Ch. 48 & 49 Flashcards
IBS is
irritable bowel syndrome
- F > M; generally younger women
most common digestive disorder
IBS
- affects 1/5 people in the US
IBS causes
- diarrhea
- constipation
- abdominal pain
causes of IBS
unclear
- environmental
- genetics
- stress (stress and anxiety triggers)
- diet can trigger IBS: wheat, dairy (gluten & lactose)
IBS classifications
- IBS-D: diarrhea
- IBS-C: constipation
- IBS-A: alternating diarrhea/constipation
- IBS-M: mix of diarrhea/constipation
IBS: s/sx
- fatigue, malaise
- abdominal pain
- changes in bowel patterns (patient’s own pattern changes)
IBS interventions
- health teaching: high-fiber diet
- drug therapy- BASED ON THE SX THEY ARE HAVING
- stress reduction (yoga, meditation)
IBS drug therapy
- metamucil- for constipation
- loperamide (immodium)- for diarrhea
- probiotics (for good flora in the intestines)
peritonitis
- Life-threatening, acute inflammation and infection of visceral/parietal peritoneum and endothelial lining of abdominal cavity
causes of peritonitis
- 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
peritonitis: incidence and prevalence
- 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
peritonitis assessment: history (sx)
- pain, type, location (abdominal pain)
- fever, N/V
peritonitis assessment: s/sx
- movement may be guarded (hand across abdomen)
- rigid, board-like abdomen (cardinal sign)
- abdominal pain, tenderness, distention
peritonitis assessment: pyschosocial
anxiety associated with it
- stress related to dx
peritonitis assessment: labs
- 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
peritonitis assessment: imaging
- abdominal x-rays and ultrasound (shows inflammation of the abdominal peritoneum)
peritonitis: priority problems
- acute pain
- potential for fluid volume shift
peritonitis interventions
- manage pain: with pain meds
- treat infection: with antibiotics
- restore fluid volume balance: NPO, IVF
peritonitis evaluation
- verbalizes relief or control of pain
- experiences fluid and electrolyte balance (I&Os)
appendicitis
- Acute inflammation of the vermiform appendix
- RLQ
- Inflammation occurs when lumen of appendix is obstructed, leading to infection
the classic area for localized tenderness during the later stages of appendicitis
McBurney’s point
- located midway between the anterior iliac crest and the umbilicus in the right lower quadrant
appendicitis complications
- abscess
- gangrene
- sepsis
- perforation of intestine
- peritonitis
appendicitis interventions
non-surgical
- keep NPO
- IVF/ IV ABT
- pain meds
surgical
- need to do ASAP
- appendectomy (can usually go home same day or next day)
appendicitis assessment: s/sx
Abdominal pain - RLQ
Muscle rigidity
Guarding and rebound
N and V, anorexia
appendicitis assessment: labs/ diagnostics
- moderate elevated WBC- like 20,000
- CT scan to confirm - then going to OR to have it removed
*ultrasound may show enlarged appendix
gastroenteritis
- 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
gastroenteritis: prevention
- norovirus often occurs where large groups of people are in close proximity (cruise ships, nursing homes)
- handwashing
- sanitize surfaces
- proper food and beverage preparation
gastroenteritis assessment
- ask about recent travel (think unfiltered water), eating at restaurants or elsewhere (salmonella outbreaks)
- GI sx (upper and lower)
- fluid volume deficit
gastroenteritis interventions
- 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
ulcerative colitis
- 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
causes of ulcerative colitis
- exact cause unknown
- genetic: often found in families and twins
- immunologic
- environmental factors
- cellular changes can increase colon cancer risk
ulcerative colitis is typically diagnosed at what age
most are diagnosed between 20-35 years old (younger person’s d/o)
how many people with IBS experience ulcerative colitis too?
about half
ulcerative colitis assessment: history
- nutrition and elimination history
- when does diarrhea happen?
- what is normal elimination pattern?
ulcerative colitis assessment: s/sx
- Bloody diarrhea- Frequent Stools containing blood and mucus**
- Weight loss**
- Abdominal pain
- Low grade fever
- Fatigue**
*Usually findings are nonspecific
ulcerative colitis assessment: psychosocial
anxiety
ulcerative colitis assessment: labs
- Hematocrit and hemoglobin (decreased- blood loss through bowels)
- Increased WBC, C-reactive protein, ESR (may be elevated)
- Low sodium, potassium, chloride
- Hypoalbuminemia
ulcerative colitis assessment: diagnostic tests
- 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
ulcerative colitis priority problems
- diarrhea
- acute or persistent pain
- potential for lower GI bleeding
- skin breakdown (acid from the diarrhea)
ulcerative colitis interventions
- 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)
ulcerative colitis: drug therapy
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)
ulcerative colitis evaluation
- 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)
crohn’s disease
- Chronic inflammatory disease of small intestine, (lg intestine) colon, or both
- Inflammation that causes a thickened bowel wall
complications of crohn’s
- hemorrhage
- severe malabsorption
- malnourishment
- debilitation
- cancer (although rare)
crohn’s assessment: s/sx
- 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
crohn’s assessment: labs/ diagnostics
- low hemoglobin and hematocrit
- elevated ESR
- abdominal x-rays, MRE*
- biopsy
crohn’s disease interventions
non-surgical management
- 5 ASA: mesalamine, sulfasalazine
surgical management
- to fix fistulas
crohn’s disease (overview)
- 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)
ulcerative colitis (overview)
- 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
crohn’s: drug therapy
- sulfasalazine (azullfidine)
- corticosteroids
crohn’s interventions
- manage diarrhea
- manage pain
- prevent or monitor for lower GI bleeding
- nutrition therapy
- drugs
- surgery
crohn’s care coordination
- home care management
- self-management education
- health care resources
diverticular disease
- 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
diverticulosis vs diverticulitis
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
complications of diverticular disease
- Perforation resulting in peritonitis
- Hemorrhage
- Obstruction
diverticular disease diagnostics
- CBC- WBC
- Stool for OB
- U/s or sigmoidoscopy
diverticular disease assessment: s/sx
May have no symptoms
May have abdominal pain, fever, tachycardia, nausea, vomiting
Abdominal distention, tenderness
Diverticulosis – no clinical manifestations
Diverticulitis – LLQ abd pain - fever
diverticular disease interventions
nonsurgical management
- drug therapy
- nutrition therapy:
- High fiber diet
- Fluids
- Avoid alcohol
surgical management
- resection with or without colostomy
diverticular disease: drug therapy (diverticulitis)
Antibiotics *
- Metronidazole **
- Ciprofloxacin **
Mild analgesics
Anticholinergics
diverticular disease: patient teaching (diverticulosis)
- High fiber diet
- Fluids
- Avoid alcohol
- S/S of diverticulits: LLQ pain
- Avoid laxatives
- Care of colostomy
foods to avoid with diverticular disease
avoid foods with seeds [can get lodged/stuck in diverticula]:
- everything bagel
- berries (strawberries, grapes, raspberries)
- corn
- popcorn
- watermelon
- nuts
