GI Flashcards
Irritable Bowel Syndrome (IBS) S/S
- Constipation, diarrhea or a combination of both (Main s/s)
- Pain (worse when eating and relieved when defecation)
- Bloating
- Abdominal distention
Irritable Bowel Syndrome (IBS) NI/Treatment
• Dietary changes / lifestyle modification
o Avoid triggers (foods)
o Increase fiber intake.
o Keep a symptom diary – intake, stress, bowel habits
• Pharmacologic – based on symptoms
o Constipation vs Diarrhea
Med for constipation
o Osmotic Laxatives (Lactulose & MgCitrate)
Work by drawing in water, softening stool and distending colon which promotes peristalsis
Med for Diarrhea
o Imodium
Inhibits peristalsis by acting on intestinal mucosal nerve endings & increases anal sphincter tone
Med for bloating and gas
o Dicyclomine (Bentyl) Blocks acetylcholine and produces smooth muscle relaxation
Diverticular Disease S/S
• May be asymptomatic • Spasms, crampy pain and tenderness in the LLQ (sigmoid colon is on the L side, appendix is on the R side) • Constipation alternating with diarrhea o Flatulence • Abd distention • Narrow stools (large bowel may narrow with fibrotic stricture) • Low grade fever • Increased constipation • Iron deficiency, anemia • Fatigue, weakness • Rectal bleeding o Maroon and “currant jelly” in appearance
Diverticular Disease NI for asymtomatic pt
• No treatment necessary • Avoidance of food items with seeds or nuts because they become trapped in the diverticula and cause inflammation • High fiber diet, bran • Bulk-forming agents o Metamucil • Anticholinergic medications o Bentyl o Donnatal • Increased fluids (2L/day)
NI for Diverticulitis
• NPO / bowel rest with NG tube • IV fluids • Antibiotics • Pain meds • Antispasmodics • Stool Softeners • Suppositories / warm oil into rectum o Soften the fecal mass to move more easily thru inflammatory obstruction
Diverticular Disease after acute attack
Maintain Normal Elimination Pattern • Fluid intake of 2L/day • Instruct client to consume some bran daily • Soft food with increased fiber (cereals, cooked vegetables) • Exercise program • Take bulk laxatives, stool softner • Avoid food triggers (nuts, popcorn) • Regular meal and defecation pattern Relieve Pain • Opioid analgesics
Crohn’s S/S
• Abdominal pain o Right lower quadrant - crampy o Not relieved by defecation o Occurs after eating • Disrupted absorption o Loud bowel sounds (borborygmi) o Chronic diarrhea o Steatorrhea o String like stool (stricture formation) • General Appearance o Thin o Weak o Anemic
Ulcerative Colitis S/S
• Diarrhea (bloody) o Up to 10-20 liquid stools • LEFT lower quadrant abdominal pain • Intermittent tenesmus o straining, especially ineffective and painful straining, during a bowel movement or urination • Rectal bleeding o If severe: pallor, anemia, fatigue
NI for Crohn’s and Ulcerative Colitis
• Low residue, low fiber, high protein, high calorie diet • Supplemental vitamins / iron • Adequate fluids to maintain hydration • Parenteral nutrition may be needed • Avoid triggers o Milk products – lactose intolerance (may cause diarrhea) o Raw fruits / vegetables - roughage o Cold items – increase peristalsis
Complications for Crohn’s
Continuous drainage of irritating discharge into colon causes chronic diarrhea and nutritional deficiencies
Inflamed areas, fistulas, or abscesses may perforate
o Peritonitis
Presence of Crohn’s disease may increase the risk of colon cancer but less likely than ulcerative colitis
Complications for ulcerative colitis
• Toxic Megacolon o Colonic distention from inflammation causing paralysis of colon o Fever, abd pain, distention, vomiting • NG, IV hydration, steroids, abx • Total colectomy • Osteopororotic fractures o Decreased bone mineral density
Teaching about Corticosteroids
o Take meds with food to decrease GI irritation
o Low sodium diet
o Calcium supplements
o Taper drug (slow stop the medication)
o Medic alert bracelet
o Monitor for signs of infection
o Monitor blood glucose levels (hyperglycemia)
