Elimination Flashcards
Major enzymes and secretions
Mouth
Stomach
Small intestine
Chewing and swallowing:
- saliva, salivary amylase
Gastric:
- hydrochloric acid, pepsin, intrinsic factor
Small intestine:
- amylase, lipase, trypsin, bile
GI history to get from patient
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
How to check placement of NG
- x ray
- mark it
- check residual ( PH )
Nursing care for NG tube
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
External feeding assessment
Nutrition status
Factor or illness that increase metabolic needs
Hydration
Digestive function
Renal and electrolyte status
Medication effecting GI
Enteral feeding diagnosis
Imbalanced nutrition
Risk for diarrhea
Risk for ineffective airway
Risk for deficient fluid
Risk for ineffective coping or therapy tic management
Enteral feeding potential complications
Diarrhea or N/V
Gas, bloating, cramping
Dumping syndrome
Aspiration pneumonia
Tube displacement / obstruction
Nasopharyngeal irritation
Hyperglycemia
IBD
broad term that describes conditions characterized by chronic inflammation of the gastrointestinal tract
Crohns and ulcerative colitis
Where is Crohn’s disease
Mouth to anus
usually in ascending colon
Spread out
Entire thickness of bowel wall (Transmural)
Bowel wall thicken and intestinal lumen narrows
Treatment crohns
No cure
Remove areas that are most effected
Ulcerative colitis treatment
Can remove whole colon and have ileostomy
What do both forms of IBD have in common
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
Crohn’s disease signs
- diarrhea & cramping
- pain/ cramping RLQ unrelieved by defecation
- bleeding RARE
- skip lesion / cobblestone
- weight loss
- excessive fat in feces
- 7-10 stools a day
Ulcerative colitis signs
- diarrhea and LLQ pain
- rectal bleeding
- anemia, fever
- 10-20 stools per day
- pipe look
- stools have blood, mucus or pus
Where is ulcerative colitis
Large intestine (lower GI)
Defending colon to rectum
Begin in rectum and move inward
Mucosa affected
Toxic megacolon
What is it and complication
Colon very enlarged and paralyzed
Could rupture and lead to sepsis
- look at temp, WBC and K+
Diagnostic IBD
CBC
Stool sample
Imaging studies:
- double contrast barium enema
- small bowel series
- trans abdominal ultrasound
- CT and MRI
- colonoscopy or endoscopy
Goal for treating IBD
Rest the bowel
Control inflammation
Combat infection
Correct malnutrition
Provide symptomatic relief and improve quality of life
- no cure for IBD
Nutritional therapy for IBD (goals and what they need)
- 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
Nutritional therapy during acute exacerbation for IBD
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
Low residue diet IBD
- 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
Foods to avoid or low residue diet
Seeds Legumes Crunchy peanut butter Popcorn Juices containing pulp or seeds Smoking Caffeine Nuts
- people with IBD need to chew food well !
UC surgery
Total proctocolectomy with permanent ileostomy
Ostomy pre op care
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
Gas causing foods
Carbonated drink 🥤
Broccoli 🥦
Cabbage 🥬
Onions 🧅
Foods causing odor
Fish 🐟
Cheese 🧀
Garlic 🧄
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
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
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
Peritonitis
- inflammation of peritoneum (usually infectious & life threatening)
Peritonitis symptoms
Fever
Racing heart
Abnormal breathing
Board like abd and abd pain (tenderness)
N/V
Constipation
Diarrhea
Peritonitis complications
Hypovolemic shock
Sepsis
Intra-abdominal abscess
Paralytic ileus: motor activity of the bowel is impaired
Acute respiratory distress
Peritonitis diagnostic test
- CBC (WBC)
- peritoneal aspiration: fluid analyzed for 🩸, bile, pus, 🦠 , fungus, amylase
- abdominal x-ray
- ultrasound and CT: identify ascites and abscess
Peritonitis treatment
Antibiotics
NG suction
Analgesics
IV fluid
Drain purulent fluid
Repair any damaged/ perforated organs
Peritonitis nursing assessment
Pain assessment
Bowel sounds
Abdominal distention
Guarding
Nausea
Fever
Hypovolemic shock signs
Nursing goals for peritonitis
Resolution of inflammation
Relief of abdominal pain
Free from complications
Normal nutrition status
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
Intestinal obstruction
Occurs when intestinal contents can’t pass through GI
Can be partial, complete, simple or strangulated
Partial obstruction
Don’t completely occlude the intestine lumen and allow for some fluid and gas to pass through
Complete obstruction
Totally occluded the lumen and usual required surgery
Simple obstruction vs strangulated obstruction
Simple- Has an intact blood supply
Strangulated- no blood supply
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
Intestinal obstruction signs
4 hallmark clinical manifestations
Abdominal pain
Nausea
Vomiting
Constipation
Intestinal obstruction diagnostic test
Abdominal X-ray
CT
Contrast enema
Sigmoidoscopy or colonoscopy
Lab test
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
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
Hernias
Protrusion of an test since through an abnormal opening or a week in the area
Men : inguinal
Women: femoral
Reducible hernias
Easily return into abdominal cavity
Can be done manually or may occur spontaneously when the patient lying supine
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
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)
Hernia treatment
Laparoscopic surgery treatment of choice
Strangulated- involves resecting involved area w/ possible placement of temporary colostomy
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
UC complications
- rupture of bowel
- toxic megacolon
- dehydration
- colon cancer
- anemia, from bleeding ulcers
Chrons complications
- abscess (pocket of infection) may burst causing fistula-> lead to sepsis
- colon cancer
- stricture-> major narrowing
- malnutrition
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
