Exam #3 Upper and Lower GI Pt.2 Flashcards
Bowel Obstruction Disease
- Intestinal contents accumulate at and above the area of obstruction. This leads to abdominal distention.
- Peristalsis increases in an effort to move intestinal contents forward.
Bowel Obstruction Causes
- HANG IV
- Hernia
- Adhesions
- Neoplasm/ Tumor
- Gallstone Ileus
- Intuessusception: part of the intestine slides into adjacent
- Volvulus: abnormal twisting
Bowel Obstruction Types
( 2 )
- Mechanical: Blockage caused by something outside the bowel : Handling of intestines during surgery
- Non-Mechanical: Decreased peristalsis due to neuromuscular disturbance : Constipation
Bowel Obstruction S/S
- Abdominal pain
- N/V
- Abdominal distention
- Inability to pass gas/ stool
- Hyperactive, high pitch bowel sounds early to hypoactive later in disease
Bowel Obstruction Interventions
- NG Tubes: For gastric decompression
- IV Fluid
Colorectal Cancer Risk Factors
- Over 50
- Genetic
- Smoking
- Obesity
- Inactivity
- Heavy alcohol consumption
- High fat diet
Colorectal Cancer Prevention
Prevent:
-Age 45, start screening
- FOBT every year
- Colonoscopy every 10 years
- Flexible Sigmoidoscopy every 5 years
- Decrease fat, refined carbs and low fiber foods
- Obesity is major factors
- No smoking / drinking
- Exercise
Colorectal Cancer S/S
- Vomiting
- Changes in bowel habits
- Rectal bleeding
- Fatigue
- Abdominal fullness
- Anemia
- Cramping
Colorectal Cancer Interventions
- Radiation Therapy: Can control the disease not cure, in rectal cancer it is part of treatment plan
- Adjuvant therapy
- Surgical: colon resection, colectomy, colostomy
Colostomies Types
Ascending: Right sides tumors
Transverse: Double barreled, has 2 stomas
Descending: Left sided tumors
Sigmoid: Rectal
Stimulant Laxatives
: Bisacodyl, Senna
MOA: Stimulate intestinal motility
Use: Constipation
Comp: Diarrhea, mid cramping, burning sensation with suppository
Contra: GI obstruction, rectal fissures
Interact: Do not give with antacids
Education: Monitor for severe diarrhea, anal burning can occur, monitor for bleeding, pus, discourage long term use.
Stool Softener
: Docusate Sodium
MOA: Change the tension of stool increasing water absorption in stool
Use: Constipation
Comp: Cramps, throat irritation
Inter: Do not administer w mineral oil / laxative
Education: 2-3 L liquid, exercise, fiber diet
Bulk Forming Agents
: Psyllium, Fiber Supplements
MOA: Soften fecal mass
Use: Constipation
Comp: Obstruction
Education: Take with 8 oz water, takes 1-3 days to take effect
Antidiarrheals
: Loperamide
MOA: Decrease GI motility and increase fluid absorption
Use: Diarrhea
Conta: Risk of Toxic Megacolon
IBS Assessment
- Fatigue, pain, changes in bowel patterns, flare ups, LLQ pain, diarrhea stools are soft, watery w mucus present.
Lab: Hydrogen breath test
Interventions: Dietary fiber, drug therapy, stress reduction
IBS Med
: Alosetron
MOA: Blocking the action of serotonin on the intestine this results in increased firmness in stool and decreased urgency.
USE: Only female clients who have severe IBS-D for more than 6 months.
- Take w meal and fluid ( 1200-1500 ml )
Probiotics
MOA: Bacteria and yeast which are normal part of flora of intestine and colon.
Comp: Gas, bloating
Education: Administer 2 hrs apart from antibiotics
Herniation
- Weakness in the abdominal muscle wall through which a segment of the bowel or other abdominal structure protrudes.
- Lump or protrusion appears, absent bowel sounds
- Treatment:Truss hernia belt, avoid coughing, herniorrrhaphy
Peritonitis
- Life threatening, acute inflammation and infection of the visceral/ parietal peritoneum and endothelial lining of the abdominal cavity.
- Caused by bacteria, chemicals
Peritonitis Complications
- Hypovolemic Shock: Delayed diagnosis means dilation continues due to increased blood vessel dilution. Fluid is shifted into peritoneal cavity, decreasing circulatory volume
- Sepsis: Peristalsis slows or stops in response to severe inflammation and infection. 7-8 L of fluid daily.
- Resp Problems: Increased abdominal pressure against diaphragm.
Peritonitis S/S
- Cardinal Signs: Abdominal pain, tenderness and distention.
Labs: WBC, BUN, creatinine, ABG
Peritonitis Interventions
Nonsurgical:
- Assess VS, monitor mental status, administer antibiotics
Surgical:
- Abdominal surgery, Exp Lap
- Hypertonic IV solution, daily weight, NGT, NPO
Appendicitis :
Causes
- Inflammation of the appendix
- Obstruction of lumen causes major increased pressure inside the appendix
- Perforation / rupture can occur
- Needs to be treated 48-72 hrs or risk for rupture which will lead to abscess and peritonitis
- Caused:
- Obstruction
- Fecalith ( hard stool )
- parasites
- foreign body
- Trauma / injury
Appendicitis S/S
- RLQ abdominal pain
- Cramps
- Tenderness w palpation
- N/V
- Low fever
