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Med surg 2 > gi > Flashcards

gi Flashcards

1
Q 
stoma colors 
rose to brick pink 
pale
blanching, dark red to purple
small blood
A

Rose- viable stoma mucosa
maybe anemia
inadequate blood supply
when touched is normal from high vascularity

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2
Q 
post op wound care stoma
2 risks 
when will the edema resolve 
gas and time 
ileostomy drainage and one thing about it 
one thing to watch 
who is most at risk for developing obstruction 
stools
teach 1 about anal 
teach about pain
A

fistula, delayed wound healing
6 weeks
2 weeks will go away
1500-1800ml/24 if small bowel is shortened may be more can decrease to 500ml a day
electrolytes na and k
corhns in 30 days
first0 4-6 then will lessen in 3-6 month
if manipulated- mucus-do kegals 4 weeks after
phantom pain

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3
Q

when do you empty a ostomy bag

A

1/3 full

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4
Q

how long does a drainable pouch last?

A

4-7 days

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5
Q

pouches for ostomy

A

transverse-dispose

sigmoid- drain or dispose

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6
Q

function after surgery

A

6-8 weeks normal no heavy lifting

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7
Q

illeostomy care 4

A

no regularity
drainable pouch
2-3 lt a day
susceptible obstruction

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8
Q

esophageal cancer patho history and risks

A

Usually advanced disease by the time of diagnosis, it narrows the esophagus, Risks-Increase with age, BE, smoking, alcohol, Obestiy, abestos, cement dust, achalasia-delayed emtying, gerd, barrets

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9
Q

Manifestatons of Esoph cancer

A 
Progressive dysphagia-meat, soft food, lq
Pain is latep substernal epigastric, back that increases with swallowing-even spit, 
Weight loss
Sore throat, choacking 
hoarseness\regur with blood tinged
Hemmorrhage-if trach
May cause obstruction
common metastasis to lungs and liver
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10
Q

Diagnosis for esoph cancer

A

Endoscope biops
ultrasound
CT/MRI
Bronchoscopy

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11
Q

Tx for Esoph cancer

A

Surg-esophagectomy-removal
esophagastromy -resection to stomach
esophagoenterostomy-resection to colon- lap or open
Photodynamic lasor therapy- no sun 3-6 weeks
Chemo and radiation

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12
Q

Post of esoph cancer

A

Watch respiratory, pain control, Chest tube, TPN, Swallow study, HOB 30 and for 2hr after meal

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13
Q

Surg risk for esoph cancer

A

DysR, anastomatic leaks, fistulas, edema, respiratory distres, dysruption of medial sternal lymph nodes

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14
Q

Care for E cancer

A

Airway, respiratory, swallow B4 oral fluids, high fowlers, tube feeding tol, pain

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15
Q

Stomach cancer patho history
rt
and associations

A

Adenocarcinoma of stomach wall usually spread by diagnosis
RT mucosal injury-Hpylori, autoimmune disorders, NSAIDS, tobacco
Association-smoked meats, salted fish/meats, pickled veggies

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16
Q

Manifestations of stomach cancer

A

Weight loss, saticty- full fast, indigestion, ab pain, anemia-blood loss or pernicious , weak fatigue, SOB, OB positive stool, Acities=poor prognosis- seeding of cancer cells introperitoneal cavity and no cure

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17
Q

Diagnosis for stomach cancer

and labs

A

Upper endoscopy and biopsy
CT/PET
Anemia, liver function, pancreatic function

18
Q

tx for stomach cancer

A

surgery
legions in fundus means full gastrectomy
biliroth 1 and 11 with vegotomy or pyloric re
monitor fluids, cuts vegas nerve so no acid, dumping syndrome-slow meals no sugar or fat
bile reflux gastritis- enzymes and acid go up too
chemo radiatin
HyperTN S/S

19
Q

Lower GI obstruction types

A

Mechanical- Detectable, commonly found in sm intestine, surgical adhesion-small intest and colorectal cancer-Large intest
non mechanical- Paralytic illeus, pseudo- acting like theres an obstruction- critically ill, trauma, burns. vascular- no blood to intestines- a fib, art obstruction, clots, heart valve issues, heart attack, congestive fail

20
Q

Types of lower gi obstruction

A

Adhesions, intessuseption, hernwas, tumors, volvus,

21
Q

Steps of lower obs

A

1.obstruction- build up fluid, gas, intestial contents-prox
Collapse- distal
2. Increase in bowel distension- reabsorption of fluids
3. increase pressure- cap perm, fluids into 3rd space
4. loss of blood volume
5, ischemic bowel no blood supply

22
Q

Sm in lower GI

A

Rapid onset

Early- Colckly, intermit ab pain, NV in large ammounts, projectile vom with bile, if long standing smells like poop

23
Q

Lg in obstruction s/s

A

Gradual onset, vom it rare, ab pain present but low grade, ab distention increased new onset of constipation and no flatulus

24
Q

diagnosis of bowel obstruction

Labs

A

x ray-ct scan
Sigmoidoscopy/colonoscopy
Increase in WBC, H and H, BUN and creatinine

25
Q

Tx for lower GI obstruction

When do you need surgery

A

conservative, NPO, rest, NG tube, IV fluids-NS or lac ringers, Pain control
if strangulated or tx not effective, May need colonosctomy or illiostomy

26
Q

What are the biggest concerns with Lrg bowel obstructions

A

Ischemia, peritinitous, sepsis

27
Q

Ostomy 2 things

A

Fluid increase with all but sigmoid

bowel regulation- can only occur with sigmoid

28
Q

Indications for the types of ostomys

A

ill-Ulcerative, chrons, injury, family polp, trauma, cancer
Assending and transverse- perf dive, trauma, rec-vag fistula, inop tumor
Sigmoid- Cancer at the rectom or seg, perf div, trauma.

29
Q

What is the non perm end stom called

A

Hartmanns pouch

30
Q

How long does the plastic place stay on the loop

A

7-10 days

31
Q

Stoma after post op normal

A

Dark pink/ red swollen beefy

32
Q

Hernias

A

Hiatal- stomach and esoph, gerd, reflux, end of sternum
Ventral-Below hiatal poke through ab wall
Umbilical-below ventrical from birht
Inguinal- crease below hip crease
Femoral-high up on femur

33
Q

What can hernias cause

A

Peritonitis, sepsis, hyposhoich, bowel reconstrus, ostomy placement ARDS

34
Q

Diverticulitis complications 1 to remember

A

Abcess

35
Q

risks for diverticulitis

A

Obesity, inactivity, smoking, alcohol use, NSAIDS increased fiber decreased carbs constipation

36
Q

Manifestations of dive losis

A

No symptoms, ab pain, bloating, flatulence, change in bowel, can lead to itis or bleeding.

37
Q

Manifestations of deverticulitis

and can lead to-

A

Pain in LLQ, distention, decreased or no bowel sounds, NV, infection- fever leukocytosis-shift to the left,
erosin and perf into peritoneum, localized abcess, bleeding can be extensive but stops spontaneously, strictures

38
Q

What is the gold standard for divertic test

A

ct with oral contrast

CBC, berium enema, cloonoscopy w. biopsy, blood culture, colonoscopy

39
Q

Care for divertic

A

Increase fiber to prevent,
high activity-prevent
Clear lq, bed rest, pain
Severe- Hospitalization (For when you can’t have PO Fluids, symptomatic of infection, or immunosuppressed.
NPO, Bed rest, IV fluids, antibiotics, watch infection, strict I and O NG on low,

40
Q

Surg for divertic indications

A

Reoccuring abcess or obstruction, resection , diverting colonostomy

41
Q

Teaching for diver

A

Increase fiber, increase fluids to 2 lt a day, no interab pressure, lose weight, stool softeners, anticholinergics

Med surg 2 (18 decks)

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