Chapter 47 Lower Gastrointestinal Problems Part 1 Flashcards
What are some common gastrointestinal (GI) problems?
Diarrhea, constipation, fecal incontinence, inflammatory bowel problems, infectious bowel problems, bowel trauma, bowel obstructions, colorectal cancer (CRC), abdominal and bowel surgery, malabsorption problems
This list covers a wide variety of GI issues that patients may experience.
What are the conceptual problems patients often face related to GI issues?
Impaired elimination and nutrition
These issues can significantly affect a patient’s overall health and well-being.
What symptoms are commonly associated with gastrointestinal problems?
Inflammation, pain, altered fluid and electrolyte balance
These symptoms can complicate the treatment and management of GI conditions.
What are the common goals in managing gastrointestinal problems?
Promoting optimal bowel habits and nutrition
These goals are essential for improving patient outcomes and quality of life.
Fill in the blank: Patients often have problems with impaired _______ and nutrition.
elimination
Impaired elimination can lead to various complications in GI health.
What is diarrhea?
The passage of at least 3 loose or liquid stools per day.
Diarrhea can be classified as acute, persistent, or chronic based on duration.
What is the duration of acute diarrhea?
14 days or less.
What is the duration of persistent diarrhea?
Longer than 14 days.
What is chronic diarrhea?
Diarrhea lasting 30 days or longer.
What is health care-associated diarrhea?
Acute diarrhea in a hospitalized patient that starts after 3 days of hospitalization and was not present on admission.
It is fairly common, developing in up to one-third of patients.
What is the primary cause of acute diarrhea?
Ingesting infectious organisms.
What causes most cases of infectious diarrhea in the United States?
Viruses.
What are the manifestations of Campylobacter jejuni infection?
Diarrhea, abdominal cramps, fever, sometimes nausea, vomiting. Lasts about 7 days.
Commonly associated with undercooked poultry.
What type of food is Clostridioides difficile associated with?
Undercooked poultry and unpasteurized milk.
Most frequent in summer months.
What are the symptoms of Clostridium perfringens infection?
Diarrhea, abdominal cramps, nausea, vomiting.
Occurs 6-24 hours after eating contaminated food.
What can prolonged use of antibiotics lead to in relation to Clostridium perfringens?
Increased susceptibility to infection due to exposure to feces-contaminated surfaces.
Spores on hands and surfaces are hard to kill.
What are the manifestations of Enterohemorrhagic Escherichia coli infection?
Severe abdominal cramping, bloody diarrhea, vomiting, low-grade fever. Can progress to life-threatening renal failure.
Lasts 5-7 days.
What are the symptoms of Norovirus infection?
Fever, vomiting, profuse watery diarrhea. Lasts 3-8 days.
Most common cause of travelers’ diarrhea.
How is Salmonella transmitted?
Transmitted via fecal-oral route or in food or water contaminated with infected feces.
Reservoir includes poultry, reptiles, and other animals.
What are the symptoms of Giardia lamblia infection?
Diarrhea, abdominal cramping, nausea, vomiting. Lasts about 2 weeks.
May be fatal in those who are immunocompromised.
True or False: Shigella can cause diarrhea that lasts 4-7 days.
True
Symptoms may include diarrhea (sometimes bloody), fever, stomach cramps.
What is the transmission method for Cryptosporidium?
Transmitted in stool of infected human or animal.
Highly contagious and can contaminate recreational water.
Fill in the blank: Enterotoxigenic E. coli can lead to _______.
[diarrhea, abdominal cramps, nausea, vomiting]
Symptoms may last 3-4 days.
What is a common symptom of Rotavirus infection?
Watery diarrhea.
Lasts about 1-3 days and may cause dehydration.
What are the symptoms associated with Staphylococcus infection?
Nausea, vomiting, abdominal cramps, diarrhea. Rapid onset, lasts 1-2 days.
Usually mild but can be severe in some cases.
What is a key characteristic of the outer shell of Cryptosporidium?
Allows it to live for long periods outside of the body and makes it resistant to chlorine.
Common cause of waterborne disease.
What type of water is Norovirus commonly found in?
Fresh lakes and rivers, swimming pools, water parks, and hot tubs.
Highly contagious and transmitted mainly by fecal-oral route.
What high-risk groups are particularly susceptible to Cryptosporidium in the United States?
Travelers, recent immigrants, and men who have sex with men.
Most common in tropical areas.
What is a common cause of bloody diarrhea in the United States?
Bacterial infection with Escherichia coli O157:H7
It is transmitted by undercooked beef or chicken contaminated with the bacteria or in fruits and vegetables exposed to contaminated manure.
What is the most common GI parasite that causes diarrhea in the United States?
Giardia lamblia
This parasite is prevalent and often associated with contaminated water.
How do some infectious organisms attack the intestines?
They change the secretion and/or absorption of enterocytes or cause inflammation
Examples include Rotavirus A, Norovirus, and G. lamblia.
What is secretory diarrhea?
A result of bacterial or viral infections that causes oversecretion of water, sodium, and chloride into the bowel
It occurs when ingested pathogens survive in the GI tract long enough to absorb into the enterocytes.
What factors influence a person’s susceptibility to gastrointestinal pathogens?
Age, gastric acidity, intestinal microflora, and immune status
Older adults are particularly at risk for life-threatening diarrhea.
What effect do proton pump inhibitors (PPIs) have on pathogen survival?
They increase the chance that pathogens will survive
This is because stomach acid kills ingested pathogens.
What is the role of normal flora in the human colon?
They aid in fermentation and provide a microbial barrier against pathogens
Antibiotics can kill normal flora, increasing susceptibility to infections.
What is C. difficile infection (CDI) associated with?
Most serious hospital-associated diarrhea and common cause of hospital-acquired GI illness
Patients receiving broad-spectrum antibiotics are particularly susceptible.
What can cause diarrhea besides infection?
Drugs and food intolerances
For example, large amounts of undigested substances can lead to osmotic diarrhea.
What are the clinical manifestations of infections attacking the upper GI tract?
Large-volume, watery stools, cramping, and periumbilical pain
Patients often experience a low-grade or no fever, nausea, and vomiting.
What diagnostic studies are typically performed for diarrhea?
Stool cultures, blood cultures, and measuring stool electrolytes, pH, and osmolality
These tests help determine the cause and severity of diarrhea.
What is the primary concern in treating acute infectious diarrhea?
Preventing transmission, replacing fluid and electrolytes, and protecting the skin
Most patients tolerate oral fluids for mild diarrhea.
What is the role of antidiarrheal drugs?
They have limited short-term use to coat and protect mucous membranes, absorb irritating substances, and decrease intestinal secretions
They are not a primary treatment for infectious diarrhea.
What are antidiarrheal drugs not recommended for?
Major infectious diarrheas
They potentially prolong exposure to the organism.
What is a major concern with fecal microbiota transplantation (FMT)?
Potential for transmitting infectious agents in the donor stool
Careful screening and intimate physical contact with the recipient can minimize this risk.
In what condition are antidiarrheal drugs used cautiously?
Inflammatory bowel disease (IBD)
They can cause toxic megacolon.
When are antibiotics used in treating acute diarrhea?
For certain infections or when the infected person is severely ill or immunosuppressed
They rarely have a role otherwise.
What two antibiotics are recommended for empiric therapy in adults with acute diarrhea?
- Ciprofloxacin
- Azithromycin
What is Clostridioides difficile infection (CDI)?
A hazardous health care-associated infection (HAI)
Risk is highest in patients on antimicrobial, chemotherapy, gastric acid-suppressing, or immunosuppressive drugs.
How long can C. difficile spores survive on objects?
Up to 70 days
What may be used to prevent CDI or as an adjunct therapy?
Lactobacillus probiotics
What is the treatment for CDI?
- Oral vancomycin (125 mg 4 times a day)
- Fidaxomicin (200 mg twice daily) for 10 days
What should be done with non-essential antibiotics and antidiarrheal drugs during CDI treatment?
They should be stopped
What is a treatment option for patients who cannot be treated with vancomycin or fidaxomicin?
Metronidazole
What are signs of severe, complicated CDI?
- Shock
- Hypotension
- Ileus
- Megacolon
What is the risk of recurrent CDI?
Occurs in about 20% of patients
What is fecal microbiota transplantation (FMT) used for?
Recurrent CDI
What is the process of preparing donor stool for FMT?
Pureed into a liquid slurry consistency using saline, water, or pasteurized cow’s milk
What clinical problems can arise from acute infectious diarrhea?
- Impaired bowel elimination
- Fluid imbalance
- Electrolyte imbalance
What is the mechanism of action for bismuth subsalicylate (Pepto-Bismol)?
Decreases secretions and has weak antibacterial activity.
Used to prevent travelers’ diarrhea.
What are the nursing considerations for bismuth subsalicylate (Pepto-Bismol)?
May cause tinnitus and confusion. Do not use with GI bleeding.
Caution patient to avoid alcohol.
What is the mechanism of action for diphenoxylate with atropine (Lomotil)?
Decreases peristalsis and intestinal motility.
Opioid and anticholinergic.
What are the nursing considerations for diphenoxylate with atropine (Lomotil)?
Blurred vision, dry mouth, drowsiness may occur. Take as directed. Overdose may be life-threatening.
Caution patient to avoid alcohol.
What is the mechanism of action for loperamide (Imodium, Pepto Diarrhea Control)?
Inhibits peristalsis, delays transit, increases absorption of fluid from stools.
Taken after each stool; up to 6 doses per day.
What are the nursing considerations for loperamide (Imodium, Pepto Diarrhea Control)?
May cause drowsiness. Use caution with hazardous activities.
Take as directed.
What is the mechanism of action for octreotide acetate (Sandostatin)?
Suppresses serotonin secretion, stimulates fluid absorption from GI tract, decreases intestinal motility.
What are the nursing considerations for octreotide acetate (Sandostatin)?
Given subcutaneously, intramuscularly, or intravenously. May cause gall bladder or liver problems.
What is the mechanism of action for paregoric (camphorated tincture of opium)?
Decreases peristalsis and intestinal motility.
Opioid.
What are general nursing considerations for antidiarrheal drugs?
Caution patient to avoid alcohol. May cause drowsiness. Use caution with hazardous activities.
What are the overall goals for a patient with diarrhea?
- Resumption of normal bowel patterns
- Normal fluid, electrolyte, and acid-base balance
- Normal nutrition status
- No perianal/perineal skin breakdown
These goals aim to restore the patient’s health and prevent complications.
What is the initial assumption regarding the cause of acute diarrhea?
All cases are considered infectious until the cause is known
This approach emphasizes the need for infection control measures.
What is essential for infection control in patients with diarrhea?
Strict infection control precautions
This includes hand hygiene and isolation measures.
What hand hygiene practice is crucial in limiting the spread of C. difficile?
Meticulous hand washing with soap and water
Alcohol-based hand cleaners are ineffective against C. difficile spores.
What should be done immediately for patients with CDI?
Put them in isolation
This helps prevent the spread of infection to others.
What personal protective equipment should visitors and providers wear for patients with CDI?
Gloves and gowns
This is to protect against contamination.
What should infected patients be provided with for their use?
Disposable stethoscopes and thermometers
This prevents cross-contamination.
How should surfaces and equipment be disinfected in the room of a CDI patient?
Using a 10% bleach solution or a disinfectant labeled as C. difficile sporicidal
This ensures effective elimination of spores.
What is fecal incontinence?
The involuntary loss of stool
It occurs when the structures that maintain continence are damaged.
What is required for voluntary defecation to occur?
An intact neuromuscular system
This system enables control over bowel movements.
True or False: Alcohol-based hand cleaners are effective against C. difficile spores.
False
Only soap and water are effective for this purpose.
What are the overall goals for a patient with diarrhea?
- Resumption of normal bowel patterns
- Normal fluid, electrolyte, and acid-base balance
- Normal nutrition status
- No perianal/perineal skin breakdown
These goals aim to restore the patient’s health and prevent complications.
What is the initial assumption regarding the cause of acute diarrhea?
All cases are considered infectious until the cause is known
This approach emphasizes the need for infection control measures.
What is essential for infection control in patients with diarrhea?
Strict infection control precautions
This includes hand hygiene and isolation measures.
What hand hygiene practice is crucial in limiting the spread of C. difficile?
Meticulous hand washing with soap and water
Alcohol-based hand cleaners are ineffective against C. difficile spores.
What should be done immediately for patients with CDI?
Put them in isolation
This helps prevent the spread of infection to others.
What personal protective equipment should visitors and providers wear for patients with CDI?
Gloves and gowns
This is to protect against contamination.
What should infected patients be provided with for their use?
Disposable stethoscopes and thermometers
This prevents cross-contamination.
How should surfaces and equipment be disinfected in the room of a CDI patient?
Using a 10% bleach solution or a disinfectant labeled as C. difficile sporicidal
This ensures effective elimination of spores.
What is fecal incontinence?
The involuntary loss of stool
It occurs when the structures that maintain continence are damaged.
What is required for voluntary defecation to occur?
An intact neuromuscular system
This system enables control over bowel movements.
True or False: Alcohol-based hand cleaners are effective against C. difficile spores.
False
Only soap and water are effective for this purpose.
What subjective health information is important to consider for diarrhea assessment?
Recent travel, hospitalization, infections, stress, diverticulitis or malabsorption, metabolic disorders, IBD, IBS
IBD: Inflammatory Bowel Disease, IBS: Irritable Bowel Syndrome
Which medications are associated with diarrhea?
Laxatives or enemas, magnesium-containing antacids, sorbitol-containing suspensions or elixirs, antibiotics, methyldopa, digitalis, colchicine, OTC antidiarrheal drugs
OTC: Over-The-Counter
What functional health patterns might be observed in a patient with diarrhea?
- Chronic laxative use
- Malaise
- Ingestion of fatty and spicy foods
- Food intolerances
- Anorexia
- Nausea
- Vomiting
- Weight loss
- Thirst
- Increased stool frequency, volume, and looseness
- Change in color and character of stools
- Steatorrhea
- Abdominal bloating
- Decreased urine output
- Abdominal tenderness
- Abdominal pain
- Cramping
- Tenesmus
Steatorrhea: Fatty stools
What objective data might indicate diarrhea?
- Lethargy
- Sunken eyeballs
- Fever
- Malnutrition
- Frequent soft to liquid stools
- Altered stool color
- Abdominal distention
- Hyperactive bowel sounds
- Pus, blood, mucus, or fat in stools
- Fecal impaction
- Pallor
- Dry mucous membranes
- Poor skin turgor
- Perianal irritation
- Decreased output
- Concentrated urine
Fecal impaction: A condition where stool becomes hard and lodged in the intestines
What possible diagnostic findings are associated with diarrhea?
- Abnormal serum electrolyte levels
- Anemia
- T WBC
- Eosinophilia
- Hypoalbuminemia
- Positive stool cultures
- Ova, parasites, leukocytes, blood, or fat in stool
- Abnormal sigmoidoscopy or colonoscopy findings
- Abnormal lower GI series
T WBC: Total White Blood Cell count, GI: Gastrointestinal
What is the first nursing management action for a patient with diarrhea?
Ensure the patient maintains an adequate fluid intake
This includes encouraging oral fluids containing glucose and electrolytes.
What types of fluids should be encouraged for patients with diarrhea?
Oral fluids containing glucose and electrolytes
IV fluids and electrolytes may also be administered as ordered.
What medications may be administered to a patient with diarrhea?
Antidiarrheal and antibiotic drugs
These should be given as ordered by a healthcare provider.
What precautions should be implemented for patients with diarrhea?
Proper isolation and infection control precautions
This is essential to prevent the spread of infection.
What should be maintained to monitor a patient’s condition with diarrhea?
Accurate intake and output records, recording weight daily
This helps in assessing the patient’s hydration status.
What should be done to assist a patient with perianal care?
Assist the patient with keeping the perianal area clean
Applying a moisturizing skin barrier cream may also be needed.
What can be used to reduce perianal irritation and pain?
Dibucaine, witch hazel, or sitz baths
These options help soothe the affected area.
What measures can be implemented to make toileting easier for patients?
Call light in reach, easy-to-manage clothing, assistive devices available, and provide privacy
Using a deodorizer can also help maintain comfort.
What dietary recommendation should be made to a patient with diarrhea?
Increase high fiber foods, such as whole-grain breads and cereals, and fresh fruits and vegetables
This is unless contraindicated.
What should patients be taught to avoid to help manage diarrhea?
Foods and fluids known to worsen diarrhea
This education is critical for symptom management.
What is the first nursing management action for a patient with diarrhea?
Ensure the patient maintains an adequate fluid intake
This includes encouraging oral fluids containing glucose and electrolytes.
What types of fluids should be encouraged for patients with diarrhea?
Oral fluids containing glucose and electrolytes
IV fluids and electrolytes may also be administered as ordered.
What medications may be administered to a patient with diarrhea?
Antidiarrheal and antibiotic drugs
These should be given as ordered by a healthcare provider.
What precautions should be implemented for patients with diarrhea?
Proper isolation and infection control precautions
This is essential to prevent the spread of infection.
What should be maintained to monitor a patient’s condition with diarrhea?
Accurate intake and output records, recording weight daily
This helps in assessing the patient’s hydration status.
What should be done to assist a patient with perianal care?
Assist the patient with keeping the perianal area clean
Applying a moisturizing skin barrier cream may also be needed.
What can be used to reduce perianal irritation and pain?
Dibucaine, witch hazel, or sitz baths
These options help soothe the affected area.
What measures can be implemented to make toileting easier for patients?
Call light in reach, easy-to-manage clothing, assistive devices available, and provide privacy
Using a deodorizer can also help maintain comfort.
What dietary recommendation should be made to a patient with diarrhea?
Increase high fiber foods, such as whole-grain breads and cereals, and fresh fruits and vegetables
This is unless contraindicated.
What should patients be taught to avoid to help manage diarrhea?
Foods and fluids known to worsen diarrhea
This education is critical for symptom management.
What are the two main functions that can result in fecal incontinence when impaired?
Motor function and sensory function
Motor function involves the contraction of sphincters and rectal floor muscles, while sensory function relates to the ability to perceive stool presence and the urge to defecate.
What is the most common cause of sphincter injury in women?
Obstetric trauma
Obstetric trauma can occur during childbirth and may lead to damage to the anal sphincters.
Which factors contribute to fecal incontinence in older adults?
Aging, menopause, mobility problems, chronic constipation
Mobility problems can prevent timely access to toilets, and chronic constipation may lead to fecal impaction.
What is fecal impaction?
A collection of hardened feces in the rectum or sigmoid colon that cannot be expelled
It often leads to incontinence when liquid stool seeps around the hardened feces.
What diagnostic method can reveal reduced anal canal muscle tone?
Rectal examination
A rectal examination can also detect internal prolapse, rectocele, hemorrhoids, masses, and fecal impaction.
What dietary changes are recommended to manage fecal incontinence?
High-fiber diet and increased intake of caffeine-free fluids
Fiber supplements or bulk-forming laxatives can help increase stool bulk and firm consistency.
Which medications are useful in slowing gastrointestinal transit for fecal incontinence?
Antidiarrheal drugs, such as loperamide
These medications can help manage the symptoms of fecal incontinence.
What is the role of physical therapy in managing fecal incontinence?
Improves awareness of rectal sensation and strengthens external sphincter contraction
Biofeedback training is a component of physical therapy that requires intact sensory and motor nerves.
What is the purpose of mild electrical stimulation in fecal incontinence treatment?
Targets communication problems between the brain and pelvic floor muscles
This treatment can improve quality of life and sphincter control.
What is dextranomer/hyaluronic acid gel (Solesta) used for?
To treat fecal incontinence by injecting into the anal canal
It builds up tissue in the anal area, narrowing the canal and improving muscle closure.
When is surgery indicated for fecal incontinence?
When conservative treatments fail, in cases of full-thickness prolapse, or for anal sphincter repair
A colostomy may be necessary in some cases.
What are common triggers for diarrhea that should be reduced in the diet?
- Caffeine
- Artificial sweeteners
- Dairy products
- High gas-producing vegetables
- Vegetables containing insoluble fiber
Examples of high gas-producing vegetables include broccoli, cabbage, and cauliflower.
What should be assessed in patients with fecal incontinence?
Bowel patterns, current habits, stool consistency, volume, frequency, and symptoms
Assessment should also include any pain during defecation.
What is a common cause of anal sphincter weakness related to childbirth?
Childbirth injury
Name a surgical procedure that can lead to anal sphincter weakness.
Anorectal surgery for hemorrhoids, fistula, fissures
List two conditions that can cause inflammation leading to fecal incontinence.
- IBD
- Radiation
What type of problems can affect toileting ability in functional fecal incontinence?
Physical or mobility problems
Name a neurological disease associated with fecal incontinence.
Multiple sclerosis
What is one congenital abnormality that can lead to fecal incontinence?
Spina bifida
Fill in the blank: Chronic _______ can contribute to fecal incontinence.
constipation
True or False: Stroke can be a cause of fecal incontinence.
True
What condition involves the denervation of pelvic muscles due to chronic straining?
Denervation of pelvic muscles from chronic straining
List two common causes of fecal incontinence related to neurologic disease.
- Brain tumor
- Diabetes
What pelvic floor dysfunction can lead to fecal incontinence?
Rectal prolapse
Name a condition that can cause fecal impaction.
Diarrhea
What injury can lead to anal sphincter weakness apart from surgery?
Perineal trauma or pelvic fracture
What is a common complication of aging that affects fecal incontinence?
Frail older person who cannot get to the bathroom in time
Fill in the blank: Internal sphincter _______ can cause fecal incontinence.
thinning
Name a condition that can lead to fecal incontinence due to nerve damage.
Neuropathy
What type of injury can lead to anal sphincter weakness from a medical procedure?
Anorectal infection
What is a common cause of anal sphincter weakness related to childbirth?
Childbirth injury
Childbirth can lead to trauma affecting the anal sphincter.
Name a physical condition that can lead to functional incontinence.
Physical or mobility problems
Examples include a frail older person who cannot get to the bathroom in time.
What are two inflammatory diseases that can cause fecal incontinence?
- IBD
- Radiation
Inflammatory bowel disease (IBD) and radiation exposure can lead to gastrointestinal issues.
Which neurologic disease is characterized by brain lesions affecting bowel control?
Brain tumor
Brain tumors can disrupt normal neural pathways responsible for bowel control.
What congenital abnormalities are associated with fecal incontinence?
- Spina bifida
- Myelomeningocele
These conditions can affect the spinal cord and surrounding structures.
What condition involves the weakening of the internal anal sphincter?
Internal sphincter thinning
This can occur due to various factors including aging and trauma.
List two causes of fecal incontinence related to pelvic floor dysfunction.
- Fistula
- Rectal prolapse
Both conditions can disrupt normal bowel function and control.
True or False: Chronic constipation can lead to fecal incontinence.
True
Chronic constipation can cause fecal impaction, leading to incontinence.
Fill in the blank: Neuropathy is a common cause of _______ incontinence.
fecal
Neuropathy can affect the nerves that control bowel function.
Name a complication of fecal impaction.
Diarrhea
Fecal impaction can lead to overflow diarrhea, causing incontinence.
What is a potential outcome of perineal trauma or pelvic fracture?
Anal sphincter weakness
Such injuries can compromise the integrity of the anal sphincter.
What is a common cause of fecal incontinence in older adults?
Dementia
Cognitive decline can impair the ability to recognize the need to use the bathroom.
List three neurologic diseases that can result in fecal incontinence.
- Diabetes
- Multiple sclerosis
- Stroke
These conditions can disrupt normal bowel function through various mechanisms.
What type of surgery may lead to anal sphincter weakness?
Anorectal surgery for hemorrhoids, fistula, fissures
Surgical interventions in this area can compromise sphincter function.
Fill in the blank: Chronic straining can lead to denervation of _______ muscles.
pelvic
Chronic straining may result in muscle damage affecting bowel control.
What is the Bristol Stool Scale used for?
To assess stool consistency
It provides a standardized way to describe the form of stool.
What sensation might indicate issues with bowel evacuation?
Feeling of incomplete evacuation (tenesmus)
What is fecal incontinence associated with?
Incontinence-associated dermatitis (IAD)
IAD results from chemical irritants in feces causing skin damage.
What are common symptoms of IAD?
- Redness
- Skin loss
- Rash
Where is IAD typically located?
- Perianal area
- Perineal area
- Buttocks
- Upper thighs
What is a recommended first step in bowel training?
Know the patient’s usual bowel pattern
What is the best time to schedule elimination for bowel training?
Within 30 minutes after breakfast
What medications can be administered to stimulate bowel evacuation?
- Bisacodyl
- Glycerin suppository
- Small phosphate enema
What is digital stimulation used for?
To stimulate the anorectal reflex
What is a stool management system?
A system that funnels liquid stool from the rectum into a containment system
Examples include Flexi-Seal, DigniCare, Actiflo.
What should be avoided when managing fecal incontinence?
Using a rectal tube or urinary catheter as a stool catheter
What is essential for maintaining perineal skin integrity?
Fecal containment
What are options for skin cleansing in patients with fecal incontinence?
- Hydrating skin cleansing foam
- Incontinence clean-up cloths
- Baby wipes
What should be avoided in skin care products for sensitive skin?
Products that contain alcohol
What is a common emotional factor that can contribute to constipation?
Anxiety, depression, and stress
What defines constipation?
Fewer than 3 stools per week
What are common risk factors for chronic constipation?
- Low-fiber diet
- Decreased physical activity
- Ignoring the defecation urge
What can prolonged retention of feces lead to?
Drying of stool due to water absorption
What is cathartic colon syndrome?
A condition in which the colon becomes dilated and atonic due to chronic laxative use
What is the clinical presentation of constipation?
Varies from mild discomfort to severe events mimicking an ‘acute abdomen’.
May include absent or hard, dry stools, abdominal distention, bloating, increased flatus, and increased rectal pressure.
What are hemorrhoids a common complication of?
Chronic constipation.
Result from venous engorgement caused by repeated Valsalva maneuvers and venous compression from hard, impacted stool.
What is the Valsalva maneuver?
A technique where the patient inspires deeply and holds the breath while contracting abdominal muscles and bearing down.
Increases intraabdominal and intrathoracic pressures, reducing venous return to the heart.
What serious outcomes can the Valsalva maneuver have for patients?
May be fatal for patients with heart failure, cerebral edema, hypertension, and coronary artery disease.
Can lead to a transient drop in arterial pressure followed by a sudden increase when the patient relaxes.
What complications may arise from chronic constipation?
Rectal mucosal ulcers, fissures, and diverticulosis.
Colonic perforation can occur in cases of obstipation or fecal impaction.
What are the signs of colonic perforation?
Abdominal pain, nausea, vomiting, fever, and a high WBC count.
Perforation is life-threatening.
How is constipation typically diagnosed?
Based on history and physical assessment, including abdominal assessment, inspection of the perianal and rectal region, and digital rectal examination (DRE).
Concerning signs include sudden changes in bowel habits, rectal bleeding, iron deficiency anemia, weight loss, significant abdominal pain, and palpable mass.
What diagnostic tests may be needed if concerning signs are present?
Abdominal x-rays, barium enema, colonoscopy, or sigmoidoscopy.
Tests are necessary to rule out serious diseases like colorectal cancer (CRC).
What interprofessional care strategies can prevent constipation?
Increasing fiber intake, fluid intake, and exercise.
Lifestyle modifications are key to prevention.
What are the options for treating constipation?
Laxatives and enemas.
Each class of laxative works differently based on the severity and duration of constipation.
What type of laxatives can prevent constipation?
Daily bulk-forming laxatives (e.g., psyllium).
They work like dietary fiber and do not cause dependence.
What is the next recommended treatment for chronic constipation if diet and lifestyle modifications do not work?
Osmotic laxatives.
Stimulant laxatives are for patients who do not respond to osmotic laxatives.
What precautions should be taken when using enemas?
Must be used cautiously, especially those containing sodium phosphate and magnesium.
Can cause electrolyte imbalances in older adults and patients with heart and kidney problems.
What therapies target constipation from opioid use?
Peripherally acting opioid receptor antagonists (methylnaltrexone, naldemedine, naloxegol).
These do not block the analgesic effects of opioids.
What type of drugs are associated with constipation?
Cardiovascular, Central nervous system, GI, Other
This includes various drug classifications that can lead to constipation as a side effect.
Name two categories of cardiovascular drugs associated with constipation.
- Antihypertensives (B-adrenergic blockers, calcium channel blockers)
- Furosemide
These drugs can affect bowel motility and lead to constipation.
Which type of hypolipidemic drugs can cause constipation?
- Cholestyramine
- Colestipol
- Statins
These medications help lower cholesterol levels but may also contribute to constipation.
What are some antidepressants that are associated with constipation?
- Tricyclics
- Selective serotonin reuptake inhibitors
These classes of antidepressants can have gastrointestinal side effects, including constipation.
List two antiepileptics that may lead to constipation.
- Carbamazepine
- Phenytoin
- Clonazepam
Antiepileptic drugs can impact gut motility and contribute to constipation.
Which antipsychotic medications are linked to constipation?
- Butyrophenones
- Phenothiazines
- Barbiturates
These medications are used to treat psychiatric disorders and can have gastrointestinal side effects.
What class of drugs do benzodiazepines belong to regarding constipation?
Central nervous system drugs
Benzodiazepines can cause sedation and may also contribute to reduced bowel activity.
Which antacids are known to cause constipation?
- Antacids containing aluminum
- Antacids containing calcium
These antacids can neutralize stomach acid but may have a constipating effect.
Name two types of supplements that can lead to constipation.
- Bismuth
- Calcium
- Iron
These supplements are often taken for various health benefits but can affect bowel movements.
What type of analgesics are associated with constipation?
Opiates and derivatives
These pain relievers are well-known for causing constipation as a common side effect.
Which antitussives may cause constipation?
- Codeine
- Dextromethorphan
These cough suppressants can have a constipating effect as they act on the central nervous system.
What are some colonic disorders that can cause constipation?
- Cancer
- Diverticular disease
- IBD
- Intestinal stenosis
- Intussusception
- Luminal or extraluminal obstructing lesions
- Prolapse
- Rectocele
Colonic disorders are significant contributors to constipation and involve various structural or functional abnormalities of the colon.
Name a systemic disorder associated with collagen vascular disease that can lead to constipation.
- Amyloidosis
- Systemic lupus erythematosus
- Systemic sclerosis (scleroderma)
Collagen vascular diseases can impact gastrointestinal motility and contribute to constipation.
List metabolic/endocrine disorders that may cause constipation.
- Chronic renal failure
- Diabetes
- Hypercalcemia/hyperparathyroidism
- Hypokalemia
- Hypothyroidism
- Pheochromocytoma
- Pregnancy
Metabolic and endocrine disorders can disrupt normal bowel function, leading to constipation.
Which neurologic disorder is associated with constipation due to autonomic neuropathy?
Diabetes
Autonomic neuropathy from diabetes can impair bowel motility and contribute to constipation.
What is Hirschsprung megacolon?
A congenital condition causing bowel obstruction due to a lack of nerve cells in the colon
This condition can lead to severe constipation in affected individuals.
True or False: Parkinson disease is a neurologic disorder that can lead to constipation.
True
Parkinson disease can affect gastrointestinal motility and contribute to constipation.
Fill in the blank: Chronic renal failure can lead to _______.
constipation
Chronic renal failure can cause various metabolic changes that affect bowel function.
Name two neurologic disorders that are associated with constipation.
- Multiple sclerosis
- Stroke
Neurologic disorders can disrupt the normal functioning of the gastrointestinal system, leading to constipation.
What is the mechanism of action for bulk forming laxatives?
Absorbs water, increases bulk, stimulating peristalsis
Action usually occurs within 24 hours.
Indications for bulk forming laxatives include:
- Acute constipation
- Chronic constipation
- IBS
- Diverticulosis
Examples include methylcellulose (Citrucel) and psyllium (Metamucil).
What is the primary action of emollients?
Lubricate intestinal tract and soften feces
Action: Softeners in 72 hours, lubricants in 8 hours.
What do prosecretory drugs do?
Increase intestinal fluid secretion, speeding colonic transit
Action usually occurs within 24 hours.
What is the action of saline and osmotic solutions?
Cause retention of fluid in intestinal lumen, reducing stool consistency and increasing volume
Action occurs within 15 minutes to 3 hours.
How do stimulant laxatives work?
Increase peristalsis and speed colonic transit by irritating colon wall
Action usually occurs within 12 hours.
Indications for stimulant laxatives include:
- Acute constipation
- Chronic constipation
- Fecal impaction
- Anorectal conditions
- Chronic idiopathic constipation
- IBS-C (women only)
Common agents include anthraquinones (cascara sagrada, senna) and bisacodyl (Dulcolax).
What are nursing considerations for laxative use?
- Do not use in patients with abdominal pain, nausea, or vomiting
- Must be taken with fluids (≥8 oz)
- Can block absorption of fat-soluble vitamins
May increase bleeding risk in patients on anticoagulants.
What is a potential side effect of stimulant laxatives?
Cause melanosis coli (brown or black pigmentation of colon)
Most widely abused laxatives; should not be used in patients with impaction or obstipation.
Fill in the blank: Emollients do not affect _______.
[peristalsis]
True or False: Saline and osmotic solutions can lead to fluid and electrolyte imbalances in older adults.
True
Overuse in those with renal failure can exacerbate this risk.
What is a common example of a lubricant laxative?
Mineral oil (Fleet Mineral Oil Enema)
Used to soften hard stools.
What is the action time for stimulant laxatives?
Usually within 12 hours
They work by stimulating the enteric nerves.
What can be a result of overusing magnesium or sodium phosphates?
Fluid and electrolyte imbalances
Particularly concerning in older adults or those with renal failure.
What is the action time for prosecretory drugs?
Usually within 24 hours
What condition may help patients who have constipation due to uncoordinated contraction of the anal sphincter?
Anismus
Anismus refers to the inability to relax the anal sphincter during bowel movements.
What might a patient with severe constipation related to bowel motility or mechanical disorders require?
More intense treatment
This may include procedures like colostomy, ileostomy, or continent fecal diversion.
What dietary component is key in preventing and treating constipation?
Fiber
Fiber is found in fruits, vegetables, and grains.
Which foods are especially effective in preventing and treating constipation?
Wheat bran and prunes
Whole wheat and bran are high in insoluble fiber.
How does fiber help alleviate constipation?
By adding to stool bulk and attracting water
Larger, bulkier stools move through the colon more quickly.
What is the recommended fluid intake for preventing constipation?
2 L/day
This may be contraindicated in patients with heart disease or renal failure.
What initial effect may increasing fiber intake have on patients?
Increased gas production
This effect decreases over several days as the body adjusts.
What should be assessed to manage a patient’s constipation?
Usual defecation patterns and habits
Assessment should include onset, duration, stool shape, consistency, and difficulty with evacuation.
What should be taught to patients about managing constipation?
Role of diet, adequate fluid intake, and regular exercise
Emphasizing a high-fiber diet is crucial.
What should be stressed to patients regarding laxatives and enemas?
Use them as ordered
Proper use of laxatives and enemas is part of effective constipation management.
Fill in the blank: Increasing fiber intake may initially increase _______ production.
gas
This is due to fermentation in the colon.
What should patients be taught regarding defecation?
Establish a regular time to defecate and not suppress the urge to defecate.
Regularity in defecation can help prevent constipation and promote bowel health.
What position facilitates easier defecation?
Sitting on a commode with knees higher than hips.
This position allows gravity to aid the process and straightens the angle between the anal canal and rectum.
What is the purpose of using a footstool in front of the toilet?
To promote flexion of the hips.
Flexed hips facilitate the defecation process.
Why is it challenging to defecate while sitting on a bedpan?
The sitting position does not allow gravity to assist effectively.
Bedpans can create discomfort and may not be conducive to natural bowel movements.
What should be done for a patient in bed to facilitate defecation?
Raise the head of the bed as high as the patient can tolerate.
This position can help mimic a sitting posture, which is beneficial for bowel movements.
What factors can cause embarrassment during defecation?
Sights, odors, and sounds of defecation.
Providing privacy and using odor eliminators can help alleviate this embarrassment.
What is recommended to maintain abdominal muscle tone?
Prompt patients to contract abdominal muscles several times a day.
Exercises like sit-ups and straight-leg raises can also improve muscle tone.
What should be discussed with patients who have rigid beliefs about bowel function?
Concerns about bowel function and the adverse consequences of overuse of laxatives and enemas.
Providing accurate information can help address misconceptions.
What is acute abdominal pain?
Pain of recent onset that may signal a life-threatening problem.
Immediate attention is required for acute abdominal pain.
What are common causes of acute abdominal pain?
Damage to organs leading to inflammation, infection, obstruction, bleeding, and perforation.
Each of these causes can lead to urgent medical conditions.
What does perforation of the GI tract result in?
Irritation of the peritoneum and peritonitis.
This condition can lead to severe complications and requires prompt medical intervention.
What can cause hypovolemic shock in the context of acute abdominal pain?
Bleeding or obstruction and peritonitis.
These conditions can lead to significant fluid loss from the vascular space.
What is the most common symptom of an acute abdominal problem?
Pain.
Other symptoms may include nausea, vomiting, diarrhea, constipation, flatulence, fatigue, fever, rebound tenderness, and bloating.
What is the first step in diagnosing acute abdominal pain?
Complete history and physical assessment.
Gathering detailed information about the pain is crucial for accurate diagnosis.
Fill in the blank: The irritation of the peritoneum is referred to as _______.
peritonitis.
Peritonitis can result from perforation of the GI tract and is a serious condition.
What are some important health history factors to consider for constipation?
Colorectal disease, neurologic problems, bowel obstruction, environmental changes, cancer, IBD, diabetes
IBD stands for Inflammatory Bowel Disease.
What are some medications that may be relevant to constipation?
Refer to Table 47.7 for specific medications
Table 47.7 is not provided here but typically includes various medications that can affect bowel function.
What health perception issues might patients with constipation have?
Chronic laxative or enema use, rigid beliefs about bowel function, malaise
These perceptions can significantly impact a patient’s management of constipation.
What nutritional changes may be relevant in assessing constipation?
Changes in diet or mealtime, fiber and fluid intake, anorexia, nausea
Adequate fiber and fluid intake are crucial for preventing constipation.
What elimination changes are indicative of constipation?
Change in usual bowel patterns, hard stool, decrease in stool frequency and amount, flatus, abdominal distention, straining, tenesmus, rectal pressure, fecal incontinence (if impacted)
Tenesmus refers to the feeling of incomplete bowel evacuation.
How might a patient’s activity-exercise level relate to constipation?
Daily activity routine, immobility, sedentary lifestyle
Increased physical activity is often recommended to alleviate constipation.
What cognitive-perceptual symptoms might be present in patients with constipation?
Dizziness, headache, anorectal pain, abdominal pain on defecation
These symptoms can contribute to the patient’s overall discomfort and distress.
What coping-stress tolerance factors may affect constipation?
Acute or chronic stress
Stress can influence bowel habits and exacerbate constipation.
What objective data might indicate constipation?
Lethargy, anorectal fissures, hemorrhoids, abscesses, abdominal distention, hypoactive or absent bowel sounds, palpable abdominal mass, fecal impaction, small hard dry stool, stool with blood
Each of these signs can provide important clues to the patient’s condition.
What diagnostic findings may suggest constipation?
Guaiac-positive stools, abdominal x-ray showing stool in lower colon
Guaiac-positive stools indicate the presence of blood in the stool, which may require further investigation.
What is a common posture observed with peritoneal irritation?
Fetal posture
This is often seen in conditions like appendicitis.
Which symptoms indicate the need for monitoring in patients with kidney stones or gallstones?
Restlessness and inability to find a comfortable position
What physical assessments are performed on patients with acute abdominal pain?
Assessment of the abdomen, rectum, and pelvis
What tests are commonly done for patients with acute abdominal pain?
- Complete blood count (CBC)
- Urinalysis
- Abdominal x-ray
- ECG
- Ultrasound or CT scan
What additional test might be required for women of childbearing age with acute abdominal pain?
Pregnancy test
What is the primary goal of emergency management for acute abdominal pain?
Identify and treat the cause and monitor for complications
Why should pain medications be used cautiously in patients with non-traumatic acute abdominal pain?
To provide pain relief without interfering with diagnostic accuracy
What surgical procedures may be performed if the cause of acute abdominal pain is found?
- Diagnostic laparoscopy
- Laparotomy
What factors are assessed when monitoring a patient with acute abdominal pain?
- Vital signs
- Intake and output
- Skin color and temperature
- Peripheral pulse strength
What does increased pulse and decreasing BP indicate in the context of acute abdominal pain?
Impending shock
What does a fever in a patient with acute abdominal pain suggest?
An inflammatory or infectious process
What clinical problems are associated with acute abdominal pain?
- Pain
- Fluid imbalance
- Risk for infection
What are the overall goals for a patient with acute abdominal pain?
- Relief of abdominal pain
- Resolution of inflammation
- Freedom from complications
- Normal nutrition status
What general care measures should be implemented for patients with acute abdominal pain?
Managing fluid and electrolyte imbalances, pain, and anxiety
What should be assessed at regular intervals in patients with acute abdominal pain?
Quality and intensity of pain
Fill in the blank: Patients with acute abdominal pain may experience _______ guarding and rigidity.
involuntary
True or False: A laparotomy is performed when laparoscopic techniques are adequate.
False
What information can be gained from assessing the abdomen in a patient with acute abdominal pain?
- Distention
- Masses
- Abnormal pulsation
- Symmetry
- Hernias
- Rashes
- Scars
- Pigmentation changes
What is the recommended daily intake of fiber to manage constipation?
20 to 30 g of fiber per day
Gradually increase fiber intake over 1 to 2 weeks to promote stool evacuation.
What foods are high in fiber?
- Raw vegetables and fruits
- Beans
- Breakfast cereals (All-Bran, oatmeal)
Eating prunes or drinking prune juice daily can also stimulate defecation.
What is the role of fluids in managing constipation?
Fluid softens hard stools; drink 2 L/day
Recommended fluids include water and fruit juices, while caffeinated beverages should be avoided.
How often should one exercise to help manage constipation?
At least 3 times per week
Activities can include walking, swimming, or biking, and abdominal exercises can strengthen muscles.
What is the best time to establish a regular schedule for defecation?
First thing in the morning or after the first meal of the day
Many people often feel the urge to defecate during these times.
True or False: It is advisable to delay defecation.
False
Delaying defecation can lead to hard stools and decreased urge to go.
Why is it important to record bowel elimination patterns?
To identify problems early
Regular monitoring helps in maintaining bowel health.
What should be the approach towards the use of laxatives and enemas?
Use as ordered; avoid overuse
Overuse can lead to dependence and inability to have a bowel movement without them.
What are common gynecologic problems that can cause acute abdominal pain?
- Pelvic inflammatory disease
- Ruptured ectopic pregnancy
- Ruptured ovarian cyst
These conditions are critical to consider during assessment for acute abdominal pain.
Name three infectious diseases associated with acute abdominal pain.
- Escherichia coli 0157:H7
- Giardia
- Salmonella
These pathogens can lead to gastrointestinal symptoms and abdominal discomfort.
List at least three inflammatory conditions that can cause acute abdominal pain.
- Appendicitis
- Cholecystitis
- Diverticulitis
- Gastritis
- IBD
- Pancreatitis
- Pyelonephritis
Inflammation of abdominal organs is a significant cause of acute pain.
What vascular problems can lead to acute abdominal pain?
- Mesenteric vascular occlusion
- Ruptured aortic aneurysm
Vascular issues can result in severe abdominal pain and require immediate attention.
What are some other causes of acute abdominal pain?
- Obstruction or perforation of abdominal organ
- GI bleeding or ischemia
- Myocardial infarction
- Trauma
These conditions may mimic abdominal pain and should not be overlooked.
What types of abdominal pain might a patient experience?
- Diffuse
- Localized
- Dull
- Burning
- Sharp
Understanding the characteristics of pain can aid in diagnosis.
What are some assessment findings related to acute abdominal pain?
- Abdominal distention
- Abdominal rigidity
- Diarrhea
- Hematemesis
- Melena
- Nausea and vomiting
- Rebound tenderness
These findings provide critical information for assessment.
What are signs of hypovolemic shock in a patient with acute abdominal pain?
- Low blood pressure
- Cool, clammy skin
- Decreased level of consciousness
- Tachycardia
- Low urine output (<0.5 mL/kg/h)
Recognizing hypovolemic shock is essential for timely intervention.
What initial interventions should be taken for a patient with acute abdominal pain?
- Ensure patent airway
- Apply oxygen via nasal cannula or nonrebreather mask
- Establish IV access with large-bore catheter and infuse warm normal saline or lactated Ringer’s solution
- Obtain blood for CBC and electrolyte levels
- Obtain blood for amylase level, pregnancy tests, clotting studies, and type and crossmatch as appropriate
- Insert indwelling urinary catheter
- Obtain urinalysis
- Insert NG tube as needed
These steps are crucial for stabilization and further evaluation.
What ongoing monitoring should be conducted for a patient with acute abdominal pain?
- Monitor vital signs
- Monitor level of consciousness
- Monitor oxygen saturation
- Monitor intake/output
- Obtain pain assessment
- Assess amount and character of emesis
- Anticipate surgical intervention
- Keep patient NPO
Continuous monitoring helps in detecting any changes in the patient’s condition.
What should be provided to a patient experiencing ingestion problems?
Medication and other comfort measures
Includes maintaining a calm environment and providing information to decrease anxiety.
What are key indicators of hypovolemic shock?
Vital signs, intake and output, level of consciousness
Ongoing assessments of these indicators are crucial.
What does postoperative care depend on?
The type of surgery performed
Refer to specific nursing care plans for detailed guidance.
After surgery, what color should the drainage from an NG tube typically be after 12 hours?
Light yellowish-brown or greenish tinge
Dark brown to dark red may indicate fresh blood.
What does ‘coffee-grounds’ granules in NG tube drainage indicate?
Blood has been changed by acidic gastric secretions
This indicates the presence of digested blood.
What common conditions may cause nausea and vomiting after a laparotomy?
Surgery, decreased peristalsis, pain medications
Antiemetics like ondansetron may be administered.
What can lead to abdominal distention and gas pains post-surgery?
Swallowed air, reduced peristalsis, manipulation of abdominal organs, anesthesia
Early ambulation helps alleviate these symptoms.
What should a patient start on after surgery regarding diet?
Clear liquids
Gradually progresses to a regular diet if tolerated.
What are patients often restricted from lifting after surgery?
Anything heavier than a few pounds
This is to prevent complications during recovery.
What are the expected outcomes for a patient with acute abdominal pain?
- Resolution of the cause of acute abdominal pain
- Relief of abdominal pain and discomfort
What are common causes of abdominal injuries?
- Blunt trauma
- Penetrating injuries
What can result from injuries to solid organs in the abdomen?
Profuse bleeding leading to hypovolemic shock
Examples include liver and spleen injuries.
What risks are associated with hollow organ injuries?
Peritonitis
This occurs when contents spill into the peritoneal cavity.
What is abdominal compartment syndrome?
Excessively high pressure in the abdomen
It can lead to respiratory failure and renal failure.
What are classic manifestations of abdominal trauma?
- Guarding and splinting of the abdominal wall
- Hard, distended abdomen
- Decreased or absent bowel sounds
- Abrasions or bruising
- Abdominal pain
- Hematemesis or hematuria
- Signs of hypovolemic shock
What does bruising around the umbilicus indicate?
Cullen sign, suggesting retroperitoneal hemorrhage
Bruising around the flanks is known as Grey Turner sign.
What may be heard in the chest if the diaphragm ruptures?
Bowel sounds
This is an abnormal finding and indicates a serious injury.
What does auscultation of bruits indicate?
Arterial damage
This could signify serious vascular injury.
What are the baseline laboratory tests included in diagnostic studies for abdominal trauma?
CBC and urinalysis
These tests help assess the patient’s condition and detect potential issues.
Why might a patient have normal hemoglobin and hematocrit levels even when bleeding?
Fluids are lost at the same rate as red blood cells
This can mask the severity of blood loss initially.
What laboratory work is done in anticipation of possible blood transfusions?
Type and crossmatch
This is crucial for preparing for potential transfusions.
What are the most common diagnostic methods for abdominal trauma?
Abdominal CT scan and focused abdominal ultrasound
The patient must be stable to undergo a CT scan.
What is diagnostic peritoneal lavage used for?
To detect blood, bile, intestinal contents, and urine in the peritoneal cavity
This procedure helps assess internal injuries.
What should be administered if a patient is hypotensive due to abdominal trauma?
Volume expanders or blood
This is part of emergency management.
What is the purpose of an NG tube in the management of abdominal trauma?
To decompress the stomach and prevent aspiration
This is important for maintaining airway safety.
What factors influence the decision to perform surgery in abdominal trauma cases?
Clinical findings, diagnostic test results, and patient response to conservative management
These factors help determine the most appropriate intervention.
What is the characteristic nature of chronic abdominal pain?
Dull, aching, or diffuse
This type of pain can arise from various abdominal structures.
What are common causes of chronic abdominal pain?
- Irritable bowel syndrome (IBS)
- Peptic ulcer disease
- Chronic pancreatitis
- Hepatitis
- Pelvic inflammatory disease
- Adhesions
- Vascular insufficiency
Identifying the cause is crucial for treatment.
What initial steps are taken to diagnose chronic abdominal pain?
A thorough history and description of pain characteristics
This includes assessing severity, location, duration, and onset.
What diagnostic tests may be performed for chronic abdominal pain?
- Endoscopy
- CT scan
- MRI
- Laparoscopy
- Barium studies
These tests help visualize and assess internal conditions.
What characterizes irritable bowel syndrome (IBS)?
Chronic abdominal pain and altered bowel patterns
Symptoms may include diarrhea, constipation, or a mix of both.
How much more often does IBS affect women compared to men?
2 to 2.5 times more often
This indicates a significant gender disparity in prevalence.
What are potential psychological stressors associated with IBS?
- Depression
- Anxiety
- Panic disorders
- Posttraumatic stress disorder
These stressors can contribute to the development and exacerbation of IBS.
What dietary intolerances may contribute to IBS symptoms?
- Gluten
- Fermentable oligo-, di-, and monosaccharides and polyols (FODMAPs)
Identifying and managing these intolerances can help alleviate symptoms.
What are examples of oligosaccharides that may affect IBS?
- Wheat and rye products
- Some fruits and vegetables
- Onions
- Garlic
- Legumes
- Nuts
These foods can trigger symptoms in sensitive individuals.
What is lactose and where is it found?
A disaccharide found in milk and milk products
Lactose intolerance can lead to gastrointestinal symptoms.
What is fructose and where is it commonly found?
A monosaccharide found in honey, apples, pears, and high-fructose corn syrup
Fructose can also contribute to gastrointestinal discomfort.
What are polyols and where can they be found?
Found in apples, pears, stone fruits, cauliflower, mushrooms, and artificial sweeteners like sorbitol
These compounds can exacerbate symptoms for some individuals with IBS.
What are the causes of blunt abdominal trauma?
Causes include:
* Assault with a blunt object
* Crush injury
* Explosions
* Falls
* Motor vehicle collisions
* Pedestrian event
Blunt trauma is often associated with non-penetrating injuries.
What are common assessment findings for abdominal trauma?
Common findings include:
* Abdominal distention
* Abdominal pain with palpation
* Abdominal rigidity
* Absent or 1 bowel sounds
* Hematemesis
* Hematuria
* Nausea and vomiting
These findings help in diagnosing the severity and type of abdominal injury.
What are signs of hypovolemic shock in abdominal trauma patients?
Signs include:
* Decreased blood pressure
* Increased heart rate
* Decreased level of consciousness
* Tachypnea
Hypovolemic shock indicates significant blood loss and requires immediate intervention.
What surface findings might indicate abdominal trauma?
Surface findings may include:
* Abrasions and bruising on the abdominal wall, flank, or peritoneum
* Impaled object
* Open wounds: lacerations, eviscerations, puncture wounds, gunshot wounds
These findings can help to assess the extent of injury.
What is the initial intervention for an unresponsive patient with abdominal trauma?
Assess circulation, airway, and breathing
This is a critical step in emergency management.
What should be done if a patient with abdominal trauma is responsive?
Monitor airway, breathing, and circulation
Continuous monitoring is essential to ensure patient stability.
What is the purpose of establishing IV access in abdominal trauma management?
To infuse normal saline or lactated Ringer’s solution
IV access is crucial for fluid resuscitation.
What steps should be taken regarding external bleeding in abdominal trauma?
Control external bleeding with:
* Direct pressure
* Sterile pressure dressing
Immediate control of bleeding is vital to prevent shock.
What should be done with an impaled object in an abdominal trauma patient?
Stabilize impaled objects with bulky dressing—do not remove
Removing an impaled object can cause further injury.
What should be covered with a sterile saline dressing in abdominal trauma?
Protruding organs or tissue
This helps to prevent contamination and further injury.
When should an indwelling urinary catheter be inserted in abdominal trauma patients?
If there is no blood at the meatus, pelvic fracture, or boggy prostate
This is to assess urinary function and potential injuries.
What is the purpose of ongoing monitoring in abdominal trauma management?
To monitor vital signs, level of consciousness, O2 saturation, and urine output
Continuous monitoring is essential for detecting changes in the patient’s condition.
How can patient warmth be maintained during ongoing monitoring?
Using:
* Blankets
* Warm IV fluids
* Warm humidified O2
Maintaining warmth is critical in trauma care to prevent hypothermia.
What are the Rome IV criteria for diagnosing IBS?
Presence of abdominal pain and/or discomfort at least 1 day per week for 3 months, associated with 2 or more of the following: related to defecation, change in stool frequency, change in stool form.
What are the categories of IBS based on stool patterns?
- IBS with constipation (IBS-C)
- IBS with diarrhea (IBS-D)
- IBS mixed
- IBS unsubtyped
What are common symptoms of IBS?
- Abdominal distention
- Nausea
- Flatulence
- Bloating
- Urgency
- Mucus in stool
- Sensation of incomplete evacuation
What non-GI symptoms may be associated with IBS?
- Fatigue
- Headache
- Sleep problems
What is key to diagnosing IBS?
A thorough history and physical assessment.
What factors should be assessed when diagnosing IBS?
- Symptoms description
- Health history (including psychosocial factors)
- Family history
- Drug and diet history
- Impact of symptoms on daily activities
What diagnostic tests are used in IBS?
To rule out other disorders such as CRC, IBD, endometriosis, and malabsorption disorders.
What are the main treatment approaches for IBS?
- Psychologic support
- Diet and lifestyle changes
- Drugs to regulate stool output and reduce discomfort
What is the benefit of keeping a diary for IBS patients?
To help identify factors that trigger IBS symptoms.
What dietary approach may help IBS patients?
Following a low-FODMAP diet.
What are high-FODMAP foods that should be avoided?
- Garlic
- Onions
- Wheat
- Dairy
What is recommended for patients with IBS-C?
A high-fiber diet to produce soft, painless bowel movements.
What are common drug therapies for IBS?
- Antidepressants
- Antispasmodic agents (e.g., hyoscyamine, dicyclomine)
- Rifaximin
- Eluxadoline
- Alosetron
What is the mechanism of action of eluxadoline?
Decreases colonic contractions to reduce diarrhea and pain.
What is a significant side effect of alosetron?
Severe constipation and ischemic colitis.
What is appendicitis?
Inflammation of the appendix.
What is the most common reason for emergency abdominal surgery?
Appendicitis.
What is the common age range for developing appendicitis?
10 to 30 years of age.
What causes appendicitis?
Luminal obstruction leading to distention, venous engorgement, and accumulation of mucus and bacteria.
What are the clinical manifestations of appendicitis?
- Dull periumbilical pain
- Anorexia
- Nausea
- Vomiting
- Persistent pain shifting to right lower quadrant
What diagnostic signs may indicate appendicitis?
- Rigidity
- Rebound tenderness
- Muscle guarding
- Positive psoas sign
- Positive obturator sign
- Positive Rovsing sign
What is the typical initial pain location in appendicitis?
Dull periumbilical pain.
What type of fever may develop in appendicitis?
Low-grade fever.
What should patients with IBS-C consider for treatment?
Linaclotide (Linzess) if laxative therapy is ineffective.
What is a contraindication for linaclotide?
History of mechanical obstruction or prior bowel surgery.
What is the preferred diagnostic procedure for appendicitis?
CT scan
Ultrasound and MRI are also options.
What is the standard treatment for appendicitis?
Immediate appendectomy
This is the surgical removal of the appendix.
What should be started before surgery for appendicitis?
Antibiotics and fluid resuscitation
These help prepare the patient for surgery.
What is the purpose of IV fluids and antibiotic therapy before appendectomy in case of a ruptured appendix?
To prevent dehydration and sepsis
Especially important if there is evidence of peritonitis or an abscess.
What are the key nursing management focuses for a patient with suspected appendicitis?
Preventing fluid volume deficit, relieving pain, preventing complications
Ensure the stomach is empty in case surgery is needed.
How long do patients typically stay in the hospital after an uncomplicated laparoscopic appendectomy?
24 hours
Ambulation begins a few hours after surgery.
What is peritonitis?
Inflammation of the peritoneum
It may result from contamination of the peritoneal cavity.
What are common causes of secondary peritonitis?
- Ruptured appendix
- Perforated ulcer
- Diverticulitis
- Trauma from gunshot or knife wounds
These lead to the release of contents into the peritoneal cavity.
What is the most common symptom of peritonitis?
Severe, continuous abdominal pain
Tenderness over the involved area is a universal sign.
What are signs of peritoneal irritation in peritonitis?
- Rebound tenderness
- Rigidity
- Spasm
Patients may lie still and take shallow breaths due to pain.
What complications can arise from peritonitis?
- Hypovolemic shock
- Sepsis
- Intra-abdominal abscess formation
- Paralytic ileus
- Acute respiratory distress syndrome
Peritonitis can be fatal if treatment is delayed.
What diagnostic studies are conducted for peritonitis?
- CBC for WBC count and hemo-concentration
- Peritoneal aspiration
- Abdominal x-ray
- Ultrasound and CT scans
- Peritoneoscopy
These help identify the cause and severity of the condition.
What conservative treatment is provided for milder cases of peritonitis?
- Antibiotics
- NG suction
- Analgesics
- IV fluid administration
Surgery is indicated for severe cases to locate the cause of inflammation.
Why is assessing the patient’s pain important in peritonitis?
It helps to determine the cause of peritonitis
Assessing pain location and quality can provide insights into the underlying issues contributing to peritonitis.
What are some clinical problems associated with peritonitis?
- Pain
- Fluid imbalance
- Impaired GI function
- Risk for infection
These problems can complicate the patient’s condition and require careful management.
What are the overall goals for a patient with peritonitis?
- Resolution of inflammation
- Relief of abdominal pain
- Freedom from complications
- Normal nutrition status
Achieving these goals is critical for the patient’s recovery.
What is a key implementation step for managing a patient with peritonitis?
Establish IV access for fluid replacement and antibiotic therapy
IV fluids help replace lost fluids and antibiotics treat the infection.
What positioning may increase comfort for a patient with peritonitis?
Knees flexed
This position can relieve abdominal tension and discomfort.
What is gastroenteritis?
An inflammation of the mucosa of the stomach and small intestine
It often presents with symptoms like diarrhea, nausea, and vomiting.
What are common features of acute gastroenteritis?
- Sudden diarrhea
- Nausea
- Vomiting
- Fever
- Abdominal cramping
These symptoms can indicate the presence of gastroenteritis.
What is the most common cause of gastroenteritis?
Viruses
Norovirus is a leading cause of foodborne outbreaks of acute gastroenteritis.
What should be encouraged to prevent dehydration in gastroenteritis?
Oral fluids containing glucose and electrolytes
These fluids help replace lost fluids and maintain electrolyte balance.
What is inflammatory bowel disease (IBD)?
A chronic inflammation of the GI tract characterized by periods of remission and exacerbation
IBD includes conditions such as Crohn’s disease and ulcerative colitis.
How is IBD classified?
- Crohn’s disease
- Ulcerative colitis
The classification is based on clinical manifestations and the affected areas of the GI tract.
What is the typical onset age for IBD?
Teenage years and early adulthood
IBD can also have a second peak in the 6th decade of life.
What is the suspected etiology of IBD?
An autoimmune disease involving an immune reaction to the intestinal tract
The exact cause of IBD is still not fully understood.
What does IBD stand for?
Inflammatory Bowel Disease
IBD encompasses conditions like Crohn’s disease and ulcerative colitis.
What type of response is associated with IBD?
Inappropriate or sustained immune response
This response is triggered by environmental and bacterial factors in genetically susceptible individuals.
Where are the highest rates of IBD found?
Northern Hemisphere and industrialized nations
The incidence varies based on geographic location and racial or ethnic background.
What is the strongest risk factor for developing IBD?
Family history
Many individuals with IBD have a family member who also has the condition.
How do lifestyle factors influence IBD?
They increase susceptibility by changing the GI microbial flora
Factors include diet, smoking, and stress.
What dietary factors are thought to contribute to IBD?
High intake of refined sugar, total fats, PUFA, and omega-6 fatty acids
Conversely, consuming more raw fruits, vegetables, omega-3-rich foods, and fiber decreases risk.
Name some medications that increase the risk of IBD.
NSAIDs, antibiotics, and oral contraceptives
These medications can alter gut health and immune responses.
What genetic link is associated with IBD?
IBD occurs more often in family members of affected individuals
This includes a higher incidence in monozygotic twins.
How many genes associated with IBD have been identified?
Over 200 genes
These genes may contribute to different forms of IBD, such as Crohn’s disease and ulcerative colitis.
Which major genes are related to Crohn’s disease?
NOD2, ATG16L1, IL23R, and IRGM
These genes are involved in immune system function.
What is the pattern of inflammation in Crohn’s disease?
Can occur anywhere in the GI tract, often involves the distal ileum and proximal colon
It features skip lesions and inflammation through all layers of the bowel wall.
What type of inflammation is characteristic of ulcerative colitis?
Mucosal layer inflammation in the colon and rectum
It typically begins in the rectum and moves continuously toward the cecum.
True or False: Fistulas are common in ulcerative colitis.
False
Fistulas and abscesses are rare in UC since inflammation does not extend through all bowel wall layers.
What are ‘skip’ lesions?
Segments of normal bowel between diseased portions
These are characteristic of Crohn’s disease.
What complications can arise from Crohn’s disease?
Bowel obstruction, abscesses, and peritonitis
These complications occur due to deep inflammation and microscopic leaks.
What is the usual age at onset for Ulcerative Colitis?
Teens to mid-30s; after 60
What type of abdominal pain is commonly associated with Ulcerative Colitis?
Common, severe constant
Is diarrhea common in Ulcerative Colitis?
Common
What is the incidence of malabsorption in Ulcerative Colitis?
Minimal incidence
What is the usual age at onset for Crohn’s Disease?
Teens to mid-30s; after 60
What type of abdominal pain is commonly associated with Crohn’s Disease?
Common, cramping
Is diarrhea common in Crohn’s Disease?
Common
What is the incidence of fever during acute attacks in Ulcerative Colitis?
During acute attacks
What is the incidence of rectal bleeding in Ulcerative Colitis?
Common
What is the incidence of tenesmus in Ulcerative Colitis?
Common
What is the weight loss incidence in Ulcerative Colitis?
Rare
What is the weight loss incidence in Crohn’s Disease?
Common, may be severe
Where does Ulcerative Colitis usually start?
Usually starts in rectum and spreads in a continuous pattern up the colon
What is the pathologic depth of involvement in Ulcerative Colitis?
Mucosa
What is the distribution pattern of inflammation in Ulcerative Colitis?
Continuous areas of inflammation
Is small bowel involvement common in Ulcerative Colitis?
Rare
Where can Crohn’s Disease occur along the GI tract?
Occurs anywhere along GI tract. Most common site is distal ileum
What is the pathologic depth of involvement in Crohn’s Disease?
Entire thickness of bowel wall (transmural)
What is a characteristic feature of Crohn’s Disease?
Healthy tissue interspersed with areas of inflammation (skip lesions)
What is the incidence of cancer in Ulcerative Colitis after 10 years of disease?
Common (because of toxic megacolon)
What is the incidence of C. difficile infection in Ulcerative Colitis?
Rare
What complication is more common in Crohn’s Disease?
Perianal abscess and fistulas
What is the incidence of strictures in Crohn’s Disease?
Common
What is a complication associated with Ulcerative Colitis?
Toxic megacolon
What is the incidence of small intestinal cancer in Crohn’s Disease?
Common
What is the incidence of colorectal cancer (CRC) in Crohn’s Disease compared to Ulcerative Colitis?
T Incidence of CRC but less than with ulcerative colitis
Is the incidence of complications in Ulcerative Colitis severe?
Common (because inflammation involves entire bowel wall)
True or False: Malabsorption is common in Crohn’s Disease.
True
