Adult Care Final Exam Flashcards
1
Q
What kind of questions should you ask during a GI assessment?
A
Any changes in appetite, weight, stool? Have you had any pain, N,V, dyspepsia? Usual diet looks like what? Alcohol consumption? Any food allergies? Family history? Any dissension or gas?
2
Q
What do you need to look for/ keep in mind when assessing the abdomen?
A
Light palpation ONLY, Inspection and Auscultation : starts in RUQ
inspect, auscultate, palpalpate
3
Q
What are the labs and diagnostics for GI?
A
CBC, AST and ALT (liver enzymes), Ammonia, Electrolytes (calcium), Amylase, Lipase, Bilirubin, CA and CEA, FOBT, FIT,
4
Q
AST and ALT, and ammonia levels will be elevated during what disorders?
A
Liver disorders like hepatitis or cirrhosis
5
Q
Excessive vomiting and diarrhea causes a loss in..?
A
electrolytes
6
Q
What electrolyte will you specifically look at in a GI patient?
A
calcium
7
Q
What is a FOBT?
A
Fecal occult blood test
NO NSAIDS prior to, no red meat or vitamin C doses above 250mg/day
8
Q
What do you need to ensure you teach your patient before an X-ray?
A
No jewelry
9
Q
What is an upper GI series?
A
Chest x-ray, supine abd, upright abd.
Evaluates hernias, abnormal air, bowel perf
10
Q
What does NOT use radiation compared to a CT?
A
MRI
11
Q
What does a CT scan look at?
A
Abnormalities in the abdomen, liver, pancreas, spleen, biliary system
12
Q
What are some nursing considerations for a CT scan?
A
If using contrast, assess for allergies, ensure IV access, NPO for at least 4 hours prior, mild sedation if clausterphobic, takes 10-30 minutes
13
Q
What is an abdominal ultrasound?
A
looks at the liver, spleen, pancreas, biliary system. Patient may need to be fasting to see certain organs, no other prep needed
14
Q
What is an endoscopic ultrasound?
A
Looks at the GI wall and the digestive organs, performed through the endoscope, looks at lymph node, mucosal, pancreatic, stomach, and rectal tumors.
Similar prep to endoscopy
15
Q
What does an EGD do?
A
visualizes the esophagus, stomach, and duodenum using an endoscope.
can clip bleeding, use thermocoagulation, dilate to treat esophageal strictures, look at lesions
16
Q
What are pre-op nursing interventions for an EGD?
A
do not take anticoagulants, aspirin, NSAIDS, unless absolutely necessary, can take all other prescribed medications, NPO 6-8 hrs prior, remove dentures, educate what will happen during the test, pt may get propfol or fentanyl for sedation and atropine to dry out secretions
17
Q
What are post-op interventions for EGD?
A
check vitals every 15-30 min, NPO until gag reflux returns
18
Q
What does an ERCP do?
A
Looks at the liver, gallblatter, bowel ducts, and pancreas, usually looking for an obstruction. Small incision in the sphincter around the gall bladder to remove any gallstone, billary duct strictures, can open up the strictures and take bopsies as well.
19
Q
What are the nursing interventions for ERCP?
A
Pre and Post same as EGD
20
Q
pH Monitoring
A
most accurate way to diagnose GERD, small catheter is placed through the nose to the esophagus and it keeps a running tab on the pH level, pt will need to keep a diary of activities and will wear it for 24-48 hours
21
Q
What is GERD?
A
acid is released in to the esophagus causing corrosion, irritation and Barrets epithelium
22
Q
What is barrels epithelium?
A
esophagus tries to heal and adapt, normal squamous epithelium changes into columnar epithelium which is precancerous
23
Q
Contributing factors for GERD include…?
A
things that lower the esophageal pressure like smoking, alcohol, tomatoes, caffeinated beverages, citrus fruits. Being overweight, obese, H.pylori
24
Q
Signs and symptoms of GERD
A
Dyspepsia and regurgitation, abdominal pain, discomfort, uncomfortably full, nausea, frequent coughing at night
25
What lifestyle changes should a patient with GERD make?
Decrease foods that make GERD worse, eat 4-6 small meals per day, no heavy lifting, no bending over, sleep with head elevated 6-12 inches, sleep on the left side, avoid tight clothing, reduce weight
26
What medications treat GERD?
PPI's- zole drugs
Antacids
H2 Blockers - dine drugs
27
What medications do you need to avoid while taking PPI's, Antacids, and H2 blockers
Calcium channel blockers, NSAIDS, anticoagulants, oral contraceptives
28
What are diagnostics for GERD?
EGD and pH monitoring
29
What are the two different types of hiatal hernias?
Sliding and Paraoesophageal (Rolling)
30
What is a sliding hiatal hernia?
stomach slides through the opening of the diaphragm and the hernia slides in and out as the abdominal pressure changes
31
What are patients at risk for with a sliding hiatal hernia if the lower sphincter pressure is relaxed?
GERD symtoms
32
What are the diagnostics for a hernia?
Barium swallow, EGD, Chest X-ray (GI series)
33
What do you need to teach your patient with the Barium swallow test?
their stool may be white and chalky for 24-72 hours after
34
What is a Paraoesophageal hernia?
different portion of the stomach inverts completely into the chest. Reflux symptoms/ GERD are less likely because the esophageal sphincter remains intact. Volvulus is more common though (twisting)
35
What is an indication of a paraesophageal hernia?
Pt will feel very full suffocated, breathless after eating, worseness when the lay down. Full because stomach size is altered. Breathlessness because stomach is in the chest.
36
How do you treat hernias?
Treat GERD with lifestyle and diet changes, drug therapy, surgical intervention (Nissen Fundoplication)
37
What are some pre op teachings for a Nissen Fundoplication?
stop smoking, lose weight
38
What are some post op interventions for a Nissen Fundoplication?
clear liquid then advance to soft diet
avoid carbonated bevs and veggies, ambulate as quick as possible
monitor respiratory status
elevate HOB 30 degrees
NG tube (check if properly anchored, avoid pulling out can cause perforation, can provide decompression)
Encourage frequent smaller meals.
Supervise initial feeding because dysphasia is super common.
39
Esophageal tumors can travel where and how quickly?
rapid growth, can easily spread to lymph nodes and metastasize
40
What are risk factors for esophageal tumors?
alcohol intake, diets that are deficient chronically in fruits and veggies, pts that eat a lot of nitrates (pickles or fermented foods), pts that are malnourished, pts that have obesity (abdominal esp, it increases pressure), smoking
41
What are signs and symptoms of esophageal tumors?
DYSPHAGIA, food is stuck in throat, odynophagia (pain with swallowing), weight loss (20lbs over several months)
42
What are the diagnostics used for esophageal tumors?
EGD, PET scan (used for cancer because it helps look at metastasizes to see if it progresses more accurately than a CT scan)
43
What is the treatment for esophageal tumors?
nutrition, treatment and radiation, esophagectomy
44
What are nursing interventions for esophageal tumors?
prevent reflux by sitting up, soft diet (thickened liquids), liquid supplements to increase calorie intake, enteral feedings, speech pathology consult or OT
45
What are some pre op nursing interventions for a esophagectomy?
stop smoking prior to, improves pulmonary function, involve nutrition
46
What are some post op interventions for a esophagectomy?
pt remain in semi fowler or high folwer to promote ventilation and reduce reflux, chest tube drainage system, respiratory care, intubation for first 24 hours post open procedure (r/f atelectasis and pneumonia, interventions include turn cough and deep breath every hour and assess lung sounds), cardiovascular complications d/t pressure on the posterior heart during surgery, monitor for signs of fluid overload, A-fib, wound management, NG tube management, nutrition management
47
What is gastritis?
inflammation of the stomach lining, can be acute or chronic
48
What are risk factors for acute gastritis?
long term NSAID use, alcohol, coffee, caffeine
49
What is the onset like for acute gastritis compared to chronic?
acute is sudden onset with a short duration and local irritation, chronic is patchy and diffuse pain and long term (which increases the r/f gastric cancer)
50
What are the s/s of acute gastritis?
severe pain, dyspepsia, hematemesis, melena
51
What are the s/s of chronic gastritis?
few symptoms unless there is an ulceration, there N/V and pain will be present
52
What is the choice diagnostic for both acute and chronic gastritis?
EGD
53
What is the treatment for acute gastritis?
somatically/ supportive: remove causative agent, treat underlying disease, medications like PPI’s (omeprezal), H2 blockers (famotidine) , antacids (aluminum hydroxide), mucosal barrier agents (sucralfate)
54
What is the treatment for both acute and chronic gastritis?
remove causative agent, treat underlying disease
55
What is the cause of chronic gastritis?
H.Pylori infection, pernicious anemia, autoimmue disorder
56
What is PUD?
damage and injury to the lining caused by H.pylori infection
57
PUD can occur in what three ways?
duodenal (upper portion of duodenum, main feature is high gastric acid)
gastric (stomach)
and stress (occurs when there is a stress on the body)
58
What are the s/s of PUD?
abdominal epigastric tenderness and pain, peritonitis (rigid board like abdomen, tenderness, severe pain) sharp burning, knawing pain
complications: bleeding, pyloric obstruction, perforation (black tarry stool, dizziness)
59
What treatment is used for PUD?
pain relief, antibiotics for h.pylori like amoxcicillin, claromycin, PPI’s, H2 blockers, Antacids, bland diet, surgery, preventing bleeds
60
What are complications of ulcers?
bleeding, pyloric obstruction, perforation
61
How do you diagnose PUD?
labs (blood, breath, stool), EGD
62
How do you manage a GI bleed?
2 large bore IVs for rapid fluid transfusion, control bleeding, monitor V/S, HCT, O2 sat
63
What are risk factors for gastric cancer?
H.pylori, chronic gastritis, pernicious anemia, pickled foods (nitrates)
64
What are early s/s of gastric cancer?
asymptomatic until its too late, dyspepsia, abdominal discomfort
65
What are advanced s/s of gastric cancer?
N/V, Iron deficiency anemia, palpable mass, weakness/ fatigue, weight loss, enlargened lymph nodes
66
What is dumping syndrome?
Rapid passage of food into the jejunum and drawing of fluid into the jejunum causing abdominal distention
67
What is treatment for gastric cancer?
chemotherapy, radiation, surgery (total or subtotal gastrectomy)
68
What are the early symptoms of dumping syndrome and when do they occur?
occurs within 30 minutes of eat, s/s include vertigo tachycardia, syncope, pallow, diaphoresis, desire to lay down
69
What are the late s/s of dumping syndrome and when does it occur after eating?
Occurs within 90 minutes-3 hours, s/s include hypoglycemia, dizziness, diaphoresis, confusion, palpitation
70
What is the treatment for dumping syndrome?
dietary changes, avoid high carbohydrate/ sugar intake, eat high protein, high fat
71
What is the cause of IBS? What are the types of?
No known cause, suspected to be diet, environmental or genetic. IBS-C (constipation) and IBS-D (diarrheal)
72
What are the universal s/s of IBS?
diarrhea, constipation, bloating
73
What are the labs for IBS?
hydrogen breath tests, FOC, stools (everything should remain normal, but assess to ensure nothing is altered and that its not something different)
74
What is the treatment for IBS?
diet (insoluble fiber: spinach broccoli brown rice whole wheat) (soluble fiber beans, oats), education, medications, stress reduction ,medications
75
What medications are used for IBS-C?
laxatives to have bowel movements, psyllium hydrophilic muciloid Metamucil, linaclomide
76
What medications are used for IBS-D?
antidiarrheals- loperamide, psyllium, aloserton
77
What is colorectal cancer?
Can enter the circulatory system or lymphatic, liver lungs brain and bones are common areas of metastasizes. Seeding is where a cell or two is missed from a resected portion of the bowel and it falls into the abdominal cavity
78
What are risk factors for colorectal cancer?
over 50, genetic predisposition, family hx, familia adenimous poplus, alcohol use, inactivity
79
What are s/s of colorectal cancer?
change in bowel habits (shape or consistency), anemia, rectal bleeding, abdominal fullness or pain, unintentional weight loss
80
What are specific signs and symptoms for a right sided colorectal tumor?
no s/s until significant weight loss
81
What are specific signs and symptoms for a transverse colon tumor?
dark red blood mixed in with the stool, frequency, pain
82
What are specific signs and symptoms for a rectosigmoid area tumor?
narrowing in stool, blood in stool, struggling to pass
83
What screening options are used for colorectal cancer?
colonoscopy, FOBT, sigmoidoscopy, CT, MRIs
84
Nursing interventions for a colonoscopy includes...?
moderate sedation, liquid diet (no red orange or purple coloration), bowel prep, monitor V/S, assess bowels, assess fever
85
How do you prevent colorectal cancer?
decrease in refined carbs, increased in fiber, increase physical activities
86
What are treatment options for colorectal cancer?
chemo/ radiation, surgery
87
What are polyps?
Little masses, they are removed and sent to lab to be tested to see if they are cancerous
88
What are complications of intestinal obstructions? What are the two types?
hypovolemia, acid-base imbalances, sepsis
89
What are the two types of intestinal obstructions? What makes them different?
Mechanical (blockage) and Non Mechanical/ Paralytic Ileus (r/t dysfunction)
90
What are the treatment options for an intestinal obstruction?
Non-surgical management (NPO, NG tube) and Surgical management
91
What are the s/s of a small bowel obstruction?
abdominal discomfort or pain accompanied by visible peristaltic waves in upper and middle abdomen and distention, N/V (may contain fecal matter), obstipation, severe fluid and electrolyte imbalances, metabolic acidosis (sometimes)
92
What are diagnostics for a small bowel obstruction?
colonoscopy, sigmoidoscopy
93
What are the s/s of a large bowel obstruction?
intermittent lower abdominal cramping and distention, minimal/ no vomiting, obstipation or ribbon like stools, no major fluid imbalances, metabolic alkalosis
94
What are hemorrhoids?
Swollen or distended veins in the anal or rectal region d/t increased abdominal pressure like obesity, pregnancy straining with bowel movements, can be internal or external
95
How do you treat a hemorrhoid?
Hemorrhoidectomy, comfort, sitz baths, treat cause (obesity lose weight)
96
When do hemorrhoids stop being symptomatic?
3-5 days
97
What surgery is used to treat colorectal cancer?
colectomy
98
What is a colectomy?
colon resection after removing tumor, take out colon and a little bit of the healthy portion to avoid the cancer from coming back, pt could have an ostomy bag afterwards
99
What is an exploratory laparotomy?
stick with a camera on the end of it put in the stomach to look around, not an open procedure
100
If there is an obstruction at the end of the large intestine, the patient will have what acid-base imbalance?
metabolic alkalosis
101
If there is an obstruction at the end of the small intestine, the patient will have what acid-base imbalance?
metabolic acidosis
102
What GI labs indicate an inflammatory bowel disorder (or cholecystitis)?
Potassium , sodium, BUN, creatinine, Hct, Hgb, WBC, UO
103
What is the appendix?
a small pouch attached to the end of the large intestine, it is a place where our body can store healthy gut bacteria
104
What is appendicitis?
inflammation of the appendix when the opening gets block (usually) with hard fecal matter. the appendix CAN rupture which leads to peritonitis
105
With appendicitis, what symptoms come first?
abdominal pain then N/V
106
What disorder is the most common cause of RLQ pain?
appendicitis
107
If the appendix ruptures, how quickly does it lead to gangrene and sepsis?
24 hour window (QUICK!! LIFE THREATENING!!)
108
What are risk factors for appendicitis?
15-19 yr olds, adolescents
109
What will you find in your assessment if the patient has appendicitis?
as inflammation progresses, pain will localized at Mcburneys point, more pain reported upon release of pressure (rebound tenderness). use caution with palpation
110
What are the labs and diagnostics for appendicitis?
WBC, imaging and CT
111
What is the treatment for appendicitis?
Nonsurgical (monitoring and likely prep for surgery)
Surgical (appendectomy)
112
What are nursing interventions for an appendectomy?
informed consent, NPO until provider determines (min 4-6 hr), semifowlers position, general anesthesia
113
What nursing interventions are contraindicated with an appendendicitis?
Heat packs (increases blood to the area which increases perf risk), enemas, laxatives
114
What is the peritoneum?
serous membrane that lines the abdominal cavity, it pads and insulates organs
115
What is peritonitis?
inflammation of the abdominal cavity lining, fluid and gas builds up (third spacing) which can cause an increase in toxics which can lead to sepsis
116
What are the s/s of peritonitis?
respiratory issues d/t the large amount of fluid in the abdominal area which pushes on the lungs, abdominal pain, tenderness, distention, RIGID BOARD LIKE ABDOMEN, diminished bowel sounds, N/V, anorexia, s/s of infection, knees flexed
117
What assessment findings will you see with peritonitis?
guarding with movement, knees flexed, patient won't want to move in bed, pain with coughing or movement that is relieved by bending the right hips or knees
118
What labs indicate peritonitis?
WBC, blood cultures, fluids and electrolytes (BNP, K, Na), BUN and creatinine (fluid status) , Hgb, Hit, O2 sat, ABGs
119
A patient has an increased Hgb and Hct and an increased BUN and creatinine, what does the patient have?
hypovolemic
120
If a patient displays tachycardia, hypotension, fever, and decreased UO, what does the patient have?
shock
121
What are causes of peritonitis?
bowel perforation, ruptured appendix, surgery, gun shots, stab wounds
122
What are risk factors for peritonitis?
young adults who have appendicitis and older adults with a decreased immunity
123
What are the diagnostics for peritonitis?
CT, imaging to look for edema, air, and ulcerations, ultrasound to look for perforations
124
What is the treatment for peritonitis?
Nonsurgical (broad spectrum antibiotics, supportive care and monitoring)
Surgical (clean out the abscess or fix a perforation, flush out area with fluids)
125
What are the nursing interventions for a patient with peritonitis?
maintain pt in a semifolowers position to promote full lung expansion, these pts may have a drain d/t all the excess fluid
126
With peritonitis, a patient may have what procedure done?
exploratory laparotomy (open or closed)
127
What is gastroenteritis?
Common, causes V/D and is r/t inflammation of the mucosa of the stomach and intestinal tract, most common location is in the small bowel
128
What are the causes of gastroenteritis?
viral or bacterial infections
129
What virus is the leading cause of food borne illnesses that cause gastroenteritis? How is it transmitted?
norovirus, fecal oral route
130
What assessment questions should the nurse ask if a patient has suspected gastroenteritis?
ask if there has been recent travel to areas that are known for gastroenteritis (Asia, Mexico, Africa, central and south Americas), have they eaten at a local restaurant in the last 24 hours and what those restaurants were
131
If a gastroenteritis outbreak is bacterial, what will happen to foods?
recalled
132
What are nursing interventions for a patient who has gastroenteritis?
contact precautions, hydrate, teach to not prepare food for others to eat if sick report if you have it to the health department
133
Patients who have gastroenteritis are at risk for..?
dehydration and hypokalemia
134
With gastroenteritis, what symptoms come first?
N/V, then abdominal pain
135
What is the treatment for gastroenteritis?
fluids, supplement oral intake for pedialyte and Gatorade, antibiotics, azithryomycin, use premoistened wipes, warm water and sitz baths for the raw bumhole
136
What medication will be given very sparingly with patients who have gastroenteritis?
loperamide, or lomotile because it reduces GI motility
137
What medications are contraindicated with gastroenteritis?
antidiarrheals, you NEED to shed to the organisms and poop it out
138
What specific teaching do you need to give patients with gastroenteritis?
hand hygiene, use plastic utensils, do not cook for others, if you consume food that makes you ill contact the health department
139
What is ulcerative colitis?
chronic inflammation in the rectum, sigmoid or entire colon. intestinal mucosa becomes swollen and red, abscesses can occur, lining can bleed. often confused with chrons disease.
140
What is associated with ulcerative colitis?
periods of exacerbations and remission
141
What are the s/s of ulcerative colitis?
bloody stool, sudden urgent sensation for defection, lower abdominal pain with defecation, anemia if ulcers are bleeding, dehydration, weight loss, low grade fever, normal vitals , 10-15 bloody stools/day, at risk for hemorrhage, nutritional deficits
142
What assessment questions will be asked for a patient with ulcerative colitis? What will you find during the physical assessment?
History of? How do you tolerate things like dairy? Whats your usual bowel habits? Do you have abdominal pain? Any relation between meal time and bowel movements? Have you recently traveled? Have you used nsaids? Do you smoke? Normal physical assessment unless you are severe, then there will be some abdominal pain
143
What are the causes of ulcerative colitis?
genetic predisposition, environmental factors, autoimmune, tbh doctors dont really known
144
Who is at risk for ulcerative colitis?
peak age 15-35 yr olds (women) , 55-70yr olds (male)
| and caucasians
145
Milid ulcerative colitis
Moderate
Severe
Fulminant
<4 stools per day
>4
>6
>10
146
What are the labs for ulcerative colitis?
low Hgb, Hct, WBCm C- reactive protein, ESR is increase, hypoalbumin (loss of protein in stool)
147
What are the diagnostics for ulcerative colitis?
MRE, CT scan, endoscopy, colonoscopy, barium enema
148
What are nursing interventions for a MRI?
NPO 4-6 hours prior, drinks a large amount of contrast so they can see the bowel, lie prone, subQ injection of glucagon (slows the GI motility for a little amount of time) and this helps get a clear picture of the bowel
149
What is the treatment for ulcerative colitis?
NPO to allow gut to rest, if someone is very sick they will be given TPN. dietary recommendations are very individualized, medication therapy, restorative proctocolectomy
150
What medications will be given to a patient with ulcerative colitis?
amino salicylates (sulfasalazine, mesalamine)
glucocorticoids (prednisone)
antidiarrheals (loperamide, Lomotil)
immunomodulators (adalimumab aka Humira)
151
What is the surgical treatment for ulcerative colitis?
Restorative proctocolectomy with ileo pouch anal anastomosis
152
What nursing interventions/ patient teaching should be include for ulcerative colitis?
caffeine, raw vegetables, dairy, can worsen symptoms, in general carbonated beverages, pepper, nuts and corn are GI stimulants so it may cause more discomfort
153
What is chrons disease?
chronic inflammatory disease thats in the small intestine, colon, or both. Can be anywhere in the GI tract with strictures and deep ulcerations that give the bowel the cobblestone appearance
154
What are the s/s of chrons disease?
severe diarrhea and malabsorption of vital nutrients, anemia is common d/t iron deficiency, intestinal obstruction, and scar tissue
155
What are some assessment findings for a patient with chrons disease?
elimination pattern, stool consistency, weight loss, diarrhea, abdominal pain, low grade fever, fatty stools, bright red blood in the stool.
156
What labs and diagnostics will be used for chrons disease?
decreases folic acids, vitamin B12, albumin, elevated C-reactive protein and ESR, WBC (infection r/t a fistula), X-rays, MRE
157
What treatment is used for chrons disease?
nutrition, medications (same as ulcerative colitis), fistula treatment
158
What is diverticula?
herniation of the bowel caused by constipation or straining
159
What is diverticulosis?
pt may not have s/s, multiple diverticula
160
What is diverticulitis?
infection of the diverticulosis
161
What are the causes of acute diverticulitis?
bacteria, food, fecal matter
162
What are complications r/t diverticulitis?
peritonitis, bleeding, absess
163
What are the s/s of diverticulitis?
tachycardia, fever, chills, abdominal distention, tenderness, guarding
164
What are labs related to diverticulitis?
decreased Hgb, Hit, WBC increased, X-rays, fecal occult, CT, ultrasound, colonoscopy (4-8 weeks)
165
What is the treatment for diverticulitis?
nonsurgical more often than not (pain management, IV fluids, bowel resting, broad spectrum antibiotics
166
What treatment options are contraindicated in diverticulitis?
laxatives and enemas d/t r/f perforation
167
What surgical treatment is used for diverticulitis?
colon resection which leads to a colostomy
168
What are nursing interventions for diverticulitis?
increase fiber 25-30 g/day, increase fruits and veggies, avoid alcohol and foods that may get stuck in diverticula and block it (seeds, nuts, corn, popcorn, tomatoes, figs), during inflammation have a low fiber diet, once inflammation resolves go to a high fiber diet
169
With sulfa drugs, what do you need to teach your patient?
take folic acid supplements and let provider know if you have a sulfa allergy
170
What do you need to teach you patient who is taking an immuenosupressant?
report s/s of infection, avoid those who are sick, avoid large crowds
171
What is the restorative proctocolectomy with ileo pouch Anal anastomosis?
J pouch or S pouch is connected to the anus and gives the body time to heal
172
Ileostomy care
use a barrier to protect the skin so it doesn't come into contact with the contents inside the body, monitor for irritation, empty the pouch when its 1/3 - 1/2 full, change the pouch before meal or before bed, change the entire pouch system 3-7 days, chew food properly, avoid enteric coated or capsule meds, avoid laxatives or enemas, climate foods that cause irritation to stomach, monitor for drastic increase or decease in changes from ostomy, if there is any swelling from the ostomy
