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NRS 105 Exam #1 > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

________________ is a burning sensation in the stomach and esophagus that moves up to the mouth.

A

Pyrosis

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2
Q

TRUE or FALSE
The vast majority of gastric cancers are acquired and not inherited.

A

True

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3
Q

Tumors of the small intestine are uncommon, of these approximately 64% are __________________.

A

Malignant

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4
Q

TRUE or FALSE
The most common site for a peptic ulcer formation is in the pylorus.

A

False

It is the duodenum

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5
Q

TRUE or FALSE
Older adults tend to have increased gastric motility.

A

False

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6
Q

________________ syndrome may occur as a result of any surgical procedure that involves the removal of a significant portion of the stomach or includes resection or removal of the pylorus.

A

Dumping

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7
Q

TRUE or FALSE
Proton pump inhibitors may be administered for at least 1 year in patients with risk factors for peptic ulcer disease.

A

True

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8
Q

TRUE or FALSE
Most peptic ulcers result from infection with the gram-negative bacteria H. pylori, which may be acquired through ingestion of food and water.

A

True

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9
Q

Gastritis and ________________ from peptic ulcer disease are the two most common causes of upper GI tract bleeding.

A

hemorrhage

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10
Q

________________________ is indigestion, an upper abdominal discomfort associated with eating.

A

Dyspepsia

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11
Q

What does PQRST stand for?

A

P: What Provokes the pain and what makes it feel better?
Q: Quality - What does it feel like? Describe it in own words
R: Region or Radiation - Where is it? Is it radiating anywhere?
S: Severity - scale of 0-10
T: Timing - How long has it been going on? How long does it last? What time of day does it happen? Is it constant or intermittent?

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12
Q

GI History Assessment

A
  • Any pain? - PQRST
  • Is there any dyspepsia?
  • Intestinal gas?: From stomach or colon?
  • Nausea/Vomiting?: How long? How much? What does it look like? Color? How long after eating?
  • Stool/Bowel Habits?: What is normal? Texture/color/firmness
  • Oral Hygiene routine?
  • Any lesions in the mouth/throat/tongue?
  • Normal dietary intake?
  • Smoking/alcohol/tobacco use?
  • Dentures?
  • Medication use?
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13
Q

GI Physical Assessment

A
  • Inspect oral cavity for hydration, color, texture, symmetry, lesions
  • Tongue: thin white coat and large vallate papillae in V formation at distal end are normal findings
  • Use tongue depressor to visualize pharynx
  • Inspect abdomen: Pt lays supine, knees flexed
  • Inspect, auscultate, percuss, palpate
    Begin in RLQ
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14
Q

What does a hollow sound on abdominal percussion mean?

A

Air

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15
Q

What does a dull thud sound on abdominal percussion mean?

A

Fluid

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16
Q

What are normoactive bowel sounds?

A

5-34 gurgling sounds in 1 minute

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17
Q

What are hyperactive bowel sounds?

A

more than 35 gurgling/click sounds in 1 minute

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18
Q

What are hypoactive bowel sounds?

A

<5 gurgling/click sounds
Must listen in each quadrant for full 2 minutes
NO Bowel Sounds could be a medical emergency

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19
Q

Why is Intrinsic Factor important?

A

Combines with dietary Vitamin B12 so it can be absorbed in the ileum
No Intrinsic Factor? ➡️ B12 deficient ➡️ pernicious anemia

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20
Q

What are the functions of gastric secretions?

A
  1. Hydrochloric acid: Breaks down food and aids in the destruction of most ingested bacteria
  2. Pepsin: protein digestion
  3. Intrinsic Factor: aids in the absorption of Vitamin B12
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21
Q

What controls the rate of gastric secretions and influences gastric motility?

A
  1. Hormones
  2. Neuroregulators
  3. Local regulators
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22
Q

What are the functions of pancreatic enzymes?

A
  1. High concentration of bicarbonate - neutralizes stomach acid to protect the small intestine
  2. Digestive function: trypsin (proteins), amylase (starch), lipase (fats)
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23
Q

How long after eating does it take waste material to pass into the terminal ileum and then slowly into the proximal portion of the right colon through the ileocecal valve?

A

Within 4 hours

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24
Q

How long after eating does it take waste materials to reach the rectum?

A

About 12 hours
(Could still be in the rectum 3 days after eating)

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25
Q

Why is the composition of fecal matter relatively unaffected by alterations in diet?

A

A large portion of the fecal mass is derived from secretions of the GI tract - not from a dietary origin.

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26
Q

When is the gut microbiome generally established?

A

By two years of age

(Begins shortly after birth)

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27
Q

What are the general functions of the gut microbiome?

A
  1. Protection
  2. Defense
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28
Q

What are some GI Diagnostic Studies?

A
  • Serum Lab Tests (CMP, CBC)
  • Stool tests (ova/parasite and guaiac)
  • Breath tests (checking for hydrogen gasses - may indicate H. pylori
  • Abdominal ultrasound
  • Genetic testing (checking for cancer risks)
  • Imaging: CT, PET, MRI, scintigraphy, virtual colonoscopy
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29
Q

What are GI trace studies?

A

Test anatomic function
* Upper GI fluoroscopy tracing (swallow barium pill)
* Lower GI fluorosopy tracing (swallow barium pill or suppository)

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30
Q

What are GI Endoscopic Studies?

A

Fiberoptic camera to visualize the anatomy
* Upper GI: Esophagogastroduodenoscopy (EGD) or Endoscopic Retrograde Cholangiopancreatography (ERCP)
* Lower GI: Fiberoptic colonoscopy

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31
Q

Important things to remember for an EGD

A
  • NPO for 8 hours
  • Moderate sedation (midazolam or propofol) (no intubation)
  • Takes about 30 min.
  • Recovery 30-60 min.
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32
Q

EGD: Post Procedure Complications

A

S/S of Esophageal perforation
* increased pain
* Bleeding
* BP ⬇️
* HR ⬆️
* Unusual difficulty swallowing
* Rapidly elevating temperature

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33
Q

Important things to know for Colonoscopy

A
  • Must have a good colon prep! Output should be clear
  • Laxative solution or pills 24-48 hours prior
  • Clear liquid/ low residue diet for 2 days
  • Monitor older patient closely during bowel prep
  • Assess glucose levels due to dietary modifications
  • Pt. laying on left side
  • Moderately sedated (ex: midazolam/propofol)
  • Takes about an hour
  • Recovery 30-60 minutes
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34
Q

Colonoscopy: Post Procedure Complications

A

S/S of Bowel perforation
* rectal bleeding
* vital signs
* severe abdominal pain
* fever
* localized peritoneal signs
* firm abdomen

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35
Q

Manometry / Electrophysiologic Studies
Things to know

A
  • Manometry used to diagnose GERD, motility disorders of esophagus, upper and lower esophageal sphincters
  • NPO for 8-12 hours
  • Meds that affect motility withheld for 24-48 hrs (calcium channel blockers, anticholinergic agents, sedatives)
  • Pressure sensitive catheter inserted through the nose, patient swallows small amounts of water, pressure changes are recorded.
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36
Q

What are some disorders of the esophagus?

A
  • Motility disorders (achalasia, esophageal spasm)
  • Hiatal hernias
  • Diverticula
  • Perforation
  • Foreign bodies
  • Chemical burns
  • GERD
  • Barrett Esophagus (from long term GERD - considered pre-cancerous)
  • Benign tumors
  • Carcinoma
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37
Q

The etiology of cancer of the colon and rectum is predominantly ________________________, a malignancy arising from the epithelial lining of the intestine.

A

adenocarcinoma

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38
Q

TRUE or FALSE
Diarrhea is defined as the increased frequency of more than three bowel movements per day.

A

True

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39
Q

TRUE or FALSE
Celiac disease is a disorder of malabsorption caused by an autoimmune response to consumption of products that contain the protein gluten.

A

True

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40
Q

Straining at stool initiates the ________________ maneuver that results in a potentially dangerous increase in BP.

A

valsalva

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41
Q

In Crohn’s disease, the common clinical manifestations include abdominal pain and ________________.

A

diarrhea

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42
Q

TRUE or FALSE
Decompression of the bowel through a nasogastric tube is necessary for all patients with small bowel obstruction.

A

True

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43
Q

________________________, the most common cause of acute surgical abdomen in the United States, is the most common reason for emergency abdominal surgery.

A

Appendicitis

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44
Q

________________________is a chronic functional disorder characterized by recurrent abdominal pain associated with diarrhea, constipation, or both.

A

Irritable Bowel Syndrome

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45
Q

TRUE or FALSE
Diverticula may occur anywhere in the small intestine or colon, but most commonly occur in the ascending colon.

A

False

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46
Q

TRUE or FALSE
The patient with irritable bowel syndrome (IBS) should select foods low in fiber in order to minimize intestinal irritation.

A

False

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47
Q

What are the most common symptoms of esophageal disease?

A
  • Dysphagia - most common
  • Odynophagia - acute pain on swallowing
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48
Q

Hiatal Hernias
Clinical Manifestations

A
  • Pyrosis (heartburn)
  • Regurgitation
  • Dysphagia
  • Vague symptoms of intermittent epigastric pain
  • Fullness after eating

(Many patients are asymptomatic)

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49
Q

What are the two types of hiatal hernias?

A

Sliding (when the stomach bulges through the diaphragm opening into the esophagus, slides in and out of the esophagus, more common, less severe)

Paraesophageal (the herniated organ is stuck in the chest next to the esophagus… less common, more severe)

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50
Q

Gastroesophageal Reflux Disease
Definition

A
  • Common disorder marked by backflow of gastric duodenal contents into the esophagus that causes troublesome symptoms and/or mucosal injury to the esophagus
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51
Q

Gastroesophageal Reflux Disease
Causes

A
  • Incompetent lower esophageal sphincter
  • Pyloric stenosis
  • Hiatal hernia
  • Motility disorder
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52
Q

Gastroesophageal Reflux Disease
Risk Factors

A
  • Increasing age
  • Irritable Bowel Syndrome
  • Obstructive airway disorders (asthma, COPD, cystic fibrosis)
  • Barrett esophagus
  • Peptic ulcer disease
  • angina
  • tobacco, coffee, or alcohol use
  • gastric infection with H. pylori
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53
Q

Gastroesophageal Reflux Disease
Diagnostics

A
  • Esophageal Manometry
  • Upper Gastrointestinal Esophagogastroduodenoscopy (EGD)
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54
Q

Gastroesophageal Reflux Disease
Clinical Manifestations

A
  • Most Common: Dyspepsia (Indigestion)
  • Heartburn
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55
Q

Gastroesophageal Reflux Disease
Self-Treatment/Nursing Care

A

Avoid situations that decrease lower esophagus sphincter pressure or cause irritation of the esophagus:
* low fat diet
* avoid caffeine, tobacco, beer, milk, peppermint, spearmint, carbonated beverages, citrus, acidic foods
* Avoid eating or drinking 2 hours before bedtime
* Elevate the head of the bed by at least 30 degrees

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56
Q

Gastroesophageal Reflux Disease
Medical Treatment

A

Surgical: Open or laparoscopic Nissen fundoplication
Medications:
* Proton Pump Inhibitors* (-prazole)
* Antacids/Acid Neutralizing: Calcium Carbonate, Aluminum hydroxide, magnesium hydroxide, simethicone
* Histamine-2 Blockers (famotadine, cimetidine)
* Prokinetic agents: Metoclopramide
* Surface agents: Sucralfate
* Uncommon: Reflux inhibitors (bethanechol chloride), Muscle Relaxers (baclofen)

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56
Q

When is enteral feeding necessary?

A
  • When aspiration risk is high
  • When the esophagus and/or stomach need to be bypassed

Nasoduodenal or nasojejunal
Gastrostomy or jejunostomy

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57
Q

What are the benefits of delivering nutrition enterally?

A
  • Safer than parenteral feeding
  • Cost effective
  • Preserves GI integrity
  • Preserves the normal sequence of intestinal and hepatic metabolism
  • Maintains fat metabolism and lipoprotein synthesis
  • Maintains normal insulin and glucagon ratios
58
Q

Enteral Feeding
Nursing Assessment

A
  • Tube placement
  • Daily weights (in hospital), weekly weights outpatient
  • Monitor I&O
  • Ability to tolerate formula and amount
  • Clinical response
  • Signs of dehydration
  • Signs of infection
  • Blood glucose
  • Edema
  • Dietician consult
59
Q

Patient with Gastrostomy or Jejunostomy
Assessment

A
  • What is pt.’s ability to care for self at home
  • Skin condition
  • Nutrition and fluid status
  • Inspection of tube
60
Q

What is a PEG or G-tube?

A

Percutaneous endoscopic gastrostomy (PEG) tube
* Surgical opening in the stomach
* Provides nutrition, fluids, medications via feeding tube (within 4 hrs. of placement)
* Provides decompression in patients with gastroparesis, GERD, or intestinal obstruction
* Preferred over nasogastric tube for long term GI dysfunction
* Can last 1-2 years by optimally needs to be replaced every 3-6 months

61
Q

What is a PEJ or J-tube?

A

Percutaneous Jejunal Tube
* Surgerical procedure to place an opening in the jejunum when the gastric route is not accessible
* Decrease aspiration risk when stomach is not functional to empty food or fluids
* Needs replacing every 6-9 months
* 4-5 ft long
* Specific liquid food needed (different from G-tube feeding)

62
Q

Gastritis
Definition

A

Disruption of the mucosal barrier that normally protects the stomach tissue from digestive juices
* Acute: Rapid onset of symptoms, usually caused by diet, self-limiting
* Chronic: Prolonged inflammation, atrophy of gastric tissue

63
Q

Gastritis
Clinical Manifestations

A

Acute:
* epigastric pain
* dyspepsia (indigestion)
* anorexia
* hiccups
* nausea
* vomiting
* melena, hematemesis, or hematochezia

Chronic:
* fatigue
* pyrosis (heartburn)
* belching
* sour taste in the mouth
* halitosis (bad breath)
* early satiety (fullness)
* anorexia
* nausea and vomiting
* pernicious anemia

64
Q

Gastritis
Diagnostics

A
  • Endoscopy
  • Histologic examination of biopsy specimen
65
Q

Gastritis
Causes

A

Acute:
* Dietary indiscretion
* alcohol
* medications
* bile reflux
* radiation therapy
* ingestion of strong acid or alkali

Chronic:
* benign or malignant ulcers of the stomach
* Heliobacter pylori infection
* autoimmune diseases
* dietary factors
* medications
* alcohol
* smoking
* chronic reflux of pancreatic secretions or bile

66
Q

Gastritis
Medical Treatment

A

Acute:
* Refrain from alcohol and food until symptoms subside
* Supportive therapy: IV fluids, ng tube, antacids, H-2 receptor antagonists, PPIs

Chronic:
* Modify diet
* promote rest
* reduce stress
* avoid alcohol
* avoid NSAIDs

67
Q

Gastritis
Medications

A
  • Antibiotics: Amoxicillin, Metronidazole, Clarithromycin, Tetracycline
  • Antidiarrheal: Bismuth subsalicylate (for H. pylori infection)
  • Histamine 2 Blockers: cimetidine, famotidine
  • Proton Pump Inhibitors: Pantoprazole, Esomeprazole, Lansoprazole, Omeprazole
  • Prostraglandin E1 Analogue: Sucralfate, Misoprostol (protects mucosa)
68
Q

Gastritis
Nursing Management

A
  • Reduce anxiety, use calm approach, explain all procedures and treatments
  • Promote optimal nutrition: no food or fluids by mouth, clear liquids, solid foods only as prescribed
  • Evaluate and report symptoms
  • Discourage caffeine, alcohol, cigarette smoking
  • Promote fluid balance: monitor I&O, monitor for dehydration, electrolyte imbalance, and hemorrhage
  • Measures to relieve pain (diet and medications)
69
Q

Peptic Ulcer Disease
Definition

A

Erosion of a mucous membrane forms an excavation in the stomach, pylorus, duodenum, or esophagus

Most common place for ulcers: duodenum

70
Q

Peptic Ulcer Disease
Causes and Risk Factors

A
  • Associated with infection of H. pylori
    Risk factors
  • excessive secretion of stomach acid
  • Dietary factors
  • chronic use of NSAIDs
  • alcohol
  • smoking
  • familial tendency
71
Q

Peptic Ulcer Disease
Clinical Manifestations

A
  • Dull, gnawing pain or burning in the mid-epigastrum
  • may include heartburn or vomiting
72
Q

Peptic Ulcer Disease
Nursing Management

A
  • Relieve pain
  • Reduce anxiety
  • Maintain optimal nutrition status
  • Monitor and manage potential complications: hemorrhage, perforation, penetration, gastric outlet obstruction (from scar tissue buildup)
  • Patient Education
73
Q

Constipation
Definition

A

Fewer than three bowel movements in a week OR bowel movements that are hard, dry, small, or difficult to pass

74
Q

Constipation
Causes

A
  • Medications
  • Chronic Laxative Use
  • weakness (from aging)
  • immobility
  • fatigue
  • inabililty to increase intra-abdominal pressure
  • diet
  • ignoring urge to defecate
  • lack of regular exercise
75
Q

What is perceived constipation?

A

A subjective problem in which the person’s elimination pattern is not consistent with what he or she believes is normal

76
Q

Constipation
Clinical Manifestations

A
  • Fewer than 3 BMs per week
  • Abdominal distention, pain, bloating
  • A sensation of incomplete evacuation
  • Straining at stool
  • Elimination of small-volume, hard, dry stools
77
Q

Constipation
Complications

A
  • Decreased cardiac ouput (increased pressure into the vascular system)
  • Fecal impaction
  • Hemorrhoids
  • Fissures
  • Rectal prolapse
  • Megacolon (stretched out from stuck fecal matter)
78
Q

Constipation
Patient Learning Needs

A
  • Respond to the urge to defecate
  • Follow a regular bowel regimen
  • Increase dietary fiber and fluids
  • Increase exercise and activity
  • Avoid overuse or long-term use of stimulant laxatives
79
Q

Constipation
Medical Management

A
  • Find underlying cause
  • Prevention
  • Patient Education: Exercise, diet, etc.
  • Laxatives or medication change
  • Enemas and suppositories NOT recommended unless medications have failed
80
Q

Constipation
Nursing Management
Gerotologic considerations

A
  • Constipation issues common in people > 65
  • Complain of straining
  • Physiologic changes in aging
  • Fluid intake low, reduced mobility, weakened abdominal muscles
  • Co-morbidities/polypharmacy
81
Q

Diarrhea
Definition

A

More than three BM per day with altered consistency
* Usually associated with urgency, incontinence, or a combination of these factors
* May be acute, chronic (6 months or more), or persistent

82
Q

Diarrhea
Causes

A
  • Infections
  • Medications (ie metformin)
  • Tube feeding formulas (enteral feedings)
  • Metabolic and endocrine disorders
  • Various disease processes
83
Q

Diarrhea
Clinical Manifestations

A
  • Increased frequency, fluid content of stools
  • Abdominal cramps
  • Distention
  • Borborygmus (rumbling noise caused by GI gas)
  • Anorexia and thirst
  • Painful spasmodic contractions of the anus
  • Tenesmus (feeling of the need to pass stool)
84
Q

Diarrhea
Complications

A
  • Fluid and electrolyte imbalances
  • Cardiac dysrhythmias
  • Chronic diarrhea can result in skin care issues related to irritant dermatitis
  • Dehydration: Cardiac arrhythmias, fatigue, dizziness, dry skin, lower BP, higher HR
85
Q

Diarrhea
Diagnostic studies

A
  • CBC (infection, anemia)
  • Serum chemistries (electrolyte imbalances)
  • Urinalysis
  • Stool examination (ova/parasites)
  • Endoscopy or barium enema
86
Q

Irritable Bowel Syndrome
Definition

A
  • Chronic functional disorder characterized by recurrent abdominal pain associated with disordered bowel movements (diarrhea, constipation, or both)
  • 15% of adults in the US report symptoms of IBS
87
Q

Irritable Bowel Syndrome
Causes

A
  • Chronic stress
  • Sleep deprivation
  • surgery
  • infections
  • diverticulitis
  • some foods
88
Q

Irritable Bowel Syndrome
Clinical Manifestations

A
  • Alteration in bowel patterns
  • Pain
  • Bloating
  • Abdominal distention
89
Q

Irritable Bowel Syndrome
Diagnostics and Assessment

A
  • Stool studies (ova/parasites)
  • Contrast radiography studies (barium)
  • Proctoscopy
  • Barium enema
  • Colonoscopy
  • Manometry
  • Electromyography
90
Q

Irritable Bowel Syndrome
Patient Learning

A
  • Dietary changes
  • Food diary (2 weeks)
  • Adequate fluid intake
  • Avoid alcohol and smoking
  • Relaxation techniques
  • Medication management
  • Complimentary medicine
91
Q

Irritable Bowel Syndrome
Medications

A

Laxative Medications:
* Bulk forming: methylcellulose, psyllium, wheat dextrin
* Saline agent: Magnesium hydroxide
* Lubricant: Mineral oil, glycerin suppository
* Stimulant: Bisacodyl, senna (NOT for long term use)
* Emollient Stool Softener: Docusate
* Osmotic Agent: Polyethylene glycol, electrolytes (Sodium, potassium)
* Serotonin-4 Receptor Agonist: Prucalopride
* Chloride Channel Activator: Lubiprostone

Probiotics
Anti-Diarrheal: Loperamide is 1st choice

92
Q

Irritable Bowel Syndrome
Nursing Management

A
  • Relieve abdominal pain
  • Control diarrhea
  • Help modify lifestyle (reduce stress, adequate sleep, exercise)
  • Increase dietary soluble fiber
  • Low FODMAP diet
  • Administer medications
93
Q

What is the Low FODMAP diet?

A

Restrict the following:
Fermented Oligosaccharides: wheat, rye, asparagus, legumes, garlic, onion
Disaccharides: lactose containing foods: milk, yogurt, etc
Monosaccharides: fructose containing foods: honey, mangoes, figs, etc.
And
Polyols: blackberries, lychee, low calorie sweeteners, etc.

94
Q

Appendicitis
Definition

A
  • Appendix becomes inflamed and edematous because of becoming kinked or occluded by fecalith or lymphoid hyperplasia
  • Inflammatory process causes edema and obstuction of the orifice
  • Appendix becomes ischemic, bacterial overgrowth occurs, becomes gangrene or perforation occurs
  • Most common reason for emergency abdominal surgery
95
Q

Appendicitis
Clinical Manifestations

A
  • Vague periumbilical pain ➡️ radiates to RLQ
  • Nausea (50% of the time)
  • Anorexia
  • Low-grade fever
  • Local tenderness in McBurney’s point (RLQ)
  • Rebound tenderness on palpation of RLQ
  • Rovsing’s Sign- pain when left lower quadrant is palpated
96
Q

Appendicitis
Gerontologic Considerations

A
  • Uncommon in older adults
  • Symptoms vary greatly and may be vague
  • Pain may be absent or minimal
  • Elevated WBCs or fever may not be present
  • Delay in diagnosis and treatment because of milder symptoms
97
Q

Appendicitis
Medical Management

A
  • Immediate Surgery
  • Correct Electrolyte Imbalance, dehydration, sepsis
  • Antibiotics
98
Q

Appendicitis
Nursing Management

A
  • Prevent Fluid Volume deficit - replace fluids as ordered
  • Relieve pain
  • Reduce patient/family anxiety
  • Prevent SSI
  • Prevent post-surgical pneumonia (incentive spirometer, coughing, breathing exercises - place pillow on chest to help with abdominal pain)
  • Maintain skin integrity - ambulate/turn patient
  • Encourage proper nutrition
  • Give anti-emetics
  • Patient education
99
Q

Appendicitis
Diagnostics

100
Q

Diverticular Disease
Definition

A
  • Diverticulum = sac-like herniation of the lining of the bowel that extends through a defect in the muscle layer
  • Most common in the sigmoid colon
  • Diverticulosis: multiple diverticula without inflammation
  • Diverticulitis: infection and inflammation of the diverticula
101
Q

Diverticular Disease
Risk Factors/Causes

A
  • Increases with age
  • Low-fiber diet
102
Q

Diverticular Disease
Diagnostic

A
  • Colonoscopy
103
Q

Diverticular Disease
Medical Management

A
  • Dietary change (high fiber, low fat)
  • Increase liquids
  • Antibiotics (ex. Metronidazole)
  • Opiates/pain management
  • Significant symptoms: hospitalization: NPO, IVF, ABx, Rest, NGT, Surgery
104
Q

Diverticular Disease
Stages

A
  • Stage 0: Uncomplicated = mild diverticulitis, colonic thickening on CT
  • Stage 1a: Uncomplicated = Colonic reaction with inflammatory reaction in the pericolic fate
  • Stage 1b: Complicated = Localized pericolic or mesenteric abscess
  • Stage 2: Complicated = Intra-abdominal, pelvic, or retroperitoneal abscess
  • Stage 3: Complicated = Perforated diverticulitis causing generalized purulent peritonitis
  • Stage 4: Complicated = Rupture of diverticula into the peritoneal cavity with generalized fecal peritonitis
105
Q

Diverticular Disease
Nursing Management

A
  • IV Fluid Replacement (2L/day if no renal/cardiac disease)
  • Encourage/provide soft, increased high fiber diet
  • Discuss stool regimen around meals
  • Encourage bulk laxatives (psyllium)
  • Avoid foods that trigger attacks (popcorn, seeds, nuts)
106
Q

Peritonitis
Definition

A
  • Primary: Spontaneous Bacterial peritonitis (SBP) - no source, starts in peritoneum
  • Secondary: From a ruptured organ - MOST COMMON - ruptured appendix, perforated peptic ulcer, perforated sigmoid colon (severe diverticulitis)
  • Tertiary: Superinfection in immunocompromised patients
107
Q

Peritonitis
Clinical Manifestations

A
  • S/S of infection
  • Diffuse abdominal pain, then constant, localized, intense abdominal pain
  • Movement increases pain
  • Decreased appetite
  • Abdomen tender to touch, distended, becomes rigid
  • N/V
  • Severe: paralytic ileus
  • Fever 100-101, increased HR, low BP
  • Can quickly become septic!
108
Q

Peritonitis
Diagnostics

A
  • CBC
  • CMP
  • Arterial Blood Gas
  • US guided paracentesis (biopsy fluid)
  • CT/MRI
109
Q

Peritonitis
Medical Management

A
  • Fluid, colloid, and electrolyte replacement
  • Pain management medications
  • Anti-emetic agents
  • Removal of fluid collection in the abdominal cavity (paracentesis)
  • Antibiotic Therapy
  • O2 therapy if abdominal distension is impairing lung expansion
  • Severe: Surgical intervention
110
Q

Peritonitis
Nursing Management

A
  • ICU monitoring for patients in septic shock
  • Contact provider if there are NO bowel sounds
  • Assessment of s/s of infection, abdomen, BMs, flatus
  • Administer fluids and encourage fluid intake
  • Monitor for worsening condition, prepare pt for emergency surgery
  • Administer pain medication and antibiotics
111
Q

Intestinal Obstruction
Definition

A
  • Exists when blockage prevents normal flow of intestinal contents
  • Mechanical obstruction: intraluminal obstruction or mural obstruction from pressure on the intestinal wall
  • Functional or paralytic obstruction: the intestinal musculature cannot propel the contents along the bowel, the blockage also can be temporary (the result of the manipulation of the bowel during surgery)
112
Q

Intestinal Obstruction
Mechanical Causes

A
  • Adhesions: intestine adheres to scar tissue, kinking of loop
  • Intussusception: one part slips into the part next to it (telescope), lumen narrows, blood supply is strangulated
  • Volvulus: bowel twists and turns, occludes blood supply, gas and fluid accumulate in trapped bowel
  • Hernia: Protrusion of intestine through a weakened area of the abdominal muscle wall, flow and blood supply obstructed
  • Tumor: A tumor that exists in the wall, or outside the intestine and puts pressure on the bowel (most common: colorectal adenocarcinoma)
113
Q

Intestinal Obstruction
Medical Management

A
  • Decompression using NG tube
  • Hypertonic gastrographin may stimulate peristalsis in pts with adhesions
  • IVF electrolyte replacement
  • Surgery: 25% of patients
  • May end in colostomy or ileostomy
114
Q

Intestinal Obstruction
Nursing Management

A
  • Insert/maintain NG tube suctioning: green = bile = bad (should be yellow)
  • Continuous abdominal assessments
  • IV Fluid administration
  • Monitor I&O, electrolyte imbalance, nutritional status
  • Monitor: return of normal BS, decreased distension, decreased pain, passing flatus/stool
115
Q

Crohn’s Disease
Definition

A
  • Chronic inflammation through ALL layers in the GI tract
  • Can happen throughout GI tract
  • Most common in distal ileum and ascending colon
  • Small bowel in 80% of cases
  • Usually right sided
  • Fistulas, masses, and abscesses are common
  • Skip areas between diseased segments
  • Recurrence common
116
Q

Crohn’s Disease
Diagnostics

A
  • CBC (elevated WBCs and ESR; low albumin/protein if malnutrition)
  • CT/MRI
117
Q

Crohn’s Disease
Clinical Manifestations

A
  • Common to have perianal involvement
  • Common to have fistulas
  • Common to have abdominal mass
  • If bleeding occurs - mild
118
Q

Inflammatory Bowel Disease

A
  • Crohn’s Disease
  • Ulcerative Colitis
119
Q

Crohn’s Disease
Medical Management

A
  • Corticosteroids, aminosalicylates, immunomodulators, monoclonal antibodies
  • Antibiotics
  • Parenteral Nutrition
  • Partial or complete colectomy, with ileostomy or anastomosis
120
Q

Inflammatory Bowel Disease
Nursing Management

A
  • Thorough health history
  • Establish normal bowel patterns
  • Medicate for pain
  • Administer IVF
  • Monitor I&Os
  • Maintain adequate nutrition
  • Promote rest periods
  • Decrease pt anxiety
  • Enhance coping skills
  • Prevent skin breakdown
  • Monitor for s/s of complications: blood loss/clotting issues, electrolyte imbalance, perforation
121
Q

Ulcerative Colitis
Definition

A
  • Chronic ulceration of mucosal and submucosal layers of colon and rectum
  • Unpredictable periods of remission and exacerbation
  • Begins in rectum and progresses to colon; inflammation is uniform and diffuse
  • Left sided
122
Q

Ulcerative Colitis
Diagnostics

A
  • CBC (Elevated WBCs)
  • Stool for occult blood or O&P
  • C-reactive protein elevated
  • Abdominal x-rays
  • CT/MRI
  • Colonoscopy
123
Q

Ulcerative Colitis
Clinical Manifestations

A
  • Severe bleeding
  • Severe Diarrhea
124
Q

Ulcerative Colitis
Medical Management

A
  • Corticosteroids, aminosalicylates, immunomodulators, monoclonal antibodies
  • Antibiotics
  • Bulk hydrophillic agents
  • Proctocolectomy, with ileostomy
125
Q

Colorectal Cancer
Definition

A
  • 3rd most common cancer in US
  • Tumor colon/rectum
126
Q

Colorectal Cancer
Risk Factors

A
  • > 65 years of age
  • Sedentary
  • Familial history
  • Smoker, high alcohol use
  • High fat, high protein, low fiber diet
  • History of inflammatory bowel disease
  • History of DM2, genital cancer, radiation to pelvis
  • Male
  • Overweight
  • Previous adenomatous polyps
  • African American or Ashkenazi Jewish
127
Q

Colorectal Cancer
Diagnostics

A
  • Colonoscopy
128
Q

Colorectal Cancer
Clinical Manifestations

A
  • Change in bowel habits
  • Blood in stool
  • tenesmus
  • symptoms of obstruction
  • abdominal or rectal pain
  • feeling of incomplete evacuation
129
Q

Colorectal Cancer
Medical Management

A
  • Treatment depends on stage
  • Surgery to remove tumor
  • Adjunctive oncological therapy
130
Q

Colorectal Cancer
Nursing Management

A
  • Preoperative care: maintenance of nutrition, prevent infection, fluid balance, education, emotional support
  • Postoperative care: similar to other abdominal surgeries, nutrition, wound assessment/care, monitor for s/s of complications, education
131
Q

Cholelithiasis
Definition

A

Stones in the gallbladder
* Pigment stones
* Cholesterol stones

132
Q

Cholelithiasis
Risk Factors

A
  • Cystic Fibrosis
  • Diabetes
  • Frequent changes in weight
  • Low dose estrogen therapy (small risk)
  • Obesity
  • High dose estrogen therapy
  • Female
  • Multiple pregnancies
  • Native American or US SW Hispanic
133
Q

Cholelithiasis
Clinical Manifestations

A
  • Could be none or minimal
  • Pain
  • Biliary colic
  • jaundice
  • Changes in urine or stool color
  • Vitamin deficiency (fat soluble: ADEK)
134
Q

Cholelithiasis
Diagnostics

A
  • Ultrasound
  • Cholesystogram/
    Cholangiogram
  • MRCP
  • Endoscopic Retrograde cholangiopancreatography
135
Q

Gallbladder Disease
Medical management

A

Cholecystitis/ Cholelithiasis
* Reduce incidence: diet management, medications, endoscopic procedures
* Surgery: Cholecystectomy

136
Q

Gallbladder Disease
Nursing Management

A

Cholecystitis
* Pain management
* Antibiotics
* Dietary management: bland, low fat diet
* IVF if N/V and antiemetics

Cholelithiasis
* postoperative care

137
Q

Pancreatitis
Definitions

A

Acute: pancreatic duct becomes obstructed, enzymes back up, causes autodigestion and inflammation of pancreas
Chronic: Progressive inflammatory disorder with destruction of the pancreas; cells are replaced with fibrous tissue; pressure within the pancreas increases obstructing the pancreatic and common bile ducts

138
Q

Pancreatitis
Risk Factors

A
  • Cholelithiasis (80% of patients)
  • Sustained Alcohol Abuse
139
Q

Pancreatitis
Clinical Manifestations

A
  • Severe abdominal pain, mid-epigastric ➡️ radiates to back
  • Pain 24-48 hrs. after ETOH or fatty meal
  • Nausea and vomiting
  • Fever, jaundice, mental confusion, agitation
  • Severe cases can develop into peritonitis and sepsis
140
Q

Pancreatitis
Diagnostics

A
  • Serum lipase and amylase elevated
  • CBC: elevated WBC
  • CMP: transient hyperglycemia, hypocalcemia
  • Serum bilirubin elevated
  • CT/MRI
141
Q

Pancreatitis
Medical Management

A

Acute:
* Relieve symptoms
* Prevent/treat complications
* Pain management
* Respiratory care (elevated diaphragm, pulmonary effusions, atelectasis)
* Biliary drainage
* Surgery
* Enteral nutrition

Chronic:
* Non-surgical: endoscopy to remove pancreatic duct stones
* Surgical: drain placement to remove pancreatic secretions
* Non-opioid management of pain (opioids if severe)
* Nerve Block
* Mindful therapies
* NPO/ETOH avoidance/ specific food avoidance

142
Q

Pancreatitis
Nursing Management

A

Acute:
* Keep patient NPO to decrease pancreatic enzyme secretion
* Pain meds
* Rest to reduce metabolic need
* IVF administration
* Manage electrolyte imbalance
* Pt. education

Chronic:
* Pain management
* Maintain NPO status
* Maintain NGT
* Maintain nutritional status
* Assess respiratory status
* Monitor I&Os

NRS 105 Exam #1 (6 decks)

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