
♣ Accompanied by nausea, vomiting, fever, chills, leukocytosis
85
inflammation from diverticulitis can cause inflammation around the bladder which will cause?
frequency of urine
86
dx of diverticulitis
CT scan with contrast
colonscopy
abd. xray
CBC
occult blood test
UA
87
outpatient treatment for diverticulitis
antispasmodics
analgesics
bulk forming laxatives
clear liquids
low residue foods
oral ATB 7-10 days
88
inpatient acute diverticulitis treatment
NPO
NG tube (paralytic ileus or suctioning)
IV fluids
IV ATB 7-10 days
antispasmodics, analgesics bulk forming laxatives, fiber supplements, stool softeners, probiotics.
89
high risk for ___ and ___ with diverticulitis
peritonitis and infection
90
monitor for sx of perforation of diverticulitis such as???
```
o increased abdominal pain and tenderness,
abdominal rigidity,
elevated WBCs and
ESR,
increased temp,
tachycardia, and
hypotension;
perforation is a surgical emergency!
```
91
how to tell patients with diverticulitis to maintain normal elimination pattern
o Fluid intake 2L per day unless contraindicated
o Soft foods with increased fiber (prepared cereals, soft-cooked vegetables) to increase bulk of stool
o Individualized exercise program encouraged
o Schedule meals and set time for defecation
o Admin bulk laxatives, stool softeners, oil retention enemas, etc. as ordered
o Avoid trigger foods if identified—such as nuts and popcorn, seeds
92
Any condition that cause bowel inflammation
CHRONIC INFLAMMATORY BOWEL DISEASE (IBD)
93
etiology is unknown for CHRONIC INFLAMMATORY BOWEL DISEASE (IBD) however there are some risk factors?
```
smoking
stress
diet
pesticides
food additives
tobacco
radiation
```
gene NOD2
NDSAIDs
age 15-30
94
2 ex of IBD
o Both characterized by exacerbations and remissions
chron's and ulcerative colitis
95
ϖ Non-specific inflammatory bowel disorder that can occur anywhere in the GI tract (anywhere between rectum to esophagus) with unknown origin
chron's disease
96
chron's disease is "____-sided"
RIGHT
| often proximal colon and ileocecal junction
97
chron's occurs in age?
15-30
98
____ have a 2-4x greater risk to develop chron's disease
smokers
99
sx of chron's
RLQ pain
diarrhea unrelieved by defecation
pain occurs AFTER MEALS (ulcers)
edema and thickening of mucosa
100
what are the ulcers like with chron's?
cobblestone clusters
101
chronic sx of chron's
```
o Diarrhea,
Abdominal pain,
Steatorrhea,
Anorexia,
weight loss, and
nutritional deficiencies
```
102
is there blood in the stool with chron's dx?
NO
103
complications with chron's ?
strictures
fistulas
perforation
impaired absorption of nutrients
104
hallmark sx of chron's
perianal fistulas
105
chron's has an increased risk for ____ CA.
colon
106
dx of chron's
Proctosigmoidoscopy performed initially
stool examination
barium study of upper GI tract
colonoscopy
barium enema
CT sca
107
o performed initially to determine whether the rectosigmoid area is inflamed
Proctosigmoidoscopy
108
assessment of acute exacerbations with chron's
CBC (anemia)
WBC
ESR
albumin (low)
109
ϖ Recurrent ulcerative and inflammatory disease of the mucosal and submucosal layers of the colon and rectum
ULCERATIVE COLITIS
110
ULCERATIVE COLITIS is "____-sided"
LEFT
111
ϖ Thinning of mucosa becomes very fragile
Pseudo polyps
Diagnosed earlier in life
ULCERATIVE COLITIS
112
predominant symptoms of ULCERATIVE COLITIS
bloody diarrhea and abdominal pain
113
other sx of ULCERATIVE COLITIS
passage of 10-20 liquid stood per day
hypocalcemia and anemia
diarrhea
passage of mucous and pus
LLQ pain
rectal bleeding
intermittent tenesmus
114
intestinal complications for ULCERATIVE COLITIS
risk of hemorrhage and strictures
toxic mega colon
115
dx of ULCERATIVE COLITIS
CBD (low H and H and albumin, high WBC, electrolyte imbalances, elevated antineutrophil cytoplasmic antibody levels)
sigmoidoscopy
abd xray
barium enema study
CT scan, MRI, ultrasound
116
complications of ULCERATIVE COLITIS
toxic megacolon
117
♣ Inflammatory process extends into muscularis, inhibiting its ability to contract and resulting in colonic distention
toxic megacolon
118
must respond within ___ -___ hours with ? for toxic megacolon?????
24-72 hours
NG tube, IV fluids, corticosteroids, ATB
119
meds for ulcerative colitis
antimicrobials
aminosalicylates
corticosteroids
immunomodulators
120
ulcerative colitis at risk for?
bone fractures
121
what foods to be avoided?
fatty, cold foods and smoking avoided
122
what injections giving monthly for ulcerative colitis??
B12
123
♣ Not cured through surgery can reoccur in other places if tried to take it out
♣ Use surgery if obstruction, stricture, or abscess—otherwise last option
chron's
124
♣ Localized into left side of colon Better chance with surgery
ulcerative colitis
125
o removes colon, rectum, and anus. (lack of improvement)
| ♣ Extensive ulcerative colitis may require total colectomy
Proctocolectomy (Total Colectomy) with Ileostomy
126
(surgical opening into ileum or small intestine) allows drainage of fecal matter from ileum to outside the body
♣ Ileostomy
127
creation of a continent ileal reservoir (Kock pouch) by diverting a portion of the distal ileum to the abdominal wall and creating a stoma.
• Eliminates the need for external fecal collection bag
continent ileostomy
128
♣ Treatment of choice if rectum can be preserved
♣ Remove bad part of valve and put in temporary ileostomy. Let then body heal for certain amount of time and then go back in once healed and reconnect the bowel—Curative option if applicable in Ulcerative Colitis
o Restorative Proctocolectomy with Ileal Pouch Analanastomosis
129
color of stoma should be?
brick red/pink
130
o Colostomy Care
♣ Protect skin, assess stoma, select appropriate pouch, assisting patient to adapt to new device (psych care)
131
pale stoma
anemia
132
dusky or purple
strangulated low blood flow
ischemic
133
black stoma
necrotic
134
edametous stoma
allergic reaction to food
135
how often to change bag ?
5-10 days unless leaking
136
risk factors for colorectal cancer?
```
over 50
family history
IBD
genetics
high fat and protein diet
low fiber diets
smoking
```
137
sx of colorectal cancer
```
change in bowel habits
blood in stool
rectal bleeding
anemia
weight loss
fatigue
```
138
dx of colorectal answer
fecal occult blood
barium enema
Proctosigmoidoscopy
Colonoscopy:
139
how often for colonoscopy
10 years if no probe
3 years if problems
140
o May occur in a variety of spaces in and around rectum
| o Foul smelling pus and is painful
ϖ Anorectal abscess
141
o Tiny, tubular, fibrous tract that extends into the anal canal from an opening located beside the anus in the perianal skin
o Purulent drainage or stool may leak constantly from the cutaneous opening
anal fistula
142
o A longitudinal tear or ulceration in the lining of the anal canal
o Caused by the trauma of passing a large, firm stool or from persistent tightening of the anal canal because of stress and anxiety, child birth, trauma, and overuse of laxatives
o Extremely painful defecation, burning, and bleeding characterize fissures
o Bright red blood may be seen on the toilet tissue after a bowel movement
ϖ Anal Fissure
143
o Dilated portion of veins in the anal canal
ϖ Hemorrhoids
144
ϖ Broad term for symptoms of stomach
symptom compounding lots of symptoms
dyspepsia
145
sx of dyspepsia
```
o Anorexia
o Belching
o Bloating
o Pain
o Nausea
o Vomiting
```
146
dyspepsia is commonly caused by
food intolerances
CA
lactose intolerxance
147
tx of dyspepsia
protonix, prilosec, and pepsid (-zole)
148
ϖ Inflammation of the stomach mucosa or gastric
gastritis
149
acute gastritis
several hours to several days (ex: alcohol intoxication)
150
chronic gastritis
repeated exposure to irritating agents or recurring episodes of acute gastritis
151
gastritis is caused by:
excessive alcohol, drugs, radiation exposure, bacterial contamination of food
152
ϖ Common causes of acute/diffuse gastritis
medications
drugs
chemo
alcohol
radiation exposure
bacterial contamination to food or water
aspirin and NSAIDs
153
sx of acute/diffuse gastritis
```
N/V
epigastric pain
Hiccuping
Fever
HA
anorexia
```
154
tx of acute/diffuse gastritis
NPO
antacids or PPI
H2 receptor antagonist
remove cause
155
ϖ Involves muscle atrophy of stomach walls; not working quite as it should
ϖ Also involves decreased acid production
ϖ Prolonged inflammation of stomach, may be caused by benign or malignant ulcers of stomach
Chronic Gastritis (H. pylori gastritis)
156
cause of
Chronic Gastritis
H. pylori
157
how is Chronic Gastritis transmitted?
fecal-oral
oral-oral
158
manifestations for chronic gastritis
```
anorexia
heartburn
belching
sour taste in the mouth
decreased intrinsic factor
```
159
tx of chronic gastritis without ulcers
NO treatment
160
tx of chronic gastritis with ulcers
tripple 1st line therapy:
PPI
ATB (chlarithmycin)
ATB (amoxicillin or metronidazole)
161
Nursing Management for Chronic Gastritis
```
NPO
reduce acid in stomach and decrease pain
alcohol abuse counseling
avoid NSAIDs
small freq. meals
```
162
what to monitor for with chronic gastritis?
hemorrhagic gastritis, bleeding in mucosa
163
education for chronic gastritis
lifelong B12 injections
164
PUD can be caused by ______.
H. Pylori
165
PUD can cause ____.
gastritis
166
how does H. pylori cause PUD
it drops the acid in your belly.
167
other causes of PUD
chronic NSAID and aspirin use
```
stress
smoking
alcohol
milk
caffeine
hispanics
```
blood type O
168
several peptic ulcers, extreme gastric hyperacidity, benign or malignant tumors of the pancreas
ϖ Zollinger-Ellison Syndrome (ZES)
169
common in those with severe burns
ϖ Hurling ulcers –
170
common in patient with head trauma
ϖ Cushing ulcers –
171
sx of PUD
ϖ May last for a few days, weeks, or months and may disappear only to reappear, often without identifiable cause
ϖ Either a lot of pain or no pain – usually come in w/ GI bleed and never knew they had an ulcer
anorexia
vomiting
172
PUDs most common sx
Dull, gnawing pain or a burning sensation in the mid-epigastrium
173
complication of PUD
Peptic ulcer bleeding--main cause of upper GI bleeding
174
hurts 1-3 hours after eating
gastric ulcer
175
pain goes away when they eat and wake up at night
duodenal ulcer
176
upper GI bleed
bright red
177
lower GI bleed
coffee ground
178
nursing management of PUD
```
lavage for suction
18G IV
NS or lactated ringer
aspiration risk
HOB high
side lying
```
179
ulcers lead to _____ which leads to ____
perforation; peritonitis
180
quadruple therapy for PUD
pepto, ATB, PPI
181
why do PUD patient need 18 G IV?
might need blood
182
perforation is common with PUD and can lead to?
| most lethal complication of PUD
peritonitis
183
sx of perforation of PUD
sudden severe upper abd. pain
absent bowel sounds
rapid shallow breaths
extremely tender and rigid boardlike abd.
184
– fatty layer of stomach to cover up ulcer
o Momentum
185
obstruction of the gastric outlet sxs
```
severe abd. pain
projectile vomiting
swelling in upper abd.
LOUD PERISTALSIS
weight loss
```
186
dx of PUD
endoscopy
CBC
biopsy
stool antigen test
urea breath test
string test
ELISA test
187
if pt with PUD has hypotension and tachycardia expect
GI bleed
188
what meds for pain with PUD
tylenol NOT NSAIDs
189
dietary education with PUD
no late night meals
avoid coke, coffee, stress, milk
eat at regular intervals, small meals
190
potential complications with PUD
perforation
hemorrhage
gastric outlet obstruction
191
nursing management of PUD
```
insert IV
NG tube lavage
insert foley
monitor O2
treat hemorrhagic shock
```
192
normal BMI
18-24
193
overweight
25-29
194
obesity
greater than 30
195
obese patients are at higher risk for ?
```
diabetes
HTN
stroke
sleep apnea
cancer
```
196
how to treat obesity
lifestyle modifications
meds
surgery
197
medications for obesity
loraserin (belviq)
meridia
orlistat
rimonabant
198
lorcaserin is an
antidepressant
199
orlistat works by ?
reducing caloric intake by binding to gastric and pancreatic lipase to prevent digestion of fats
200
sx of orlistat?
incontinence, gas with oily discharge
201
what is recommended with orlistat?
multivitamin
202
rimonabant side effects
depression, anxiety, agitation, sleep disorders
| taken off marker from suicidal tendencies
203
surgical management of obesity
bariatric surgery
204
prelim process for bariatric surgery
6-18 months of extensive counseling
205
after bariatric surgery
patients require lifelong monitoring of weight loss, comorbidities
206
women are advised to use contraceptives for ___ years after surgery until weight stabilizes
2
207
complications of bariatric surgery
```
bleeding
blood clots
bowel obstruction
incisional or ventral hernias
infection
nausea
```
208
monitor for side effects of bariatric surgery such as
nausea from overfilling
dumpling syndrome
changes in bowel function
nutritional deficiencies
