Adult Health Chapter 57 Flashcards
What are 3 acute inflammatory disorders?
Appendicitis, peritonitis, and gastroenteritis
What are the 4 chronic inflammatory disorders?
Ulcerative colitis
Crohn’s disease
Diverticular disease
Celiac disease
What are some anal disorders?
Anal abscess, fissure & fistula
What are the main topics in inflammatory intestinal disorders?
Acute inflammatory disorders, chronic inflammatory disorders, anal disorders, parasitic infection
What is appendicitis?
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
What is McBurney’s rebound pain?
Pain during palpation or during release
Do this last because it may be painful for patient
What are some problems being a female with appendicitis?
appendicitis can be confused with ovarian cysts- may take longer to diagnose due to this
What is some non-surgical management for appendicitis?
administer fluids, ensure comfort and prepare for surgery
Describe the surgical management for appendicitis.
Appendectomy open or laparoscopic (better for the patient because they can go home after 24 hours or so- recover quicker)
What are some nursing interventions to focus on after an appendectomy?
Pain management
Bleeding
Signs of infection
Drains assessment
What is important to know about teaching pre surgery for an appendectomy?
Pre surgery teaching is limited due to urgency
What is peritonitis?
Life threatening inflammation of visceral peritoneum and endothelial lining of abdominal cavity
What can peritonitis lead to?
Hypovolemic shock
Slower peristalsis
Respiratory problems
What is the classic sign for peritonitis?
Rigid, board like abdomen
What does the assessment include for peritonitis?
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
What are some non surgical interventions for peritonitis?
IV hypertonic fluids (5%dextrose in NS, 3%saline)
Antibiotics
Pain control
NG tube (to decompress stomach)
What are some surgical interventions for peritonitis?
Laparotomy Infection IV fluids I+O Fluid electrolyte balance Drains- when they come out of surgery- looking for baseline then
Describe some patient education on peritonitis.
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
Who does the dressing change for peritonitis when the patient is discharged?
Dressing change by home care RN- not by patient
What is gastroenteritis?
Inflammation of stomach and intestinal tract (mainly small bowel)
Caused by viruses or bacteria (Norovirus)
Self limiting 1-3 days in healthy individuals
What is gastroenteritis most commonly caused by?
Caused by viruses or bacteria (Norovirus)
How long does gastroenteritis usually last in a health individual?
Self limiting 1-3 days in healthy individuals
What are some nursing interventions regarding gastroenteritis?
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
What is ulcerative colitis?
Inflammation of rectum and sigmoid colon
- unknown cause
- peak diagnosis at age 30-40 and 55-65
- has remissions and exacerbations
How are the stages of ulcerative colitis determined?
Mild, moderate, severe- depends on amount of stool and how often there are trips to the bathroom
What is fulminant?
most severe stage of ulcerative colitis- > 10 bloody stools a day- increasing symptoms, anemia may require a transfusion, colonic distention on X-Ray
Describe the mild stage of ulcerative colitis.
Describe the moderate stage of ulcerative colitis.
> 4 stools/day with/without blood- minimal symptoms, mild abdominal pain, mild intermittent nausea, possible increased C-reactive protein or ESR
Describe the severe stage of ulcerative colitis.
> 6 bloody stools/day, fever, tachycardia, anemia, abdominal pain, elevated C-reactive protein and/or ESR
Describe an acute onset of ulcerative colitis
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,
What are some diagnostic tools to check for ulcerative colitis?
MRI with contrast, CT scan to differentiate between ulcerative colitis and Crohn’s disease
What are some labs that may occur with ulcerative colitis?
High WBC count
Low H&H
Low Na, K, Chloride
Low albumin
What are some nursing interventions for ulcerative colitis?
Decrease diarrhea- symptom relief, skin care, medications
What are some medications to help with ulcerative colitis?
aminosalicylates, glucocorticoids (prednisone), anti-diarrhea drugs (Imodium), immunomodulator (not a 1st line drug)
What are aminosalicylates?
used as a pharmacologic intervention for ulcerative colitis. anti-inflammatory to promote remission. Mild to moderate UC. Takes 2-4 weeks to work
What are glucocorticoids such as prednisone?
used as a pharmacologic intervention for ulcerative colitis- during the exacerbation stage.
What are anti-diarrhea drugs such as imodium?
used as a pharmacologic intervention for ulcerative colitis- use with caution because it may cause toxic mega colon(super dilated colon!-distention).
What is an immunomodulator?
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.
What are some nursing interventions regarding nutrition for severe symptoms of ulcerative colitis?
NPO with TPN(total parenteral nutrition)
What are some nursing interventions for nutrition for patients with ulcerative colitis?
Avoid irritants: coffee, alcohol, raw vegetables (high fiber foods), lactose, carbonated beverages, pepper, nuts, dried fruit and smoking
What are 2 ways of surgical management for ulcerative colitis?
ileostomy and Restorative proctocolectomy with ileo pouch-anal anastimosis (RPC-IPAA)-
Describe an ileostomy.
Skin care
Drainage: 1st 24 hours- watery
1 week drainage becomes thicker
Blockage/infection- unpleasant odor –infection or blockage
describe a Restorative proctocolectomy with ileo pouch-anal anastimosis (RPC-IPAA)-2 phase surgery.
2 phase surgery Bowel continence is maintained (some leaking) Burning sensation post 2nd stage Internal pouch inflammation-Flagyl Avoid foods that cause gas
what are some nursing interventions for ulcerative colitis?
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
Describe ileostomy skin protection care.
Use skin barrier and skin care products
Watch for irritation and redness
Describe ileostomy pouch care
Empty pouch when its 1/3 to ½ full
Change during inactive times
Change the entire system every 3-7 days
Describe nutrition with an ileostomy.
Chew food thoroughly
Be cautious of high fiber and high cellulose foods
Describe drug therapy for patients with an ileostomy.
Avoid enteric coated and capsule medication
Do not take laxative or enema
Inform MD if no stool has passed in 6-12 hours
What are some symptoms to watch for while having an ileostomy?
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
What is Crohn’s disease?
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.
Hemorrhage and nutritional deficiencies are a common complication for which disease?
ulcerative colitis
fistuals and nutritional deficiencies are a common complication for which disease?
crohn’s disease
What is some non-surgical management for crohn’s disease?
Immunosuppressant’s and corticosteroids
Nutrition-at risk for malnourishment and electrolyte imbalance
Watch for signs of infections
What is some surgical management for crohn’s disease?
Surgery is only done to control the symptoms not as a cure
What is diverticulosis?
Herniation (pouches) on the intestinal wall
What is diverticulitis?
Inflammation of diverticula
Describe a diverticular disease assessment.
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
A perforated diverticulum can lead to?
sepsis and peritonitus
Describe diverticular disease management.
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
What is celiac disease?
Chronic inflammation of small intestinal mucosa
Describe the assessment for celiac.
Weight loss Anorexia Diarrhea /constipation Abdominal pain Vomiting Therapy- Gluten free diet
What are the top three anal disorders?
anal abscess, anal fissure, and anal fistula
Describe an anal abscess.
Localized area of induration & puss caused by inflammation of the soft tissue of rectum and anus
Pain, discharge bleeding, itching
Surgery
Describe an anal fissure
Tear in anal lining
Self repairing or surgical intervention
Pain
Describe an anal fistula
Abnormal opening leading to perianal skin
Pain discharge, itching
Surgery/ stool softener/pain management
Describe parasitic infections.
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
What are the top 3 parasitic infection?
Giardiasis- Giardia Lambia Amebiasis – Entamoeba Histolytica Cryptospridium Symptoms: diarrhea dehydration
What is the main therapy for amebiasis?
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
What is the main therapy for giardiasis?
Metronidazole
Stool exam 2 weeks after therapy has started
what is the main therapy for cryptosporidium?
Self limiting in generally healthy individuals
Immunocompromized- Paromycin (Dizziness)
What is the main thing to watch for in everything in this chapter especially parasitic infections?
DEHYDRATION! :)
