Disorders of the Lower GI Tract Flashcards
for occult blood tests this will create a false positive if
red meat, horseradish, or hemroids
two types of ostomies
ileostomy
colostomy
with any ostomie what area is at risk for break down
surrounding area
illeostomy
liquid
- should start putting out with in 2 hours
colostomy
formed
stoma
beefy red and moist
constipation
less than 3 per week
meds that cause constipation
opioids
iron
some antacids
what are some disorders that can cause constipation
rectal fistula
significant hemroids
obstruction
neurogenic disorders that can cause constipation
MS
parkinsons
hypothyroidism
what are some acute processes that can cause constipation
peritonitis
appendicitis
constipation can lead to straining which is what, who do we not want doing this
vasovagal/valsalva manöver
- vagus nerve stimulation = decrease HR
* avoid in elderly and cardiac patients
how do we prevent reoccurrence of constipation
exercise
diet
- increase fiber
fluid and fiber
- remind elderly about fluid
judicious use of laxitives
- do not want to become dependent
what is key in treating diarrhea
NEED TO RULE OUT AN INFECTION BEFORE TREATMENT
why do we need to rule out an infection before treatment of diarrhea
because if there is an infection and you are giving a med to slow the bowels then the bacteria is sitting in bowel reproducing
diarrhea causes what acid base disturbance
metabolic acidosis
vomitting causes what acid base disturbances
metabolic alkalosis
complications of diarrhea
fluid volume deficit
electrolyte disorders
metabolic acidosis
skin breakdown
management of diarrhea
controlling symptoms and preventing complications
fecal incontinence
involuntary passage of stool from the rectum
what can cause fecal incontinence
some meds
- diabetic meds
- blood pressire
feccal incontinence
- management
- improve quality of life
bowel training program
frequent toileting
elimination of causative factors
how do we diagnose irritable bowel syndrome
last ditch diagnosis
everything else is ruled out
irritable bowel syndrome
- diet
restrictions followed by gradual reintroduction able to find trigger foods
ultimately want a high fiber diet
nursing role for irritable bowel syndrome
- patient family education
diet habits
food diary
limit fluids with meals
avoid smoking and alcohol
appendicitis
- pain location
right lower quadrant/periumbilical
appendicitis
common age
10-30
if appendicitis ruptures it would cause
peritonitis
who has an atypical presentation of appendicitis
elderly
who are more likely to come in with a ruptured appendix
elderly
- it is missed the first time and then ruptures
why do we do a pregnancy test when we think of appendicitis
rule out ectopic pregnancy
perforation of appendicitis occurs how long after onset of pain
24 hours
perforation of appendicitis manifestations
fever
toxic apperence
increased pain
management for appendicitis
surgery
appendicitis
- IV fluids
isotonic
appendicitis
- postion
high fowlers
- reduce tension
- help with N/V
appendicitis
- pain management and relating adverse effects
morphine
- respiratory depression
- constipation
appendicitis
incision care
redness/swelling/ drainage
divertuculitis
food and bacteria retention in diverticulum producing infection and inflammation
complications of divertuculitis
perforation
abscess formation
peritonitis
bleeding
divertuculitis
- pain location
left lower quadrant
divertuculitis
- other clinical manifestations
nausea
vomitting
weakness
fever
chills
leukocytosis
main management of divertuculitis
gut rest
do we do a colonoscopy with patients with divertuculitis
no
we do not want to perforate
complications of divertuculitis
peritonitis
abscess
fistual
bleeding
divertuculitis management
diet
gut rest= complete NPO
clear liquid and then advance to high fiber and low fat diet
divertuculitis management pharm
analgesics
antispasmodic
antibiotics (7-10 days)
divertuculitis
assess/monitor for complications
increase abdominal pain
tenderness
rigidity
elevated WBC
ESR
temp
increase HR
decrease BP
if a patient is going for bowel surgery what profilaxis are they going to be on
antibiotics
- prevent infection and decrease bacterial load to reduce cause of peritonitis
complications of peritonitis
sepsis
shock
do we treat pain like peritonitis right away
we need to identify the source of pain and this gives us clues about what is wrong with the patient
early manifestations of peritonitis
s/s of causative disorder
- appendicitis/diverticulitus
what happens after early manifestations of peritonitis
diffuse abdominal pain more localized
aggravated by movement
tender
distended
rigid
bowel sounds with peritonitis
decreased sounds
peritonitis other manifesations
N/V
increase temp
increase pulse
increase WBC
peritonitis
medical management
fluids, colloids, electrolytes (N/V)
pain management
antiemetic
bowel decompression with NG tube
respiratory management
antibiotics
surgery
peritonitis
positioning
high fowlers
bowel obstruction
blockage of intestines preventing the flow of intestinal contents
bowel obstruction
- mechanical
bowel twists/adhesions
bowel obstruction
functional
post op anesthesia
bowel obstruction most common site
small intestine
bowel obstruction major complaint
pain
bowel obstruction large bowel symptoms develop
slowly
bowel obstruction large bowel complaint
constipation
bowel obstruction small bowel complaint
extreme pain (crampy/wavelike/colicly)
if you have a complete bowel obstruction what is the resolution
surgery
if you have a partial bowel obstruction what is the resolution
we will medically manage to see if the issue resolves on its own
bowel obstruction
- how do we decompress the stomach
NG tube on low intermittent suction
bowel obstruction
NG tube what do we need to monitor and replace
monitor drainage
replace fluides/lytes
bowel obstruction
careful management of pain
opioids
colon cancer
screening changes based on
risk factors
colon cancer clinical manifestations
change in bowel habits
- constipation
blood in stools
colon cancer
- gerontological considerations
change in bowel habits
treatment for colon cancer
surgery
chemo
radiation
