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

care of pt. with noninflammatory intestinal disorders Flashcards

1
Q

types of intestinal obstruction

A

mechanical

nonmechanical

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2
Q

mechanical obstruction

A

the bowel is physically blocked by problems outside the intestine (e.g., adhesions), in the bowel wall (e.g., Crohn’s disease), or in the intestinal lumen (e.g., tumors)

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3
Q

non-mechanical obstruction

A

Does not involve a physical obstruction in or outside the intestine, peristalsis is decreased or absent because of neuromuscular disturbance, resulting in slowing of the movement or backup of intestinal contents

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4
Q

complications of an obstruction

A
  • fluid and electrolyte balance and acid base balance
  • Severe hypovolemia results in acute kidney injury or even death
  • Bacterial peritonitis with or without perforation
  • Closed-loop obstruction (blockage in two different areas) or strangulated obstruction (obstruction with compromised blood flow that can be life threatening)
  • Septic Shock
  • Sepsis and bleeding can result in an increased intra-abdominal pressure (IAP) or acute compartment syndrome
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5
Q

types of mechanical obstruction

A

telescoping of bowel

intussusception

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6
Q

etiology and genetic risk for mechanical obstrcution

A
  • Adhesions (scar tissue from surgeries or pathology)
  • Tumors
  • Appendicitis complications
  • Hernia
  • FECAL IMPACTION (especially in order adults)
  • STRICTURES (due to Crohn’s disease, a chronic inflammatory bowel disease, or previous radiation surgery)
  • Intussusception (telescoping of a segment of the intestine within itself)
  • Volvulus (twisting of the intestine)
  • Fibrosis (due to disorders such as endometriosis)
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7
Q

Etiology and Genetic Risk nonmechanical obstrucution

A

Handling of intestines during surgery

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8
Q

intestinal obstruction history

A
  • GI disorders, surgeries, treatments
  • Recent N/V, color of emesis
  • Pain (attention to onset, aggravating factors, alleviating factors, and patterns or rhythms of pain)
  • Elimination habits
  • SINGULTUS (hiccups) is common with all types of intestinal obstruction
  • Family history of colorectal cancer (CRC)
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9
Q

physical assessment of obstruction

A

Obstipation (NO PASSAGE OF STOOL), PAIN OR CRAMPING. Vomiting, Distention, alteration in bowel pattern, blood in stool, peristaltic waves, high-pitched bowel sounds (borborygmi), ABSENT BOWL SOUNDS, minimal abdominal tenderness and rigidity

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10
Q

lab assessment of intestinal obstruction

A
  • WBC
  • Hemoglobin and hematocrit
  • Creatinine
  • BUN
  • Serum sodium, chloride, potassium**
  • Serum amylase
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10
Q

lab assessment of intestinal obstruction

A
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11
Q

diagnsotic assessment for IO

A
  • CT or MTI
  • Abdominal ultrasound
  • An ENDSCOPY (sigmoidoscopy or colonoscopy)
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12
Q

what does IO have a potential for

A

Potential for life-threatening complications due to reduced flow or blocked flow of intestinal contents

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13
Q

nonsurgical management for IO

A
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13
Q

nonsurgical management for IO

A
  • NASOGASTRIC TUBE
  • NPO status
  • IV Fluid replacement and maintenance (monitor weight for fluid balance)
  • Disempaction and enemas for obstruction due to fecal impaction
  • For post-op ileus, alvimopan may be used short term
  • MOUTH CARE
  • PAIN management
  • Turn and reposition
  • Antibiotics most likely ordered if strangulation is suspected
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14
Q

surgical management for IO

A
  • Exploratory laparotomy (a surgical opening of the abdominal cavity)
  • Conventional open surgical approach
  • Laparoscopic surgery (MIS)
  • Colectomy (surgical removal of the entire colon) in severe cases
15
Q

evaluation of outcomes for IO

A
  • Have relief from the obstruction and no evidence of life-threatening complications. –> rupture, peritonitis, eschema
  • Report that he or she has returned to having USUAL bowel habits.
16
Q

colorectal

A

refers to colon and rectum, which together make up large intestine

17
Q

colonscopy

A
  • CT-guided virtual colonoscopy: noninvasive and includes a CT scan of the rectum and colon
  • Sigmoidoscopy: provides visualization of the lower colon using a fiberoptic scope
  • COLONOSCOPY (definitive test): provides views of the entire large bowel from the rectum to the ileocecal valve
18
Q

colostomies ascending colostomy

A

right-sided tumors

19
Q

colostomies tranverse

A

colostomy—used in emergencies and has two stomas

20
Q

colostomies descending colostomy

A

left-sided tumors

21
Q

sigmoid colostomies

A

rectal tumors

22
Q

slef management education colostomy

A
  • Before teaching, teach the patient to avoid lifting heavy objects or straining on defecation to prevent tension on anastomosis site
  • Patient should avoid driving and extreme physical activity for 4 to 6 weeks while the incision heals
  • Laparoscopy: patient can return to normal activity within 1- 2 weeks
23
Q

IBS

A

IBS: A functional GI disorder that causes chronic or recurrent diarrhea, constipation, and/or abdominal pain and bloating
Most common digestive disorder
One in five people in the U.S.

24
Q 
ibs classdications
d
c
a
m
A

IBS-D (diarrhea)
IBS-C (constipation)
IBS-A (alternating diarrhea/constipation)
IBS-M (mix of diarrhea/constipation)

25
Q

assessment findings ibs

A
  • Fatigue, malaise
  • Cramps
  • ABDOMINAL PAIN
  • Changes in bowel patterns (***constipation, diarrhea, or an alternating pattern of both)
  • Consistency of stools
  • Passage of mucus
  • FOOD INTOLERANCE
  • NAUSEA
  • Belching, gas, anorexia and bloating
26
Q

health teaching for IBS

A

dietary fiber and bulk; 30 to 40 g fiber each day; eat regular meals, drink 8 to 10 glasses of water each day, and chewing food slowly help promote normal bowel function

27
Q

drug therapy ibs

A

bulk-forming or antidiarrheal agents and/or newer drugs to control symptoms such as pain, laxatives

28
Q

complemenatry and integrative health

A
  • probiotics, peppermint oil

- Stress reduction: relaxation techniques, meditation, and/or yoga, counseling, exercise

29
Q

herniation

A

A weakness in the abdominal muscle wall through which a segment of the bowel or other abdominal structure protrudes
Any hernia that is not reducible requires immediate surgical evaluation

30
Q

strangulated hernia

A

there is ischemia and obstruction of the bowel loop, which can lead to necrosis of the bowel, sepsis and possible bowel perforation. Signs of strangulation are abdominal distention, N/V, pain, fever, and tachycardia

31
Q

assessment hernication

A
  • “Lump” or protrusion
  • Absent bowel sounds = medical emergency
  • The hernia is never forcibly reduced; this maneuver could cause strangulated intestine or rupture
32
Q

non surgical management herniation

A
  • Truss: a pad made with firm material
  • Herniorrhaphy: a minimally invasive inguinal hernia repair (MIIHR) through a laparoscope is the surgery of choice, a conventional open herniorrhaphy performed when laparoscopy is not appropriate
33
Q

hemmrrhoids

A

Swollen or distended veins in anorectal region
Internal, external, prolapsed

  • Prevention of constipation, straining
  • Bleeding, swelling, prolapse
  • Manage pain, increase dietary fiber
  • Hemorrhoidectomy can be performed if needed

Med Surg 1 (25 decks)

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