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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
Gas causing foods
Carbonated drink 🥤 Broccoli 🥦 Cabbage 🥬 Onions 🧅
26
Foods causing odor
Fish 🐟 Cheese 🧀 Garlic 🧄
27
Ostomy post op care
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
Ileostomy
- 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
Colostomy
- 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
Peritonitis
- inflammation of peritoneum (usually infectious & life threatening)
31
Peritonitis symptoms
Fever Racing heart Abnormal breathing Board like abd and abd pain (tenderness) N/V Constipation Diarrhea
32
Peritonitis complications
Hypovolemic shock Sepsis Intra-abdominal abscess Paralytic ileus: motor activity of the bowel is impaired Acute respiratory distress
33
Peritonitis diagnostic test
- CBC (WBC) - peritoneal aspiration: fluid analyzed for 🩸, bile, pus, 🦠 , fungus, amylase - abdominal x-ray - ultrasound and CT: identify ascites and abscess
34
Peritonitis treatment
Antibiotics NG suction Analgesics IV fluid Drain purulent fluid Repair any damaged/ perforated organs
35
Peritonitis nursing assessment
Pain assessment Bowel sounds Abdominal distention Guarding Nausea Fever Hypovolemic shock signs
36
Nursing goals for peritonitis
Resolution of inflammation Relief of abdominal pain Free from complications Normal nutrition status
37
What should a nurse do for someone with peritonitis
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
Intestinal obstruction
Occurs when intestinal contents can’t pass through GI Can be partial, complete, simple or strangulated
39
Partial obstruction
Don’t completely occlude the intestine lumen and allow for some fluid and gas to pass through
40
Complete obstruction
Totally occluded the lumen and usual required surgery
41
Simple obstruction vs strangulated obstruction
Simple- Has an intact blood supply Strangulated- no blood supply
42
Intestinal obstruction causes
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
Intestinal obstruction signs 4 hallmark clinical manifestations
Abdominal pain Nausea Vomiting Constipation
44
Intestinal obstruction diagnostic test
Abdominal X-ray CT Contrast enema Sigmoidoscopy or colonoscopy Lab test
45
Intestinal obstruction treatment
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
What should the nurse monitor for W/ intestinal obstruction
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
Hernias
Protrusion of an test since through an abnormal opening or a week in the area Men : inguinal Women: femoral
48
Reducible hernias
Easily return into abdominal cavity Can be done manually or may occur spontaneously when the patient lying supine
49
Irreducible or incarcerated hernia
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
Hernia signs
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
Hernia treatment
Laparoscopic surgery treatment of choice Strangulated- involves resecting involved area w/ possible placement of temporary colostomy
52
After hernia repair
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
UC complications
- rupture of bowel - toxic megacolon - dehydration - colon cancer - anemia, from bleeding ulcers
54
Chrons complications
- abscess (pocket of infection) may burst causing fistula-> lead to sepsis - colon cancer - stricture-> major narrowing - malnutrition
55
Nurses goal for intestinal obstruction
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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