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AHI > Care of Patient with Non-inflammatory Intestinal Disorders > Flashcards

Care of Patient with Non-inflammatory Intestinal Disorders Flashcards

1
Q

Functional GI disorder that causes/characterized chronic or recurrent diarrhea, constipation (some have both), and/or abdominal pain and bloating associated with it
spasms/contractions in colon
Most common digestive disorder
Symptoms typically appear in young adulthood and continue throughout the patient’s life
Etiology - causes unknown

A

Irritable bowel syndrome (IBS)

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2
Q

Research suggests that a combination of factors
Certain food and fluids - exacerbation: Ex. carbonated or caffeinated beverages, dairy products
Immunologic
Genetic
Hormonal: 2 times more likely in women
Stress - precursor: Anxiety and depression can play a role

A

Etiology - causes unknown - Irritable bowel syndrome (IBS)

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3
Q

Weight change - not have colorectal cancer
Malaise and fatigue - some
Abdominal pain
Changes in bowel pattern and consistency of stools
Passage of mucus - lot more common
Nutrition
Factors causing exacerbations such as diet, stress, anxiety, food intolerance - keep diary of triggers

A

IBS assessment - History - rule out other things

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4
Q

Usually have a stable weight

A

Weight change - not have colorectal cancer

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5
Q

Most common in left lower quadrant

A

Abdominal pain

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6
Q

Can have diarrhea or constipation or alternate with both - when having; when occurring

A

Changes in bowel pattern and consistency of stools

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7
Q

Caffeine, sorbitol or fructose can cause bloating and diarrhea - fake sweetners

A

Nutrition

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8
Q

CBC (normal)
Serum albumin (normal)
ESR (normal)
Stools for occult blood (normal)
Hydrogen breath test

A

IBS assessment - Laboratory testing: - rule out others

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9
Q

Will exhale a higher level of hydrogen secondary to bacterial overgrowth and malabsorption of nutrients in the small intestines - get into bloodstream and exhale

A

Hydrogen breath test

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10
Q

LLQ abdominal pain
Alternating Diarrhea and/or constipation
Cramping
Belching or increased gas
Anorexia
Bloating
Nausea with meals

A

IBS assessment - Clinical manifestations:

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11
Q

Dietary fiber (30 to 40 g of fiber each day)
Eating regular meals
8-10 cups of liquid a day - lots fluids
Chewing slowly - help with passage food

A

IBS interventions - Health teaching:

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12
Q

Constipation predominant
Diarrhea predominant
Pain predominant

A

IBS interventions - Drug therapy depends on the symptoms:

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13
Q

Bulk-forming laxatives, such as Metamucil - fluid into stool
Lubiprostone (Amitiza) to increase fluid in the intestine to offset constipation
Linaclotide (Linzess) to increase fluid in intestines and increase intestinal motility to offset constipation

A

Constipation predominant

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14
Q

Antidiarrheal agents, such as loperamide (Immodium)

A

Diarrhea predominant

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15
Q

Tricyclic antidepressants (Elavil) - may help with stress/nerve pain

A

Pain predominant

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16
Q

Probiotics to reduce bacteria - keeps intestines healthy
Peppermint oil capsules - helps with pain
Stress management such as relaxation techniques, meditation and/or yoga
Exercise

A

IBS interventions - Complimentary and alternative therapies:

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17
Q

Weakness in the abdominal muscle through which a segment of the bowel or other abdominal structure protrudes
Causes
Most common types

A

Hernia

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18
Q

Congenital or acquired muscle weakness
Increased intra-abdominal pressure (obesity, pregnancy, lifting heavy objects); abdominal weakness

A

Causes - Hernia

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19
Q

Indirect inguinal (occur mostly in men)
Direct inguinal (occur more often in older adults)
Femoral (common in obese or pregnant women)
Umbilical (congenital or common in obese or pregnant women)
Incisional or ventral (occurs in people who have undergone abdominal surgery - cut into so weakness)

A

Most common types - Hernia

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20
Q

Reducible
Irreducible (incarcerated)
Strangulated

A

Hernias classifications

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21
Q

Contents of the hernial sac can be placed back into the abdominal cavity by gentle pressure
Least serious
Reduce them - push them back in without surgery from outside

A

Reducible - Hernias classifications

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22
Q

hernia cannot be reduced or placed back into the abdominal cavity
Require surgery
Requires immediate surgical evaluation

A

Irreducible (incarcerated) - Hernias classifications

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23
Q

Blood supply to the herniated segment of the bowel is cut off by pressure from the hernial ring
Can lead to necrosis of the bowel and possibly bowel perforation - death of bowel
Surgical intervention
Symptoms:

A

Strangulated - Hernias classifications

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24
Q

abdominal distension/perforation if left untreated
N/V
Severe pain
fever
tachycardia

A

Strangulated hernia - Symptoms:

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25
Q

Observe for bulging or protrusion over involved area
Inspect when lying and standing
If reducible it may disappear when lying flat
Assess for bowel sounds
Absent bowel sounds may indicate obstruction or strangulation

A

Hernias - assessment

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26
Q

Truss (pad made with firm material) - after hernia reduced; not worn at night; worn when awake
Held in place over hernia with a belt
Treatment of an inguinal hernia
Applied after the hernia has been reduced

A

Hernias - Nonsurgical interventions

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27
Q

Surgical option for inguinal hernia repairs - often; not reducible or strangulated
Postoperative teaching

A

Hernias - surgical interventions

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28
Q

Minimally invasive inguinal hernia repair (MIIHR)
Open herniorrhaphy (open incision)

A

Surgical option for inguinal hernia repairs - often; not reducible or strangulated

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29
Q

Laproscopic herniorrhaphy
Recover more quickly, have less pain, fewer postop complication

A

Minimally invasive inguinal hernia repair (MIIHR)

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30
Q

Follow general postoperative care of patients
Assess for difficulty in voiding

A

Open herniorrhaphy (open incision)

31
Q

Avoid coughing - increased intraabdominal pressure - not lifting heavy for awhile
Elevation of scrotum for inguinal repairswith a soft pillow to prevent and control swelling
Ice bags to prevent and control swelling
Follow surgeon’s recommendation for returning to usual activities
Avoid straining and lifting for several weeks
Observe for fever, chills, wound drainage, redness or separation of the incision and increasing incisional pain - assess for infection
Keep wound clean and dry and clean with antibacterial soap and water

A

Postoperative teaching

32
Q

Cancer of the colon or rectum
Third most common cause of cancer death in the US
Most are adenocarcinomas
Can metastasize by direct extension or by spreading through the blood or lymph - easily preventable so always educate on how prevent this
Complications

A

Colorectal cancer

33
Q

Tumors that arise from the glandular epithelial tissue of the colon
Colon or rectum

A

Most are adenocarcinomas - Colorectal cancer

34
Q

Tumor: Bowel obstruction or can lead to perforation with peritonitis
Abscess formation
Fistula formation to the urinary bladder or the vagina

A

Complications- Colorectal cancer

35
Q

Older than 50 years - preventative after 50
Genetic predisposition
Personal or family history of cancer
Diseases that predispose the patient to cancer
Infectious agents
Long-term smoking
Obesity
Physical inactivity
Heavy alcohol consumption
High-fat diet
Focus on modifiable

A

Colorectal cancer: etiology/risk factors

36
Q

Familial adenomatous polyposis - precursor for malignant colorectal cancer
Crohn’s disease
Ulcerative colitis

A

Diseases that predispose the patient to cancer - Colorectal cancer: etiology/risk factors

37
Q

H. pylori
Human papilloma virus (HPV)
Predispose and strep ones as well

A

Infectious agents - Colorectal cancer: etiology/risk factors

38
Q

Big because catch early can get good outcomes
People of average risk and without a family history should undergo screening at age 50
Diagnostic screening after 50
Modify diets
Avoid smoking
Avoid excessive alcohol
Increase physical activity

A

Colorectal cancer: prevention

39
Q

Fecal occult blood testing (FOBT) - blood in stool big manifestation of colon cancer
Colonoscopy every 10 years unless increased risk or double-contrast barium enema every 5 years - barium and air to get pic

A

Diagnostic screening after 50 - Colorectal cancer: prevention

40
Q

Fecal occult blood testing (FOBT) - blood in stool big manifestation of colon cancer
Colonoscopy every 10 years unless increased risk or double-contrast barium enema every 5 years - barium and air to get pic

A

Diagnostic screening after 50 - Colorectal cancer: prevention

41
Q

Decrease fat
Decrease refined carbohydrates - simple sugars
Encourage high fiber foods
Avoid fried food
Increase intake of broccoli, cabbage, cauliflower, and sprouts

A

Modify diets - Colorectal cancer: prevention

42
Q

History
Physical assessment/clinical manifestations
Psychosocial assessment
Laboratory assessment
Imaging:

A

Colorectal cancer: assessment

43
Q

Rectal bleeding - fecal occult blood in stools
Anemia - losing lot blood shown in bloodwork: H&H
Change in stool consistency or shape - mass in there; diff shape good be growing and affecting shape and consistency of stool
Possible abdominal pain
Possible abdominal distention or visible mass - late stages

A

Physical assessment/clinical manifestations - Colorectal cancer: assessment

44
Q

Especially important after diagnosis of cancer; oftentimes need ostomy - lot thoughts in head

A

Psychosocial assessment - Colorectal cancer: assessment

45
Q

Positive FOBT
Elevated carcinoembryonic antigen (CEA): normal is 5 ng/ml - cancer marker; not specific to colon cancer so can be elevated with other malingnant or benign disease and smokers
Decreased Hct and Hbg
Liver function tests may be elevated if metastasis to the liver has occurred

A

Laboratory assessment - Colorectal cancer: assessment

46
Q

Colonscopy (definitive test for the diagnosis; can biopsy)
Double-contrast barium enema
Sigmoidoscopy (definitive test for the diagnosis)
Abdominal computerized tomography (CT) - mass there
Abdominal magnetic resonance imaging (MRI) - mass there

A

Imaging: - Colorectal cancer: assessment

47
Q

Potential for colorectal cancer metastasis - big concern and goal treatment remove tumor and prevent spread
Grieving related to cancer diagnosis - psychosocial effects
Goal of treatment is to remove the entire tumor or as much of the tumor as possible to prevent or slow metastatic spread of the disease

A

Colorectal cancer: nursing diagnosis/planning: Priority nursing diagnoses:

48
Q

Type of intervention is based on the pathologic staging of the disease
Nonsurgical management -
Surgical management

A

Colorectal cancer: interventions

49
Q

Radiation therapy: Can be used pre or post op for either local control for cancer or for pain management - palliative care for less pain and symp
Adjuvant chemotherapy post op - make sure stage 2 and 3 preventing and minimize metastasis in pats
Important to help and talk patients with the side effects of radiation and chemotherapy - lot GI and urinary issues with radiate abd

A

Nonsurgical management -

50
Q

best and what want do - remove tumor and margins beyond tumor so not metastasis or spread of disease - getting all removed; depends on stage or metastasized levels
Surgical removal of the tumor with margins free of disease is the best method
Type of surgery is based on the size of tumor, location, extent of metastasis, integrity of bowel, and condition of patient
Most common surgeries

A

Surgical management

51
Q

Colon resection (removal of the tumor and regional lymph nodes - can also reanastomose where not have ostomy bag)
Colectomy (colon removal with colostomy or ileostomy)
Abdominoperineal (AP) resection (performed when rectal tumors are present-removal of sigmoid colon, rectum and anus)
Vary on how large tumor and where; may have ostomies temporarily or permanent
Let bowel calm down then reastamosis; too much bowel taken then have permanent ostomy

A

Most common surgeries

52
Q

Patient informed that a colostomy is possible - so not shock
Consult to CWOCN (certified wound, ostomy, continence nurse)or ET (enterostomal therapist) - preop teaching; look at abd and do number things - marks best place for stoma; helps prepare pat
Will recommend placement of stoma and provide some pre op instructions
Routine preoperative teaching, including nasogastric tube (NG)
Bowel preparation per surgeon - bowel as clean as possible
Oral or IV antibiotics - decrease risk of peritonitis

A

Colorectal cancer: Preoperative Care

53
Q

Similar to other abdominal surgeries - not increase intrabdominal pressure
IV pain medication immediately post op - PCA pump
NG tube placement initially - wait for peristalsis
After NGT removal - after have persitalsis returns
Star with clear liquids and progress to solid foods as tolerated
Monitor bulb suction drains
If ostomy present then extensive education required - teach ASAP
Minimally invasive surgery versus open resection– less pain, ambulate earlier, shorter hospital stay, can eat solid foods very soon after the procedure, progress faster

A

Colorectal cancer: Postoperative Care

54
Q

A clear ostomy pouch system (also called an appliance) will be in place to allow for visualization of stoma - imp look at the stoma
Assess the color and integrity of the stoma frequently
May be slightly edematous and have a small amount of bleeding initially - look immediately postop
Should start functioning in 2-3 days
Stool consistency depends on where in the colon the stoma was placed:
Collaborate with CWON for education and ongoing stoma and pouch care - good for nurse and pat

A

Colostomy management

55
Q

Healthy stoma should be reddish pink and moist and protrude about ¾ inch (2 cm) from the abdominal wall; beefy; not want be ischemic; protrude from skin

A

Assess the color and integrity of the stoma frequently

56
Q

Liquid: ascending colon
Pasty: traverse colon
More solid: descending colon and sigmoid

A

Stool consistency depends on where in the colon the stoma was placed:

57
Q

Partial (better) or complete
Mechanical
Nonmechanical
Strangulated

A

Intestinal obstruction

58
Q

Bowel is physically blocked
Problems outside the intestine: adhesions - prior surgeries
In the bowel wall: Crohn’s - inflammatory disease
In the intestinal lumen: tumors/mass/fecal impaction
Most common causes in patients over 65: diverticulitis, tumors, fecal impaction

A

Mechanical - Intestinal obstruction

59
Q

Paralytic ileus: peristalsis is decreased or absent as a result of neuromuscular disturbance, resulting in a slowing of the movement or a backup of intestinal contents - common postop comp
Most common cause: handling of the intestines during abdominal surgery

A

Nonmechanical - Intestinal obstruction

60
Q

Obstruction bowel twists with compromised blood flow - emergency; take care of it; necrotic if bowels ischemic for too long

A

Strangulated - Intestinal obstruction

61
Q

Abdominal discomfort or pain
Upper or epigastric abdominal distention
Nausea and early, profuse vomiting - LOT
Possible visible peristaltic waves in upper and middle abdomen
Obstipation (no passage of stool) - leakage around obstruction as well
Severe fluid and electrolyte imbalances - vomiting more

A

Intestinal obstruction CM: Small-Bowel Obstruction

62
Q

Intermittent lower abdominal cramping
Lower abdominal distention
Minimal or no vomiting
Obstipation or ribbon-like stools
No major fluid and electrolyte imbalances
High pitched bowel sounds transitioning to absent bowel sounds

A

Intestinal obstruction CM: Large Bowel Obstruction

63
Q

WBC usually normal unless a strangulated obstruction present or perforation - elevated
H/H, creatinine, BUN values are often elevated because of dehydration - vomiting
Na, Cl, K decreased because of loss of fluid and electrolytes - vomiting; suctioning
Amylase may be elevated with strangulated obstructions - damage because of pancreas: Can cause damage to the pancreas

A

Intestinal obstruction: assessment - Laboratory assessment

64
Q

Abdominal computerized tomography scan (CT) - most common thing; more definitive diagnosis
Abdominal ultrasound
Sigmoidoscopy or colonoscopy

A

Intestinal obstruction: assessment - Imaging

65
Q

Not used when perforation or complete obstruction is suspected
Not lot can do; esp for prep

A

Sigmoidoscopy or colonoscopy

66
Q

Try these first - esp those with ileus
NPO
NGT
Assess the NGT for proper placement, patency, and output every 4 hours - output frequently for bowels
Assess and record passage of flatus and character of bowel movements daily
Assess and treat nausea
IV fluid replacement and maintenance - not TPN unless long period timeMonitor VS, weight, I/O and electrolytes because issues
Monitor pain - NG tube decreased pain: perforation and peritonitis as well
Assist patient to obtain a position of comfort with frequent position changes to promote increased peristalsis - not want straight up; want get bowels moving

A

Intestinal obstruction: nonsurgical interventions

67
Q

Placed to low intermittent suction - avoid irritation

A

NGT

68
Q

Parenteral nutrition may be indicated if the patient has chronic nutritional problems or has been NPO for an extended period

A

IV fluid replacement and maintenance - not TPN unless long period time

69
Q

Increase or change may indicate perforation of the intestine or peritonitis
Opiod analgesics may be temporarily withheld so clinical manifestations of perforation or peritonitis are not masked
Discomfort is generally less with nonmechanical obstruction
treat pain; ileus: cautious opioids and other things - slow down bowel

A

Monitor pain - NG tube decreased pain: perforation and peritonitis as well

70
Q

Semi-Fowler’s position may help alleviate the pressure of abdominal distention on the chest

A

Assist patient to obtain a position of comfort with frequent position changes to promote increased peristalsis - not want straight up; want get bowels moving

71
Q

If nonsurgical not effective
In mechanical obstruction, surgical intervention is necessary to relieve the obstruction
Exploratory laparotomy
More specific surgical procedures depend on the cause of the obstruction
Patients have either minimally invasive surgery (MIS) via laparoscopy (most common today) or conventional open approach
Post op care

A

Intestinal obstruction: surgical interventions

72
Q

Surgical opening of the abdominal cavity to investigate the cause of the obstruction
What going on; risk factors for obstruction is surgery

A

Exploratory laparotomy - Intestinal obstruction: surgical interventions

73
Q

Lysis of adhesions - cut and release
Tumor resection - remove tumor
Colon resection with temporary or permanent colostomy - diverticulitis
Embolectomy or thrombectomy - necrotic tissue
Colectomy - take out whole colon

A

More specific surgical procedures depend on the cause of the obstruction - Intestinal obstruction: surgical interventions

74
Q

NG tube in place - bowel surgeries/nonsurg interventions
Slow introduction of PO intake
Assess for bowel sounds, flatus and stool indicating peristalsis return - start with clear liquids and move up
Not increase intrabdominal pressure to ensure staying good

A

Post op care - Intestinal obstruction: surgical interventions

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