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Nursing 2016 > Adult Health Chapter 57 > Flashcards

Adult Health Chapter 57 Flashcards

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1
Q

What are 3 acute inflammatory disorders?

A

Appendicitis, peritonitis, and gastroenteritis

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2
Q

What are the 4 chronic inflammatory disorders?

A

Ulcerative colitis
Crohn’s disease
Diverticular disease
Celiac disease

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3
Q

What are some anal disorders?

A

Anal abscess, fissure & fistula

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4
Q

What are the main topics in inflammatory intestinal disorders?

A

Acute inflammatory disorders, chronic inflammatory disorders, anal disorders, parasitic infection

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5
Q

What is appendicitis?

A

Inflammation of the appendix, characterized by a sudden and constant pain at the navel and shifts to RLQ with N/V- McBurney’s rebound pain, elevated WBC

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6
Q

What is McBurney’s rebound pain?

A

Pain during palpation or during release

Do this last because it may be painful for patient

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7
Q

What are some problems being a female with appendicitis?

A

appendicitis can be confused with ovarian cysts- may take longer to diagnose due to this

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8
Q

What is some non-surgical management for appendicitis?

A

administer fluids, ensure comfort and prepare for surgery

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9
Q

Describe the surgical management for appendicitis.

A

Appendectomy open or laparoscopic (better for the patient because they can go home after 24 hours or so- recover quicker)

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10
Q

What are some nursing interventions to focus on after an appendectomy?

A

Pain management
Bleeding
Signs of infection
Drains assessment

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11
Q

What is important to know about teaching pre surgery for an appendectomy?

A

Pre surgery teaching is limited due to urgency

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12
Q

What is peritonitis?

A

Life threatening inflammation of visceral peritoneum and endothelial lining of abdominal cavity

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13
Q

What can peritonitis lead to?

A

Hypovolemic shock
Slower peristalsis
Respiratory problems

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14
Q

What is the classic sign for peritonitis?

A

Rigid, board like abdomen

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15
Q

What does the assessment include for peritonitis?

A 
Rigid, board like abdomen (classic sign)
Abdominal pain (localized, poorly localized or referred to shoulder and chest)
Distended abdomen
Nausea, vomiting anorexia
Diminishing bowel sounds
Inability to pass flatus or feces
Rebound tenderness in the abdomen
High fever
Tachycardia
Dehydration
Decreased urine output
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16
Q

What are some non surgical interventions for peritonitis?

A

IV hypertonic fluids (5%dextrose in NS, 3%saline)
Antibiotics
Pain control
NG tube (to decompress stomach)

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17
Q

What are some surgical interventions for peritonitis?

A 
Laparotomy
Infection
IV fluids
I+O
Fluid electrolyte balance
Drains- when they come out of surgery- looking for baseline then
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18
Q

Describe some patient education on peritonitis.

A

At discharge inform the patient to report:

  • Foul smell from drain
  • Swelling, redness, warmth, -bleeding from incision
  • Increased temperature
  • Abdominal pain
  • Wound dehiscence
  • no lifting 6 weeks post surgery (or for 2 weeks if laparoscopy)
  • possible need to antibiotics
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19
Q

Who does the dressing change for peritonitis when the patient is discharged?

A

Dressing change by home care RN- not by patient

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20
Q

What is gastroenteritis?

A

Inflammation of stomach and intestinal tract (mainly small bowel)
Caused by viruses or bacteria (Norovirus)
Self limiting 1-3 days in healthy individuals

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21
Q

What is gastroenteritis most commonly caused by?

A

Caused by viruses or bacteria (Norovirus)

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22
Q

How long does gastroenteritis usually last in a health individual?

A

Self limiting 1-3 days in healthy individuals

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23
Q

What are some nursing interventions regarding gastroenteritis?

A 
Hand washing !!!
Dehydration 
Hypokalemia
Fluid replacement (Gatorade)
Antibiotics- only if it is bacterial
Skin damage from frequent stools & wiping (around anal area)
Warm washcloths and protective crème 
Protect and contain- not allow it to spread
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24
Q

What is ulcerative colitis?

A

Inflammation of rectum and sigmoid colon

  • unknown cause
  • peak diagnosis at age 30-40 and 55-65
  • has remissions and exacerbations
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25
Q

How are the stages of ulcerative colitis determined?

A

Mild, moderate, severe- depends on amount of stool and how often there are trips to the bathroom

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26
Q

What is fulminant?

A

most severe stage of ulcerative colitis- > 10 bloody stools a day- increasing symptoms, anemia may require a transfusion, colonic distention on X-Ray

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27
Q

Describe the mild stage of ulcerative colitis.

A
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28
Q

Describe the moderate stage of ulcerative colitis.

A

> 4 stools/day with/without blood- minimal symptoms, mild abdominal pain, mild intermittent nausea, possible increased C-reactive protein or ESR

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29
Q

Describe the severe stage of ulcerative colitis.

A

> 6 bloody stools/day, fever, tachycardia, anemia, abdominal pain, elevated C-reactive protein and/or ESR

30
Q

Describe an acute onset of ulcerative colitis

A

many don’t want to go out because they are worried about not making it to the bathroom( patient “tied to the toilet”- diarrhea, low grade fever,

31
Q

What are some diagnostic tools to check for ulcerative colitis?

A

MRI with contrast, CT scan to differentiate between ulcerative colitis and Crohn’s disease

32
Q

What are some labs that may occur with ulcerative colitis?

A

High WBC count
Low H&H
Low Na, K, Chloride
Low albumin

33
Q

What are some nursing interventions for ulcerative colitis?

A

Decrease diarrhea- symptom relief, skin care, medications

34
Q

What are some medications to help with ulcerative colitis?

A

aminosalicylates, glucocorticoids (prednisone), anti-diarrhea drugs (Imodium), immunomodulator (not a 1st line drug)

35
Q

What are aminosalicylates?

A

used as a pharmacologic intervention for ulcerative colitis. anti-inflammatory to promote remission. Mild to moderate UC. Takes 2-4 weeks to work

36
Q

What are glucocorticoids such as prednisone?

A

used as a pharmacologic intervention for ulcerative colitis- during the exacerbation stage.

37
Q

What are anti-diarrhea drugs such as imodium?

A

used as a pharmacologic intervention for ulcerative colitis- use with caution because it may cause toxic mega colon(super dilated colon!-distention).

38
Q

What is an immunomodulator?

A

used as a pharmacologic intervention for ulcerative colitis- not 1st line drug. Used in combination. May be given as Tx for mega colon or Crohn’s disease.

39
Q

What are some nursing interventions regarding nutrition for severe symptoms of ulcerative colitis?

A

NPO with TPN(total parenteral nutrition)

40
Q

What are some nursing interventions for nutrition for patients with ulcerative colitis?

A

Avoid irritants: coffee, alcohol, raw vegetables (high fiber foods), lactose, carbonated beverages, pepper, nuts, dried fruit and smoking

41
Q

What are 2 ways of surgical management for ulcerative colitis?

A

ileostomy and Restorative proctocolectomy with ileo pouch-anal anastimosis (RPC-IPAA)-

42
Q

Describe an ileostomy.

A

Skin care
Drainage: 1st 24 hours- watery
1 week drainage becomes thicker
Blockage/infection- unpleasant odor –infection or blockage

43
Q

describe a Restorative proctocolectomy with ileo pouch-anal anastimosis (RPC-IPAA)-2 phase surgery.

A 
2 phase surgery
Bowel continence is maintained (some leaking)
Burning sensation post 2nd stage
Internal pouch inflammation-Flagyl  
Avoid foods that cause gas
44
Q

what are some nursing interventions for ulcerative colitis?

A

Pain management
Monitor for GI bleeds (Bright red or black, tarry stools)
Diet management- individualized
Avoid foods that cause gas
Immediately report: fever, blood, tachycardia, pain

45
Q

Describe ileostomy skin protection care.

A

Use skin barrier and skin care products

Watch for irritation and redness

46
Q

Describe ileostomy pouch care

A

Empty pouch when its 1/3 to ½ full
Change during inactive times
Change the entire system every 3-7 days

47
Q

Describe nutrition with an ileostomy.

A

Chew food thoroughly

Be cautious of high fiber and high cellulose foods

48
Q

Describe drug therapy for patients with an ileostomy.

A

Avoid enteric coated and capsule medication
Do not take laxative or enema
Inform MD if no stool has passed in 6-12 hours

49
Q

What are some symptoms to watch for while having an ileostomy?

A 
Drastic increase or decrease in drainage
Stomal swelling, abd cramping, distension or ileostomy stops draining:
Remove the pouch
Assume the knee-chest position
Abd massage
Drink hot tea
Call provider
50
Q

What is Crohn’s disease?

A

terminal ileum with patchy involvement of all layers of the bowel- unknown cause, peak incidence at age 15-40, number of stools per day is 5-6 loose and non bloody stools, fistulas are common complications and the need for surgery is frequent.

51
Q

Hemorrhage and nutritional deficiencies are a common complication for which disease?

A

ulcerative colitis

52
Q

fistuals and nutritional deficiencies are a common complication for which disease?

A

crohn’s disease

53
Q

What is some non-surgical management for crohn’s disease?

A

Immunosuppressant’s and corticosteroids
Nutrition-at risk for malnourishment and electrolyte imbalance
Watch for signs of infections

54
Q

What is some surgical management for crohn’s disease?

A

Surgery is only done to control the symptoms not as a cure

55
Q

What is diverticulosis?

A

Herniation (pouches) on the intestinal wall

56
Q

What is diverticulitis?

A

Inflammation of diverticula

57
Q

Describe a diverticular disease assessment.

A 
Patients are usually asymptomatic unless there is a Diverticulitis
Pain in lower abdomen,
Fever
Nausea
Bleeding
Constipation 
High WBC count
Low H&H
Perforated diverticulum can lead to sepsis and peritonitus
58
Q

A perforated diverticulum can lead to?

A

sepsis and peritonitus

59
Q

Describe diverticular disease management.

A

Antibiotics
Rest
Nutrition and hydration
High fiber foods (introduce gradually)
Avoid alcohol, nuts, seeds (strawberry, cucumber, tomato…)
Surgical interventions only if ruptured, abscess, fistula, bowel obstruction

60
Q

What is celiac disease?

A

Chronic inflammation of small intestinal mucosa

61
Q

Describe the assessment for celiac.

A 
Weight loss
Anorexia
Diarrhea /constipation
Abdominal pain
Vomiting
Therapy- Gluten free diet
62
Q

What are the top three anal disorders?

A

anal abscess, anal fissure, and anal fistula

63
Q

Describe an anal abscess.

A

Localized area of induration & puss caused by inflammation of the soft tissue of rectum and anus
Pain, discharge bleeding, itching
Surgery

64
Q

Describe an anal fissure

A

Tear in anal lining
Self repairing or surgical intervention
Pain

65
Q

Describe an anal fistula

A

Abnormal opening leading to perianal skin
Pain discharge, itching
Surgery/ stool softener/pain management

66
Q

Describe parasitic infections.

A

Bacteria/Virus enters through the mouth.
Contaminated food, water, contact with feces or contaminated person
Hand washing is the best way to prevent parasitic infections
Ask patients of recent travels.
GI symptoms may be delayed 1-2 weeks after travel

67
Q

What are the top 3 parasitic infection?

A 
Giardiasis- Giardia Lambia
Amebiasis – Entamoeba Histolytica
Cryptospridium
Symptoms: diarrhea
dehydration
68
Q

What is the main therapy for amebiasis?

A 
Amebicide drugs (Flagyl, Entamide, Tetracyclins)
Therapy effectivness is based on examining stool q2-3 day 2-4 weeks after start of therapy
Make sure to keep up appointments to make sure that treatment is working
69
Q

What is the main therapy for giardiasis?

A

Metronidazole

Stool exam 2 weeks after therapy has started

70
Q

what is the main therapy for cryptosporidium?

A

Self limiting in generally healthy individuals

Immunocompromized- Paromycin (Dizziness)

71
Q

What is the main thing to watch for in everything in this chapter especially parasitic infections?

A

DEHYDRATION! :)

Nursing 2016 (20 decks)

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