Chapter 47 Lower Gastrointestinal Problems Part 2 Flashcards
What is toxic megacolon?
A condition associated with inflammatory bowel disease (IBD), particularly ulcerative colitis, that increases the risk for perforation and may require emergency colectomy.
What complications can occur in Crohn’s disease?
Complications include perineal abscesses and fistulas, which occur in up to a third of patients.
How does CDI relate to IBD?
Clostridium difficile infection (CDI) increases in frequency and severity in patients with inflammatory bowel disease.
What is the risk associated with IBD regarding cancer?
IBD is related to an increased risk for colorectal cancer (CRC) and small intestinal cancer in Crohn’s disease.
What systemic complications can arise from IBD?
Complications can include multiple sclerosis, ankylosing spondylitis, malabsorption, liver disease (primary sclerosing cholangitis), and osteoporosis.
How often should patients with IBD undergo bone density scans?
Patients should have a bone density scan at baseline and every 2 years.
What diagnostic studies are important for IBD?
Diagnostic studies include ruling out diseases with similar symptoms, stool examination, imaging studies, and colonoscopy.
What are common clinical manifestations of IBD?
Common manifestations include diarrhea, weight loss, abdominal pain, fever, and fatigue.
What symptoms are associated with Crohn’s disease?
Symptoms include diarrhea, cramping abdominal pain, weight loss due to malabsorption, and occasional rectal bleeding.
What symptoms are characteristic of ulcerative colitis (UC)?
Characteristic symptoms include bloody diarrhea and varying degrees of abdominal pain.
What is the stool output in mild UC?
In mild disease, diarrhea may consist of no more than 4 semiformed stools daily containing small amounts of blood.
What defines moderate disease in UC?
In moderate disease, the patient has up to 10 stools per day, increased bleeding, and systemic symptoms such as fever and malaise.
What are the symptoms of severe UC?
Severe symptoms include bloody diarrhea occurring 10 to 20 times a day, fever, rapid weight loss, anemia, tachycardia, and dehydration.
What local complications can occur in IBD?
Local complications include hemorrhage, strictures, perforation, abscesses, fistulas, and Clostridium difficile infection.
What laboratory findings may indicate complications in IBD?
Findings may include iron deficiency anemia, high WBC count, electrolyte imbalances, hypoalbuminemia, and increased inflammatory markers.
What imaging studies are used for diagnosing IBD?
Imaging studies include double-contrast barium enema, small bowel series, transabdominal ultrasound, CT, and MRI.
What is the goal of treatment for IBD?
Goals include resting the bowel, controlling inflammation, correcting malnutrition, providing symptomatic relief, and improving quality of life.
Is there a cure for IBD?
No, there is no cure for IBD; treatment focuses on managing inflammation and maintaining remission.
What is the preferred treatment for Crohn’s disease due to high recurrence rates?
Drugs are the preferred treatment due to high recurrence rates after surgical treatment.
What indicates the need for hospitalization in IBD patients?
Hospitalization is needed if the patient does not respond to drug therapy, the disease is severe, or complications are suspected.
What is the goal of drug treatment in IBD?
To induce and maintain remission.
Name the five major classes of drugs used in IBD treatment.
- Aminosalicyclates
- Antimicrobials
- Corticosteroids
- Immunomodulators
- Biologic therapies
What factors influence drug choice in IBD treatment?
Location and severity of inflammation.
What is the initial treatment for UC?
A corticosteroid for symptom relief with an aminosalicylate or a biologic therapy.
What therapies are included in the management of Crohn’s disease?
- Biologic therapy
- Corticosteroid
Can IBD therapies be used alone or in combination?
Yes, they can be used alone or as combination therapy.
What drug class treats both UC and Crohn’s disease?
5-aminosalicylic acid (5-ASA).
For which condition are 5-ASA drugs much more effective?
Ulcerative colitis (UC).
What is the proposed mechanism of action for 5-ASA?
They suppress the production of proinflammatory cytokines and other inflammatory mediators in the intestine.
How can aminosalicylates be administered?
- Orally
- Rectally
What is the advantage of rectal use of aminosalicylates?
Delivers the 5-ASA directly to the affected tissue.
What combination is better for treating IBD: oral and rectal therapy together or alone?
Combination of oral and rectal therapy is better.
How do biologics reduce IBD-related inflammation?
By blocking specific proteins that play a role in inflammation.
List the four main classes of biologics used in IBD treatment.
- Anti-TNF agents
- Alpha 4-integrin inhibitors
- Interleukin (IL)-12/23 antagonists
- Janus kinase (JAK) inhibitors
What is the route of administration for infliximab (Remicade)?
Intravenous (IV).
What conditions is infliximab used to treat?
- Ulcerative colitis (UC)
- Crohn’s disease
- Draining fistulas
How are the other anti-TNF agents administered?
Subcutaneously.
What are the most common side effects of the discussed therapies?
Upper respiratory infections, urinary tract infections, headaches, nausea, joint pain, abdominal pain
More serious effects include reactivation of hepatitis and tuberculosis, opportunistic infections, and cancers, especially lymphoma.
What must patients be tested for before beginning treatment?
Tuberculosis (TB) and hepatitis
Therapy must be delayed if an active infection is present.
What are alpha 4-integrin inhibitors used for?
To inhibit leukocyte adhesion by blocking da-integrin
Examples include natalizumab (Tysabri) and vedolizumab (Entyvio).
What is a significant risk associated with natalizumab?
Progressive multifocal leukoencephalopathy
Natalizumab is available only through a restricted program due to this risk.
How are IL-12/23 antagonists administered?
The first dose is given IV followed by injections every 8 weeks
Examples include ustekinumab and risankizumab.
What do JAK inhibitors do?
Suppress the immune system by blocking the TAK enzyme
They prevent the activation of specific immune system cells that cause inflammation.
What must patients be tested for before starting tofacitinib?
Tuberculosis (TB)
Tofacitinib should not be given with other biologics or immunomodulators.
What does immunogenicity in biologic therapy lead to?
Acute infusion reactions and delayed hypersensitivity-type reactions
Patients may develop antibodies against the biologic agents.
What is the purpose of corticosteroids in treating intestinal inflammation?
To prevent or decrease inflammation of the intestinal mucosa
They are given for the shortest possible time due to long-term side effects.
How are corticosteroids delivered to the inflamed tissue in patients with left colon, sigmoid, and rectal disease?
Suppositories, enemas, and foams
This method minimizes systemic effects.
What is the oral medication given to patients with mild to moderate disease who did not respond to 5-ASA?
Oral prednisone
It is part of the treatment for those who did not respond to other therapies.
What is included in the diagnostic assessment for Inflammatory Bowel Disease?
- History and physical assessment
- CBC, erythrocyte sedimentation rate
- Serum chemistries
- Testing of stool for occult blood and infection
- Capsule endoscopy
- Radiologic studies with barium contrast
- Sigmoidoscopy and/or colonoscopy with biopsy
- Ultrasound studies
None
What dietary recommendations are made for managing Inflammatory Bowel Disease?
- High-calorie
- High-vitamin
- High-protein diet
None
What is the role of enteral nutrition (EN) in the management of Inflammatory Bowel Disease?
EN is used during exacerbations.
None
List the types of drug therapy used in the management of Inflammatory Bowel Disease.
- Aminosalicylates
- Antimicrobials
- Biologic therapies
- Corticosteroids
- Immunomodulators
None
What non-pharmacological management strategies are recommended for Inflammatory Bowel Disease?
- Physical and emotional rest
- Referral for counseling or support group
None
True or False: Surgical therapy is not an option in the management of Inflammatory Bowel Disease.
False
Surgical therapy is considered when necessary.
What is the action of 5-Aminosalicylates (5-ASA) in the treatment of Inflammatory Bowel Disease?
Decrease inflammation by suppressing proinflammatory cytokines and other inflammatory mediators
What is the role of antimicrobials in treating Inflammatory Bowel Disease?
Prevent or treat secondary infection
What do Anti-TNF agents inhibit in the treatment of Inflammatory Bowel Disease?
The cytokine tumor necrosis factor (TNF)
What is the function of integrin receptor antagonists in Inflammatory Bowel Disease therapy?
Prevent migration of leukocytes from bloodstream to inflamed tissue
What do IL-12/23 antagonists bind to prevent activation of immune cells?
Bind IL-12 and IL-23
What is the mechanism of action of JAK inhibitors in Inflammatory Bowel Disease?
Block the JAK enzyme, preventing it from activating immune cells that cause inflammation
What is the primary action of immunomodulators in the treatment of Inflammatory Bowel Disease?
Suppress immune response
Give an example of a systemic 5-Aminosalicylate used in Inflammatory Bowel Disease.
balsalazide (Colazal), mesalamine (Asacol, Apriso, Delzicol, Liada, Pentasa), olsalazine (Dipentum), sulfasalazine (Azulfidine)
What are some topical forms of 5-Aminosalicylates?
5-ASA enema, foam, suppositories
Name an example of an antimicrobial used in treating Inflammatory Bowel Disease.
ciprofloxacin (Cipro), clarithromycin (Biaxin), metronidazole (Flagyl)
List some examples of Anti-TNF agents.
adalimumab (Humira), certolizumab pegol (Cimzia), golimumab (Simponi), infliximab (Remicade)
What are some examples of integrin receptor antagonists used in Inflammatory Bowel Disease?
natalizumab (Tysabri), vedolizumab (Entyvio)
Name two IL-12/23 antagonists used in the treatment of Inflammatory Bowel Disease.
Risankizumab (Skyrizi), ustekinumab (Stelara)
What is a JAK inhibitor used in treating Inflammatory Bowel Disease?
tofacitinib (Xeljanz)
What are systemic corticosteroids commonly used for in Inflammatory Bowel Disease?
prednisone, budesonide; hydrocortisone, methyl-prednisolone (IV for severe IBD)
What are some topical corticosteroids used in Inflammatory Bowel Disease?
hydrocortisone suppository, foam (Cortifoam), enema (Cortenema)
Name some examples of immunomodulators used in Inflammatory Bowel Disease.
azathioprine, cyclosporine, methotrexate, 6-mercaptopurine
What are topical corticosteroids used for?
They are used to treat severe inflammation.
What is required when planning surgery for patients on corticosteroids?
Corticosteroids must be tapered to very low levels.
What complications can arise from not tapering corticosteroids before surgery?
Infection, delayed wound healing, fistula formation.
What is the role of immunomodulators in treating IBD?
They maintain remission after corticosteroid therapy.
Who may benefit from immunomodulators?
Patients who do not respond to 5-ASA, corticosteroids, or antibiotics, have side effects from corticosteroids, or have fistulas.
Do immunomodulators have a rapid onset of action?
No, they have a delayed onset of action.
What monitoring is required for patients on immunomodulators?
Regular CBC monitoring.
What side effects can immunomodulators cause?
Suppression of bone marrow, infections, bleeding, liver and pancreas problems, flu-like symptoms.
Why must women of childbearing age avoid pregnancy while taking methotrexate?
It can cause birth defects and fetal death.
What are the indications for surgery in Ulcerative Colitis?
- Bowel obstruction
- Drain abdominal abscess
- Fistulas
- Inability to decrease corticosteroids
- Lack of response to conservative therapy
- Massive hemorrhage
- Perforation, impending or actual
- Severe anorectal disease
- Strictures
- Suspicion of cancer
What are the common surgical procedures for Ulcerative Colitis?
- Proctocolectomy with ileal pouch/anal anastomosis (IPAA)
- Proctocolectomy with permanent ileostomy
Is total proctocolectomy curative for Ulcerative Colitis?
Yes, since UC affects only the colon.
What is the most common reason for surgery in Crohn’s disease?
Complications such as obstructions or lack of response to therapy.
What is Short Bowel Syndrome (SBS)?
Occurs when there is too little small intestine surface area to maintain normal nutrition and hydration.
What may be needed for patients with Short Bowel Syndrome?
Lifetime fluid boluses and parenteral nutrition (PN).
What is strictureplasty?
A surgery that opens narrowed areas obstructing the bowel.
What is the advantage of strictureplasty over resection?
It reduces the risk of developing Short Bowel Syndrome.
What are the goals of diet management for IBD patients?
- Provide adequate nutrition without worsening symptoms
- Correct and prevent malnutrition
- Replace fluid and electrolyte losses
- Prevent weight loss
What nutritional deficiencies are common in IBD patients?
- Iron deficiency anemia
- Zinc deficiency
- Cobalamin deficiency
What supplements may be needed for IBD patients?
- Oral iron supplements
- Zinc supplements
- Cobalamin injections
- Calcium supplements
- Potassium supplements
What is the preferred nutritional support during an acute exacerbation of IBD?
Liquid enteral feedings.
What is the role of cholestyramine in IBD treatment?
It helps control diarrhea by binding unabsorbed bile salts.
What should patients with IBD do to identify food triggers?
Keep a food diary.
What are common clinical problems for patients with IBD?
- Impaired bowel elimination
- Nutritionally compromised
- Difficulty coping
- Pain
What health history is important for assessing IBD?
Infection, autoimmune disorders
Important to note for the patient’s background and risk factors.
What medications are commonly associated with IBD?
Antidiarrheal drugs
These medications help manage symptoms of diarrhea.
What family history is significant in IBD assessment?
Family history of ulcerative colitis, Crohn’s disease
Genetic predisposition can influence the likelihood of developing IBD.
What are common symptoms of IBD related to nutritional status?
Nausea, vomiting, anorexia, weight loss
These symptoms may indicate malnutrition and require further evaluation.
What elimination symptoms are characteristic of IBD?
Diarrhea, blood, mucus, pus in stools
These symptoms are crucial for diagnosis and management of IBD.
What cognitive-perceptual symptoms may indicate IBD?
Lower abdominal pain, cramping, tenesmus
Tenesmus refers to the feeling of incomplete evacuation after a bowel movement.
What general objective data might indicate IBD?
Intermittent fever, emaciated appearance, fatigue
These signs suggest a chronic inflammatory process.
What cardiovascular signs may be observed in IBD?
THR, 1 BP
These abbreviations refer to tachycardia and low blood pressure, indicating possible dehydration or anemia.
What GI symptoms are observed in IBD?
Abdominal distention, hyperactive bowel sounds, abdominal cramps
These symptoms are indicative of gastrointestinal distress.
What skin symptoms might be present in patients with IBD?
Pale skin, poor turgor, dry mucous membranes, skin lesions, anorectal irritation, skin tags, cutaneous fistulas
Skin manifestations can occur due to systemic effects of IBD.
What possible diagnostic findings are associated with IBD?
Anemia, WBC elevation, electrolyte imbalance, hypoalbuminemia, vitamin deficiencies, guaiac-positive stool, abnormal sigmoidoscopy, colonoscopy, and/or barium enema findings
These findings help confirm the diagnosis and assess disease severity.
What should be calculated to assess nutritional adequacy post-surgery for IBD?
Daily calorie intake
This includes obtaining a daily weight and assessing the abdomen.
What is a key aspect of postoperative care for IBD?
Similar to bowel resection and ostomy surgery care
Refer to general nursing care of the postoperative patient.
What chronic illness management aspect should be emphasized to IBD patients?
Acceptance of chronicity and coping strategies
Teaching includes rest, diet management, and stress reduction.
List three important teaching topics for patients with IBD.
- Importance of rest and diet management
- Drug action and side effects
- Symptoms of recurrence of disease
True or False: Establishing rapport with IBD patients is unimportant.
False
Building trust is crucial for promoting self-care.
What should patients with Crohn’s disease be encouraged to do regarding smoking?
Quit smoking
Smoking can lead to more severe disease.
What are the overall goals for a patient with IBD?
- Fewer and less severe acute exacerbations
- Maintain normal fluid and electrolyte balance
- Be free from pain or discomfort
- Adhere to medical regimens
- Maintain nutrition balance
- Have an improved quality of life
What is a common psychological struggle for patients with IBD?
Depression and anxiety
Many patients deal with feelings related to the chronic nature of the disease.
During the acute phase of IBD, what should be the focus of care?
Hemodynamic stability, pain control, fluid and electrolyte balance, nutrition support
Monitoring intake and output is also crucial.
What should be monitored to assess a patient’s condition during the acute phase?
- Number and appearance of stools
- Presence of blood in stools and emesis
- Serum electrolytes
- CBC
- Vital signs
What is crucial for maintaining patient hygiene during acute diarrhea?
Keeping the patient clean, dry, and free of odor
Using a deodorizer can help manage odor.
What preventive measure can reduce perianal irritation and pain?
Meticulous perianal skincare
Use plain water and moisturizing skin barrier cream.
What is a second peak in the occurrence of IBD associated with?
The 6th decade of life
Proctitis and left-sided UC are more common in older patients.
Fill in the blank: The expected outcome is that the patient with IBD will have a decrease in the number of _______.
diarrhea stools
What should be taught to a patient experiencing orthostatic hypotension?
Change position slowly and use safety precautions
This is important to prevent falls.
What is a bowel obstruction?
A bowel obstruction occurs when intestinal contents cannot pass through the GI tract.
What are the two types of bowel obstruction?
- Mechanical
- Nonmechanical
What is the difference between partial and complete bowel obstruction?
Partial obstruction does not completely occlude the intestinal lumen, while complete obstruction totally occludes the lumen.
What characterizes a simple obstruction?
A simple obstruction has an intact blood supply.
What characterizes a strangulated obstruction?
A strangulated obstruction does not have an intact blood supply.
What is the most common cause of small bowel obstruction (SBO)?
Surgical adhesions.
What are other causes of small bowel obstruction (SBO)?
- Hernia
- Cancer
- Strictures from Crohn’s disease
- Intussusception after bariatric surgery
What is the most common cause of large bowel obstruction (LBO)?
Colorectal cancer (CRC).
What are other causes of large bowel obstruction (LBO)?
- Diverticular disease
- Adhesions
- Ischemia
- Volvulus
- Crohn’s disease
What is a nonmechanical bowel obstruction?
A nonmechanical obstruction occurs with reduced or absent peristalsis due to altered neuromuscular transmission.
What is the most common form of nonmechanical obstruction?
Paralytic ileus.
What can cause paralytic ileus?
- Abdominal surgery
- Peritonitis
- Inflammatory responses
- Electrolyte imbalances
- Thoracic or lumbar spinal fractures
What is pseudo-obstruction?
A GI motility disorder that mimics a mechanical obstruction without a detectable cause on imaging.
What are some conditions associated with pseudo-obstruction?
- Neurologic conditions
- Drugs
- Endocrine and metabolic problems
- Lung disease
- Trauma
- Burns
What are vascular obstructions, and what are their common causes?
Vascular obstructions result from interference with blood supply to the intestines, commonly caused by emboli and atherosclerosis.
What is the daily fluid intake to the small intestine?
About 6 to 8 liters.
What happens to fluid, gas, and intestinal contents during a bowel obstruction?
They accumulate proximal to the obstruction, reducing fluid absorption and stimulating intestinal secretions.
What happens to the bowel distal to the obstruction?
The bowel empties and then collapses.
True or False: Anemia and malnutrition are less common in older adults with bowel obstruction.
False.
Fill in the blank: A _______ obstruction does not allow any intestinal contents to pass through.
complete
What happens to capillary permeability during increased pressure?
It increases, leading to extravasation of fluids and electrolytes into the peritoneal cavity.
This process contributes to fluid retention and a decrease in circulating blood volume.
What is the result of intestinal muscle fatigue?
Peristalsis stops.
This leads to retention of fluids and a decrease in blood volume.
What can inadequate blood flow to bowel tissue lead to?
Ischemia, necrosis, and possible bowel perforation.
This can result in serious complications including infection and septic shock.
What is intestinal strangulation?
A condition where the bowel becomes distended, causing blood flow to stop and leading to edema, cyanosis, and gangrene.
If untreated, it can lead to bowel necrosis and rupture.
List the 4 hallmark manifestations of an obstruction.
- Abdominal pain
- Nausea and vomiting
- Distention
- Constipation
The order and degree of these symptoms vary based on the cause and type of obstruction.
What type of abdominal pain is usually the first symptom of obstruction?
Colicky abdominal pain.
This pain is often of sudden onset in small bowel obstructions.
Describe the vomiting in proximal obstruction.
It is frequent, copious, and may be projectile and contain bile.
Vomiting usually provides temporary relief from abdominal pain.
What are the bowel sounds like in paralytic ileus?
Usually absent.
This differs from bowel sounds being high-pitched above the area of obstruction.
What is a sign of large bowel obstruction (LBO)?
Abdominal distention and lack of flatus.
Patients may experience persistent cramping abdominal pain.
What occurs with strangulation in bowel obstructions?
Severe, constant pain that is rapid in onset.
This can indicate a serious complication requiring immediate attention.
What are the signs of dehydration and sepsis in a patient with obstruction?
- Tachycardia
- Dry mucous membranes
- Hypotension
- Elevated temperature
These signs indicate a deteriorating condition.
What type of metabolic imbalance may occur with a high obstruction?
Metabolic alkalosis.
This results from loss of gastric hydrochloric acid through vomiting.
What occurs rapidly with a small intestine obstruction?
Dehydration.
This can happen due to fluid retention and electrolyte imbalances.
What is a key early concern in patients with large bowel obstruction?
Preventing fluid and electrolyte imbalances
Early intervention is crucial to avoid complications such as hypovolemic shock and sepsis.
What imaging studies can identify an obstruction in the gastrointestinal tract?
- Abdominal x-rays
- CT scan
- Contrast enema
- Sigmoidoscopy
- Colonoscopy
These imaging techniques help visualize obstructions and guide surgical decisions.
What blood test results might indicate strangulation or perforation in bowel obstruction?
A high WBC count
Elevated white blood cell count is a common indicator of infection or severe complications.
How can metabolic alkalosis develop in patients with bowel obstruction?
From vomiting
Vomiting leads to loss of gastric acid, resulting in metabolic alkalosis.
What is the treatment goal for a patient with a bowel obstruction?
Regain intestinal patency and resolve the obstruction
Successful treatment aims to restore normal bowel function and alleviate symptoms.
What clinical problems may arise for a patient with an obstruction?
- Pain
- Impaired GI function
- Fluid imbalance
These issues can complicate treatment and recovery.
What are the potential surgical interventions for bowel obstruction?
- Resection of the obstructed bowel segment
- Partial or total colectomy
- Colostomy
- Ileostomy
The type of surgery depends on the extent and cause of the obstruction.
What should be monitored in a patient with a bowel obstruction?
- Laboratory values
- Arterial blood gas values
- Intake and output records
- Signs of dehydration
Regular monitoring helps detect complications early.
Fill in the blank: A patient with a high obstruction is more likely to have _______.
[metabolic alkalosis]
What is the purpose of placing stents in patients with bowel obstruction?
Palliative purposes or as a bridge to surgery
Stents can help relieve symptoms and provide time for stabilization before surgery.
What nursing management strategies should be implemented for a patient with bowel obstruction?
- Give IV fluids and electrolytes
- Monitor for dehydration
- Maintain NPO status
- Implement pain management
- Insert indwelling urinary catheter
These strategies are essential for patient comfort and safety.
What is a common symptom that indicates an obstruction in the gastrointestinal tract?
Abdominal pain
Patients often exhibit restlessness and frequent position changes to relieve pain.
True or False: A patient with a bowel obstruction should be allowed to eat and drink normally.
False
Patients are typically placed on NPO status to prevent further complications.
What are colonic polyps?
Arise from the mucosal surface of the colon and project into the lumen
Polyps can be sessile (flat, broad-based) or pedunculated (with a stalk).
What are the two types of polyps based on their attachment?
Sessile and pedunculated
Sessile polyps are attached directly to the intestinal wall, while pedunculated polyps are attached by a thin stalk.
What is the most common symptom in patients with polyps?
Asymptomatic, rectal bleeding, and occult blood in the stool
Most patients with polyps do not exhibit symptoms.
What are the most common types of polyps?
Hyperplastic and adenomatous
Hyperplastic polyps are noncancerous and rarely cause symptoms.
What is the risk associated with adenomatous polyps?
Closely linked to colorectal adenocarcinoma
There are three types of adenomatous polyps: tubular, tubulovillous, and villous.
What is the second leading cause of cancer-related deaths?
Colorectal cancer (CRC)
Annually about 148,000 people are diagnosed with CRC in the United States.
At what age is the risk of CRC significantly higher?
Older than 50
About 85% of new CRC cases are detected in this age group.
What factors are thought to contribute to the rising CRC cases in people aged 20 to 49?
Diet, physical inactivity, and increasing rates of obesity
The rate of CRC in younger populations is expected to continue rising.
What is familial adenomatous polyposis (FAP)?
A genetic disorder characterized by hundreds or thousands of polyps in the colon
FAP usually leads to cancer by age 40, necessitating removal of the colon and rectum by age 25.
What cancers are patients with classic FAP at risk for?
Thyroid, stomach, small intestine, liver, and brain cancers
Lifetime cancer surveillance is essential for these patients.
What diagnostic studies are used to discover polyps?
Colonoscopy, sigmoidoscopy, barium enema, and virtual colonoscopy
Colonoscopy is preferred for evaluating the total colon.
What should be done with all discovered polyps?
They should be removed (polypectomy)
Polyps can be removed during colonoscopy or sigmoidoscopy but not during barium enema or virtual colonoscopy.
What are patients monitored for after polypectomy?
Rectal bleeding, fever, severe abdominal pain
These are potential complications following the procedure.
What are the two types of polyps based on their attachment?
Sessile and pedunculated
Sessile polyps are attached directly to the intestinal wall, while pedunculated polyps are attached by a thin stalk.
What is the most common symptom in patients with polyps?
Asymptomatic, rectal bleeding, and occult blood in the stool
Most patients with polyps do not exhibit symptoms.
What are the most common types of polyps?
Hyperplastic and adenomatous
Hyperplastic polyps are noncancerous and rarely cause symptoms.
What is the risk associated with adenomatous polyps?
Closely linked to colorectal adenocarcinoma
There are three types of adenomatous polyps: tubular, tubulovillous, and villous.
What is the second leading cause of cancer-related deaths?
Colorectal cancer (CRC)
Annually about 148,000 people are diagnosed with CRC in the United States.
At what age is the risk of CRC significantly higher?
Older than 50
About 85% of new CRC cases are detected in this age group.
What factors are thought to contribute to the rising CRC cases in people aged 20 to 49?
Diet, physical inactivity, and increasing rates of obesity
The rate of CRC in younger populations is expected to continue rising.
What is familial adenomatous polyposis (FAP)?
A genetic disorder characterized by hundreds or thousands of polyps in the colon
FAP usually leads to cancer by age 40, necessitating removal of the colon and rectum by age 25.
What cancers are patients with classic FAP at risk for?
Thyroid, stomach, small intestine, liver, and brain cancers
Lifetime cancer surveillance is essential for these patients.
What diagnostic studies are used to discover polyps?
Colonoscopy, sigmoidoscopy, barium enema, and virtual colonoscopy
Colonoscopy is preferred for evaluating the total colon.
What should be done with all discovered polyps?
They should be removed (polypectomy)
Polyps can be removed during colonoscopy or sigmoidoscopy but not during barium enema or virtual colonoscopy.
What are patients monitored for after polypectomy?
Rectal bleeding, fever, severe abdominal pain
These are potential complications following the procedure.
What percentage of colorectal cancer (CRC) cases occur in patients with a family history of CRC?
About 20% of cases
What are the hereditary forms of CRC that account for another percentage of cases?
FAP and hereditary nonpolyposis colorectal cancer (HNPCC) syndrome
These hereditary forms account for about 5% of CRC cases.
What percentage of people with CRC have an abnormal KRAS gene?
About 30% to 50%
What is the primary function of the KRAS gene?
Regulating cell division
What lifestyle factors may decrease the risk for CRC?
- Maintaining a healthy weight
- Being physically active
- Limiting alcohol use
- Not smoking
- Eating a diet high in fruits, vegetables, and grains
How long does it typically take for CRC to develop from a polyp?
10 to 20 years
What type of polyp is most commonly associated with CRC?
Adenomas
What are the five stages of CRC?
- Stage 0: Cancer has not grown beyond the mucosal layer
- Stage I: Cancer has grown into the submucosa, no lymph nodes involved
- Stage II: Cancer has grown into the muscle, no lymph node involvement or metastasis
- Stage III: Tumor with lymph node involvement, no metastasis
- Stage IV: Tumor with lymph node involvement and metastasis
What is a common site of metastasis for CRC?
Liver
What symptoms may indicate advanced CRC?
- Fatigue
- Weight loss
- Abdominal pain
- Change in bowel habits
What is a common early manifestation of right-sided CRC?
Anemia
What is hematochezia?
Fresh blood in the stool
Which side of CRC is more likely to cause diarrhea?
Right-sided cancers
What complications can arise from CRC?
- Obstruction
- Bleeding
- Perforation
- Peritonitis
- Fistula formation
At what age should screening for CRC begin for those at average risk?
Age 45
What screening tests are recommended for CRC detection?
- Flexible sigmoidoscopy (every 5 years)
- Colonoscopy (every 10 years)
What are the key components of diagnostic assessment for colorectal cancer?
• History and physical assessment
• DRE
• Testing of stool for occult blood
• CBC
• Liver function tests
• Barium enema
• Sigmoidoscopy and/or colonoscopy with biopsy
• Abdominal CT scan, ultrasound, or MRI
• Carcinoembryonic antigen (CEA) test
DRE stands for Digital Rectal Examination.
List the management options for colorectal cancer.
• Surgery
• Right hemicolectomy
• Left hemicolectomy
• Abdominal-perineal resection
• Laparoscopic colectomy
• Low anterior resection
• Chemotherapy
• Targeted therapy
• Radiation therapy
Surgical options vary based on the location and extent of the cancer.
What is the gold standard for colorectal cancer screening?
Colonoscopy.
Colonoscopy allows for the examination of the entire colon, biopsies, and polyp removal.
At what age should individuals at average risk for colorectal cancer begin screening with colonoscopy?
Age 45.
Screening should occur every 10 years.
What tests primarily find colorectal cancer?
• High-sensitivity fecal occult blood test (FOBT) (every year)
• Fecal immunochemical test (FIT) (every year)
• Stool DNA test (every 3 years)
FOBT and FIT look for blood in the stool, which may indicate cancer.
What is the recommended colonoscopy schedule for individuals with a first-degree relative who developed colorectal cancer before age 60?
Every 5 years beginning at age 40 or 10 years earlier than when the youngest relative developed cancer.
This is to ensure early detection due to increased risk.
True or False: Carcinoembryonic antigen (CEA) is the best screening tool for colorectal cancer.
False.
CEA has a large number of false-positive findings and may be elevated in non-colon cancers and some noncancerous conditions.
What does the tumor, node, metastasis (TNM) staging system correlate with?
Prognosis and treatment of colorectal cancer.
Prognosis worsens with greater size and depth of tumor, lymph node involvement, and metastasis.
Fill in the blank: Once tissue biopsies confirm the diagnosis of CRC, the patient needs a _______ to check for anemia.
CBC.
CBC stands for Complete Blood Count.
What imaging techniques may be used to detect metastases and determine the depth of penetration of the tumor into the bowel wall?
• CT scan
• PET scan
• MRI
These imaging techniques help assess the extent of cancer spread.
What are the primary goals of surgical therapy for cancer?
Complete resection of the tumor, thorough exploration of the abdomen, removing all lymph nodes, restoring bowel continuity.
What is polypectomy during colonoscopy used for?
Resect CRC in situ.
What indicates a successful polypectomy?
Resected margin free of cancer, well-differentiated cancer, no lymphatic or blood vessel involvement.
What factors influence the decision for surgical treatment in cancer?
Staging and location of the cancer, ability to restore normal bowel function and continence.
What surgical treatments are indicated for stage I and stage II colon cancers?
Removing the tumor, surrounding tissues, and nearby lymph nodes, followed by anastomosis when possible.
When is laparoscopic surgery particularly used?
For tumors in the left colon.
What is the role of chemotherapy after surgery for high-risk stage II tumors?
It is used to reduce the risk of cancer recurrence.
How are stage III tumors typically treated?
With surgery and chemotherapy.
What is the purpose of radiation and chemotherapy before surgery?
To reduce tumor size.
What determines the course of treatment in rectal cancer?
The location and size of the tumor.
What is an abdominal-perineal resection (APR)?
Removal of the entire rectum with the tumor, resulting in a permanent colostomy.
What is a low anterior resection (LAR)?
Removal of the rectum while preserving sphincters, anastomosing the colon to the anal canal.
What may be done to allow time for the anastomosis to heal after a LAR?
A temporary ostomy may be created.
What is the purpose of palliative surgery in cancer treatment?
To control hemorrhage or relieve bowel obstruction.
What is the role of chemotherapy and radiation in the context of metastatic cancer?
To control the spread and provide pain relief.
What are some examples of targeted therapies for metastatic CRC?
- Aflibercept (Zaltrap) * Bevacizumab (Avastin) * Ramucirumab (Cyramza) * Cetuximab (Erbitux) * Panitumumab (Vectibix)
What is the function of angiogenesis inhibitors in cancer treatment?
They inhibit the blood supply to tumors.
What is Regorafenib (Stivarga)?
A multikinase inhibitor that blocks several enzymes promoting cancer growth.
What is the role of trifluridine and tipiracil in cancer treatment?
Trifluridine impairs DNA function and angiogenesis; tipiracil increases trifluridine’s bioavailability.
What is the purpose of adjuvant chemotherapy in cancer treatment?
To reduce the risk of cancer recurrence after surgery.
True or False: Chemotherapy is only used after surgery.
False.
What is the primary goal of palliative care for patients with metastatic cancer?
To reduce tumor size and provide symptomatic relief.
What are the clinical problems associated with colorectal cancer (CRC)?
- Altered bowel elimination
- Anxiety
- Difficulty coping
- Planning
What are the overall goals for patients with colorectal cancer?
- Normal bowel elimination patterns
- Quality of life appropriate to disease progression
- Relief of pain
- Feelings of comfort and well-being
At what age should individuals start having regular CRC screenings?
Over 45 years
What is a barrier to CRC screening mentioned in the text?
- Lack of accurate information
- Fear of diagnosis
What are the key components of postoperative care for patients after bowel resection?
- Sterile dressing changes
- Care of drains
- Patient and caregiver teaching about the ostomy
What emotional support needs do patients with CRC have?
Discussion about prognosis and future screening; emotional support.
What dietary advice may be necessary for patients who have undergone sphincter-sparing surgery?
- Antidiarrheal drugs
- Bulking agents
What are the expected outcomes for patients with CRC?
- Minimal changes in bowel elimination patterns
- Optimal nutrition intake
- Quality of life appropriate to disease progression
- Feelings of comfort and well-being
What are the reasons for surgical resection of the bowel?
- Remove cancer
- Repair a perforation, fistula, or traumatic injury
- Relieve an obstruction or stricture
- Treat an abscess, inflammatory disease, or hemorrhage
Fill in the blank: The expected outcomes for a patient with CRC include achieving _______.
[optimal nutrition intake]
True or False: Patients with CRC should be taught about bowel cleansing for outpatient diagnostic procedures.
True
What is the importance of ostomy rehabilitation for patients?
Teaching and ongoing support for all ostomy patients.
What important health history factors are associated with colorectal cancer?
Previous breast or ovarian cancer, familial polyposis, villous adenoma, adenomatous polyps, IBD
IBD stands for Inflammatory Bowel Disease.
Which medications should be considered when assessing for colorectal cancer?
Medications affecting bowel function (e.g., laxatives, antidiarrheal drugs)
These medications can alter bowel habits and affect symptoms.
What family history factors are significant in colorectal cancer assessment?
Family history of colorectal, breast, or ovarian cancer
A strong family history may increase risk.
What nutritional patterns are associated with colorectal cancer?
High-calorie, high-fat, low-fiber diet; anorexia, nausea and vomiting, weight loss
These dietary factors can contribute to cancer risk.
What changes in bowel habits may indicate colorectal cancer?
Alternating diarrhea and constipation, defecation urgency, rectal bleeding, mucoid stools, black tarry stools, flatulence, decrease in stool caliber, feelings of incomplete evacuation
These symptoms are critical for early detection.
What cognitive-perceptual symptoms are associated with colorectal cancer?
Abdominal and low back pain, tenesmus
Tenesmus refers to the feeling of incomplete evacuation after a bowel movement.
What are some objective signs of colorectal cancer?
Pallor, cachexia, lymphadenopathy, palpable abdominal mass, distention, ascites, hepatomegaly
Cachexia is a wasting syndrome often seen in cancer patients.
What possible diagnostic findings indicate colorectal cancer?
Anemia, guaiac-positive stools, palpable mass on DRE, positive sigmoidoscopy, colonoscopy, barium enema, or CT scan, positive biopsy
A positive biopsy confirms the presence of cancer.
What is an ostomy?
A surgically created opening on the abdomen that allows the discharge of body waste when the normal elimination route is no longer possible.
The outermost visible part is called a stoma.
What is the stoma?
The stoma is the result of the large or small bowel being brought to the outside of the abdomen and sutured in place.
It allows for fecal diversion when normal elimination is not possible.
What are the two main types of ostomies?
- Ileostomy
- Colostomy
Ostomies are named according to their location and type.
What is an ileostomy?
An ostomy in the ileum.
It results in liquid to thin paste output since it does not enter the colon.
What is a colostomy?
An ostomy in the colon.
Output resembles normal formed stool.
How does the output differ between ileostomies and colostomies?
- Ileostomy: liquid to thin paste
- Colostomy: resembles normal formed stool
Patients with ileostomies have no control over drainage.
What characterizes the more distal the ostomy?
The more functioning bowel remains, and the more likely that the intestinal contents will resemble the feces that would have been eliminated from an intact colon and rectum.
This is important for understanding ostomy output.
What are the two categories of ostomies based on permanence?
- Temporary
- Permanent
Some ostomies are created to prevent stool from reaching a diseased area.
What is a permanent ostomy?
An ostomy that is created when bowel distal to the ostomy is removed, such as in cancer involving the rectum.
It may be continent or traditional.
What is a continent ileostomy?
Uses 40 to 45 cm of the terminal ileum to fashion an internal pouch, nipple valve, and abdominal stoma.
The pouch replaces the rectum as a reservoir for stool.
How does a continent ileostomy function?
Patients must drain the pouch manually by inserting a catheter through the nipple valve.
Initially done every 1 to 2 hours, decreasing to 4 times daily as the pouch enlarges.
What must patients with a continent ileostomy follow for diet?
A low-residue diet to keep stool consistency relatively fluid.
This is crucial for pouch function.
What are the major types of traditional ostomies?
- End ostomy
- Double-barreled ostomy
- Loop ostomy
These types vary based on surgical technique and purpose.
What is an abdominal-perineal resection (APR)?
Removal of the entire rectum with creation of a permanent colostomy
This procedure is often used in cases of rectal cancer.
What is involved in an anterior rectosigmoid resection?
Removal of part of descending colon, the sigmoid colon, and upper rectum with the descending colon anastomosed to remaining rectum
This procedure preserves some function of the rectum.
Define colectomy.
Removal of the entire colon with the ileum anastomosed to the rectum
This procedure is typically performed for colon cancer or severe colitis.
What is a left hemicolectomy?
Removal of splenic flexure, descending colon, and sigmoid colon with the transverse colon anastomosed to rectum
This procedure is used to treat conditions affecting the left side of the colon.
Describe a low anterior resection (LAR).
Removal of the rectum with anastomosis of the colon to the anal canal, may include temporary ileostomy or colostomy
This procedure allows for preservation of anal function.
What does a proctocolectomy with ileostomy entail?
Removal of the colon, rectum, and anus with closure of the anal opening and formation of a permanent ileostomy
This is often done in severe cases of inflammatory bowel disease.
What is a proctocolectomy with ileal pouch/anal anastomosis (IPAA)?
Two surgeries, first includes colectomy, rectal mucosectomy, ileal pouch construction, ileoanal anastomosis; second surgery closes ileostomy to direct stool toward new pouch
This procedure allows for preservation of anal function with a new reservoir for stool.
What is involved in a right hemicolectomy?
Removal of ascending colon and hepatic flexure with the ileum anastomosed to transverse colon
This procedure treats conditions in the right colon.
What is an end stoma?
An end stoma is made by dividing the bowel and bringing out the proximal end as a single stoma
It results in either a colostomy or ileostomy, with the distal part of the GI tract being surgically removed or oversewn.
What is the procedure called when the distal bowel is oversewn and left in the abdominal cavity?
Hartmann pouch
This allows for the potential of reanastomosing the bowel and closing the stoma.
What characterizes a loop stoma?
A loop stoma is made by bringing a loop of bowel to the abdominal surface and opening the anterior wall
It results in one stoma with a proximal opening for feces and a distal opening for mucus drainage.
How long is a plastic rod typically used to hold a loop stoma in place after surgery?
7 to 10 days
This prevents the loop of bowel from slipping back into the abdominal cavity.
What is a double-barreled stoma?
A double-barreled stoma is created by dividing the bowel and bringing both proximal and distal ends through the abdominal wall as 2 separate stomas
The proximal stoma functions, while the distal stoma acts as a mucus fistula.
What are the three unique care aspects for ostomy surgery?
- Psychologic preparation for the ostomy
- Educational preparation
- Selecting the best site for the stoma
These aspects aid in the patient’s adjustment and management post-surgery.
What is the role of a WOCN in ostomy surgery preparation?
A WOCN should choose the site for the ostomy and mark the abdomen before surgery
The site should be within the rectus muscle and on a flat surface for better management.
Why is psychologic preparation important for patients undergoing ostomy surgery?
It helps the patient cope with changes in body image and elimination
Emotional support can enhance feelings of control and ability to cope.
Fill in the blank: The distal stoma in a double-barreled stoma is a _______.
mucus fistula
True or False: A loop stoma is usually a permanent solution.
False
A loop stoma is usually temporary.
What should the site for the ostomy ideally be like?
Flat, within the rectus muscle, and visible to the patient
This facilitates better care and management of the ostomy.
What is the stool consistency for an ileostomy?
Liquid to semiliquid
Is bowel regulation required for an ileostomy?
Yes
What are the indications for surgery for an ileostomy?
- UC
- Crohn’s disease
- Diseased or injured colon
- Familial polyposis
- Trauma
- Cancer
What is the stool consistency for a colostomy?
- Semiliquid (Ascending)
- Semiliquid to semiformed (Transverse)
- Formed (Sigmoid)
Is bowel regulation required for a colostomy?
No
What are the indications for surgery for a colostomy?
- Perforating diverticulum in lower colon
- Trauma
- Rectovaginal fistula
- Inoperable tumors of colon, rectum, or pelvis
- Cancer of the rectum or rectosigmoid area
Fill in the blank: The stool consistency for a sigmoid colostomy is _______.
Formed
True or False: A colostomy requires a change in fluid requirements.
False
What is the fluid requirement for an ileostomy?
No
What is the fluid requirement for a colostomy?
Possibly T
Fill in the blank: The stool consistency for a transverse colostomy is _______.
Semiliquid to semiformed
What should be assessed if the patient’s wound is closed or partially closed?
The integrity of the incision
Monitor for complications such as delayed wound healing, hemorrhage, fistulas, and infections.
What complications should be monitored in postoperative care?
- Delayed wound healing
- Hemorrhage
- Fistulas
- Infections
Regular assessment and documentation are crucial.
What should be recorded when assessing the wound?
- Bleeding
- Excess drainage
- Unusual odor
- Edema
- Redness
- Drainage
- Fever
- High WBC count
Observing the skin and the area around drains for signs of inflammation is also important.
When caring for a patient with an open wound and packing, what is crucial?
Meticulous care
Reinforce dressings and change them often during the first several hours postoperatively.
What type of drainage is typically expected postoperatively?
Serosanguineous
Assess all drainage for amount, color, and consistency.
What should be assessed in a patient with an ostomy?
The stoma
The stoma should be rosy pink to red and mildly swollen.
How often should stoma color be assessed and documented?
Every 4 hours
Report any sustained color changes or bleeding to the HCP.
When does the colostomy start functioning?
When peristalsis returns
Record the volume, color, and consistency of the drainage.
What is common during the first 2 weeks after a colostomy?
Excessive amounts of gas
Assure patients that this is common and may be distressing.
What may the ileostomy output be when peristalsis returns?
As high as 1500 to 1800 mL/24 hr
If the small bowel is shortened by surgery, drainage may be greater.
What should be observed in patients post-surgery for ileostomy?
Fluid deficits and electrolyte imbalances, particularly potassium and sodium
Over time, the proximal small bowel adapts and increases fluid absorption.
What is the expected consistency of feces after adaptation post-surgery?
Paste-like consistency
The volume decreases to around 500 mL/day.
How many stools may a patient have after an IPAA initially?
4 to 6 stools or more daily
Adaptation over the next 3 to 6 months results in fewer bowel movements.
What may occur after intraoperative manipulation of the anal canal?
Transient incontinence of mucus
Kegel exercises are recommended about 4 weeks after surgery.
What is the purpose of Kegel exercises post-surgery?
To strengthen the pelvic floor and sphincter muscles
This is especially important after anal canal manipulation.
Fill in the blank: The area around any drains should be kept _______.
Clean and dry
This is vital for preventing infection and promoting healing.
What color characterizes a healthy stoma?
Rose to brick-red
A healthy stoma should exhibit a rose to brick-red color, indicating good blood supply and viability.
What color indicates a pale stoma?
Pale
A pale stoma may suggest anemia or inadequate blood supply.
What does blanching, dark red to dusky blue or purple indicate in stoma health?
Inadequate blood supply
These colors can indicate potential necrosis or serious issues with blood flow to the stoma.
What color suggests necrosis in a stoma?
Brown-black
Brown-black coloration indicates necrosis and should be addressed immediately.
What is the typical edema characteristic of a viable stoma?
Mild to moderate edema
Mild to moderate edema is expected in a healthy stoma postoperatively.
What edema characteristic can indicate a problem with the stoma?
Moderate to severe edema
Moderate to severe edema may indicate complications such as obstruction or infection.
What is the typical amount of bleeding in a healthy stoma?
Small amount
A small amount of bleeding may occur, especially when the stoma is touched.
What amount of bleeding is concerning for stoma health?
Moderate to large amount
Moderate to large amounts of bleeding can indicate serious complications and should be evaluated.
What describes viable stoma mucosa?
Normal appearance with adequate blood supply
Viable stoma mucosa appears healthy and well-perfused.
What causes necrosis in a stoma?
Inadequate blood supply or trauma
Necrosis can occur due to lack of blood flow or injury to the stoma.
What can cause obstruction of the stoma?
Allergic reaction to food, gastroenteritis
These conditions can lead to swelling and blockage of the stoma.
What is the significance of oozing from the stoma mucosa when touched?
Normal due to high vascularity
Oozing is expected and indicates good blood supply to the stoma.
What conditions can lead to lower GI bleeding?
Coagulation factor deficiency, stomal varices
These conditions can result in bleeding from the stoma.
What is important to protect the epidermis from?
Mucous drainage and maceration
What should the patient use to clean the skin?
A mild cleanser
What may be used alongside a moisture barrier ointment?
A perineal pad
What is a common sensation some patients experience post-surgery?
Phantom rectal pain
True or False: Phantom sensations can be mistaken for perineal abscess pain.
True
What can pelvic surgery disrupt that affects sexual function?
Nerve and vascular supplies to the genitalia
What nerve plexus is at risk during surgeries that remove the rectum?
Parasympathetic nerve plexus
For men, what are the main concerns regarding sexual function?
Erection and ejaculation
What factors affect the ability to have an erection?
- Intact parasympathetic nerves
- Nonadrenergic noncholinergic nerves
- Adequate blood supply
What surgical procedure can disrupt ejaculation due to sympathetic nerve damage?
APR procedure
How long may sexual problems be temporary after surgery?
3 to 12 months
What can nerve-sparing surgical techniques help preserve?
Sexual function
What issues can nerve damage cause for women post-surgery?
Vaginal dryness and decreased sensation
What may help women experiencing vaginal dryness post-surgery?
Experimenting with positions and using lubrication
What concerns do patients with an ostomy often have regarding sexuality?
- Fear of rejection
- Concerns about desirability
What should patients do before engaging in sexual activities?
Empty the pouch
What is crucial for patients with new ostomies?
Frequent assessment, planning, intervention, and evaluation
What are the two major aspects of nursing care for ostomy patients?
- Patient and caregiver teaching about ostomy care
- Emotional support for body image changes
What should patient teaching focus on for ostomy care?
- Basic skills about managing the ostomy
- Diet
- How to get help for problems
What is vital to protect the skin around the ostomy?
An appropriate pouching system
What components do most pouching systems include?
- Adhesive skin barrier
- Pouch to collect feces
What is a key nursing management task for ostomy care?
Assess and document stoma and peristomal skin appearance
What should be included in patient and caregiver teaching about ostomy self-care?
- Explain what an ostomy is
- Describe the underlying condition
- Demonstrate skin barrier removal and application
- Explain diet and fluid management
Fill in the blank: The ostomy pouch should be emptied before it is ______ full.
one-third
What is a recommended fluid intake for ostomy patients to prevent dehydration?
At least 3000 mL/day
What should patients do to reduce the chance of blockage?
Chew food very well
What are some symptoms of fluid and electrolyte imbalance?
Fever, diarrhea, skin irritation, stomal problems
What can help with emotional and psychologic adjustment to the ostomy?
Community resources
Why is follow-up care important for ostomy patients?
To monitor health and manage potential complications
What factors can the ostomy potentially affect?
- Sexual activity
- Social life
- Work
- Recreation
What type of pouch should be used in the initial postoperative period for stoma assessment?
A transparent pouch
This allows for easy assessment of stoma viability and pouch application.
How often should the peristomal skin be assessed?
Each time the pouch is changed
This is important to check for irritation.
What should be done if the peristomal skin is irritated and raw?
More products may have to be applied.
What is the stool consistency for a colostomy in the ascending and transverse colon?
Semi-liquid stools.
What type of pouch is recommended for a colostomy in the ascending and transverse colon?
A drainable pouch.
How long may a drainable pouch last?
Up to 4 to 7 days.
What stool consistency is associated with a colostomy in the sigmoid or descending colon?
Semiformed or formed stools.
What type of pouch can a patient with a sigmoid or descending colostomy use?
- Drainable pouch
- Disposable, closed-end pouch changed every day.
What is a feature of charcoal filters for ostomy pouches?
They can deodorize and automatically release flatus.
What is colostomy irrigation used for?
To stimulate emptying of the colon.
What are the requirements for a patient to perform colostomy irrigation?
Manual dexterity and adequate vision.
What should patients who irrigate have on hand?
Ostomy bags in case they develop diarrhea.
What is important for patients with a colostomy regarding diet?
The effect of food on stoma output is individual.
What can most patients with colostomies do regarding their diet?
Eat anything they want.
What activities can a patient resume within 6 to 8 weeks post-surgery?
Activities of daily living.
What should patients avoid lifting post-surgery?
Heavy lifting.
Is swimming with an ostomy pouch intact a problem?
No.
What type of obstruction is an ileostomy susceptible to?
Obstruction due to a lumen less than 1 inch in diameter.
What foods should be chewed very well before swallowing with an ileostomy?
- Nuts
- Raisins
- Popcorn
- Coconut
- Mushrooms
- Olives
- Stringy vegetables
- Foods with skins
- Dried fruits
- Meats with casings.
What is diverticulosis?
Saccular dilations or outpouchings of the mucosa that develop in the colon.
What occurs when diverticula become inflamed?
Diverticulitis.
What is a common concern for patients adjusting to an ostomy?
Stool leaking, odor, sounds of flatus, pouch reliability, and changes in lifestyle.
What should be provided to patients to help them cope with an ostomy?
Information, emotional support, and mastering basic skills.
What is vital for supporting patients with an ostomy?
Support from caregivers, family, and friends.
What type of pouching system is important for patients with an ileostomy?
A secure pouching system.
How much fluid intake is recommended for patients with an ileostomy?
At least 2 to 3 L/day.
What are the signs and symptoms patients must learn regarding fluid and electrolyte imbalance?
Signs and symptoms of fluid and electrolyte imbalance.
What types of foods can cause odor in stoma output?
- Alcohol
- Asparagus
- Broccoli
- Cabbage
- Eggs
- Fish
- Garlic
- Onions.
What foods can cause gas formation in stoma output?
- Beans
- Beer
- Cabbage family
- Carbonated beverages
- Strong cheeses
- Onions
- Sprouts.
What foods can cause diarrhea in stoma output?
- Alcohol
- Beer
- Cabbage family
- Coffee
- Raw fruits
- Green beans
- Spicy foods
- Spinach.
What is diverticulitis?
Inflammation of 1 or more diverticula, resulting in perforation into the peritoneum.
What does diverticular disease encompass?
A spectrum from asymptomatic, uncomplicated diverticulosis to diverticulitis with complications such as perforation, abscess, fistula, and bleeding.
Where are diverticula most commonly found in the GI tract?
In the left (descending, sigmoid) colon.
What are the main contributing factors to the development of diverticula?
- Genetic factors
- Environmental factors
- Diet
- Lifestyle
What dietary habits are associated with a higher prevalence of diverticulitis?
Low fiber intake and high consumption of red meat and refined carbohydrates.
What are common risk factors for diverticulitis?
- Obesity
- Inactivity
- Smoking
- Excess alcohol use
- NSAID use
What symptoms are typically associated with diverticulosis?
Most patients are asymptomatic; those with symptoms may experience abdominal pain, bloating, flatulence, and changes in bowel habits.
What are the most common signs of diverticulitis?
- Acute pain in the left lower quadrant
- Distention
- Decreased or absent bowel sounds
- Nausea
- Vomiting
- Systemic symptoms of infection
What complications can arise from diverticulitis?
- Erosion of the bowel wall
- Perforation into the peritoneum
- Localized abscess
- Peritonitis
- Extensive bleeding
What is the preferred diagnostic test for diverticulitis?
CT scan with oral contrast.
What clinical assessments are involved in diagnosing diverticular disease?
- History and physical assessment
- Testing of stool for occult blood
- CBC
- Urinalysis
- Imaging studies (CT scan, X-ray, MRI, ultrasound)
What is the primary goal of treatment in acute diverticulitis?
To let the colon rest and the inflammation subside.
What conservative therapies are recommended for diverticulosis?
- High-fiber diet
- Fiber supplements
- Weight loss (if overweight)
- Smoking cessation
What are some management strategies for acute diverticulitis?
- Antibiotic therapy
- NPO status
- IV fluids
- Analgesics
- NG suction
- Surgery (possibly resection or temporary colostomy)
True or False: Most patients with diverticulosis have symptoms.
False.
What nursing management steps should be taken for a patient with acute diverticulitis?
- Give IV fluids and electrolyte replacement
- Place the patient on NPO status
- Administer IV fluids and antibiotics
- Observe for signs of abscess, bleeding, and peritonitis
- Monitor the WBC count
- Implement pain management measures
- Maintain a strict intake and output record
- Provide frequent oral care and lubricant for the lips
- Institute NG suctioning and check for patency
Fill in the blank: Diverticula are uncommon in _______.
[vegetarians]
What is a fistula?
An abnormal tract between two hollow organs or a hollow organ and the skin
Fistulas are named based on the tract they form, such as enterocutaneous or enterovaginal.
What are the types of GI fistulas?
They are classified as simple or complex and by the amount of output:
* Simple fistula: one short, direct tract
* Complex fistula: associated with abscess and multiple organs
What characterizes a high-output fistula?
Drains more than 500 mL/day
Other classifications include moderate-output (200-500 mL/day) and low-output (less than 200 mL/day).
What are early signs of a fistula?
Fever and abdominal pain
Other signs depend on the type of fistula present.
What are common complications associated with GI fistulas?
Increased morbidity and mortality, extended hospital stays, and increased costs
Most fistulas occur after surgery or trauma.
What is the importance of maintaining fluid and electrolyte balance in fistula management?
To prevent dehydration and manage output effectively
Accurate intake and output records are essential for fluid replacement.
What dietary considerations should be taken for patients with fistulas?
High-calorie, high-protein parenteral or enteral nutrition is needed
Consult a dietitian for tailored nutritional support.
What is a hernia?
A protrusion of tissue through an abnormal opening or weakened area in a cavity wall
Hernias commonly occur in the abdominal cavity.
What is the difference between reducible and irreducible hernias?
Reducible hernias can return to the abdominal cavity, while irreducible hernias cannot
Irreducible hernias may lead to strangulation and acute bowel obstruction.
What complications can arise from strangulated hernias?
Gangrene and necrosis of the hernia contents
Strangulation compromises blood supply to the trapped contents.
What is the recommended fluid intake for patients with diverticular disease?
At least 2 L/day
This helps manage symptoms and prevent exacerbations.
What lifestyle modifications should be encouraged for patients with diverticular disease?
High-fiber diet, weight loss, smoking cessation, and avoiding increased intraabdominal pressure
Activities that increase pressure include straining, vomiting, and heavy lifting.
What is an enterocutaneous fistula?
An opening between the small intestine and the skin
It allows intestinal contents to drain through the skin.
What are some manifestations of a colovesical fistula?
Fecaluria, recurrent urinary tract infections, dysuria, and hematuria
This type of fistula connects the colon to the urinary tract.
What is the typical surgical procedure for recurrent diverticulitis?
Resection of the involved colon with a primary anastomosis
A temporary diverting colostomy may be necessary if anastomosis is not possible.
What is the impact of patient education on diverticular disease management?
Patients who understand the disease process and adhere to the regimen are less likely to have exacerbations
Education includes explaining dietary needs and symptom management.
What is a femoral hernia?
A protrusion through the femoral ring into the femoral canal, appearing as a bulge below the inguinal ligament.
What is herniorrhaphy?
A surgical procedure to repair a hernia, usually performed on an outpatient basis.
What is the most common type of hernia?
Inguinal hernia.
What are the common causes of ventral or incisional hernias?
- Weakness of the abdominal wall at a previous incision site
- Obesity
- Multiple surgeries in the same area
- Inadequate wound healing due to poor nutrition or infection.
What is the classic symptom of a hernia?
Pain, which may worsen with activities that increase intraabdominal pressure.
What complications can arise after an inguinal hernia repair?
Scrotal edema, which is painful.
What is the lifetime risk for men developing an inguinal hernia?
25% lifetime risk.
What is the lifetime risk for women developing an inguinal hernia?
Less than a 5% lifetime risk.
What is malabsorption syndrome?
Impaired absorption of fats, carbohydrates, proteins, minerals, and vitamins.
What is the most common malabsorption disorder?
Lactose intolerance.
What are the most common signs of malabsorption?
- Weight loss
- Diarrhea
- Fatigue
- Abdominal pain
- Steatorrhea.
What laboratory studies are needed to diagnose malabsorption?
- CBC
- Prothrombin time
- Liver function tests
- Serum levels of vitamin A, carotene, electrolytes, iron, and calcium.
What imaging studies can help diagnose malabsorption?
- CT scan
- Endoscopy
- Barium studies.
Fill in the blank: A hernia may be readily visible, especially when the person tenses the _______.
abdominal muscles.
True or False: Women are more likely to have inguinal hernias than men.
False.
What are the symptoms of a strangulated hernia?
- Severe pain
- Symptoms of bowel obstruction (vomiting, cramping, abdominal pain, distention).
What is the treatment of choice for a hernia?
Laparoscopic surgery.
What is steatorrhea?
Bulky, foul-smelling, yellow-gray, greasy stools with putty-like consistency.
