Exam 3 Study Guide - NonInflammatory Disorders Flashcards

1
Q

Irritable Bowel Syndrome (IBS)

define
etiology

A
  • Functional GI disorder tht causes chronic or recurrent diarrhea, constipation, and/or abdominal pain & bloating
  • Most common digestive disorder
  • Etiology
    > research suggests tht a combination of factors
    > certain food & fluids; carbonated or caffeinated bevs, dairy products
    > immunologic
    > genetic
    > hormonal; 2x more likely in women
    > stress; anxiety & depression can play a role
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

IBS - Assessment

basic

A
  • Hx
    > weight change; usually have a stable weight
    > malaise & fatigue
    > abdominal pain; most common in left lower quadrant
    > changes in bowel pattern & consistency of stools; can have diarrhea or constripation of alternate w/ both
    > passage of mucus
    > nutrition; caffeine, sorbitol or fructose can cuase bloating & diarrhea
    > factors causing exacerbations such as diet, stress, anxiety, food intolerance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

IBS - Assessment

lab testing
manis

A
  • Lab Testing
    > CBC (normal)
    > Serum albumin (normal)
    > ESR (normal)
    > Stools for occult blood (normal)
    > Hydrogen breath test; will exhale a higher lvl of hydrogen secondary to bacterial overgrowth & malabsorp in small intestines
  • CMs
    > LLQ abd pain
    > diarrhea and/or constipation
    > cramping
    > belching or gas
    > anorexia
    > bloating
    > nausea w/ meals
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

IBS - Interventions

teaching
drug therapy

A
  • Health Teaching
    > dietary fiber (30-40g of fiber each day)
    > eating regular meals
    > 8-10 cups of liquid a day
    > chewing slowly
  • Drug Therapy depends on symps:
    > constipation predominant: bulk-forming laxative (Metamucil), Lubiprostone (Amitiza) to incr fluid in intestine, Linaclotide (Linzess) to incr fluid in testines & incr intestinal motility
    > diarrhea predominant: antidiarrheal agents like loperamide (Immodium)
    > pain predominant: tricyclic antidepressants (Elavil)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

IBS - Interventions

complimentary & alternative

A
  • Probiotics to reduce bacteria
  • Peppermint oil capsules
  • Stress management: relaxation techniques, meditation and/or yoga
  • Exercise
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Hernias

causes
types

A
  • Causes
    > congenital or acquired muscle weakness
    > incrd intra-abd pressure (obesity, pregnancy, lifting heavy objects)
  • Most Common Types
    > indirect inguinal (occur mostly in men)
    > direct inguinal (occur more often in older adults)
    > femoral (common in obese or pregnant women)
    > umbilical (congenital or common in obese or pregnancy)
    > incisional or ventral (occurs in ppl who have undergone abd surgery)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Reductible Hernias

A

Contents of the hernial sac can be placed back into abd cavity by gentle pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Irreducible (incarcerated) Hernias

A
  • Hernia cannot be reduced or placed back into abd cavity
  • Requires immediate surgical evaluation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Strangulated Hernias

A
  • Blood supply to the herniated segment of bowel is cut off by pressure from hernial ring
  • Can lead to necrosis of bowel & possible bowel perforation
  • Symprtoms:
    > abd distension
    > N/V
    > pain
    > fever
    > tachycardia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Hernias - Assessment

A
  • Observe for bulging or protrusion ove rinvolved area
  • Inspect when lying & standing
    > if reducible it may disappear when lying flat
  • Assess for bowel sounds
    > absent bowel soubds may indicate obstruction or strangulation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Hernia - Nonsurgical Intervention

A
  • Treatment of an inguinal hernia
  • Truss (pad made w/ firm material); held in place over hernia w/ a belt
  • Applied after hernia has been reduced
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Hernias - Surgical Interventions

A
  • Surgical option for inguinal hernia repairs:
  • Minimally Invasive Inguinal Hernia Repair (MIIHR)
    > laproscopic herniorrhaphy
    > recover more quickly, have less pain, fewer postop complications
  • Open Herniorrhaphy (open incision)
    > follow general postop care of pts
    > assess for difficulty in voiding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Hernias - PostOp Teaching

A
  • Avoid coughing
  • Elevation of scrotum w/ a soft pillow to prevent & control swelling
  • Ice bags to prevent & control swelling
  • Follow surgeon’s recommendation for returning to usual activities
  • Avoid straining & lifting for several weeks
  • Observe for fever, chills, wound drainage, redness or separation of incision & incring incisional pain
  • Keep wound clena & dry w/ antibacterial soap & water
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Colorectal Cancer - Etiology/Risk Factors

A
  • Older than 50yrs
  • Genetic predisposition
  • Personal or family hx of cx
  • Diseases tht predispose the pt to cx
    > familial adenomatous polyposis
    > Crohn’s disease
    > Ulcerative colitis
  • Infectious agents
    > H. pylori
    > Human papilloma virus (HPV)
  • Long term smoking
  • Obesity
  • Physical inactivity
  • Heavy alcohol consumption
  • HIgh-fat diet
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Colorectal Cancer - Assessment

basic

A
  • Hx
  • Physical Assessment/CMs
    > rectal bleeding
    > anemia
    > change in stool consistency or shape
    > possible abd pain
    > possible abd distention or visible mass
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Colorectal Cancer - Assessment

psychosocial
lab

A
  • Psychosocial
    > especially important after diagnosis
  • Lab
    > positive FOBT
    > elevated carcinoembryonic antigen (CEA): normal is 5ng/mL
    > dcrd H/H
    > liver func tests may be elevated if metasis to liver has occured
17
Q

Colorectal Cancer - Imaging

A
  • Colonscopy (definitive test for diagnosis)
  • Double-contrast barium enema
  • Sigmoidoscopy
  • Abdominal computerized tomography (CT)
  • Abdominal magnetic resonance imaging (MRI)
18
Q

Colorectal Cancer - Nonsurgical Interventions

A
  • Type of intervention is based on pathologic staging of disease
  • Radiation Therapy
    > can be used pre or post op for either local control or for pain management
  • Adjuvant chemotherapy post op
  • Important to help pts w/ side effects of radiation & chemotherapy
19
Q

Colorectal Cancer - Surgical Interventions

A
  • Type of intervention is based on pathologic staging of disease
  • Surgical removal of tumor w/ margins free of disease is best method
  • Type of surgery is based on size of tumor, location, extent of metastasis, integrity of bowel, & condition of pt
20
Q

Most Common Surgies for Colorectal Cancer

A
  • Colon Resection: removal of tumor & regional lymph nodes
  • Colectomy: colon removal w/ colostomy or ileostomy
  • Abdominoperineal (AP) Resection: performed when rectal tumors are present; removal of sigmoid colon, rectum, & anus
21
Q

Mechanical Intestinal Obstruction

A
  • Partial or complete
  • Bowel is physically blocked
  • Problems outside the intestine: adhesions
  • In the bowel wall: Crohn’s
  • In the intestinal lumen: tumors
  • Most common causes in pts over 65: diverticulitis, tumors, fecal impaction
22
Q

Nonmechanical Intestinal Obstruction

A
  • Partial or complete
  • Paralytic ileus: peristalsis is dcrd or absent as a result of neuromuscular disturbance, resulting in slwoing of movement or backup of intestinal contents
  • Most common cause: handling of intestins during abdominal surgery
23
Q

Stangulated Intestinal Obstruction

A
  • Partial or complete
  • Obstruction w/ compromised blood flow
24
Q

Small Bowel Obstruction - CMs

A
  • Abd discomfort or pain
  • Upper or epigastric abd distention
  • Nausea & early, profuse vomiting
  • Possible visible peristaltic waves in upper & middle abdomen
  • Obstipation (no passage of stool)
  • Severe fluid & electrolyte imbalances
25
Q

Large Bowel Obstruction - CMs

A
  • Intermittent lower abdominal cramping
  • Lower abdominal distention
  • Minimal or no vomiting
  • Obstipation or ribbon-like stools
  • No major fluid & electrolyte imbalances
  • High pithed bowel sounds transitioning to absent bowel sounds
26
Q

Intestinal Obstruction - Assessment

lab

A
  • WBC usually noraml unless a strangulated obstruction present or perforation
  • H/H, creatinine, BUN values are often elevated bc of dehydration
  • Na, Cl, K dcrd bc of loss of fluid & electrolytes
  • Amylase may be elevated w/ strangulated obstructions
    > can cause damage to pancreas
27
Q

Intestinal Obstruction - Assessment

imaging

A
  • Abd computerized tomography scan (CT)
  • Abd ultrasound
  • Sigmoidoscopy or colonoscopy
    > not used when perforation or complete obstruction is suspected
28
Q

Intestinal Obstruction - Nonsurgical Interventions

A
  • NPO
  • NGT
    > placed to low intermittent suction
  • Assess the NGT for proper placement, patency, & output q4
  • Assess & record passage of flatus & character of BMs daily
  • Assess & treat nausea
  • IV fluid replacement & maintenance
    > parenteral nutrition may be indicated if pt has chronic nutriontional problems or has been NPO for an extended period
  • Monitor VS, weight, I&Os
  • Monitor pain
    > incr or change may indicate perforation of intestine or peritonitis
    > opioid analgesics may be temporarily withheld so CMs of perforation or peritonitis are not masked
    > discomfort if generally less w/ nonmechanical obstruction
  • Assist pt to obtain a position of comfort w/ frequent position changes to promote incrd peristalsis
    > semi-fowler’s position may help alleviate pressure of abd distention on chest
29
Q

Intestinal Obstruction - Surgical Interventions

A
  • In mechanical obstruction, surgical intervention is necessary to relieve obstruction
  • Exploratory Laparotomy
    > surgical opening of abd cavity to investigate cause of obstruction
  • More specific surgical procedures depend on cause of obstruction
    > lysis of adhesions
    > tumor resection
    > colon resection w/ temporary or permanent colostomy
    > embolectomy or thrombectomy
    > colectomy
  • Pts have either minimally invasive surgery (MIS) via laparoscopy (most common) or cenventional open approach
  • Post op care
    > NG tube in place
    > slow introduction of PO intake
    > assess for bowel sounds, flatus, & stoo indicating peristalsis return