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Nursing Semester 3 > Cyndi - Week 2 - Exam 1 > Flashcards

Cyndi - Week 2 - Exam 1 Flashcards

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1
Q

what are the s/sx of acute abdomen?

A
  • Abdominal pain that’s worse with movement
  • Involuntary guarding
  • Abdominal rigidity
  • Rebound tenderness
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2
Q

what is the veriform appendix?

A

‐ narrow blind tube below cecum, 2.5 cm long; wormlike

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3
Q

what is appendicitis?

A

inflammation of the appendix

  • located at McBurney’s point
  • formation of fecalith
  • narrowed lumen
  • trapped fluid becomes harbor for bacterial growth
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4
Q

what is a fecalith?

A

accumulated calcified feces, bacteria, mucus

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5
Q

what are the risk factors for appendicitis?

A

age, dietary habits, family fx, cystic fibrosis

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6
Q

what are the s/sx of appendicitis?

A
  • Rebound RLQ, pain
  • Guarding, knees drawn up
  • Psoas, Rovsing, Obturator signs
  • Anorexia, vomiting
  • Fever
  • Constipation, bloating, or diarrhea
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7
Q

what are psoas, rovsing, and obturator signs?

A

positive signs that it is appendicitis - not definitive, but then we do more intrusive tests

  • psoas: pain with putting left leg back
  • rovsing: push on left side, right side is painful
  • obturator: put right leg over left → pain
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8
Q

what are positive signs of appendicitis used for children?

A

stand on one foot and hop → pain

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9
Q

what are the diagnostic tests for appendicitis?

A
  • Pain pattern – may occur over 1‐3 days
  • Abdominal assessment
  • Labs
  • Labs
  • Abdominal X‐ray, CT, (most accurate) ultrasound
  • Females of child bearing age should be ruled out for ectopic preg, etc.
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10
Q

what are the complications of appendicitis?

A
  • Ileus (blockage d/t bowel unable to squeeze; stretched out)
  • Perforation (stool in the sterile peritoneum cavity; LT)
  • Shock (sepsis or hypovolemia)
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11
Q

what are the nursing priorities for appendicitis?

A
  • NPO’
  • Tx for pain
  • ATBs
  • IVFs
  • Monitor for worsening
  • Communicate with surgeon and team
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12
Q

T/F if appendicitis is suspected, you should hold pain meds for MD to assess

A

TRUE; it’s important to hold the meds so we are sure where the pain is and the characteristics of the pain.

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13
Q

what is the pre-op treatment for appendicitis?

A
  • No laxatives or enemas: (may cause rupture)
  • Antibiotics for gram negative bacteria
  • Pain medicine may be withheld until appendicitis diagnosed
  • IVF
  • NPO (strict)
  • Plan for surgery
  • Monitor for peritonitis s/s
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14
Q

what is the post-op tx for appendicitis?

A
  • Antibiotics for 48 hours+
  • Antiemetics (N+V)
  • Ambulate on day of surgery
  • Flatus?
  • Advance diet as tolerated
  • Monitor for S/S peritonitis (rigid, distended, pain, guarding, nausea)
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15
Q

what is peritonitis?

A

Inflammation/infection of peritoneum

• Primary or secondary cause R/T whether there is organ rupture

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16
Q

what are the s/sx of peritonitis?

A 
• Severe abdominal pain
• Abdominal rigidity and/or distention
• Nausea and vomiting
• Tympanic abdomen
• Absent bowel sounds
• Hypotension
 Fever, chills
 Weak rapid pulse
 Tachypnea ‐ due to distention
 Weakness
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17
Q

what are the diagnostics used for peritonitis?

A
  • Labs
  • X‐ray
  • CT scan or ultrasound
  • Peritoneoscopy (cut hole→put in scope)
  • Paracentesis, culture (milky, yuck → infection)
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18
Q

what are the possible complications of peritonitis?

A

• Shock (septic or hypovolemic - rapid fluid shift)
• Abscess formation
• Paralytic ileus (no movement)
• ARDS (Adult/Acute Respiratory Distress Syndrome)
Condition can spiral down to DEATH if treatment delayed

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19
Q

what is the treatment for peritonitis?

A
  • Strict NPO
  • IVF
  • Antibiotics
  • NG tube
  • Analgesics
  • Monitor pt status closely
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20
Q

what is the surgical tx for peritonitis?

A

Surgical intervention (laparotomy - little opening to fix problem)
• Find cause and repair damage
• Drain purulent fluid
• Flush with antibiotic solution
Postop care same as with Appendicitis
Pt education if secondary to preventable cause

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21
Q

what is crohn’s disease?

A

A chronic transmural (throughout the bowel), incurable, inflammatory disease of the bowel - life long

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22
Q

Crohn’s disease can lead to ____ and _____

A

fibrosis and obstruction (infection → tries to heal → lesions heal → tissue not the same → problems absorbing nutrients)

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23
Q

characteristics of crohn’s disease?

A
  • Entire thickness of bowel wall and all layers of submucosa
  • Deep fissures develop, leading to fistulas and abscesses
  • Can have “skip” lesions, with health tissue between,“cobblestoning”
  • Altered nutrition due to malabsorption and scarring (high sugar and fat exacerbates it)
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24
Q

what are the risks factors for crohn’s disease?

A 
probably a combination of:
• Environmental
• Dietary
• Genetic – heredity (caucasian), gender (female), age, familial
• Altered immune system, gut microflora
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25
Q

what are the clinical manifestations of crohn’s disease?

A
  • Episodes of diarrhea and abdominal pain (asses number, type, appearance of stool, aggravating and alleviating factors)
  • Steatorrhea (fatty stools)
  • Anorexia, nausea, vomiting
  • Malabsorption (weight loss, anemia, fatigue)
  • May have rectal bleeding
  • May have remissions, exacerbations and systemic problems (arthritis)
26
Q

what is ulcerative colitis?

A

An inflammatory disease of the colon, with unknown cause

• 3 X more common than Crohn’s

27
Q

T/F Ulcerative colitis is an autoimmune disorder.

A

TRUE; antibodies against intestinal epithelial cells are

found in UC

28
Q

UC only affects _______ surfaces of the ______; altered ____ _____ often found.

A

mucosal; colon; gut flora

29
Q

What are 6 other characteristics of UC?

A

• May be normal weight
• Bloody diarrhea and cramping
• ↑ risk of colon cancer (3‐5% of pts)
• Continuous pattern of inflammation
• May have pseudopolyps (raised lesion; not cancerous)
• Other factor; use of steroids, milk consumption,
stress, gen

30
Q

what are the s/sx of UC?

A

• 4‐20 stools/day with pus, blood
• Abdominal cramping
• Involuntary leakage of stool (paralyzing for pts)
• With severe disease can lose weight
– Fluid loss can be 500‐2000 mL per day (hypovolemia)
• May have remissions, exacerbations

31
Q

what are the diagnostic tests used for both UC and Crohn’s disease?

A
  • Colonoscopy – can differentiate between Crohn’s and Colitis
  • Biopsy of inflamed and normal tissue
  • CT, MRI
  • Labs
  • Stool occult blood, culture
32
Q

what are the diagnostic tests used for ONLY Crohns?

A

capsule endoscopy - pill-like camera takes pictures as it travels through GI system

33
Q

what different types of treatment are available for both Crohns and UC?

A

nutrition; surgical; and medications

34
Q

what nutritional interventions are used as tx for Crohns and Colitis?

A
  • May need enteral, parenteral, or vitamins for Crohn’s
  • Manage weight loss and dehydration in Colitis
  • May need to make dietary changes
35
Q

what surgical treatments are available for Crohn’s and Colitis?

A

• Surgery does not cure Crohn’s, although 75% will have surgery at some point
• For severe colitis can connect ileum to rectum
• Possible ostomy ‐ may need to make lifestyle changes
• Support group
Quality of life – may have disease‐specific management goals

36
Q

how can you differentiate between an colostomy bag and an ileostomy bag?

A

colostomy → more like stool; more absorbed

ileostomy → watery; not all absorbed yet

37
Q

what medications are used for Crohn’s and Colitis?

A
  • Anti‐inflammatory drugs – sulfasalazine
  • Immune suppressors - humira
  • Steroids – esp during exacerbations
  • Antibiotics
  • Anti‐diarrheal agents
  • Sulfasalazine
  • Pain relievers
  • Antiemetics
  • Correct anemia or fluid volume deficit if necessary
  • Supplements to correct anemia (B12, calcium, vitamin D, and iron)
38
Q

what are the main tx goals for patient’s with Crohn’s and UC?

A
  • correct anemia
  • control diarrhea
  • control pain/cramping
  • control infection
  • maintain fluid balance
39
Q

what are the NIs for Crohn’s and Colitis?

A

• Bowel rest – may need to be NPO
• Control inflammation, infection, nutrition (keep journal)
• Teach to avoid triggers and alleviate stress
• Provide symptom relief
• Improve quality of life
Complications:
• Toxic megacolon (so stretched out and infection)
• Bowel obstruction → perforation

40
Q

what foods should be avoided with crohn’s and colitis?

A

cabbage, capsicum/peppers, sprouts, raw salads, radish, okra, broccoli, and raw onions

41
Q

what is diverticulitis?

A

the inflammation of one or more diverticula

42
Q

what is diverticulOSIS?

A

saccular outpouching in the colon

43
Q

what are the causes of diverticulitis?

A

weakness of the bowel wall, and ↑ intraluminal pressure

44
Q

what are risk factors of diverticulitis?

A

• ↑ age (60-70)
• Previous incident (20‐35% recur without surgery)
• Decreased fiber intake
• Uncommon in vegetarians
• Occurs in areas where blood vessels penetrate
the colon wall (not as strong)

45
Q

what are complications of diverticulitis?

A

• Peritonitis, perforation, abscess formation, scarring

46
Q

what are the s/sx of diverticulitis?

A

• May be asymptomatic (80‐85%) or have a change in bowel habits
• Can have severe pain (esp LLQ) or fever
• Alternating diarrhea/constipation; bloating, flatulence
Decision‐making: Will this pt need surgery?

47
Q

what are the diagnostic test for diverticulitis?

A

• X‐ray, CT,MRI, sigmoidoscopy or colonoscopy, Labs, stool for OB

48
Q

what are the treatment options for diverticulitis?

A
  • Conservative course ‐
  • Bowel rest ‐ NPO with IV hydration
  • Pt education – especially dietary modifications
  • Medications
  • NG to LIWS
  • Surgery ‐ colon resection or possible temporary colostomy
49
Q

what are is a bowel obstruction?

A

Partial or complete inability of contents to pass through GI tract

50
Q

what are the different types of obstructions?

A 
- Mechanical
• Adhesion or stricture (lumen tighter)
• Intussusception (floppy bowel goes up on itself; stuff gets stuck)
• Volvulus (twists on itself)
• Cancer
- Non‐mechanical
- Simple
- Strangulated
- Small bowel versus large bowel (10‐15%)
51
Q

what are the complications of a bowel obstruction?

A

Ileus, perforation, necrotic bowel

52
Q

what diagnostic studies are used in bowel obstructions?

A
  • CT scan
  • X‐ray abdomen
  • Possible endoscopy
  • Labs
53
Q

what are the s/sx of bowel obstructions?

A 
• Severe abdominal pain
• Nausea, vomiting
• Sweating, anxiety, restlessness
• Abdominal distension
• Constipation, lack of flatus, high‐pitched, hyperactive,
hypoactive, or absent bowel sounds
54
Q

what is the tx for bowel obstructions?

A

• NPO status, strict I & O
• NG tube to decompress and rest the bowel
• IV fluid resuscitation/electrolyte replacement
• Antiemetic
• Pain control
• ProphylacticATB therapy
• Possible TPN
• Monitor closely for worsening condition –
– What will a worsening pt look like???
• Surgery consult – surgery will be required for mechanical
obstruction
Laxative or motility agents contraindicated in obstructions
***REST THE GUT

55
Q

what is colorectal cancer?`

A

Malignant neoplasm ‐ invades the epithelium and surrounding tissue of the colon and rectum – can extend through bowel wall and metastasize – preventable with screening (age 50)

56
Q

what are the risk factors of colorectal cancer?

A

Genetic, ethnicity, diet, obesity, sedentary, alcohol, smoking, IBD, age

57
Q

what are the diagnostic tests for colorectal cancer?

A
  • Colonoscopy (virtual may be done for screening)
  • Sigmoidoscopy
  • Digital rectal exam, barium enema
  • CT, MRI, ultrasound
  • Labs
  • Stool tests for occult blood
  • Biopsy for diagnosis and/or staging
58
Q

what are the s/sx of colorectal cancer?

A
  • Vague in early disease – insidious – asymptomatic for years
  • Symptoms do not appear until disease is advanced!
  • Rectal bleeding (hematochezia), anemia
  • Abdominal pain
  • Weight loss
  • Malaise but don’t know why
59
Q

what are the warning signs of colorectal cancer?

A 
• Change in bowel elimination habits
• Blood in the stool
• Rectal or abdominal pain
• Change in the character of the stool
• Sensation of incomplete emptying
Patient education should also include ways to decrease risk
60
Q

what is the treatment of colorectal cancer?

A

Prognosis correlates with TNM staging (Table 43‐24)
• Surgery:
–Bowel prep
–Colectomy, colostomy, colon and/or rectum removal
• Chemotherapy for some patients
• Radiation for some patients
• Body image concerns
• Quality of life
• Recurrence – CEA every 3 months, annual colonoscopy
• Complications

61
Q

what is important for post op bowel surgery care?

A 
Surgical site care and dressing changes
– Stoma care and teaching if indicated
• NG tube ‐ strict NPO;
– Progress to diet after flatus
• Ambulate, ambulate, ambulate
• Fluid volume status
– Dehydration versus overload
• Strict I & O
• Drain care if indicated
• Prevent complications

Nursing Semester 3 (29 decks)

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