Exam 4 Flashcards
1
Q
Inflammation of the mouth
A
Stomatitis
2
Q
Acyclovir is used for what?
A
Oral herpes if renal function is adequate
3
Q
How to care for stomatitis
A
- Rinse every 2-3 hours with warm saline with or without baking soda (Na+HCO3)
- dont use lemon swabs
4
Q
Statins are used for what?
A
Oral yeast infections
5
Q
Develops from long term irritation of the mucous membranes
Non-removable, white rounded, elevated benign → malignant lesions
In patients with HIV, signals conversion to AIDS
A
Leukoplakia
6
Q
Considered more likely to become cancerous
Red, velvety lesions on the mucous membranes
A
Erythroplakia
7
Q
Lips, tongue, buccal mucosa & oropharnyx
Red, raised, eroded, & non healing for 2 weeks
-90% of oral cancer
A
Squamous Cell Carcinoma
8
Q
Occurs on the lips Raised scab Pearly borders Do not metastasize Due to sun
A
Basal Cell Carcinoma
9
Q
Malignant lesion of blood vessels Painless Purple nodule Raised Hard palate, gums, tongue, tonsils Mostly seen with AIDS
A
Kaposi’s Sarcoma
10
Q
Oral Cancer biopsies
A
Biopsy
MRI for neural involvement and spread
CT for spread
1% toluidine dye
11
Q
Oral Cancer Interventions
A
Oral hygiene every 2 hours when infection/lesions or fresh post-op/ saline or HCO3 rinse
Soft bristle brush - no toothettes
Apply lubricants to the lipsAssess gag reflex before feeding
Feed small bites
Thickened liquids
Semi Fowlers
12
Q
Preoperative Care for oral cancer
A
Placement of a temporary tracheostomy, oxygen therapy, and suctioning
Temporary loss of speech because of the tracheostomy
Frequent monitoring of postoperative vital signs
NPO status until intraoral suture lines are healed
Need to have IV lines in place for drug delivery and hydration
Postoperative drug therapy and activity (out of bed on the first postoperative day)
Possibility of surgical drains
13
Q
Postop Care for oral cancer
A
Use a non deodorant soap
Add seasonings to food
Rinse chemobrush with H2O2/water or bleach weekly
14
Q
Inflammation of the salivary glands
A
Sialadenitis
15
Q
Chronic autoimmune disease in which a person’s white blood cells attack their moisture-producing glands.
-Can cause Sialadenitis
A
Sjögrens syndrome
16
Q
How do you assess for Sialadenitis?
A
Assess facial nerve (7)
-smile, raise brows, puff cheeks
17
Q
Sialadenitis interventions
A
Frequent small sips of water Sialagogues (drugs that promote saliva) -Lemon slices -Fruit flavored candy Glycerin preparations Saline
18
Q
Failure of muscle to relax
A
Achalasia
19
Q
Pouches of pressure in colon
A
Diverticula
20
Q
Painful swallowing
A
Odynophagia
21
Q
Pyrosis
A
Heartburn
22
Q
Eructation
A
Burp
23
Q
Endoscopy
A
Views inside body
24
Q
Laparoscopy
A
Incision in abdomen
25
Laparotomy
Large surgical incision into abdominal wall
26
Upper esophageal sphincter
Keeps food/secretions from going down windpipe. Conscious control
27
Lower esophageal sphincter (Cardiac)
Prevents acid from going back up esophagus from stomach. Unconscious control
28
Pyloric sphincter
Allows stomach contents to enter intestines
29
EGD
5-20 minute test to examine the lining of the esophagus, stomach, and first part of the small intestine.
30
Laparoscopic Nissen fundoplication (LNF)
Treats GERD
31
Tissue in the esophagus is replaced by tissue similar to the intestinal lining.
Barrett's esophagus
32
Pt teaching for GERD
```
4-6 small meals daily
Eat slowly
Chew thoroughly
NPO 2-3 hours before bedtime
Avoid culprits
No tight clothes
Avoid heavy lifting
Avoid working in a bent-over position
Right side lying while sleeping
```
33
Nu interventions for GERD
```
Elevate HOB about 6 inches
Help with smoking and alcohol cessation
CPAP if the patient is also obese
Elimination of drugs that lower LES pressure
Oral contraceptives
NSAIDs
Anticholinergics
Sedatives
Nitrates
Calcium channel blockers
```
34
Drugs that protect gastric mucosa for GERD
Maalox/Mylanta
Carafate/Gaviscon
Pepto-Bismol
35
Drugs that accelerate Gastric emptying for GERD
Reglan
36
Drugs that inhibit Gastric Acid Secretions for GERD
Histamine Receptor Antagonists
| (Pepcid, Zantac, Tagamet, Axid)
37
Proton pump inhibitors for GERD
Prilosec, Prevacid, Aciphex, Protonix, Nexium
38
Why should a pt contact the health care provider after Nissen surgery?
```
Chest or abdominal pain
Bleeding
Dysphagia
SOB
NV
```
39
Postop care after Nissen surgery
```
Assess for return of gag reflex
Clear liquids for 24 hours post procedure
Soft diet following first 24 hours
Avoid ASA/NSAIDS for 10 days
Continue GERD meds when possible
Use liquid meds when available
No NG tubes for a month post procedure
```
40
Sliding Hiatal Hernias signs
* Heartburn
* Regurgitation
* Chest pain
* Dysphagia
* Belching
41
Paraesophageal Hernias signs (rolling)
* Feeling of fullness after eating
* Breathlessness after eating
* Feeling of suffocation
* Chest pain that mimics angina
* Worsening of manifestations in a recumbent position
42
Preoperative care for hiatal hernia
Prepare the patient for an anatomically high incision (trans-thoracic with chest tube insertion) vs laparoscopic approach
Crush or dissolve simethicone in water and take OTC for bloating
3-6 week activity restriction with open procedures
Use stool softeners/fiber to prevent constipation
Report reflux S&S to healthcare provider
43
A condition where part of the stomach pushes up through the diaphragm muscle
Hiatal Hernia
44
How to prevent gas bloat syndrome
No straws, chewing gum, carbonated beverages, gas forming, high fat foods
45
Postop complications after hiatal hernia
Prevent resp. complications (cough)
| Dysphagia is common w/ first feeding
46
Aerophagia
Swallowing air
47
Pt teaching for Nissen surgery
Stay on a soft diet for about a week, including mashed potatoes, puddings, custard, and milkshakes; avoid carbonated beverages, tough foods, and raw vegetables that are difficult to swallow.
Remain on antireflux medications as prescribed for at least a month.
Do not drive for a week after surgery; do not drive if taking opioid pain medication.
Walk every day, but do not do any heavy lifting.
Remove small dressings 2 days after surgery, and shower; do not remove Steri-Strips until 10 days after surgery.
Wash incisions with soap and water, rinse well, and pat dry; report any redness or drainage from the incisions to your surgeon.
Report fever above 101° F (38.3° C), nausea, vomiting, or uncontrollable bloating or pain. For patients older than 65 years, report elevations above 100° F (37.8° C).
Schedule an appointment for follow-up with your surgeon in 3 to 4 weeks.
48
Esophageal tumors
Most are malignant
Metastasize quickly
Smoking and heavy alcohol intake are primary risk factors
Obesity & malnutrition are also risk factors
Low fresh fruit and high nitrosamines are risks
Long term GERD→Barrett’s Esophagus→ adenocarcinoma
49
Halitosis
Bad breath, present w/ esophageal tumors
50
Esophageal tumors
Loss of interest in eating and socialization
Fear of choking
Barium swallow for dx
Esophagogastroduodenoscopy (EGD)-visualize
Reports of food sticking in their throat
51
Esophageal tumor care
Keep the HOB elevated to at least 30o
Remain upright for a few hours after meals
Semi-soft foods and thickened liquids
Swallowing exercises:
Suck on lollipop
Reach for food on lip with tongue
Forward flexion of the head (chin tuck) aids swallowing
Place food in the back of mouth, close lips tight, and use tongue to aid swallowing
Chemotherapy, chemoradiation, radiation, & photodynamic therapy may be used to shrink tumors before excision
Esophageal dilation with stent placement may be used when surgery is not possible
52
Postop care for esophagectomy
Maintain patent airway
Be vigilant for hypotension
Monitor for fluid volume overload
Monitor for atrial fibrillation – irregular pulse
Monitor for infection
Mediastinitis
Anastomosis leak- NPO until healed
Splint incision during coughing & turning
NG tube – secure, DO NOT IRRIGATE OR REPOSITIONNG drainage should change from red to greenish-yellow by 24 hours
Meticulous oral and nasal care every 2-4 hours
Once oral feedings start ( may be as long as a month) prevent aspiration and reflux
Take liquids between meals rather than with meals due to vagotomy syndrome diarrhea
Teach the patient to continue good pulmonary care and prevent infection
Teach to report temp>101oF, swollen painful neck incision (anastomosis leak)
High calorie& protein soft foods
Provide hospice care information
53
Preop care for esophagectomy
Prompt smoking cessation 2-4 weeks pre-op
Enhanced nutrition pre-op
Dental visit pre-op to prevent infection followed by meticulous oral care 4x/day
Teaching related to tubes and drains (N/G, Jejunostomy, NG, Chest tube maybe)
Bowel prep
Teaching for respiratory post-op
Manage grief and anxiety
54
Esophageal Diverticula
```
Dysphagia
Regurgitation (reflux)
Nocturnal cough
HalitosisMonitor for perforation
Small frequent meals
Semisoft food
Similar to GERD management
```
55
Pyloroplasty
Surgery to widen the lower stomach so the contents can empty into the small intestine
56
Saline lavage
Help keep nasal passages clear by washing out mucous
57
Vagotomy
Removal of vagus nerve to reduce stomach acid secretion
58
Prostaglandins
Provide a protective mucosal barrier preventing autodigestion
59
Erosive gastritis
Acute gastritis short term in response to stimuli resolves over several months
Stress ulcers
-pathogenic break in the protective barrier (H.pylori most common)
Inflammatory process begins
Histamine is released
Vagus nerve is stimulated
Hydrochloric acid then is able to reach and damage the gastric mucosa which causes small vessel injury, edema and more damage.
60
Nonerosive gastritis
Chronic as a result of mucosal damage, doesn't resolve easily
-Chronic insult leads to atrophy and thinning of the lining and mucosa
Atrophy leads to decreased acid secretion by the parietal cells causing a loss of intrinsic factor (necessary for B12 absorption)
Increased incidence of cancer
61
Autoimmune attack on the parietal cells and intrinsic factor
Chronic gastritis type A
62
Caused by Helicobacter pylori
Chronic gastritis type B
63
Seen in older adults and is associated with chronic irritation
Atrophic gastritis
64
Rapid onset of epigastric pain, N/V, hematemesis (vomitting blood), gastric hemorrhage, dyspepsia, anorexia
Pt has what?
Acute gastritis
65
Vague complaint of epigastric pain relieved by eating,
intolerance of fatty/spicy foods, pernicious anemia (body can't absorb enough b-12, melena (blood in stool)
Pt has what?
Chronic gastritis
66
Signs of problems w/ patency/position of NG tube
Pain, fullness, hiccups, tachycardia, hypotension
67
Postop complications for gastritis
Dumping syndrome (30 min after ingestion)- rapid emptying of gastric contents into the small intestine
Late dumping syndrome (1.5 -3 hours after ingestion) – release of large amounts of insulin
Reflux gastropathy – regurgitation of bile into the stomach. S/S: include pain, vomiting, and early satiety
Delayed gastric emptying – due to mechanical or metabolic factors
Afferent loop syndrome – partial obstruction of the duodenal loop
68
Carafate for gastritis
Mucosal barrier fortifier (demulcent)
69
Ph Buffers for gastritis
Antacids
| Maalox, Mylanta
70
Antisecretory drugs for gastritis
Proton pump inhibitors
Generic names end in -prazole
Prilosec, Pervacid, AcidHex
71
Why give antimicrobials for gastritis?
To eradicate the gram negative H. pylori
72
Why give postaglandin analogs for gastritis?
To protect the mucosal lining
| Cytotec (misoprostol)
73
Types of peptic ulcer dz
1. Gastric
- Antrum
2. Duodenal
- Upper portion
3. Stress
74
Stress ulcers
```
Acute gastric lesions
Follow an acute medical crisis or trauma or NPO status
Curling’s ulcer- burns
Cushing’s ulcer – increased ICP
Bleeding is the major concern
```
75
Complications of stress ulcers
```
Hemorrhage is the most lethal
Hematemesis
Melena
Perforation- emergency
Infection & peritonitis
Pyloric obstruction
Intractability
```
76
Signs for stomach ulcers
Tenderness at the midline between the umbilicus and the xiphoid
Right – gastric
Left- duodenal
77
PUD complications
Rigid, board like abdomen
Coffee ground emesis
Bright red blood hematemesis
Tarry stools
78
PUD diagnostic tests
Stool H. pylori
Esophagogastroduodenoscopy (EGD)
Nuclear medicine scan
79
DOC for PUD
PPIs
- Associated with osteoporotic fractures over time
- Reduce efficacy of clopidogrel (Plavix)
80
GI bleed interventions
```
Provide oxygen
2 large bore intravenous catheters
0.9% NS
RBCs
Fresh frozen plasma (FFP)
Monitor vs for impending shock
Track H&H and coags
N/G tube with lavage
Left side lying
200-300ml of room temp solution water or saline in and out until clear without clots
EGD for embolization of the bleeder
Pre:
1 or 2 large bore IVs
NPO for 4-6 hours prior
Insure consent has been signed
Post:
VS frequently
Assess swallow and gag
Clot the bleeder via the femoral approach
```
81
Perforation interventions
Fluid & electrolyte replacement
Antibiotics
N/G to suction
NPO
82
Obstruction interventions
```
Assess for symptoms of delayed emptying
Fullness
Distention
Post prandial nausea
Copious vomiting
N/G tube to decompress
Monitor for F & E and acid base imbalance
Surgical procedures
Vagotomy
Sub total gastrectomy
Pyloroplasty
```
83
PUD home care teaching
No NSAIDs following surgery – Teach the patient to read labels as many OTC therapies contain ASA
84
Gastric cancer
Atrophic gastritis, and intestinal metaplasia are precursors to the adenocarcinoma
Gastric polyps, pernicious anemia, achlorhydria, lead to atrophic gastritis
H. pylori greatest risk factor
Intake of pickled foods, nitrates from processed food, and salt lead to atrophic gastritis
Low fruit/vegetable diet risk
HX of gastric surgery is risk
Incidence is higher in Asians and Asian Americans
Older age is a risk
Spreads vastly and quickly
Lymphatics
Blood
Peritoneal seeding
Direct invasion
85
Gastric Ulcer Assessment
Adherence to lifestyle to prevent gastritis, eliminate high risk foods
Hx of risk factors
Family Hx of gastric cancer
Indigestion or abdominal, epigastric, or back discomfort
Nausea and vomiting due to obstruction
Weakness, fatigue, anemia
Palpable epigastric mass
Lymphandopathy
Hematochezia
Abnormal liver tests with advanced disease
86
Gastric cancer interventions
Chemotherapy – multi-agent
Radiation- limited use
Surgical resection is best option for cure but is usually palliative due to late diagnosis
Pre-op
NG tube placement
Nutrition - ? Enteral or parenteral
Review pre-op for patients having abdominal surgery and general anesthesia
Intra-op – gastrectomy, partial gastrectomy or gastroenterostomy
Post- op:
Review post op management of patients with abdominal surgery
Blocked NG tube – hiccups, fullness, tachycardia, hypotension- irrigate or replace per order
87
Gastric cancer complication-Dumping syndrome
```
Rapid dumping of food into the small intestines which pulls lots of fluid in as well causing distention.
Symptoms occur within 30 minutes of eating
Vertigo
Tachycardia
Syncope
Sweating
Pallor
Palpitations
Desire to lay down
```
```
Symptoms occurring within 90 min-3 hr are due to high levels of insulin released
Diaphoresis
Confusion
Dizziness
Lightheadedness
Palpitations
High protein/fat & low to moderate carbs in small amounts
Octreotide (Sandostatin) 2-3/day
```
88
Gastric cancer teaching
```
Teach the patient to report abdominal bloating and pain, early satiety, vomiting
Teach patient signs of pernicious anemia
Administer and encourage B12 per orders
Monitor for leukopenia and anemia
Assess need for end of life care
Teach wound management when indicated
Teaching related to chemo and radiation therapy
Eliminate liquids with meals
```
89
Hole or weakness in the abdominal wall through which intestine or other abdominal structure protrudes
Hernia
90
Strangulated hernia
Blood supply is stopped, EMERGENCY
| -bowel sounds may be absent
91
Hernia assessment findings
Lump or protrusion with or without straining
| Lump may disappear when lying down and be present when standing
92
Truss use teaching
Inspect skin daily, put on before getting out of bed
93
Herniorrhaphy post op care
```
No coughing otherwise standard post-operative care
No straining/lifting for prescribed time
Elevate scrotum
Use antibacterial soap
Urination may be difficult
Males-Stand
1500-25oomL fluid/day
Catheterization (In/Out)
```
94
Colorectal cancer
Arises from polyps, easily metastasizes to liver
95
FOBT
2-3 specimens on 3 consecutive days
| -avoid red meant, aspirin, vitamin C
96
What should the stoma look like?
Pink-red, moist, protrude about ¾ inch from the abdominal wall, may be slightly swollen, may have a little bit of blood
97
Stoma care post op
Stoma should begin to function in 2-4 days.
Phantom rectal pain
Rectal itching
Avoid lifting/straining
Open procedure – no driving for 4-6 weeks
Stool softener
Avoid gas forming foods
Teach patient how to measure stoma and instruct patient to do so at last once a week for the first 6 weeks as the stoma shrinks or when weight changes
98
Stoma care
```
1/16-1/8 inch of skin around stoma
Trace shape on the wafer and cut out
Clip peristomal hair
Do not apply lubricants to the area
Teach bowel regulation will occur with diet vs irrigation
```
99
Paralytic ileus
Obstruction in the intestines due to intestinal muscle paralysis. Non-mechanical
100
Mechanical Obstruction
Physical blockage
101
Intestinal Obstruction findings
Plasma leakage due to inflammation→↓vascular volume
F & E imbalance and metabolic alkalosis/acidosis occurs depending on location of obstruction
Strangulation leads to necrosis and perforation
Shock and sepsis may occur
102
Volvulus
Intestinal Obstruction caused by twisting
103
Intussusception
A part of the intestine folds into another part
104
Intestinal Obstruction findings
```
Borborygmi→ absent distal bowel sounds
Distention
F&E imbalance with upper obstruction
Vomiting bile
Alkalosis with vomiting in upper
May have acidosis with lower
Labs consistent with dehydration
↓Na+, K+, & Cl- due to vomiting
CT scan
```
105
Non-surgical interventions for intestinal obstructions
```
NG to LWS/NPO
Listen for BS with LWS disconnected
Meds to ↑ gastric motility
Flatus assessment
Assess patency of NG tube every 4 hours
Irrigate NG every 4 hr with 30 mL NS or per order
Disimpaction and enema
F & E replacement based on labs
Monitor fluid status every 2-4 hours
Blood replacement as needed
Manage TPN
Oral care
Notify MD of pain that changes from crampy/colicky to constant – perforation/peritonitis
Opioids are held
Semi fowlers
```
106
Postop intestinal obstruction surgery
Clamp NG and give clear liquids unless vomiting ensues
Residual checks
Teach S&S of obstruction so they can report recurrence
Teach incision care
Encourage expression of fears and concerns
107
Harmless unless they bleed or cause pain
| Caused by increased abdominal pressure
Hemorrhoids
108
Hemorrhoid care
```
Cold packs for comfort
Tepid sitz bath
OTC topical anesthetics
Steroids for itching
Moist wipes
Dab, don’t wipe
High fiber, high fluid intake
Stool softeners not laxatives
Avoid spicy foods, nuts, alcohol, coffee
```
109
Hemorrhoidectomy postop care
Tell the patient who has had surgical intervention for hemorrhoids that the first postoperative bowel movement may be very painful. Be sure that someone is with or near the patient when this happens. Some patients become light-headed and diaphoretic and may have syncope (“blackout”).
monitor for bleeding
Moist heat – sitz baths 3-4 times a day for pain relief
110
Care for chronic diarrhea
Observe for fungal or yeast infections, which appear as dark red rashes with “satellite” lesions. Obtain prescription for medication if this problem occurs.
111
IBS assessment
Caffeinated and artificially sweetened drinks
Dairy products, raw fruits, grains cause bloating
Pain in left lower quadrant usual reason for seeking help
Bowel sounds – normal
Hydrogen breath test
112
IBS interventions
Symptom diary can help identify triggers
30-40g bulk a day to regulates bowels
Medication compliance
Daily probiotic
113
Appendicitis
Blockage of the lumen results is increased retained secretions, decrease blood flow, and infection
Perforation may occur esp after 48 hours
Peritonitis is life threatening and may occur
114
Appendicitis pain pattern
Pain may begin anywhere in the abdomen or flank and progress to the RLQ at McBurney’s point
followed by N/V
115
Appendicitis assessment
Perforation or Peritonitis
Pain that increases with cough or movement and is relieved by bending the right hip or knees
WBC.20,000/mm3
116
Appendicitis surgery
NPO for surgery and pain management
Open (laparotomy) or closed procedure (laparoscopy)
Closed procedure=less pain, shorter recovery, fewer complications
No laxatives, enemas or heat
117
Peritonitis
Inflammatory process → third spacing of fluids in the abdomen (7-8L/day) → hypovolemia/shock → organ failure → death
Peristalsis slows or stops
Distended abdomen → respiratory compromise
118
Peritonitis assessment
```
Leukocytosis
Free air or fluid on X-ray
Hiccups
Rigid, board-like abdomen (classic)
Abdominal pain (localized, poorly localized, or referred to the shoulder or chest)
Distended abdomen
```
119
Peritonitis implementation
```
Hypertonic fluids
Broad spectrum antibiotics
NG & NPO
Oxygen
Analgesics
Monitor for S&S of shock
Sterile care for irrigating drains – I&O
```
120
Peritionitis surgery postop care
Monitor the patient's level of consciousness, vital signs, respiratory status (respiratory rate and breath sounds), and intake and output at least hourly immediately after abdominal surgery. Maintain the patient in a semi-Fowler's position to promote drainage of peritoneal contents into the lower region of the abdominal cavity. This position helps increase lung expansion.
121
Self-limiting viral or bacterial infection of the small bowel spread by the fecal oral route. Vomiting causes the pathogens to become airborne.
Gastroenteritis
122
Gastroenteritis causes
Norovirus is the most common and spreads among crowds in close proximity - HANDWASHING
123
Gastroenteritis implementation
Push fluids
Oral rehydration therapy – fluid and electrolyte replacement
Do not use peristalsis slowing drugs –diphenoxylate hydrochloride (Lomotil)
Administer/teach antibiotics when ordered
124
Ulcerative Colitis
Widespread inflammation of the rectum and/or colon
Ulcerations occur and abscesses and necrosis form at the ulceration sites
Scarring → narrowed colon and partial obstruction
Flare-ups & remissions
125
S/S of UC
Colicky pain relieved by defecation
| Tenesmus: cramps like you need to defecate
126
Lab values of UC
↓ H&H
↓albumin
↑ESR
↑C-reactive protein
127
Meds for UC
Teach patients taking sulfasalazine to report nausea, vomiting, anorexia, rash, and headache to the health care provider. With higher doses, hemolytic anemia, hepatitis, male infertility, or agranulocytosis can occur. This drug is in the same family as sulfonamide antibiotics. Therefore assess the patient for an allergy to sulfonamide or other drugs that contain sulfur before the patient takes the drug. The use of a thiazide diuretic is also a contraindication for sulfasalazine.
128
UC care
Expect ileostomy drainage in about 24 hours
Drink an additional 500mL/day, increase salt intake and avoid sweating, etc
Monitor for toxic megacolon
Provide written information and healthcare contact numbers
Petroleum based ointments
129
Chron's Dz
Inflammatory disease of the small intestine
Flare-ups & remissions
Thickened bowel wall
Develop fistulas
Malabsorption diarrhea → anemia
Obstructions from inflammation and scarring
130
Chron's signs
```
Constant pain RLQ
Pain around the umbilicus pre and post BM
↓albumin
↑ESR
↑C-Reactive protein
Absent or decreased BS
High pitched rushing BS
```
131
Chron's care
3000 cal/day
High cal, high protein, high vitamin, low fiber
Enteral supplements
TPN
Hypokalemia
DehydrationDressing for low output and pouch for high output
Vac dressings to prepare for surgery
132
Diverticulosis
Pouch like intrusions
133
Diverticular Dz
Mostly commonly in the sigmoid colon
Food gets trapped, blood supply is decreased, bacteria invade, abscesses form
Bleeding, fistula formation, and obstruction can occur
High luminal pressure may be the cause of the pouching
134
Diverticular Dz assessment
Diverticulosis usually S&S free unless bleeding or pain develops
Constipation
LLQ pain=diverticulitis
Acute Mental Status change in elders sign of peritonitis
Watching for sepsis and bleeding
Leukocytosis
H&H changes with bleeding
135
Diverticular Dz dx
Barium contrast X-ray in non acute periods
CT scan
Ultrasound
136
Diverticular Dz implementation
```
Teach to seek help
Temperature over 101oF
Severe for persistent pain >3 days
Lower GI bleeding
High fiber diet when stable and low fiber with flare ups
Rest during acute phases
No laxatives or enemas
Watch for dehydration
Opioid analgesics
Broad spectrum antibiotics
Stool checks for blood
Frequent abdominal assessments
Avoid coughing, bending, straining
Re-introduce fiber slowly once bowel function returns to normal
```
