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Adult 1 > Exam 4 > Flashcards

Exam 4 Flashcards

1
Q

Inflammation of the mouth

A

Stomatitis

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2
Q

Acyclovir is used for what?

A

Oral herpes if renal function is adequate

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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
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4
Q

Statins are used for what?

A

Oral yeast infections

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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

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6
Q

Considered more likely to become cancerous

Red, velvety lesions on the mucous membranes

A

Erythroplakia

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7
Q

Lips, tongue, buccal mucosa & oropharnyx
Red, raised, eroded, & non healing for 2 weeks
-90% of oral cancer

A

Squamous Cell Carcinoma

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8
Q 
Occurs on the lips
Raised scab
Pearly borders
Do not metastasize
Due to sun
A

Basal Cell Carcinoma

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9
Q 
Malignant lesion of blood vessels
Painless
Purple nodule
Raised
Hard palate, gums, tongue, tonsils
Mostly seen with AIDS
A

Kaposi’s Sarcoma

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10
Q

Oral Cancer biopsies

A

Biopsy
MRI for neural involvement and spread
CT for spread
1% toluidine dye

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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

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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

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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

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14
Q

Inflammation of the salivary glands

A

Sialadenitis

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15
Q

Chronic autoimmune disease in which a person’s white blood cells attack their moisture-producing glands.
-Can cause Sialadenitis

A

Sjögrens syndrome

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16
Q

How do you assess for Sialadenitis?

A

Assess facial nerve (7)

-smile, raise brows, puff cheeks

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17
Q

Sialadenitis interventions

A 
Frequent small sips of water
Sialagogues (drugs that promote saliva)
-Lemon slices
-Fruit flavored candy
Glycerin preparations
Saline
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18
Q

Failure of muscle to relax

A

Achalasia

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19
Q

Pouches of pressure in colon

A

Diverticula

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20
Q

Painful swallowing

A

Odynophagia

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21
Q

Pyrosis

A

Heartburn

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22
Q

Eructation

A

Burp

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23
Q

Endoscopy

A

Views inside body

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24
Q

Laparoscopy

A

Incision in abdomen

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25
Q

Laparotomy

A

Large surgical incision into abdominal wall

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26
Q

Upper esophageal sphincter

A

Keeps food/secretions from going down windpipe. Conscious control

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27
Q

Lower esophageal sphincter (Cardiac)

A

Prevents acid from going back up esophagus from stomach. Unconscious control

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28
Q

Pyloric sphincter

A

Allows stomach contents to enter intestines

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29
Q

EGD

A

5-20 minute test to examine the lining of the esophagus, stomach, and first part of the small intestine.

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30
Q

Laparoscopic Nissen fundoplication (LNF)

A

Treats GERD

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31
Q

Tissue in the esophagus is replaced by tissue similar to the intestinal lining.

A

Barrett’s esophagus

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32
Q

Pt teaching for GERD

A 
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
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33
Q

Nu interventions for GERD

A 
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
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34
Q

Drugs that protect gastric mucosa for GERD

A

Maalox/Mylanta
Carafate/Gaviscon
Pepto-Bismol

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35
Q

Drugs that accelerate Gastric emptying for GERD

A

Reglan

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36
Q

Drugs that inhibit Gastric Acid Secretions for GERD

A

Histamine Receptor Antagonists

(Pepcid, Zantac, Tagamet, Axid)

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37
Q

Proton pump inhibitors for GERD

A

Prilosec, Prevacid, Aciphex, Protonix, Nexium

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38
Q

Why should a pt contact the health care provider after Nissen surgery?

A 
Chest or abdominal pain
Bleeding
Dysphagia
SOB
NV
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39
Q

Postop care after Nissen surgery

A 
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
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40
Q

Sliding Hiatal Hernias signs

A
  • Heartburn
  • Regurgitation
  • Chest pain
  • Dysphagia
  • Belching
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41
Q

Paraesophageal Hernias signs (rolling)

A
  • Feeling of fullness after eating
  • Breathlessness after eating
  • Feeling of suffocation
  • Chest pain that mimics angina
  • Worsening of manifestations in a recumbent position
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42
Q

Preoperative care for hiatal hernia

A

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

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43
Q

A condition where part of the stomach pushes up through the diaphragm muscle

A

Hiatal Hernia

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44
Q

How to prevent gas bloat syndrome

A

No straws, chewing gum, carbonated beverages, gas forming, high fat foods

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45
Q

Postop complications after hiatal hernia

A

Prevent resp. complications (cough)

Dysphagia is common w/ first feeding

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46
Q

Aerophagia

A

Swallowing air

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47
Q

Pt teaching for Nissen surgery

A

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.

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48
Q

Esophageal tumors

A

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

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49
Q

Halitosis

A

Bad breath, present w/ esophageal tumors

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50
Q

Esophageal tumors

A

Loss of interest in eating and socialization
Fear of choking
Barium swallow for dx
Esophagogastroduodenoscopy (EGD)-visualize
Reports of food sticking in their throat

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51
Q

Esophageal tumor care

A

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

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52
Q

Postop care for esophagectomy

A

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

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53
Q

Preop care for esophagectomy

A

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

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54
Q

Esophageal Diverticula

A 
Dysphagia
Regurgitation (reflux)
Nocturnal cough
HalitosisMonitor for perforation
Small frequent meals
Semisoft food
Similar to GERD management
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55
Q

Pyloroplasty

A

Surgery to widen the lower stomach so the contents can empty into the small intestine

56
Q

Saline lavage

A

Help keep nasal passages clear by washing out mucous

57
Q

Vagotomy

A

Removal of vagus nerve to reduce stomach acid secretion

58
Q

Prostaglandins

A

Provide a protective mucosal barrier preventing autodigestion

59
Q

Erosive gastritis

A

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
Q

Nonerosive gastritis

A

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
Q

Autoimmune attack on the parietal cells and intrinsic factor

A

Chronic gastritis type A

62
Q

Caused by Helicobacter pylori

A

Chronic gastritis type B

63
Q

Seen in older adults and is associated with chronic irritation

A

Atrophic gastritis

64
Q

Rapid onset of epigastric pain, N/V, hematemesis (vomitting blood), gastric hemorrhage, dyspepsia, anorexia

Pt has what?

A

Acute gastritis

65
Q

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?

A

Chronic gastritis

66
Q

Signs of problems w/ patency/position of NG tube

A

Pain, fullness, hiccups, tachycardia, hypotension

67
Q

Postop complications for gastritis

A

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
Q

Carafate for gastritis

A

Mucosal barrier fortifier (demulcent)

69
Q

Ph Buffers for gastritis

A

Antacids

Maalox, Mylanta

70
Q

Antisecretory drugs for gastritis

A

Proton pump inhibitors
Generic names end in -prazole
Prilosec, Pervacid, AcidHex

71
Q

Why give antimicrobials for gastritis?

A

To eradicate the gram negative H. pylori

72
Q

Why give postaglandin analogs for gastritis?

A

To protect the mucosal lining

Cytotec (misoprostol)

73
Q

Types of peptic ulcer dz

A
  1. Gastric
    - Antrum
  2. Duodenal
    - Upper portion
  3. Stress
74
Q

Stress ulcers

A 
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
Q

Complications of stress ulcers

A 
Hemorrhage is the most lethal
Hematemesis
Melena
Perforation- emergency
Infection & peritonitis
Pyloric obstruction
Intractability
76
Q

Signs for stomach ulcers

A

Tenderness at the midline between the umbilicus and the xiphoid
Right – gastric
Left- duodenal

77
Q

PUD complications

A

Rigid, board like abdomen
Coffee ground emesis
Bright red blood hematemesis
Tarry stools

78
Q

PUD diagnostic tests

A

Stool H. pylori
Esophagogastroduodenoscopy (EGD)
Nuclear medicine scan

79
Q

DOC for PUD

A

PPIs

  • Associated with osteoporotic fractures over time
  • Reduce efficacy of clopidogrel (Plavix)
80
Q

GI bleed interventions

A 
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
Q

Perforation interventions

A

Fluid & electrolyte replacement
Antibiotics
N/G to suction
NPO

82
Q

Obstruction interventions

A 
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
Q

PUD home care teaching

A

No NSAIDs following surgery – Teach the patient to read labels as many OTC therapies contain ASA

84
Q

Gastric cancer

A

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
Q

Gastric Ulcer Assessment

A

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
Q

Gastric cancer interventions

A

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
Q

Gastric cancer complication-Dumping syndrome

A 
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
Q

Gastric cancer teaching

A 
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
Q

Hole or weakness in the abdominal wall through which intestine or other abdominal structure protrudes

A

Hernia

90
Q

Strangulated hernia

A

Blood supply is stopped, EMERGENCY

-bowel sounds may be absent

91
Q

Hernia assessment findings

A

Lump or protrusion with or without straining

Lump may disappear when lying down and be present when standing

92
Q

Truss use teaching

A

Inspect skin daily, put on before getting out of bed

93
Q

Herniorrhaphy post op care

A 
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
Q

Colorectal cancer

A

Arises from polyps, easily metastasizes to liver

95
Q

FOBT

A

2-3 specimens on 3 consecutive days

-avoid red meant, aspirin, vitamin C

96
Q

What should the stoma look like?

A

Pink-red, moist, protrude about ¾ inch from the abdominal wall, may be slightly swollen, may have a little bit of blood

97
Q

Stoma care post op

A

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
Q

Stoma care

A 
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
Q

Paralytic ileus

A

Obstruction in the intestines due to intestinal muscle paralysis. Non-mechanical

100
Q

Mechanical Obstruction

A

Physical blockage

101
Q

Intestinal Obstruction findings

A

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
Q

Volvulus

A

Intestinal Obstruction caused by twisting

103
Q

Intussusception

A

A part of the intestine folds into another part

104
Q

Intestinal Obstruction findings

A 
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
Q

Non-surgical interventions for intestinal obstructions

A 
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
Q

Postop intestinal obstruction surgery

A

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
Q

Harmless unless they bleed or cause pain

Caused by increased abdominal pressure

A

Hemorrhoids

108
Q

Hemorrhoid care

A 
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
Q

Hemorrhoidectomy postop care

A

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
Q

Care for chronic diarrhea

A

Observe for fungal or yeast infections, which appear as dark red rashes with “satellite” lesions. Obtain prescription for medication if this problem occurs.

111
Q

IBS assessment

A

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
Q

IBS interventions

A

Symptom diary can help identify triggers
30-40g bulk a day to regulates bowels
Medication compliance
Daily probiotic

113
Q

Appendicitis

A

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
Q

Appendicitis pain pattern

A

Pain may begin anywhere in the abdomen or flank and progress to the RLQ at McBurney’s point
followed by N/V

115
Q

Appendicitis assessment

A

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
Q

Appendicitis surgery

A

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
Q

Peritonitis

A

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
Q

Peritonitis assessment

A 
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
Q

Peritonitis implementation

A 
Hypertonic fluids
Broad spectrum antibiotics
NG & NPO
Oxygen
Analgesics
Monitor for S&S of shock
Sterile care for irrigating drains – I&O
120
Q

Peritionitis surgery postop care

A

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
Q

Self-limiting viral or bacterial infection of the small bowel spread by the fecal oral route. Vomiting causes the pathogens to become airborne.

A

Gastroenteritis

122
Q

Gastroenteritis causes

A

Norovirus is the most common and spreads among crowds in close proximity - HANDWASHING

123
Q

Gastroenteritis implementation

A

Push fluids
Oral rehydration therapy – fluid and electrolyte replacement
Do not use peristalsis slowing drugs –diphenoxylate hydrochloride (Lomotil)
Administer/teach antibiotics when ordered

124
Q

Ulcerative Colitis

A

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
Q

S/S of UC

A

Colicky pain relieved by defecation

Tenesmus: cramps like you need to defecate

126
Q

Lab values of UC

A

↓ H&H
↓albumin
↑ESR
↑C-reactive protein

127
Q

Meds for UC

A

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
Q

UC care

A

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
Q

Chron’s Dz

A

Inflammatory disease of the small intestine
Flare-ups & remissions
Thickened bowel wall
Develop fistulas
Malabsorption diarrhea → anemia
Obstructions from inflammation and scarring

130
Q

Chron’s signs

A 
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
Q

Chron’s care

A

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
Q

Diverticulosis

A

Pouch like intrusions

133
Q

Diverticular Dz

A

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
Q

Diverticular Dz assessment

A

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
Q

Diverticular Dz dx

A

Barium contrast X-ray in non acute periods
CT scan
Ultrasound

136
Q

Diverticular Dz implementation

A 
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

Adult 1 (8 decks)

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