Cyndi - Week 2 - Exam 1 Flashcards
what are the s/sx of acute abdomen?
- Abdominal pain that’s worse with movement
- Involuntary guarding
- Abdominal rigidity
- Rebound tenderness
what is the veriform appendix?
‐ narrow blind tube below cecum, 2.5 cm long; wormlike
what is appendicitis?
inflammation of the appendix
- located at McBurney’s point
- formation of fecalith
- narrowed lumen
- trapped fluid becomes harbor for bacterial growth
what is a fecalith?
accumulated calcified feces, bacteria, mucus
what are the risk factors for appendicitis?
age, dietary habits, family fx, cystic fibrosis
what are the s/sx of appendicitis?
- Rebound RLQ, pain
- Guarding, knees drawn up
- Psoas, Rovsing, Obturator signs
- Anorexia, vomiting
- Fever
- Constipation, bloating, or diarrhea
what are psoas, rovsing, and obturator signs?
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
what are positive signs of appendicitis used for children?
stand on one foot and hop → pain
what are the diagnostic tests for appendicitis?
- 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.
what are the complications of appendicitis?
- Ileus (blockage d/t bowel unable to squeeze; stretched out)
- Perforation (stool in the sterile peritoneum cavity; LT)
- Shock (sepsis or hypovolemia)
what are the nursing priorities for appendicitis?
- NPO’
- Tx for pain
- ATBs
- IVFs
- Monitor for worsening
- Communicate with surgeon and team
T/F if appendicitis is suspected, you should hold pain meds for MD to assess
TRUE; it’s important to hold the meds so we are sure where the pain is and the characteristics of the pain.
what is the pre-op treatment for appendicitis?
- 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
what is the post-op tx for appendicitis?
- 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)
what is peritonitis?
Inflammation/infection of peritoneum
• Primary or secondary cause R/T whether there is organ rupture
what are the s/sx of peritonitis?
• 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
what are the diagnostics used for peritonitis?
- Labs
- X‐ray
- CT scan or ultrasound
- Peritoneoscopy (cut hole→put in scope)
- Paracentesis, culture (milky, yuck → infection)
what are the possible complications of peritonitis?
• 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
what is the treatment for peritonitis?
- Strict NPO
- IVF
- Antibiotics
- NG tube
- Analgesics
- Monitor pt status closely
what is the surgical tx for peritonitis?
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
what is crohn’s disease?
A chronic transmural (throughout the bowel), incurable, inflammatory disease of the bowel - life long
Crohn’s disease can lead to ____ and _____
fibrosis and obstruction (infection → tries to heal → lesions heal → tissue not the same → problems absorbing nutrients)
characteristics of crohn’s disease?
- 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)
what are the risks factors for crohn’s disease?
probably a combination of: • Environmental • Dietary • Genetic – heredity (caucasian), gender (female), age, familial • Altered immune system, gut microflora
what are the clinical manifestations of crohn’s disease?
- 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)
what is ulcerative colitis?
An inflammatory disease of the colon, with unknown cause
• 3 X more common than Crohn’s
T/F Ulcerative colitis is an autoimmune disorder.
TRUE; antibodies against intestinal epithelial cells are
found in UC
UC only affects _______ surfaces of the ______; altered ____ _____ often found.
mucosal; colon; gut flora
What are 6 other characteristics of UC?
• 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
what are the s/sx of UC?
• 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
what are the diagnostic tests used for both UC and Crohn’s disease?
- Colonoscopy – can differentiate between Crohn’s and Colitis
- Biopsy of inflamed and normal tissue
- CT, MRI
- Labs
- Stool occult blood, culture
what are the diagnostic tests used for ONLY Crohns?
capsule endoscopy - pill-like camera takes pictures as it travels through GI system
what different types of treatment are available for both Crohns and UC?
nutrition; surgical; and medications
what nutritional interventions are used as tx for Crohns and Colitis?
- May need enteral, parenteral, or vitamins for Crohn’s
- Manage weight loss and dehydration in Colitis
- May need to make dietary changes
what surgical treatments are available for Crohn’s and Colitis?
• 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
how can you differentiate between an colostomy bag and an ileostomy bag?
colostomy → more like stool; more absorbed
ileostomy → watery; not all absorbed yet
what medications are used for Crohn’s and Colitis?
- 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)
what are the main tx goals for patient’s with Crohn’s and UC?
- correct anemia
- control diarrhea
- control pain/cramping
- control infection
- maintain fluid balance
what are the NIs for Crohn’s and Colitis?
• 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
what foods should be avoided with crohn’s and colitis?
cabbage, capsicum/peppers, sprouts, raw salads, radish, okra, broccoli, and raw onions
what is diverticulitis?
the inflammation of one or more diverticula
what is diverticulOSIS?
saccular outpouching in the colon
what are the causes of diverticulitis?
weakness of the bowel wall, and ↑ intraluminal pressure
what are risk factors of diverticulitis?
• ↑ 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)
what are complications of diverticulitis?
• Peritonitis, perforation, abscess formation, scarring
what are the s/sx of diverticulitis?
• 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?
what are the diagnostic test for diverticulitis?
• X‐ray, CT,MRI, sigmoidoscopy or colonoscopy, Labs, stool for OB
what are the treatment options for diverticulitis?
- Conservative course ‐
- Bowel rest ‐ NPO with IV hydration
- Pt education – especially dietary modifications
- Medications
- NG to LIWS
- Surgery ‐ colon resection or possible temporary colostomy
what are is a bowel obstruction?
Partial or complete inability of contents to pass through GI tract
what are the different types of obstructions?
- 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%)
what are the complications of a bowel obstruction?
Ileus, perforation, necrotic bowel
what diagnostic studies are used in bowel obstructions?
- CT scan
- X‐ray abdomen
- Possible endoscopy
- Labs
what are the s/sx of bowel obstructions?
• Severe abdominal pain • Nausea, vomiting • Sweating, anxiety, restlessness • Abdominal distension • Constipation, lack of flatus, high‐pitched, hyperactive, hypoactive, or absent bowel sounds
what is the tx for bowel obstructions?
• 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
what is colorectal cancer?`
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)
what are the risk factors of colorectal cancer?
Genetic, ethnicity, diet, obesity, sedentary, alcohol, smoking, IBD, age
what are the diagnostic tests for colorectal cancer?
- 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
what are the s/sx of colorectal cancer?
- 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
what are the warning signs of colorectal cancer?
• 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
what is the treatment of colorectal cancer?
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
what is important for post op bowel surgery care?
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
