GI Disorders Flashcards
x-ray done using barium as a contrast agent; allows for a view of the stomach, esophagus, stomach, and small bowel
barium swallow study
A barium swallow study aids in the diagnosis of what disorders?
ulcers, varices, tumors, regional enteritis
Nursing Considerations of a Barium Swallow Study
pre-op:
- clear liquids the day before
- NPO after midnight
- hold PO meds
- insulin dosages may need to be adjusted
post-op:
- increase fluid intake after procedure
- monitor for constipation
- assess bowel sounds
Barium Enema Nursing Considerations
pre-op:
- bowel prep before procedure
- low residue diet 1-2 days
- clear liquids the day before
- laxatives of gloytely the night before
- NPO after midnight
- may have cleansing enemas until clear morning of test
post-op:
- inform pt they will have increase BMs
- increase fluids to help with elimination/constipation and possible obstruction
procedure that allows for clear x-ray of colon
Barium Enema
A barium enema is used to see what?
polyps, tumors, and lesions
A barium enema is contraindicated with what conditions?
- active IBS
- bowel perforation
Endoscopy Nursing Considerations
pre-procedure:
- NPO 8 hrs prior to procedure
- signed informed consent
- verify allergies
- sedation used
post-procedure:
- assess LOC
- NPO after until gag reflex returns
- check vitals
- monitor for signs of perforation
What are the major S/S of perforation after an endoscopy?
- sudden onset of pain
- may be throat or back pain
- bleeding (inc. HR, dec. BP)
- unusual difficulty swallowing
- rapidly elevating temperature
procedure done to screen for colon cancer using a flexible fiber optic cable
colonoscopy
Colonoscopy Nursing Considerations
pre-procedure:
- golytely (most common prep)
- NPO past midnight
post-op:
- assess for s/s of bowel perforation
s/s of bowel perforation
- rectal bleeding
- sudden onset of abd pain
- cramping
- abd distension
- fever
- focal peritoneal signs (rebound, rigidity, guarding, pain, distension, N/V, paralytic ileus
GI disorder caused by gram-positive anaerobic bacteria that is associated with antibiotic use; can be community or hospital acquired
c. diff
Which antibiotics are most likely to cause c. diff?
cephalosporins, fluoroquinolones, levaquin, ciprofloxin, clindamycin
potential complications of c. diff
- dehydration
- electrolyte imbalances (potassium especially)
- skin break down
S/S of c. diff
liquid stools, frequency, distention, rumbling noise in intestines, thirst, loss of appetite
C. diff nursing considerations
- strict I/O
- auscultate
- palpate for tenderness
- assess hydration status
- assess perianal area
- stool specimen
- may be NPO
short term:
- avoid: bulky food, alcohol, dairy, fatty and fried foods
- monitor serum electrolytes
acute abdomen potential complications
- peritonitis
- sepsis
- septic shock
- death
localized or generalized inflammation of the peritoneum, usually bc of a bacterial infection
peritonitis
S/S of peritonitis
- rebound tenderness
- rigidity
- guarding
- severe pain
- distention
- N/V
- paralytic ileus
- absent bowel sounds
What usually causes a paralytic ileus?
surgery, narcotic pain med uses, peritonitis
condition with s/s of intestinal obstruction, but without a physical blockage
paralytic ileus
What is the immediate response of the intestinal tract to peritonitis?
paralytic ileus
Diagnosis tools for peritonitis
- inc. WBC
- H&H may drop (if bleeding occurs)
- altered serum electrolytes
- culture of abd blood and fluid
- x-ray may show: air, fluid levels, distended bowel loops
- ultrasound may show: abscess, fluid collection
- CT scan
Nursing Considerations for Peritonitis
- assess abdomen (placement of NG tube for gastric decompression)
- fluid and electrolyte balance (strict I/O, daily weights)
- vital signs q4h
- nutritional support
- comfort (N/V management)
- pain management
- post-op care
Peritonitis treatment options
- fluid and electrolyte replacement to prevent septic shock
- surgery
- drain fluid or abscess
- NG suction
- antibiotics
- pain management
- antiemetic
inflamed, infected appendix
appendicitis
What is the most common cause of acute abdomen in the U.S?
appendicitis
S/S of appendicitis
- vague, poorly localized periumbilical pain
- anorexia
- sharp RLQ pain (McBurney’s Point)
- increased WBC
- low grade fever
- nausea
- rebound tenderness
Potential complications of Appendicitis
- gangrene
- perforation
- abscess formation
Nursing management of appendicitis
- pain relief
- preventing dehydration
- surgical site infection
- maintaining skin integrity
- preventing atelectasis
- administering ordered antibiotics
- monitor for peritonitis and septic shock
- never use heat/heating pad
A NG tube sits where?
stomach
A NE tube sits where?
duodenum or jejunum
Gastrostomy and Jejunostomy tubes are ordered when?
Tube feedings lasting longer than 4 weeks
GI tube indications
- decompress the stomach
- lavage the stomach
- administer meds and feedings
- compress a bleeding site
- aspirate gastric contents for analysis
Potential GI tube complications
- fluid volume deficit
- electrolyte imbalance
erosion of the mucosal lining and gastric, duodenal, and esophageal ulcers
peptic ulcer disease
What are the common causes of peptic ulcer disease?
- NSAIDs
- H. pylori infection
Potential causes of stress ulcers
- burns
- shock
- sepsis
- ventilator-dependence
- trauma
- after surgery
Which ulcer presents pain immediately after eating?
gastric ulcer
Which ulcer presents pain 2-3 hours after eating?
duodenal ulcer
Clinical manifestations of peptic ulcer disease
s/s of bleeding
Peptic Ulcer treatment
- antibiotics (if caused by H. pylori)
- smoking cessation
- avoiding caffeine and alcohol
- eating regular meals
Peptic Ulcer Nursing Considerations
- monitor for hemorrhage
- relieve pain
- NG tube may be required
- assess for signs of perforation
Intestinal obstructions most commonly occur where?
small intestine
What is the most common cause of intestinal obstruction?
surgical adhesion
inflammation or surgery leading to tissues bonding together
adhesion
types of mechanical obstructions
- hernias
- tumors
- carcinoma
- stool impaction
- gallstones
- volvulus (twisted intestines)
- foreign bodies
common causes of functional obstructions
- abd surgery
- peritonitis
- diabetes
- pancreatitis
- appendicitis
- hypokalemia
- narcotics
- lumbar and thoracic fx
What is the initial symptom of an intestinal obstruction?
crampy, wavelike pain due to persistant peristalsis and vomiting
What are the clinical manifestations of an intestinal obstruction?
- N/V (eventually fecal matter)
- abd pain and distension
- unable to pass gas
- obstipation
- slow large bowel progression that may only manifest as constipation
What are teh common s/s of a bowel perforation?
- rectal bleeding
- sudden onset abd pain
- pain worsening suddenly
- abd distension
- fever
- peritoneal signs (rebound, guarding, rigidity, etc)
- inc HR and dec BP
Diagnostic tools for a bowel obstruction
x-ray and CT
Management of bowel obstruction
- NPO
- NG tube insertion
- IV fluids
- K+ replacement
- nutritional support
- possible colonoscopy to untwist and decompress large bowel
What are the two kinds of inflammatory bowel disease?
- ulcerative colitis
- crohn’s disease
inflammation of the small and large intestines
Crohn’s disease
inflammation and/or ulceration of the colon
ulcerative colitis
clinical manifestations of inflammatory bowel disease
- diarrhea
- weight loss
- abd pain
- fever
- fatigue
inflammatory bowel disease complications
- hemorrhage
- strictures
- perforation
- abscesses
- fistulas (Crohn’s)
- colonic dilation (toxic megacolon)
IBD dx studies
- Hx and physical exam
- blood studies (CBC, WBC, serum electrolyte disorders, sed rate)
- stool examination
- stool cultures
- CT scan
Crohn’s vs Colitis Location
- crohn’s : ileum, ascending colon
- colitis: rectum, descending colon
Crohn’s vs Colitis Bleeding
- crohn’s: if it occurs, it is mild
- colitis: severe
Crohn’s vs Colitis Diarrhea
- crohn’s: less severe
- colitis: severe
Ulcerative Colitis Clinical Manifestations
- diarrhea with mucus (10-20 liquid stools/day)
- diarrhea is severe and may be bloody
- rectal bleeding
- LLQ abd pain
- pallor, anemia, fatigue
- weight loss
- electrolyte and fluid loss
- symptoms range from mild to severe
- remissions and relapses
ulcerative colitis complications
- hemorrhage
- perforation
- peritonitis
- colon cancer
Crohn’s Disease Clinical Manifestations
- diarrhea (up to 20x/day)
- steatorrhea
- dehydration
- mild diarrhea (if it even occurs)
- rapid weight loss
- malabsorption
- fever and fatigue
- periods of remission and exacerbation
Crohn’s Disease Complications
- small bowel obstruction
- severe malnutrition
- strictures and fistula
- anal fissures
- small bowel cancer
- abscesses
- peritonitits
Management of acute IBD exacerbations
- NPO
- IV fluids and TPN
- electrolyte replacement if needed
What should be done as an IBD exacerbation resolves?
- clear liquids -> full liquids
- low-fiber, high protein, high calorie diet
- vitamin and iron supplements
- determine food triggers and avoid
What high fiber foods should be eliminated from someone’s diet if they have IBD?
- whole grain breads
- cereal
- nuts
- seeds
- raw or dried fruits
eliminate dairy products
What are the surgical options for ulcerative colitis?
- total proctocolectomy w/ permanent ileostomy
this is a curative surgery!
What are the surgical options for crohn’s?
- partial or complete colectomy with ileostomy
not curative!
What is the patient goal post-op?
- promoting independence in caring for colostomy
