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NUR 155 med surg > Elimination > Flashcards

Elimination Flashcards

1
Q

Major enzymes and secretions

Mouth
Stomach
Small intestine

A

Chewing and swallowing:
- saliva, salivary amylase

Gastric:
- hydrochloric acid, pepsin, intrinsic factor

Small intestine:
- amylase, lipase, trypsin, bile

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2
Q

GI history to get from patient

A 
Abd pain 
Dyspepsia
Gas
N/V
Constipation, diarrhea, change in bowel pattern 
Characteristics of stool
Jaundice 
History of GI surgery 
Appetite or eating pattern 
Teeth 
Weight pattern
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3
Q

How to check placement of NG

A
  • x ray
  • mark it
  • check residual ( PH )
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4
Q

Nursing care for NG tube

A

Patient Education and preparation

Tube insertion and removal

Confirm placement

Clearing tube obstruction

Monitor patient

Maintain tube function

Oral and nasal care

Monitor, prevent, managing complications

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5
Q

External feeding assessment

A

Nutrition status

Factor or illness that increase metabolic needs

Hydration

Digestive function

Renal and electrolyte status

Medication effecting GI

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6
Q

Enteral feeding diagnosis

A

Imbalanced nutrition

Risk for diarrhea

Risk for ineffective airway

Risk for deficient fluid

Risk for ineffective coping or therapy tic management

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7
Q

Enteral feeding potential complications

A

Diarrhea or N/V

Gas, bloating, cramping

Dumping syndrome

Aspiration pneumonia

Tube displacement / obstruction

Nasopharyngeal irritation

Hyperglycemia

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8
Q

IBD

A

broad term that describes conditions characterized by chronic inflammation of the gastrointestinal tract

Crohns and ulcerative colitis

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9
Q

Where is Crohn’s disease

A

Mouth to anus

usually in ascending colon

Spread out

Entire thickness of bowel wall (Transmural)

Bowel wall thicken and intestinal lumen narrows

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10
Q

Treatment crohns

A

No cure

Remove areas that are most effected

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11
Q

Ulcerative colitis treatment

A

Can remove whole colon and have ileostomy

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12
Q

What do both forms of IBD have in common

A

Cause inflammation / ulcer flare ups followed by remission

At risk for colon cancer

Autoimmune

Trigger: air pollution, foods, tobacco, viral illness

Need low residue diet

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13
Q

Crohn’s disease signs

A
  • diarrhea & cramping
  • pain/ cramping RLQ unrelieved by defecation
  • bleeding RARE
  • skip lesion / cobblestone
  • weight loss
  • excessive fat in feces
  • 7-10 stools a day
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14
Q

Ulcerative colitis signs

A
  • diarrhea and LLQ pain
  • rectal bleeding
  • anemia, fever
  • 10-20 stools per day
  • pipe look
  • stools have blood, mucus or pus
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15
Q

Where is ulcerative colitis

A

Large intestine (lower GI)

Defending colon to rectum
Begin in rectum and move inward

Mucosa affected

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16
Q

Toxic megacolon

What is it and complication

A

Colon very enlarged and paralyzed

Could rupture and lead to sepsis
- look at temp, WBC and K+

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17
Q

Diagnostic IBD

A

CBC

Stool sample

Imaging studies:

  • double contrast barium enema
  • small bowel series
  • trans abdominal ultrasound
  • CT and MRI
  • colonoscopy or endoscopy
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18
Q

Goal for treating IBD

A

Rest the bowel

Control inflammation

Combat infection

Correct malnutrition

Provide symptomatic relief and improve quality of life

  • no cure for IBD
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19
Q

Nutritional therapy for IBD (goals and what they need)

A
  • provide adequate nutrition w/o worsening symptoms
  • correct and prevent malnutrition
  • replace fluid and electrolyte losses and prevent weight loss
  • need high calorie, high vitamin, high protein, low residue, lactose free
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20
Q

Nutritional therapy during acute exacerbation for IBD

A

May not be able to tolerate a regular diet

Liquid enteral feedings are preferred over PN because atrophy of the guy in bacterial ever growth occur when the GI track is not used

Enteral Nutrition is high in calories and nutrients and is easily absorbed

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21
Q

Low residue diet IBD

A
  • refined / enriched white breads
  • plain crackers
  • cool cereals: cream of wheat and grits
  • cold cereal: puffed rice and corn flakes
  • white rice, noodles and refined pasta
  • cooked fruits and veggies w/o skin
  • milk products
  • meats
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22
Q

Foods to avoid or low residue diet

A 
Seeds
Legumes 
Crunchy peanut butter 
Popcorn 
Juices containing pulp or seeds
Smoking 
Caffeine 
Nuts
  • people with IBD need to chew food well !
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23
Q

UC surgery

A

Total proctocolectomy with permanent ileostomy

24
Q

Ostomy pre op care

A

1) phychologic preparation and emotional support
2) educational preparation
3) selecting the best site for the stoma
4) WOCN Visit for teaching in determining the patient’s ability to perform self-care support system and determine any modifications

25
Q

Gas causing foods

A

Carbonated drink 🥤

Broccoli 🥦

Cabbage 🥬

Onions 🧅

26
Q

Foods causing odor

A

Fish 🐟

Cheese 🧀

Garlic 🧄

27
Q

Ostomy post op care

A

1) asses s/s of wound inflammation and infection
2) assess stoma color
3) assess peri stoma skin for redness and irritation
4) edema will go down over for 6wk
5) drink plenty of fluids

  • empty 1/3 full
  • may have petroleum dressing over stoma tile bag is in place
28
Q

Ileostomy

A
  • large intestine completely removed (IBD)
  • usually above groin on right side
  • first 24-48 drainage may be low, when peristalsis returns output may be as high as 1500-1800 ml/ day
  • susceptible to obstruction due to small lumen, carefully chew before shallowing
  • fluid intake 2-3 L/ day
  • dark green to yellow stool
29
Q

Colostomy

A
  • start functioning when peristalsis returns of colon was not cleaned out before surgery
  • if bowel was cleansed it may take a few days after eating again
30
Q

Peritonitis

A
  • inflammation of peritoneum (usually infectious & life threatening)
31
Q

Peritonitis symptoms

A

Fever

Racing heart

Abnormal breathing

Board like abd and abd pain (tenderness)

N/V

Constipation

Diarrhea

32
Q

Peritonitis complications

A

Hypovolemic shock

Sepsis

Intra-abdominal abscess

Paralytic ileus: motor activity of the bowel is impaired

Acute respiratory distress

33
Q

Peritonitis diagnostic test

A
  • CBC (WBC)
  • peritoneal aspiration: fluid analyzed for 🩸, bile, pus, 🦠 , fungus, amylase
  • abdominal x-ray
  • ultrasound and CT: identify ascites and abscess
34
Q

Peritonitis treatment

A

Antibiotics

NG suction

Analgesics

IV fluid

Drain purulent fluid

Repair any damaged/ perforated organs

35
Q

Peritonitis nursing assessment

A

Pain assessment

Bowel sounds

Abdominal distention

Guarding

Nausea

Fever

Hypovolemic shock signs

36
Q

Nursing goals for peritonitis

A

Resolution of inflammation

Relief of abdominal pain

Free from complications

Normal nutrition status

37
Q

What should a nurse do for someone with peritonitis

A

IV access for fluids & antibiotics

Position w/ knees flexed to increase comfort

Monitor for pain/ response to pain meds

Antiemetic- prevent further fluid/ electrolyte lose through vomit

NPO

NG tube

Low flow o2 as needed

38
Q

Intestinal obstruction

A

Occurs when intestinal contents can’t pass through GI

Can be partial, complete, simple or strangulated

39
Q

Partial obstruction

A

Don’t completely occlude the intestine lumen and allow for some fluid and gas to pass through

40
Q

Complete obstruction

A

Totally occluded the lumen and usual required surgery

41
Q

Simple obstruction vs strangulated obstruction

A

Simple- Has an intact blood supply

Strangulated- no blood supply

42
Q

Intestinal obstruction causes

A

Mechanical: PHYSICAL obstruction of lumen - surgical adhesion are most common cause

Non-Mechanical: occurs w/ reduced or absent peristalsis due to altered neuromuscular transmission
- paralytic ileus: lack of intestinal peristalsis and bowel sounds is most common

43
Q

Intestinal obstruction signs

4 hallmark clinical manifestations

A

Abdominal pain

Nausea

Vomiting

Constipation

44
Q

Intestinal obstruction diagnostic test

A

Abdominal X-ray

CT

Contrast enema

Sigmoidoscopy or colonoscopy

Lab test

45
Q

Intestinal obstruction treatment

A

May need surgery if perforation or strangulated

NPO status 
IV fluids
Antiemetic 
NG tube prn decompression 
Blood cultures 
Antibiotics 
PN- allow bowel rest and improve nutrition before surgery
46
Q

What should the nurse monitor for W/ intestinal obstruction

A

Monitor for signs of:

  • dehydration and electrolyte in balance
  • metabolic alkalosis or acidosis
  • nares skin irritation form NG
  • check NG placement q4h

IV fluids
Oral care w/ NG tube

47
Q

Hernias

A

Protrusion of an test since through an abnormal opening or a week in the area

Men : inguinal

Women: femoral

48
Q

Reducible hernias

A

Easily return into abdominal cavity

Can be done manually or may occur spontaneously when the patient lying supine

49
Q

Irreducible or incarcerated hernia

A

Can’t be placed back into abdominal cavity

Abdominal contents trapped in opening

Strangulation occurs if blood supply to the contents becomes compromised- result is an acute intestinal obstruction- gangrene and necrosis of hernia contents are possible

50
Q

Hernia signs

A

Pain that widen w/ actives that increase intra abdominal pressure ( lifting, coughing, straining)

W/ strangulated hernia: severe abd pain, sign of bowel obstruction ( vomit, cramping, distention)

51
Q

Hernia treatment

A

Laparoscopic surgery treatment of choice

Strangulated- involves resecting involved area w/ possible placement of temporary colostomy

52
Q

After hernia repair

A

Issues voiding

I/O
Observe for distended bladder
Watch for scrotal edema/ pain w/ inguinal
Scrotal support w/ ice, elevating
Encourage deep breathing but no coughing
Splint incision and Keep Mouth Open when sneezing or coughing
Avoid Heavy lifting over 10lb for 6-8 wk

53
Q

UC complications

A
  • rupture of bowel
  • toxic megacolon
  • dehydration
  • colon cancer
  • anemia, from bleeding ulcers
54
Q

Chrons complications

A
  • abscess (pocket of infection) may burst causing fistula-> lead to sepsis
  • colon cancer
  • stricture-> major narrowing
  • malnutrition
55
Q

Nurses goal for intestinal obstruction

A

1) relief of obstruction / return to normal bowel function

2) minimal discomfort, normal fluid and electrolyte and acid base balance

NUR 155 med surg (15 decks)

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