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Med Surg I > Exam 4 > Flashcards

Exam 4 Flashcards

1
Q

more NON differentiated cells = (characteristic of the canceR)

A

more aggressive cancer

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2
Q

problems r/t cancer can be caused by (3)

A
  1. cancer itself
  2. treatment
  3. both
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3
Q

management / goals for cancer:

A
  1. cure
  2. control
  3. minimize SE of treatment
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4
Q

main nursing priorities r/t cancer + related concerns

A

BM suppression….

  1. neutropenia –>infection
  2. anemia –> fatigue/oxygenation
  3. thrombocytopenia –> bleeding
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5
Q

severe neutropenia is defined as what?

A

ANC <1000 cells

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6
Q

most infections r/t neutropenia are what type?

A

opportunistic (suppressed immune system)

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7
Q

name some ways to prevent infections with neutropenic patients

A

handwashing, educate patients to be their own advocates, no fresh flowers or raw foods, avoid sick people, monitor VS (fever!), no cat litter

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8
Q

how do we treat patients if develop opportunistic infections r/t cancer? (general pharm)

KNOW

A

anti infectives

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9
Q

re: neutropenia and cancer, what changes should be reported to provider? (4)

A
  1. changes in skin + mucous membranes
  2. fever
  3. cough
  4. s+s of infection at central line
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10
Q

when should neutropenic precautions be started?

A

ANC <1000 w/fever

OR

ANC <500

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11
Q

name some elements of neutropenic precautions

A 
no fresh flowers or raw foods
no shared supplies
private room + no sick visitors 
no stagnant water
no indwelling catheters 
wear masks 
regular hygiene 
ASSESS often!
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12
Q

what are nurse-led protocols re: ABX with neutropenic patients?

A

ABX stewardship: get cultures, monitor for s+s of infection, get the right ABX on board + quickly!!

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13
Q

<50,000 platelets =

<20,000 platelets =

A

50k = prolonged bleeding

20k = spontaneous

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14
Q

what complication are we most concerned with re: platelets <20,000? + what specific assessment should occur?

A

spontaneous bleeding –> hemorrhagic stroke

FREQUENT NEURO CHECKS

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15
Q

what should you be assessing for if patient has thrombocytopenia?

A

bleeding:
- petichiae
- prolonged bleeding
- large flank bruise (sign of internal bleeding)
- blood in urine or stool
- tachycardia
- hypotension

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16
Q

what interventions should be introduced for patients with thrombocytopenia? (4)

A
  1. neuro assessments
  2. fall precautions
  3. bleeding precautions
  4. platelet administration
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17
Q

what should be avoided in patient with thrombocytopenia?

A

anything that could cause injury + bleeding: rectal tubes, rectal meds, unnecessary tube inserts

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18
Q

name some elements of bleeding precautions (7)

A
  1. limit venipunctures + IM injections
  2. lift sheet
  3. electric razor
  4. soft toothbrush, no floss
  5. ABD girth measurement
  6. no nose blowing
  7. assess IV sites
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19
Q

what interventions should be implemented for fatigue r/t anemia / cancer? (3)

A
  1. find exercise that feels good (can even be a walk to the bathroom)
  2. treat underlying cause if possible
  3. energy conservation + manage activities
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20
Q

why does chemo have such an effect on the GI cells?

A

chemo attacks rapidly dividing cells and GI cells fall into this category

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21
Q

what interventions should be implemented for cachexia? (2)

A
  1. protein + CHO - rich foods

2. small, frequent meals

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22
Q

interventions for mucositis + stomatitis r/t chemo or cancer

A
  1. cryotherapy
  2. mouth rinses (bicarbonate / magic mouthwash)
  3. soft toothbrush + no floss
  4. non-irritating cleansers
  5. hygiene
  6. ASSESS often!
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23
Q

N/V r/t cancer + therapy, what types can you have?

A

acute, anticipatory, breakthrough

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24
Q

motor + sensory deficits seen with cancer are related to what?

A

possible bone mets + compressed nerves

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25
Q

motor + sensory deficits r/t cancer put a person at risk for what? what interventions should we implement?

A

pain, injuries + falls

–> fall precautions, assess ability, offer assistance

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26
Q

peripheral nerve fxn r/t cancer puts a person at risk for what? what interventions should we implement?

A

pain, injuries, loss of balance + falls

–> fall precautions, assess for sensation + wounds

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27
Q

reduced oxygenation r/t anemia with cancer can lead to what? what interventions should we implement?

A

hypoxia + poor tissue perfusion

–> raise HOB + administer O2

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28
Q

interventions for pain r/t cancer should be _______

A

MULTIMODAL + patient specific <3

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29
Q

interventions for hair loss r/t cancer + chemo

A

protect scalp, wear hat, keep warm, address psychosocial aspect <3

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30
Q

“chemo brain” / cognitive changes can be from what?

A

cancer itself, brain mets, treatment or both

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31
Q

goals of radiation

A

cure, control + palliate

minimize destruction of normal tissue

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32
Q

exposure vs dose?

A

exposure: amt delivered
dose: amt absorbed

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33
Q

differences between teletherapy + brachytherapy? what are the 2 types of brachytherapy?

A

teletherapy: external
brachytherapy: internal

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34
Q

what are the 2 types of brachytherapy? + describe them

A

sealed: only patients emit radiation (not body fluids)
unsealed: bodily fluids are radioactive + patient

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35
Q

precautions for patients w/brachytherapy? (5)

A
  1. private room w/sign
  2. lead apron + limited time inside
  3. visitors 6 feet away + limited time (30 mins)
  4. no pregnant caregivers
  5. keep all linens in room until discharge
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36
Q

SE of teletherapy (remember, it’s localized) (6)

A
  1. hair loss @ site
  2. erythema
  3. inflammation
  4. fatigue
  5. secondary malignancies
  6. CV disease
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37
Q

what are the 3 categories for breast cancer?

A
  1. noninvasive
  2. invasive
  3. metastasis
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38
Q

describe ductal carcinoma in SITU

A

early noninvasive –> can become invasive if untreated

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39
Q

describe lobal carcinoma in SITU (4 things) + what is treatment?

A
  1. begins in lobules
  2. not true cancer
  3. cannot spread
  4. increases chance of developing breast cancer later

tx: OBSERVATION

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40
Q

describe infiltrating ductal carcinoma

A

INVASIVE: starts in ducts –> epithelial cells lining the ducts –> grows into tissue

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41
Q

re: infiltrating ductal carcinoma, fibrosis, dimpling + peau d’orange indicates what?

A

late disease

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42
Q

inflammatory breast cancer

A

INVASIVE, highly aggressive + usually diagnosed later in disease

no palpable lump + might not show up on mammogram

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43
Q

s+s of inflammatory breast cancer (3)

A

swelling, pain, redness

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44
Q

triple negative breast cancer

A

HIGHLY AGGRESSIVE

lacks typical receptors (locks), so medication (keys) to treat cancer will have no effect

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45
Q

triple negative breast cancer is common with what populations? (3)

A

BRCA positive + pre-menopausal females + black women

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46
Q

risk factors for breast cancer

A

gender, age, genetics, breast density, early menstruation, hormone replacement therapy, ETOH, obesity, oral contraceptives, null parity

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47
Q

re: screening for breast cancer, what are protocols for normal risk + high risk?

A

normal risk: annual mammogram from 40-45 yrs old

high risk: annual mammogram + annual MRI + clinical breast exams

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48
Q

what is a diagnostic mammogram? what is screening mammogram?

A

diagnostic: mammogram + ultrasound (if someone has lump)
screening: mammogram only

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49
Q

what s+s (r/t skin) might you see with more progressed breast cancer

A
  1. peau d’orange
  2. nipple changes (retractions)
  3. ulceration
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50
Q

describe these surgery options for breast cancer:

lumpectomy
partial mastectomy
total mastectomy
radical mastectomy
neoadjuvant
A

lumpectomy: lump removal
partial mastectomy: remove part of breast tissue
total mastectomy: all breast tissue removed
radical mastectomy: all breast tissue + lymph node removed
neoadjuvant: chemo before surgery to reduce lump size

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51
Q

postop care after surgery for breast cancer

A
  1. no BP readings or venipuncture on affected side
  2. VS q15
  3. monitor drains
  4. educate patient on what to report (s+s of infection
  5. semi fowlers
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52
Q

when can patient start arm exercises post surgery for breast cancer? what can they do?

A

one week –> start active ROM

  • squeeze ball
  • arm raises
  • elbow extension

if they have pain? STOP!

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53
Q

home care for patient after having surgery for breast cancer

A
  1. no commercial lotion
  2. no deodorant
  3. monitor for lymphedema + report
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54
Q

how can we prevent lymphedema?

A

don’t take BP on affected side, even if it’s been years!!

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55
Q

s+s of lymphedema (5) + what should you do?

A
  1. heaviness
  2. aching
  3. numbness
  4. swelling
  5. tingling

CONTACT PROVIDER ASAP

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56
Q

what is nurse role for chemo?

A
  1. monitor central line
  2. manage symptoms
  3. give chemo
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57
Q

name some effects of chemotherapy? (4)

KNOW

A
  1. myelosuppression –> low WBCs, RBCs, platelets KNOW
  2. fatigue
  3. GI effects
  4. nerve + motor involvement
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58
Q

Hormonal therapy for cancer can only be used for which type of cancer

A

w/hormone receptors

NOT triple-negative - wouldn’t be effective

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59
Q

what is colorectal cancer?

A

cancer of large bowel: large intestine + rectum

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60
Q

where are most colorectal cancers found? + what type are most of them?

A

rectosigmoid region

most are adenocarcinoma (starting in mucous producing cells)

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61
Q

precancerous cells of colorectal cancer =

A

polyps

visualized on colonoscopy

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62
Q

metastasis of colorectal cancer can happen via which 3 routes?

A
  1. blood
  2. lymph
  3. through intestinal wall to surrounding organs
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63
Q

what is “seeding” r/t colorectal cancer surgery?

A

cancer cells that are dropped into new places, spreading cancer

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64
Q

what are some complications of colorectal cancer? (5)

A
  1. obstruction
  2. perforation
  3. fistula
  4. abscess
  5. bleeding
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65
Q

re: colorectal cancer, where are obstructions most common?

A

transverse + descending colon

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66
Q

what are s+s of obstruction? (3)

A
  1. gas pains
  2. cramping
  3. incomplete evacuation
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67
Q

what are s+s of partial bowel obstruction? (3)

A
  1. PAIN
  2. visible peristalsis
  3. tinkling/high pitched bowel sounds
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68
Q

what are s+s of complete bowel obstruction? (2)

A
  1. PAIN

2. absent bowel sounds

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69
Q

what are risk factors for colorectal cancer? (8)

A
  1. ULCERATIVE COLITIS
  2. age
  3. genetics
  4. ETOH + smoking
  5. sedentary lifestyle
  6. high fat diet + low fiber
  7. Crohn’s disease
  8. obesity
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70
Q

what is gold standard for screening for colorectal cancer?

A

colonoscopy

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71
Q

what is the “con” to fecal occult blood test?

A

positive? need colonoscopy
negative? can’t rule out cancer
= VERY LIMITED

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72
Q

screening recommendations for colorectal cancer:

  • average
  • high risk
  • close relative or strong hx
A

average: colonoscopy 45 years

high risk: colonoscopy before 45 years

close relative or strong hx: genetic testing

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73
Q

most common s+s of colorectal cancer (3)

+ name some others…

A
  1. changes in stool
  2. changes in bowel habits
  3. bleeding

fatigue, weight loss, pain, distention, fullness, palpable mass

74
Q

re: CRC, mahogany blood =

A

further up in colon

75
Q

re: CRC, bright red blood =

+ most likely which location

A

lower in colon

probably rectosigmoid

76
Q

what is our BEST tool to diagnose CRC? why?

A

colonoscopy - can visualize entire colon

77
Q

what lab tends to be low with CRC?

A

H+H

normal per Messer 11-17 Hgb

78
Q

surgical intervention options for CRC (2)

A
  1. colon resection

2. colectomy

79
Q

what is colostomy?

A

piece of colon diverted through ABD wall to bypass part of colon –> stoma formed

80
Q

ileoanal pullthrough =

A

entire colon removed + j pouch formed

81
Q

name some components of wound management after surgery for CRC (4)

A
  1. monitor for s+s of infection
  2. manage drains
  3. pain management (incl. phantom pain)
  4. comfort (physical + psychosocial)
82
Q

postoperative care after surgery for CRC (3) think orders

A
  1. NG tube
  2. NPO
  3. colostomy care w/WOCN
83
Q

assessment findings for stoma ◡̈

A
  1. beefy red
  2. budding + protruding from skin 3/4”
  3. intact peristomal skin
84
Q

after colostomy, what should drainage look like and progress towards?

A

start: sanguineous –> serosanguineous –> “working” in 2-3 days (stool)

85
Q

what would excoriated skin around stoma indicate?

A

wafer not cut properly + skin exposed to stool

86
Q

how should wafer be cut for stoma?

A

1/8-1/16 larger than stoma

87
Q

stool findings if colostomy formed in:

  • ascending colon:
  • transverse colon:
  • descending colon:

-ileostomy:

A

ascending colon: liquid
transverse colon: pasty
descending colon: solid

ileostomy: liquid

88
Q

what is most common upper GI disorder?

A

GERD

89
Q

what is GERD?

A

reflux of stomach contents into esophagus –> inflammation –> hyperemia

90
Q

GERD can be caused by what? (3)

A
  1. excessive relaxation of LES
  2. increased ABD pressure
  3. reduced stomach emptying
91
Q

re: GERD, reduced stomach emptying can be caused by what?

A

gastric neuropathy from DM

92
Q

risk factors for GERD (7)

A
  1. ETOH + smoking
  2. spicy foods
  3. large portions
  4. pregnancy
  5. lying down after eating
  6. obesity
  7. tubes (NG tube)
93
Q

complications of GERD

A
  1. Barrett’s epithelium (precancerous cells - cells changed to protect from acidic stomach contents in esophagus)
  2. PNA
  3. dental decay
  4. cardiac disease
94
Q

s+s of GERD (5)

A
  1. indigestion (20 min - 2 hrs after eating)
  2. pain
  3. regurgitation + water brash
  4. heartburn
  5. morning hoarseness
95
Q

what is definitive way we diagnose GERD? but how do we usually diagnose GERD?

A

pH exam

don’t usually need this; we usually diagnose based on symptoms – if we treat and it works? assume GERD

96
Q

interventions for GERD (9)

*Emily’s fav card ◡̈ *

A
  1. small, frequent meals
  2. sit upright after eating for 1 hour
  3. avoid irritating foods + spicy foods
  4. don’t eat before bedtime
  5. sleep on right side
  6. weight loss
  7. sleep apnea eval
  8. ETOH + smoking cessation
  9. meds to reduce acid (usually PPIs)
97
Q

why would someone get nissen fundoplication surgery?

A

unrelenting GERD not improving with meds; to create a tighter LES

98
Q

peptic ulcer + what is common cause?

A

mucosal lesion of stomach or duodenum

common cause: H. pylori

99
Q

gastric ulcers are often caused by what?

A

DELAYED stomach emptying (food sitting in stomach too long –> causes lesions)

100
Q

gastric ulcer pain is often felt where?

A

upper epigastrium and left

101
Q

how long after eating would manifestations of a gastric ulcer be felt?

A

30-60 mins

102
Q

if bleeding was present with gastric ulcers, what would you see?

A

hematemesis

103
Q

duodenal ulcers are often caused by what?

A

INCREASED stomach emptying

104
Q

duodenal ulcer pain is often felt where?

A

below epigastrium and right

105
Q

how long after eating would manifestations of a duodenal ulcer be felt?

A

1.5-3 hrs after eating

106
Q

if bleeding was present with duodenal ulcers, what would you see?

A

melena (blood in stool)

107
Q

stress ulcers are often caused by what? (7) + what medical scenarios? (4)

A

H. pylori*, NSAIDs, corticosteroids, ETOH, smoking, caffeine, stress

+ often after medical crisis or trauma (burns, head injury, sepsis, NPO)

108
Q

s+s of stress ulcer

A
  1. indigestion
  2. sharp, burning pain
  3. fullness
  4. tenderness
  5. hyperactive bowel sounds EARLY
  6. hypoactive bowel sounds LATE
  7. N/V
109
Q

what assessment is very important with stress ulcers? why?

A

VS - can give us cues about bleeding happening in the body

110
Q

what is diagnostic for PUD?
what is diagnostic for H. pylori?

KNOW

A

PUD: EGD

H. pylori: urea breath test

111
Q

interventions for PUD

A

reduce pain + complications + meds

112
Q

re: PUD treatment, what is triple therapy? what is quadruple therapy?

A

triple: PPI + 2 ABX
quadruple: triple + Pepto-Bismol

113
Q

what nutrition interventions should be implemented with PUD? (3)

A

BRAT diet (banana, rice, applesauce, toast)

no irritating foods

no bedtime snacks

114
Q

what is a major complication of PUD?

A

hemorrhage

hematemesis: upper bleed
melena: dark, tarry stool

115
Q

things to monitor for with hemorrhage r/t PUD? (4)

A
  1. VS (tachycardia + BP trending down) KNOW
  2. hemoccult test
  3. H+H
  4. s+s of bleeding
116
Q

management of hemorrhage rt PUD (4)

KNOW

A
  1. AIRWAY PROTECTION –> position on their side if vomiting KNOW
  2. O2
  3. fluids (volume replacement)
  4. prepare patient for EGD
  5. IV PPI
117
Q

if patient is unstable with hemorrhage r/t PUD, what should you do?

KNOW

A

anticipate blood products + fluids…. GET IV!!!!

118
Q

what could happen with perforation as complication of PUD?

A

GI contents leak into peritoneal cavity

119
Q

s+s of perforation (2)

A
  1. sudden, sharp mid epigastric pain –> radiates through ABD
  2. tender, rigid, boardlike abdomen with rebound tenderness = peritonitis
120
Q

gastritis

A

inflammation of mucosal lining of stomach

121
Q

acute gastritis is usually _______

A

self-limiting (several days)

122
Q

most common cause of acute gastritis

A

NSAIDs

123
Q

acute gastritis symptoms usually occur when? what are they? (6)

A

AFTER MEALS

pain, cramping, indigestion, anorexia, N/V, bleeding

124
Q

interventions for acute gastritis (2)

A

SUPPORT:

  1. fluids
  2. BRAT diet (banana, rice, applesauce, toast)
125
Q

chronic gastritis

A

patchy, diffuse inflammation –> stomach wall things and atrophies

126
Q

what is common cause of chronic gastritis?

A

H. pylori (burrows –> activate activates toxins –> inflammation)

127
Q

what can chronic gastritis cause if not treated? what would this lead to?

A

pernicious anemia

(parietal cell fxn decreases –> less acid + less intrinsic factor)

= B12 injections needed!!

128
Q

intervention for chronic gastritis

A

remove cause + PPI

129
Q

prevention of chronic gastritis

A
  1. diet (healthy foods + avoid irritating / spicy foods - caffeine, spicy, chocolate)
  2. exercise
  3. smoking cessation
  4. limit ASA + NSAIDs
130
Q

some patient education for UC + CD

A
  1. medication adherence: continue even through remissions
  2. food journal + BM journal
  3. how to get adequate nutrition
  4. check perineal area while maintaining dignity (Explain why you’re doing what you’re doing)
131
Q

what is tenesmus?

A

urge to defecate

132
Q

what is ulcerative colitis?

A

inflammation of rectum + sigmoid colon (starts at “end” and can move up the colon to involve all of it)

133
Q

with ulcerative colitis, the intestinal mucosa is _______, _______ + ______.

(adjectives)

A

hyperemic, edematous + narrowed

134
Q

re: UC, edema of the colon can cause ________, which can lead to ___________ (complication)

A

edema can cause THICKENING/NARROWING, which can lead to OBSTRUCTION

135
Q

what is the main difference re: stool in Ulcerative Colitis + Crohn’s Disease?

A

UC stool: diarrhea w/blood or pus

CD: steatorrhea (fatty stool)

136
Q

what is the main difference re: stool in Ulcerative Colitis + Crohn’s Disease?

A

UC stool: diarrhea w/blood or pus

CD: steatorrhea (fatty diarrhea)

137
Q

what is toxic megacolon?

A

dilation of colon + ileus…. BIG ASS COLON on xray

138
Q

what are the main (2) complications of UC?

A
  1. malabsorption

2. GI bleed

139
Q

1/3 of all deaths r/t ulcerative colitis are from what?

A

development of colorectal cancer

140
Q

what psychosocial aspect of both UC + CD are very important to look for and care for?

A

anxiety + depression

strong correlation

141
Q

what psychosocial aspect of both UC + CD are very important to look for and care for?

A

anxiety + depression

strong correlation

142
Q

with both UC + CD, we can have manifestations involving nearly any organ system. what is this called? what are some systems affected?

A

extraintestinal symptoms

liver, lungs, kidney, eye, skin + joints

143
Q

re: ulcerative colitis and nutrition, what would be something to assess with patient?

A

nutrition history: food diary + triggers

weight loss

144
Q

re: ulcerative colitis, what aspects of bowel elimination should we be assessing?

A

color, characteristic, frequency, pain, pattern, blood

145
Q

what medication class can cause an exacerbation of ulcerative colitis?

A

NSAIDs

GI!!

146
Q

why is it especially important to assess bowel elimination patterns with patients with UC or CD?

A

we can prepare them for BM + set them up for success!!

147
Q

re: UC, fever + tachycardia could be sign of worsening complication…. what complication might this be?

A

dehydration / F+E imbalances

148
Q

re: UC/CD and extraintestinal complications, what are some very important assessment pieces? (Harrell repeated this multiple times)

A

skin assessment + oral mucosa assessment

149
Q 
re: UC + CD, what might labs look like:
H+H:
WBC:
CRP + ESR:
electrolytes:
albumin:
A 
H+H: low (r/t bleeding)
WBC: high (r/t inflammation + infection)
CRP+ ESR: high (r/t inflammation)
electrolytes: low (malabsorption + diarrhea)
albumin: low (loss of protein in stool)
150
Q

what is gold standard for diagnosing Ulcerative Colitis + Crohn’s disease?

A

MRI - can visualize bowel, bowel wall + surrounding organs

151
Q

if you’ve had ulcerative colitis for > 10 years, how often should you get a colonoscopy?

TEST QUESTION

A

annually ◡̈

152
Q

with ulcerative colitis management, what are goals? (3)

A
  1. relieve symptoms
  2. decrease inflammation
  3. intestinal healing
153
Q

re: nutrition therapy + UC and CD, is diet a major factor in the inflammatory process?

A

Harrell says NO.

154
Q

re: nutrition and UC + CD, what would be a recommendation to the patient to track their food tolerances and how it impacts eliminiation?

A

food journal

+

BM journal

very individualized

155
Q

re: UC + CD and management, what’s one way we can relieve symptoms, decrease inflammation + promote healing?

A

bowel rest / NPO <3

156
Q

name some potential food triggers for UC + CD (7)

A
  1. high fiber foods
  2. ETOH
  3. caffeine
  4. raw veggies
  5. carbonated drinks
  6. lactose
  7. nuts + corn

= foods that increase GI motility

157
Q

what is the GOLD STANDARD for surgical treatment of ulcerative colitis? (just the name)

A

restorative proctocolectomy w/ ileostomy pouch anal anastomosis

(phew)

158
Q

what happens with a restorative proctocolectomy w/ ileostomy pouch anal anastomosis?

A

2 step procedure:

  1. remove colon + most of rectum (leave anus and sphincter intact). create internal pouch (j pouch) and connect to anus –> temporary ileostomy so pouch can heal
  2. reverse the ileostomy 1-2 months later
159
Q

what happens with a total proctocolectomy?

A

removal of colon, rectum + anus.

surgical closure of anus.

permanent ileostomy

160
Q

re: UC + ileostomy, what characteristics will the output have when ostomy is new and before adaptation has taken place? (4 things)

A
  1. known as “effluent”
  2. sweet smell
  3. liquid green
  4. very caustic to skin
161
Q

re: UC + ileostomy, if we see >2000mL in 24 hours, this is known as what? what’s our MAIN concern? what are some of our solutions? (4)

A

HIGH OUTPUT ILEOSTOMY

main concern: fluid loss + electrolyte imbalance

solutions:

  1. TPN until regulated
  2. benefiber to bulk up stool
  3. gatorade (replace electrolytes)
  4. opium tincture (slow things down)
162
Q

re: UC and a new ileostomy, after time adaptation will occur. what is this? what will you see with the stool? (2)

A

small intestine adapt to take on functions of the colon –> stool volume decreases and becomes thicker / pasty –> stool is brown or yellow-green color

163
Q

crohn’s disease is what?

A

chronic inflammation of small intestine, colon or both

“gum to bum”
= can affect ENTIRE GI tract

164
Q

crohn’s disease most commonly affects what area of the GI tract?

A

terminal ileum

165
Q

what is the hallmark sign of crohn’s disease?

A

cobblestone appearance of the bowel

166
Q

crohn’s disease causes ______ + ________ which could lead to ________

A

causes EDEMA + NARROWING, which could lead to OBSTRUCTION

167
Q

what risk increases with Crohn’s disease? (complication)

A

fistulas

168
Q

what is the main difference re: pain in Ulcerative Colitis + Crohn’s Disease?

A

UC: rectum + abdominal

CD: abdominal (constant around umbilicus)

169
Q

what manifestation is more common in Crohn’s (VS)?

A

FEVER

common when pt has fistula, abscess or severe inflammation

170
Q

which sign/symptom is much more SIGNIFICANT in CD compared to UC?

A

weight loss

secondary to malabsorption

171
Q

GI bleed more likely in Crohn’s or UC?

A

UC

172
Q

colon cancer and small bowel cancer more likely in Crohn’s or UC?

A

UC

173
Q

severe malabsorption + malnutrition more common in Crohn’s or UC?

A

Crohn’s

174
Q

fistula formation more common in Crohn’s or UC?

A

Crohn’s

175
Q

perirectal abscess more common in Crohn’s or UC?

A

Crohn’s

176
Q

what would you hear re: bowel sounds in severe inflammation and/or obstruction?

A

decreased or absent

177
Q

what would you hear re: bowel sounds over narrowing?

A

high pitched

178
Q

what assessment is very important if abscess or fistula is present? (with UC or CD) + who should we consult?

A

skin assessment / perineal assessment

consult WOCN

179
Q

neurological changes with UC or CD could indicate what complication?

A

electrolyte imbalances (Na)

180
Q

re: CD, what would you expect labs for folic acid and vitamin B12 to look like?

A

decreased (r/t malabsorption)

181
Q

re: fistula management with Crohn’s disease, how many calories are needed per day for wound healing?

A

3000 cal/day

182
Q

if an abscess forms from CD, what would you expect to give as a nurse?

A

ABX!

Med Surg I (6 decks)

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