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NU 340 > Ch. 48 & 49 > Flashcards

Ch. 48 & 49 Flashcards

1
Q

IBS is

A

irritable bowel syndrome
- F > M; generally younger women

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2
Q

most common digestive disorder

A

IBS
- affects 1/5 people in the US

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3
Q

IBS causes

A
  • diarrhea
  • constipation
  • abdominal pain
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4
Q

causes of IBS

A

unclear
- environmental
- genetics
- stress (stress and anxiety triggers)

  • diet can trigger IBS: wheat, dairy (gluten & lactose)
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5
Q

IBS classifications

A
  • IBS-D: diarrhea
  • IBS-C: constipation
  • IBS-A: alternating diarrhea/constipation
  • IBS-M: mix of diarrhea/constipation
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6
Q

IBS: s/sx

A
  • fatigue, malaise
  • abdominal pain
  • changes in bowel patterns (patient’s own pattern changes)
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7
Q

IBS interventions

A
  • health teaching: high-fiber diet
  • drug therapy- BASED ON THE SX THEY ARE HAVING
  • stress reduction (yoga, meditation)
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8
Q

IBS drug therapy

A
  • metamucil- for constipation
  • loperamide (immodium)- for diarrhea
  • probiotics (for good flora in the intestines)
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9
Q

peritonitis

A
  • Life-threatening, acute inflammation and infection of visceral/parietal peritoneum and endothelial lining of abdominal cavity
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10
Q

causes of peritonitis

A
  • Often caused by contamination of the peritoneal cavity by bacteria or chemicals
  • common bacteria (e coli, strep, staph)
  • chemical: leakage of bile, pancreatic enzymes, gastric acid
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11
Q

peritonitis: incidence and prevalence

A
  • most common cause of death from surgical infections with mortality rate of 50%
  • significant post-op complications with 50% mortality rate
  • occurs most commonly in young adults with appendicitis
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12
Q

peritonitis assessment: history (sx)

A
  • pain, type, location (abdominal pain)
  • fever, N/V
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13
Q

peritonitis assessment: s/sx

A
  • movement may be guarded (hand across abdomen)
  • rigid, board-like abdomen (cardinal sign)
  • abdominal pain, tenderness, distention
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14
Q

peritonitis assessment: pyschosocial

A

anxiety associated with it
- stress related to dx

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15
Q

peritonitis assessment: labs

A
  • WBC elevated** (bc its an infection)
  • Blood cultures: bacteria moved out of peritonitis into blood (septicemia)
  • BUN, creatinine (kidney involvement)
  • Hemoglobin, hematocrit
  • ABG, oxygen saturation
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16
Q

peritonitis assessment: imaging

A
  • abdominal x-rays and ultrasound (shows inflammation of the abdominal peritoneum)
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17
Q

peritonitis: priority problems

A
  • acute pain
  • potential for fluid volume shift
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18
Q

peritonitis interventions

A
  • manage pain: with pain meds
  • treat infection: with antibiotics
  • restore fluid volume balance: NPO, IVF
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19
Q

peritonitis evaluation

A
  • verbalizes relief or control of pain
  • experiences fluid and electrolyte balance (I&Os)
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20
Q

appendicitis

A
  • Acute inflammation of the vermiform appendix
  • RLQ
  • Inflammation occurs when lumen of appendix is obstructed, leading to infection
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21
Q

the classic area for localized tenderness during the later stages of appendicitis

A

McBurney’s point
- located midway between the anterior iliac crest and the umbilicus in the right lower quadrant

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22
Q

appendicitis complications

A
  • abscess
  • gangrene
  • sepsis
  • perforation of intestine
  • peritonitis
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23
Q

appendicitis interventions

A

non-surgical
- keep NPO
- IVF/ IV ABT
- pain meds

surgical
- need to do ASAP
- appendectomy (can usually go home same day or next day)

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24
Q

appendicitis assessment: s/sx

A

Abdominal pain - RLQ
Muscle rigidity
Guarding and rebound
N and V, anorexia

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25
Q

appendicitis assessment: labs/ diagnostics

A
  • moderate elevated WBC- like 20,000
  • CT scan to confirm - then going to OR to have it removed
    *ultrasound may show enlarged appendix
26
Q

gastroenteritis

A
  • very common health problem
  • diarrhea and vomiting
  • can be a viral or bacterial infection (viral more common)
  • self-limiting to 2-3 days
  • can require medical attention/hospitalization for older adults or patients who are immunosuppressed
27
Q

gastroenteritis: prevention

A
  • norovirus often occurs where large groups of people are in close proximity (cruise ships, nursing homes)
  • handwashing
  • sanitize surfaces
  • proper food and beverage preparation
28
Q

gastroenteritis assessment

A
  • ask about recent travel (think unfiltered water), eating at restaurants or elsewhere (salmonella outbreaks)
  • GI sx (upper and lower)
  • fluid volume deficit
29
Q

gastroenteritis interventions

A
  • encourage fluid replacement and oral rehydration therapy (IVF at hospital if vomiting and diarrhea is really bad)
  • antibiotics may be needed if bacterial cause
  • viral sort of just works its way out; no ABT needed
  • NO ANTIDIARRHEAL MEDS: want bug to work its way out of GI tract
30
Q

ulcerative colitis

A
  • Widespread chronic inflammation of the rectum and rectosigmoid colon (mainly in large intestine, spec. colon)
  • Can extend into entire colon
  • Has periodic remissions and exacerbations
  • often confused with Crohn disease
31
Q

causes of ulcerative colitis

A
  • exact cause unknown
  • genetic: often found in families and twins
  • immunologic
  • environmental factors
  • cellular changes can increase colon cancer risk
32
Q

ulcerative colitis is typically diagnosed at what age

A

most are diagnosed between 20-35 years old (younger person’s d/o)

33
Q

how many people with IBS experience ulcerative colitis too?

A

about half

34
Q

ulcerative colitis assessment: history

A
  • nutrition and elimination history
  • when does diarrhea happen?
  • what is normal elimination pattern?
35
Q

ulcerative colitis assessment: s/sx

A
  • Bloody diarrhea- Frequent Stools containing blood and mucus**
  • Weight loss**
  • Abdominal pain
  • Low grade fever
  • Fatigue**

*Usually findings are nonspecific

36
Q

ulcerative colitis assessment: psychosocial

A

anxiety

37
Q

ulcerative colitis assessment: labs

A
  • Hematocrit and hemoglobin (decreased- blood loss through bowels)
  • Increased WBC, C-reactive protein, ESR (may be elevated)
  • Low sodium, potassium, chloride
  • Hypoalbuminemia
38
Q

ulcerative colitis assessment: diagnostic tests

A
  • MRE** magnetic resonance enterography: drink oral contrast solution, go in for imaging of contrast going through GI
  • upper endoscopy: upper GI tract
  • colonoscopy: lower GI tract; through rectum
39
Q

ulcerative colitis priority problems

A
  • diarrhea
  • acute or persistent pain
  • potential for lower GI bleeding
  • skin breakdown (acid from the diarrhea)
40
Q

ulcerative colitis interventions

A
  • manage diarrhea
  • manage pain
  • prevent or monitor for lower GI bleeding (bowels for blood and labs: Hgb&Hct)
  • nutrition therapy
  • drugs
  • surgery- postop ileostomy * pt teaching how to change bag; normal stoma vs inflamed skin, purulent drainage (usually have visiting nurses at home to make sure that they can care for these)
41
Q

ulcerative colitis: drug therapy

A

5-ASA
- mesalamine
- sulfasalazine
- corticosteriods (7 day course of prednisone to keep the inflammation under control with flare ups)

may be on 1 or multiple
* meds work well but don’t work right away (2-4 weeks to work)

42
Q

ulcerative colitis evaluation

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- usually temporary bag)
43
Q

crohn’s disease

A
  • Chronic inflammatory disease of small intestine, (lg intestine) colon, or both
  • Inflammation that causes a thickened bowel wall
44
Q

complications of crohn’s

A
  • hemorrhage
  • severe malabsorption
  • malnourishment
  • debilitation
  • cancer (although rare)
45
Q

crohn’s assessment: s/sx

A
  • Unintentional weight loss
  • Stool characteristics: frequent (less frequent than ulcerative colitis) soft, loose stools, Steatorrhea – fatty; rarely bloody
  • Fever, abdominal pain
  • Assess for distention, masses, visible peristalsis
  • Fistulas from bowel to other organs
  • Anemia is common
46
Q

crohn’s assessment: labs/ diagnostics

A
  • low hemoglobin and hematocrit
  • elevated ESR
  • abdominal x-rays, MRE*
  • biopsy
47
Q

crohn’s disease interventions

A

non-surgical management
- 5 ASA: mesalamine, sulfasalazine

surgical management
- to fix fistulas

48
Q

crohn’s disease (overview)

A
  • Small intestines
  • Etiology unknown
  • Peak incidence 15-40y
  • 5-6 soft, loose stools per day, steatorrhea
  • Complications:
    • Fistulas
    • Nutritional deficiencies
  • Surgery frequent (to fix fistulas)
49
Q

ulcerative colitis (overview)

A
  • Rectum and Colon
  • Etiology unknown
  • Peak incidence 15-25y; 55-65y
  • Diarrhea 10-20 liquid bloody stools per day
  • Complications:
    • Hemorrhage
    • Nutritional deficiencies
  • Surgery infrequent
50
Q

crohn’s: drug therapy

A
  • sulfasalazine (azullfidine)
  • corticosteroids
51
Q

crohn’s interventions

A
  • manage diarrhea
  • manage pain
  • prevent or monitor for lower GI bleeding
  • nutrition therapy
  • drugs
  • surgery
52
Q

crohn’s care coordination

A
  • home care management
  • self-management education
  • health care resources
53
Q

diverticular disease

A
  • Can occur in any part of the small or large intestine
  • Diverticula without inflammation usually cause few problems (diverticular vs diverticulitis)
  • Abscess, peritonitis can develop
54
Q

diverticulosis vs diverticulitis

A

Diverticulosis- outpouching of walls of intestine
- not super serious
- take precautions to prevent diverticulitis
- no clinical s/x; usually don’t know they have it

Diverticulitis – inflammation or infection of diverticulum
- low grade fever, N/V, abdominal pain LLQ

55
Q

complications of diverticular disease

A
  • Perforation resulting in peritonitis
  • Hemorrhage
  • Obstruction
56
Q

diverticular disease diagnostics

A
  • CBC- WBC
  • Stool for OB
  • U/s or sigmoidoscopy
57
Q

diverticular disease assessment: s/sx

A

May have no symptoms
May have abdominal pain, fever, tachycardia, nausea, vomiting
Abdominal distention, tenderness

Diverticulosis – no clinical manifestations

Diverticulitis – LLQ abd pain - fever

58
Q

diverticular disease interventions

A

nonsurgical management
- drug therapy
- nutrition therapy:
- High fiber diet
- Fluids
- Avoid alcohol
surgical management
- resection with or without colostomy

59
Q

diverticular disease: drug therapy (diverticulitis)

A

Antibiotics *
- Metronidazole **
- Ciprofloxacin **

Mild analgesics
Anticholinergics

60
Q

diverticular disease: patient teaching (diverticulosis)

A
  • High fiber diet
  • Fluids
  • Avoid alcohol
  • S/S of diverticulits: LLQ pain
  • Avoid laxatives
  • Care of colostomy
61
Q

foods to avoid with diverticular disease

A

avoid foods with seeds [can get lodged/stuck in diverticula]:
- everything bagel
- berries (strawberries, grapes, raspberries)
- corn
- popcorn
- watermelon
- nuts

NU 340 (26 decks)

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