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n233 final > diarrhea and nausea/vomiting > Flashcards

diarrhea and nausea/vomiting Flashcards

1
Q

what is diarrhea? (3)

A
  • increased frequency of bowel movements (more than 3 a day) -increased amount of stool (more than 200g a day)
  • altered consistency (increased liquidity of stool)
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2
Q

diarrhea is associated with…

A

urgency, perianal discomfort, incontinence

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3
Q

any condition that causes….. can produce diarrhea

A
  • decreased intestinal secretions
  • decreased mucosal absorption
  • altered motility
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4
Q

two underlying potential causes of diarrhea?

A

inflammatory bowel disease
and
lactose intolerance

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5
Q

acute diarrhea=

A

infection, self-limiting 7-14 days

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6
Q

chronic diarrhea=

A

2-3 weeks, may return sporadically
common causes:
-tumours, IBD, AIDs, diabetes, hyperthyroidism, addisons disease

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7
Q

causes of diarrhea? tons

A

medication (stool softeners, laxatives, thyroid hormone, antibiotics, chemotherapy, antiarrhythmics, antihypertension, magnesium based), tube feed, metabolic and endocrine disorders (addisons, thyroid, diabetes) viral or bacterial infections
-celiac, sphincters defect, zollinger-ellison syndrome, paralytic ileus, obstruction, AIDs)

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8
Q

secretory diarrhea=

A

high volume, increased production and secretion of water and electrolytes by intestinal mucosa into lumen
-associated with toxins and neoplasms

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9
Q

osmotic diarrhea=

A

occurs when water is pulled into intestines by osmotic pressure of unabsorbed particles, slowing the reabsorption of water
-caused by lactase deficiency, pancreatic dysfunction, or intestinal hemorrhage

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10
Q

malabsorptive diarrhea=

A

inhibiting effective absorption of nutritions manifested by marked of malnutrition that include hypoalbuminemia—> low serum albumin and intestinal mucosa swelling, liquid stool
-combines mechanical and biochemical actions

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11
Q

infectious diarrhea=

A

invade the mucosa, c. diff common

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12
Q

exudative diarrhea=

A

caused by changes in mucosal integrity, epithelial loss or tissue destruction by radiation or chemo

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13
Q

manifestations

A

-abdominal cramps, distension, borborygmus, anorexia, thirst
-painful spasmodic contractions of the anus, ineffective straining (tenesmus) may occur
-

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14
Q

nocturnal diarrhea-

A

diabetic

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15
Q

watery stools=

A

characteristic of small bowel

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16
Q

loose, semisolid stools=

A

large bowel

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17
Q

voluminous, greasy stools=

A

intestinal malabsorption

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18
Q

blood mucus and pus in stool=

A

suggest inflammatory enteritis or colitis

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19
Q

oil droplets on the toilet water=

A

indicate pancreatic insufficency

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20
Q

assessment and diagnostics for diarrhea?

A
  • CBC
  • serum chemistries
  • urinalysis
  • stool exam routine and parasitic
  • infectious, toxins, blood
  • fat electrolytes
  • endoscopy or barium enema
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21
Q

complications of diarhea?

A
  • CARDIAC DYSRHYTHMIAS because significant fluid and electrolyte loss (potassium!!)
  • urinary output of less than 30ml per hour for 2-3 hours… muscle weakness, paresthesia, hypotension, anorexia
  • POTASSIUM LESS THAN 3.5 REPORT
  • skin care issues from irritant dermatitis
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22
Q

geri considerations?

A
  • older, dehydrated more quickly, develop lower potassium levels
  • muscle weakness, dysrhythmias or decreased peristalsis motility—> paralytic ileus
  • if taking digoxin be aware of how quickly dehydration and hypokalemia occur with diarrhea
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23
Q

medical management of diarrhea?

A

-antibiotics, anti-inflammatory agents, antidiarrheals reduce severity and treat underlying

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24
Q

nursing management/assessments for diarrhea?

A

-assess and monitor characteristics, pattern, health history, diet, intake
-abd auscultation, palpation, inspection of mucous membranes and skin
-stool samples
-encourage bed rest, avoid caffeine, carbonated beverages, very hot or cold foods (stimulate intestinal motility)
report dysrhythmias or change in LOC

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25
Q

pediatric considerations for GI system?

A
  • mouth is highly vascular, common port for infection
  • lower esophageal sphincter prevents regurgitation into esophagus, not fully developed until 1 moth of age… so tend to regurgitate after feeds until 1 year
  • childs stomach capacity increases with age (10-20 ml for newborn, 200ml for 2 month, 1500ml for adolescent)
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26
Q

at what age is the gastric contents equal to the adults?

A

by 6 months

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27
Q

intestinal growth spurts occur…

A

1-3 years. 15-16 years

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28
Q

clincal manifestations of GI dysfunction in children?

A
  • growth failure
  • spitting up or regurgitation
  • vomiting, projectile vomiting (vigorous peristalic waves and pyloric stenosis or spasm)
  • nausea
  • constipation
  • encopresis (more water stools)
  • diarrhea
  • bowel sounds (hypo,hyper,absent)
  • abd distension
  • pain
  • GI bleeding
  • jaundice
  • dysphagia
  • dysfunctional swallowing
  • fever
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29
Q

antiemetics=

A

given to supress nausea and vomiting

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30
Q

emesis=

A

complex reflex by activating vomiting center, a nucleus of neurons in the medulla or oblongata

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31
Q

-direct stimuli of the vomiting center?

A
  • cerebral cortex (anticipation or fear)
  • sensory organs (upsetting sights, noxious odors, pain)
  • vestibular apparatus of inner ear
32
Q

indirect stimuli of vomiting center?

A

-first activate chemoreceptor trigger zone and vomiting center
-occurs in 2 days:
… by signals from stomach and intestine (vagal afferents)
by direct action of emetogenic compounds (anticancer drugs, opioids, ipecac) that are carried to CTZ in blood

33
Q

the vomiting center signals…

A

the stomach, diaphragm and abdominal muscles to expel gastric contents

34
Q

serotonin receptor antagonists…

A

ONDANSETRON
…. most effective for nausea and vomiting caused by cisplatin or other emetogenic anticancer drugs, radiation, anesthesia, viral gastritis, pregnncy

35
Q

ondansetron … tell me about it

A
  • for radiation, anesthesia, childhood viral gastritis, morning sickness
  • blocks type 3 serotonin receptors in CTZ and afferent vagal neurons in upper GI
  • oral or parenteral
  • side effects: headache, diarrhea, dizzy, PROLONG QT INTERVAL life threatening dysrhythmia
  • DO NOT GIVE TO PT WITH LONG QT INTERVAL, caution with other GT syndrome, HF, bradyarrhythmias
36
Q

metoclopramide…. tell me about it

A

DOPAMINE ANTAGNOIST
(ANOTHER is prochlorperazine)
-suppresses emesis through blockage of dopamine receptors in CTZ. can suppress postop nausea and vomiting as well as emesis caused by antiulcer drugs, opioids, toxins and radiation therapy
-prokinetic agent SO… increase the TONE and MOTILITY of GI TRACT
(indication= gastroesophageal reflux diseae, CINV, diabetic gastroparesis)
-increases upper GI motility!!
-contraindication= GI obstruction, perforation or hemorrhage!!!!
-treatment should be as brief as possible (irreversible dyskinesia is a side effect)

37
Q

scopolamine… tell me aboutit

A
  • DRUG FOR MOTION SICKNESS
  • muscarinic antagonist… most effective drug for prevention and treatment of motion sickness
  • suppresses nerve in vestibular appartus of inner ear to vomiting center
  • side effects: blurred vision, dry mouth, drowsy, urinary retention, constipation, disoritentation
38
Q

antihistamines…. tell me about it

A

DIMENHYDRINATE!!
-MOTION SICKNESS
-block receptor for acetylcholine in addition to receptor for histmaine
-blocks receptor that connects inner ear to vomiting center
-side effects: SEDATION from H1 receptor, dry mouth, blurred vision, urinary retention, constipation (all from blocking muscarinic receptor)
LESS effective than scopolamine for motion sickness

39
Q

nonspecific antidiarrheal agents?

A

-opioids (diphenoxylate with atropine)
more effective antidiarheal agents
activate opioid receptors in GI tract—> decrease intestinal motility, slow intestinal transit, allows more time for absorption of fluid and electrolytes
-opioid receptors decrease secretion of fluid into small intestine and increase absorption of fluid and salt
—-> less water in large intestine, volume of stools reduced
ONLY USED FOR DIARRHEA
-ONLY AVAIL with atropine, present to discourage abuse
-NO significant effect on CNS

40
Q

antidiarrheal medication can change…

A

change the concentration and availability of medications—> some med binds to the toxins…. so if patients are on other meds, drug-drug interactions….

41
Q

adsorbents?

A

an antidiarrheal (ex. bismuth subsalicylate)

  • mild cases
  • may blacken stools/tongue (activated charcoal!)
  • they bind/adhere to toxins that cause diarrhea
  • disadvantage: do not address dehydration
42
Q

bulk forming agents?

A

an antidiarrheal

  • methylcellulose
  • causes stools to be less watery
  • does not effect volume of stool
  • can be used as laxatives
43
Q

anticholinergics?

A

ex. atropine
- can relieve cramping
- do not change consistency or volume of stool
- has undesirable side effects….

44
Q

opioids (ex. diphenoxylate, loperamide)

A

last resort

  • decrease motility and painn
  • increase in time stool is in bowel= increased absorption of nutrients, h20, electrolytes
45
Q

NURSING ASSESSMENTS diarrhea

A
  • NOPQRSTUV for diarrhea
  • normal history of bowel habits
  • amt consistency and quality of stools
  • ins, outs, weights
  • signs of dehydration (VS, physical exam, lab work)
46
Q

NURSING DIANGOSIS: diarrhea

A 
risk of: deficient fluid volume 
inbalance nutrition 
acute pain
activity intolerance
ineffective coping 
impaired skin integrity 
electrolyte imbalance
47
Q

nursing interventions of diarrhea?

A
  • establish cause if possible and treat
  • supportive care
  • IV fluids
  • bland diet with slow advancement
  • electrolyte balance
  • possible antidiarrheal
  • maintain skin integrity
  • comfort measures
  • psychological support
48
Q

diphenoxylate vs. atropine

A 
diphenoxylate= opioid, slows peristalsis 
atropine= anticholinergic, slows peristalsis and reduces gastric secretions 
SIDE EFFECTS (opioid- constipation and resp depression)
assess LOC, vitals (RR, BP)
49
Q

kidneys in children…

A

immature until age 2, cannot retain water as well

50
Q

dehydration in kids…

A

becomes medical emergency. can lead to kidney failure, cardiac collapse, death
-INFANTS and children become dehydrated fast…. infants can lose 40% ECF in 24 hours

51
Q

assessments for child with diarrhea? (early)

A

-dry mouth, decreased urine output, weight loss, what is the childs normal consistency of stool???

52
Q

assessments for child with diarrhea (LATE SIGNS)

A
  • sunken fontanelles in babies
  • loss of tears when crying
  • sunken eyes
  • rapid, deep respirations (acidosis)
  • rapid weak pulse
  • cold extremities
  • cyanosis
  • loss of skin turgor
  • COMA
53
Q

nursing assessments for baby with diarrhea?

A

similar to adult: IV fluids based on weight, advance diet slowly (yes popsicles count!)

  • daily weights
  • STRIKT ins and outs, weigh diapers
  • PRE and POST feed weights
  • little bloodwork
  • MOM is hydrated (if breast fed)
54
Q

what is oral rehydration therapy?

A

low-tech solution that has saved millions of lives

-oral rehydration solution: boilted water, sugar, salt, orange juice or banana can be addedfor taste

55
Q

nausea is…. ???? S or O

A

SUBJECTIVE!!

56
Q

complications of nausea and vomiting?

A
  • aspiration pneumonia
  • dehydration
  • malnutrition
  • disruption of surgical site
  • metabolic disturbances
  • increased intracranial pressure
  • stress/anxiety
57
Q

4 pathways to the vomiting center?

A
  1. chemoreceptor for trigger zone (CTZ)
  2. GI tract
  3. Labyrinth (Inner ear)
  4. cerebral cortex
58
Q

GI tract- Triggers of nausea and vomiting?

A

distension, obstruction, infection

59
Q

neurotransmitters involved in GI tract?

A

-serotonin, dopamine, prostaglandins

60
Q

chemoreceptor trigger zone? (what are the triggers) hint S!!

A

outside the blood brain barrier

SYSTEMIC triggers of vomiting so… hormones, toxins, metabolic abnormalities

61
Q

neurotransmitters involved in CTZ?

A

dopamine, serotonin

62
Q

vestibular and labyrinth trigger?

A

stimulated by: motion sickness, vertigo, opioids exert some influence

63
Q

neurotransmitters in inner ear?

A

histamines, acetylcholine

64
Q

cerebral cortex? triggers???

A

psychological component of nausea

-triggers: emotions, smells, anticipatory nausea, taste, gag reflex

65
Q

so how do you pick which drugs for nausea and vomiting??

A

match trigger or cause with right drug or therapy!

  • many type of antiemetics
  • know your nursing considerations for each
66
Q

anticholinergics… tell me more connecting with the route etc

A

BLOCKS acetylcholine receptors in vestibular nuclei an reticular formation!! so used for motion sickness and PONV
-side effects: sedation, dry mouth, constipation, difficult urination, blurred vission
EXAMPLE: scopolamine

67
Q

antihistamines (H1 receptor antagonist)

A

mechanism: blocks H1 receptors, preventing Ach from binding to receptor in vestibular nuclei
USE: motion sickness, non-productive cough, sedation, rhinitis, allergies
side effects: sedation, dry mouth, urinary retention, blurred vision

68
Q

example of a antihistamine???

A

dimenhydrinate, diphenhydramine

69
Q

dopamine antagonist (d2 receptor)…. tell me more again

A

BLOCK DOPAMINE IN CTZ may also block ach, calm CNS
use: n/v from chemo, psychotic disorders, hiccups, radiation
side effects: orthostatic hypotension, extrapyramidal symptoms, tardive dyskinesia, headache, dry eyes, constipation, urinary retention

70
Q

example of dopamin antagonist

A

PROCHLORPERAZINE

71
Q

prokinetics tell me more again please

A

stimulates peristalsis
blocks dopamine receptors in CTZ, desensitizing to impulses from GI tract
use: delayed gastric emptying, GERD, N/V from chemo, PONV
side effects: ypotension, headache, dystonia, dry mouth, sedation, diarrhea
METOCLOPRAMIDE

72
Q

serotonin antagonist?

A

block serotonin receptors in GI, CTZ, VC

  • used for chemotherapy nausea or radiation, PONV
  • side effects: rash, headache, diarrhea, PROLONGED QT INTERVAL
  • ONDANSETRON
73
Q

THC for n/v???

A

inhibitory effects on reticular formation, thalamus, cerebral cortex
use for n/v from chemo, stimulate appetite in AIDs, cancer
-side effects: drowsy, dizzy, anxious, confused, euphoria, visual disturbances, dry mouth
WEED

74
Q

benzodiazepines for nausea????

A

used as adjunct, depresses CNS to help manage n/v from triggers related to CEREBRAL CORTEX
-side effects: sedation, amnesia
LORAZEPAM!!

75
Q

corticosteroids for nausea?

A

usually not given alone but with one or more other category of antiemetic
ADJUNCT for nausea caused by chemotherapy

n233 final (11 decks)

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