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Med Surg 1 > care of pt. with inflammatory intestinal disorders > Flashcards

care of pt. with inflammatory intestinal disorders Flashcards

1
Q

complications of peritonitis

A
  • adhesions
  • exudates
  • inflamed peritoneum
  • absecessess
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2
Q

peritonitis patho

A
  • Life-threatening, acute inflammation and infection of visceral/parietal peritoneum and endothelial lining of abdominal cavity
  • Often caused by contamination of the peritoneal cavity by bacteria or chemicals
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3
Q

peritonitis history

A
  • Pain, type, and location, is the pain localized or generalized
  • Fever
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4
Q

peritonitis physical assessment & s/s

A
  • Movement may be guarded
  • Abdominal pain, tenderness, and distention
  • Bowel sounds usually disappear with progression of inflammation
  • The cardinal signs of peritonitis are abdominal pain, tenderness, and distention
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5
Q

peritonitis psychosocial assessment

A
  • Patient may be fearful and anxious about implications of a diagnosis of peritonitis
  • Distressed due to physical pain
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6
Q

peritonitis lab assessment

A
  • WBC- often elevated to 20, 000/mm3 with a high neutrophil count (leukocytosis)
  • BLOOD CULTURES- determines whether septicemia has occurred and to identify causative organism for antibiotic treatment
  • Assess fluid and electrolyte balance: POTASSIUM, SODIUM, CHLORIDE
  • BUN, creatinine
  • Hemoglobin, hematocrit
  • ABG, oxygen saturation
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7
Q

peritonitis imaging assessment

A
  • Abdominal x-rays or ultrasound

- Computerized tomography (CT) scan may be performed

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8
Q

peritonitis prioritizing cues

A
  • Acute pain due to abdominal inflammation and infection

- Potential for fluid volume shift due to fluid moving into interstitial or peritoneal space

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9
Q

peritonitis nonsurgical

A
  • Assess vital signs frequently, noting any change that may indicate septic shock: fever, tackycardia, increased rr, hypotension, increased wbc
  • **Monitor mental status changes for confusion or altered level of consciousness
  • Decrease chances of infection
  • Observe and document wound drainage
  • Administer broad- spectrum antibiotics
  • **Provide oxygen as prescribed and according to patient’s respiratory status and O2 saturation
  • ***Manage pain
  • Restore fluid volume balance: hypertonic IV fluids and broad-spectrum antibiotics needed
  • NGT placed if a laparotomy is anticipated
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10
Q

surgical management peritonits

A
  • Exploratory laparotomy or laparoscopy

- Open conventional surgical procedure

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11
Q

peritonitis outcomes

A
  • Verbalizes relief or control of pain

- Experiences restoration of fluid balance

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12
Q

mcburneys point

A

located midway between the anterior iliac crest and the umbilicus in the right lower quadrant. This is the classic area for localized tenderness during the later stages of appendicitis.

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13
Q

appendicitis

A

Acute inflammation of the vermiform appendix

Most common cause of RLQ pain

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14
Q

appendicits inflammation occurs

A

when lumen (opening) of appendix is obstructed (blocked), leading to infection as bacteria invades the wall of the appendix

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15
Q

what causes pain in appendicits

A

When the lumen is blocked, the mucosa secretes fluid, increasing pain

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16
Q

abscess

A

abscess (a localized infection in which there is a collection of pus) can develop if the process occurs slowly

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17
Q

peritonitis complications

A

gangrene, sepsis, perforation can occur

  • All complications of peritonitis are serious.
  • Gangrene and sepsis can occur within 24 to 36 hours, are life threatening and are some of the most common indications for emergency surgery.
  • Perforation may develop, but the risk rises rapidly after 48 hours
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18
Q

appendicitis recognize cues

A
  • RLQ abdominal pain, followed by nausea and vomiting
  • Cramping pain in the epigastric and periumbilical area
  • Anorexia
  • McBurney point **
  • Abdominal pain that increases with cough or movement and is relieved by bending the right hip or the knees suggest perforation and peritonitis
  • ***Rebound tenderness- assessment of muscle rigidity and guarding on palpation of the abdomen and pain after the release of pressure
  • Moderate ***WBC elevation- moderate elevation to 10, 000 to 18, 000/mm3, greater than 20, 000/mm3 may indicate a perforated appendix
  • **Ultrasound may show enlarged appendix
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19
Q

nonsurgical appendicitis

A
  • Keep ***NPO to prepare for probability of surgery and avoid making the inflammation worse
  • **Manage pain prior to surgical intervention
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20
Q

surgical appendicitis

A
  • Appendectomy as soon as possible
  • Appendectomy- the removal of the inflamed appendix by one of several surgical procedures which includes a laparoscopy, natural orifice transluminal endoscopic surgery (NOTES), and a laparotomy
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21
Q

gastroenteritis

A
  • Causes diarrhea and/or vomiting related to inflammation of the mucous membranes of the stomach and intestinal tract
  • Self-limiting to ~ 3 days
  • Can require medical attention or hospitalization for older adults or patients who are immunosuppressed since dehydration and hypovolemia can occur as complications
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22
Q

what bowl is most effected in gastroenteritis

A

The small bowel is most commonly affected, can be caused by viral (more common) or bacterial infection

23
Q

what is the leading foodborne disease that causes gastroenteritis

A

norovirus

24
Q

Gastroenteritis: Health Promotion and Maintenance

A
  • Norovirus often occurs where large groups of people are in close proximity
  • Handwashing
  • Sanitize surfaces
  • Proper food and beverage preparation is important to prevent contamination
25
Q

gastroeneteritis assessment

A
  • Ask about recent travel, eating at restaurants or elsewhere
  • ***Nausea and vomiting usually occurs first, followed by abdominal cramping and diarrhea
  • For older adults or people who are immunocompromised, weakness and **dysrhythmias may occur from loss of potassium (hypokalemia) from diarrhea
  • Monitor for hypokalemia and hypovolemia (dehydration)
26
Q

gastroenteritis interventions

A
  • Encourage **fluid replacement and oral rehydration therapy (ORT)
  • Antibiotics may be needed if the gastroenteritis is caused by bacterial infection with fever and severe diarrhea
  • Consider ways to reducer skin irritation
  • For leakage of stool, the patient can use an absorbent cotton or panty liner and for incontinence, pads can be used at night
    Prevent transmission of gastroenteritis
27
Q

ulcerative colitis

A

Widespread chronic inflammation of the rectum and rectosigmoid colon
Can extend into entire colon
Has periodic remissions and exacerbations

28
Q

ulcerative colotis many factors

A
  • exacerbations, including infection
  • The intestinal mucosa becomes hyperemic (increased blood flow), edematous, and reddened
  • With severe inflammation, the lining can bleed and ulcers can occur
  • Stool contains blood and mucus
  • Patients report tenesmus (an unpleasant and urge sensation to defecate) and lower abdominal colicky pain relieved with defecation
29
Q

ulcerative colitis are at risk for

A

impaired fluid and electrolyte balance as a result of diarrhea, including dehydration and hypokalemia

30
Q

common symtoms ulcerative colitis

A
  • Malaise
  • anorexia
  • anemia,
  • dehydration
  • fever
  • weight loss
31
Q

ulcerative colitis history

A
  • Nutrition and elimination history
  • Consider family history of Inflammatory bowel disease
  • Rule out Clostridium difficile infection
  • Has the patient traveled to or emigrated from a tropical area
  • Any recent NSAID use
32
Q

physical assessment & s/s of uc

A
  • May have low-grade fever
  • Note any abdominal distention along the colon
  • Assess for signs and symptoms associated with extraintestinal complications, such as inflamed joints and lesions inside the mouth
  • Usually finding are nonspecific
33
Q

ulcerative colitis lab assessment

A
  • Hematocrit and hemoglobin
  • Increased WBC, C-reactive protein, erythrocyte sedimentation rate (ESR) is consistent with inflammatory disease
  • ***Low sodium, potassium, chloride
  • ***Hypoalbuminemia
34
Q

diagnotic assessment ulcerative colitis

A
  • Magnetic resonance enterography (MRE) is the main examination used to study chronic Inflammatory Bowel Disease (IBD)
  • Upper endoscopy
  • ***Colonoscopy
  • ***CT scan can confirm the disease or its complications
  • **`Barium enemas with air contrast can show differences between Ulcerative colitis and Crohn’s disease
35
Q

ulcerative colitis hypothesis

A
  • Diarrhea due to inflammation of the bowel mucosa
  • Acute or persistent pain due to inflammation and ulceration of the bowel mucosa and skin irritation inflammation
  • Potential for lower GI bleeding and resulting anemia due to Ulcerative colitis
36
Q

managing diarrhea ulcerative colitis

A
  • Patient should **record color, volume, frequency, and consistency of stools
  • **Monitor skin in the perianal area for irritation and ulceration resulting from loose, frequent stools
  • **Stool cultures may be sent for analysis
  • If patient is hospitalized, ***patient will be weighed
37
Q

consider nutrional therapy and rest ulcerative colitis

A
  • Patients with severe symptoms who are hospitalized are NPO to allow for bowel rest
  • Consider foods that may increase diarrhea, cramping or GI symptoms
  • During exacerbations, rest is encouraged
38
Q

drug therapy for uc

A
  • Common drug therapy includes aminosalicylates, glucocorticoids, antidarrheal drugs and immunomodulators
39
Q

complementary and inegrative health uc

A
  • Herbs (flaxseed), selenium, and Vitamin C

- Biofeedback, hypnosis, yoga, and Ayurveda (a combination of diet, yoga, herbs, and breathing techniques)

40
Q

ulcerative colitis surgical management

A
  • Surgery performed with complications such as toxic megacolon, hemorrhage, bowel perforation, dysplastic biopsy results and colon cancer
    -Temporary or permanent ileostomy may be placed
    -An ileostomy is a procedure
    External pouching system
41
Q

illeostomy

A

a procedure in which a loop of the ileum is placed through an opening in the abdominal wall (stoma) for drainage of fecal material into a pouching system worn on the abdomen

42
Q

external pouching system

A

consists of solid skin barrier (wafer), to protect the skin and a fecal collection device (pouch)

43
Q

operative procedures for ulcerative colitis

A
  • Restorative proctocolectomy with ileo pouch- pouch anal anastomosis (PCA- IPAA)- gold standard for patients with ulcerative colitis
  • Total proctocolectomy with a permanent ileostomy- done for patients who are not candidates for or do not want an ileo-anal pouch
  • Involves removal of the colon, rectum, and anus with surgical closure of the anus, the patient has a permanent ostomy
44
Q

ulcerative colitis home care management

A

Self-management occurs at home but may require hospitalization during severe exacerbations or after surgical intervention
Focus on controlling signs and symptoms and monitoring for complications

45
Q

UC self-management education

A
  • TEACH patient about ulcerative colitis, including acute episodes, remissions, and symptom management
  • Instruct patient on how to reduce or control abdominal pain, cramping, and diarrhea
  • REPORT symptoms such as fever higher than 101.0 degrees F, tachycardia, palpitations, and an increase in diarrhea, severe abdominal pain or nausea/vomiting to the primary health care provider
    Certified wound, ostomy, continence nurse (CWOCN) will explain and demonstrate care to the patient and/or family members
46
Q

UC home care resources

A
  • Coordinate with case manager or social worker for home care services like a home care aide or nurse
  • Patient and family need to know where to purchase ostomy supplies
  • Ostomy support group through the United Ostomy Associations of America
47
Q

UC evaluating outcomes

A
  • Experience no diarrhea or a decrease in diarrheal episodes
  • Verbalize decreased pain
  • Have absence of lower GI bleeding
  • Self-manage the ileostomy or ileo-anal pouch (temporary or permanent)
48
Q

crohns disease patho

A
  • Chronic inflammatory disease of small intestine (most often), colon, or both
  • Slowly progressive and unpredictable disease with involvement of multiple regions of the intestine with normal sections in between
  • Recurrent with remissions and exacerbations
  • Inflammation that causes a thickened bowel wall
49
Q

complications of crohns disease

A
  • hemorrhage
  • severe malabsorption
  • malnourishment
  • debilitation
  • cancer (although rare)
50
Q

chrons disease recognizing cues

A
  • Unintentional weight loss, stool characteristics, fever, abdominal pain
  • Assess for distention, masses, Visible Peristalisis
  • Anemia is common
  • Evaluate nutrition and hydration status
  • Inspection of perianal area may reveal ulcerations, fissures, and fistulas
  • During auscultation, bowel sounds may be decreased or absent with severe inflammation or obstruction
  • fatty sttol, loose stool, constant pain
51
Q

nonsurgical management for chrons

A
  • drug therapy
  • fistual management
nutrition therapy 
- bowl rest 
- nutrition suuport with TPN
- Ensure & Sustacal
advoid gi stimulatns
52
Q

fistual management

A

treatment includes

  • nutrition and electrolyte therapy, skin care, and prevention of infection
  • patient requires at least 3000 calories daily to promote healing of fistula
  • Total enteral nutrition (TEN) or TPN may be needed
  • if the patient cannot take adequate fluids and electrolytes; skin barriers, pouching systems, and insertion drains needed to reduce skin irritation
  • relaxation therapies to relax the patient and soothe the GI tract
53
Q

surgical managment of chrohns disease

A
  • patients who have not improved with medical management or for patients with complications from the disease such as perforation, massive hemorrhage, intestinal obstruction or strictures. Abscesses or cancer
  • Patient with a fistula may undergo a resection of the diseased area
  • Surgery for Crohn’s disease not as successful as that for ulcerative colitis because of the extent of the disease

Med Surg 1 (25 decks)

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