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NSG 470 - Exam 4 > GI Elimination > Flashcards

GI Elimination Flashcards

1
Q

what is IBS?

A

affects muscle contractions + colon sensitivity (disorder of intestinal motility)

chronic functional disorder w/ recurrent ab pain + altered bowel habits

affects freq of defecation + stool consistency

does NOT cause intestinal inflammation nor bowel damage

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2
Q

what is IBD?

A

consists of 2 separate disorders = cause inflammation (redness/swelling) and ulceration (sores) of small + large intestines

Ulcerative Colitis and Crohns Disease
acute + chronic results in nutritional deficits, altered bowel, infection, pain + fluid/electrolyte imbalances

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3
Q

what are the s/s of IBS?

A

diarrhea, constipation, bloating and abdominal pain, tenesmus

goal: relieve ab pain + control diarrhea/constipation

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4
Q

how is IBS diagnosed?

A

recurrent ab pain >= 1 day/wk plus 2 or more of:
- inc or improving pain (defecation)
- change in stool fre
- stool appearance/form

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5
Q

what is the treatment for IBS?

A

IBS w/ diarrhea (IBS-D):
Loperamide (dec peristalsis = controls diarrhea + fecal urgency)
Psyllium - bulk forming laxative
Alosetron - IBS specific med, selectively blocks 5-HT3 receptors = inc firmness in stools + dec urgency & freq

IBS w/ constipation (IBS-C):
Lubiprostone - inc fluid secretion to promote intestinal motility (contraindicated in bowel obstruction)
Linaclotide - inc fluid + motility in the intestine (relieves pain + cramps)

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6
Q

what is the nursing mgmt for IBS?

A

encourage self care
avoid trigger foods: dairy, wheat, corn, fried foods, high fat, alc, spicy foods, aspartame, caffeine, fructose, sorbitol

keep food + bowel diary
inc fluids + fiber
avoid large, heavy meals
good sleep habits/avoid sleep deprivation
teach stress reduction (yoga, exercise, meditation)
referral for anxiety, depression, CBT

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7
Q

what is the FODMAP diet?

A

F - fermentable
O - oligosaccharides (raspberries, grapefruit, dates, currants, banana, artichoke, leek, onion, garlic, brussel sprouts, beans, wheat, almonds, cashews, pistachios)
D - disaccharide (cow milk, goat milk, sheep milk, ice cream, yogurt, sour cream, cream cheese, brie)
M - monosaccharide (apples, pears, cherries, mango, asparagus, broccoli, sugar snap pea, agave syrup, high fructose corn syrup, honey)
A - and
P - polyols (apple ,lychee, nectarine, prune, cauliflower, corn, sweet potatoes, mushrooms, gum)

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8
Q

how is IBD characterized?

A

freq stools cramping ab pain, periods of exacerbation + remission

common sites of inflammation: joints (arthritis), skin/mouth (rash apthous ulcers, erythema nodosum), hepatobiliary (choloangitis, hepatitis)
ocular (uveitis)

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9
Q

what is ulcerative colitis?

A

cause: autoimmune response, genetics
location: large intestine only (rectum + sigmoid region)
affected layers: superficial/inner lining (Mucosa/submucosa)
pattern: continuous
stools per day: 15-20 (liquidly, watery, loose bloody
complications: toxic megacolon, hemorrhage, peritonitis
surgery: can cure disease
colon cancer risk: very high

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10
Q

what is Crohn’s disease?

A

cause: autoimmune response, genetics
location: anywhere along GI tract (ileum)
affected layers: all layers down to serosa
pattern: skip lesions
stools per day: 5-6 nonbloody
complications: fistulas, fissures, strictures, abscess, obstruction
surgery: only useful in tx complications
colon cancer risk: moderately inc

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11
Q

ulcerative colitis

A

chronic, recurrent episodes of inflammation + ulcerations in mucosal and submucosal layers of colon and rectum

bleeding from ulceration
narrow bowel (shortens/thickens) = partial bowel obstruction
severe = entire length of colon

mild - <= 4days
moderate - 4-6 days
severe - >=6day w/ continuous bleeding

abscesses, fistulas, fissures (uncommon)

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12
Q

what are the s/s of ulcerative colitis?

A

diarrhea with pus, mucus or blood (>6 stools/day)
LLQ abdominal pain
Cramping
Intermittent tenesmus
Anemia, pallor, fatigue w/bleeding
Anorexia, weight loss

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13
Q

lab levels for ulcerative colitis

A

decreased: hematocrit, hemoglobin, albumin, K+, Na, Mg, Ca, Cl
increased: WBC, ESR, CRP
positive: stool guiac

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14
Q

lab levels (ulcerative colitis

A

decreased: hematocrit, hemoglobin, albumin, K+, Na, Mg, Ca, Cl
increased: WBC, ESR, CRP
positive: stool guiac (occult blood)

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15
Q

what are the complications of ulcerative colitis?

A

toxic megacolon = rare, nonobstructive distention of colon (fever, ab pain, distention, vomiting, fatigue)
tx: within 72 hrs - NG tube suction, IVF, electrolytes, corticosteroids, antibiotics, may need surgery (LIFE THREATENING)

peritonitis
perforation (req surgery)
bleeding
colorectal cancer

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16
Q

Crohn’s Disease

A

chronic inflammation (extends through all layers of intestine)
can affect any part of GI tract (distal ileum, ascending colon
begin w/ crypt inflammation + abscesses –> dev into small, focal ulcers

lesions are sporadic + sharply demarcated w/ norm tissue in bt (called skip lesions)

as disease progresses, bowel thickens, narrows and become fibrotic
malabsorption + malnutrition can develop when jejunum + ileum become involved

17
Q

what are the s/s of Crohn’s?

A

ab pain/cramping - RLQ
bloating/distention
tenderness/firmness on palpation
high pitched bowel sounds
ulcers (mouth + GI)
diarrhea = 5 loose stools/day w/ mucus or pus
rectal bleeding
steatorrhea - fatty stool
fever
anorexia, weight loss

18
Q

lab levels for Crohns

A

decreased: hematocrit, hemoglobin, albumin, folic acid, B12, K+, Mg, Ca

increased: ESR, CRP, WBC

UA - pos for WBC

19
Q

what are the complications for Crohn’s?

A

abscess formation
perforation (sudden rupture of bowel)
fistulas (abnormal channel)
stricture
partial bowel obstruction
fluid + electrolytes abnormalities
malabsorption + malnutrition (supplemental vitamins, minerals)

20
Q

differences in Crohns v. ulcerative colitis

A

Crohns: depends on loc, ab pain, diarrhea, weight loss, fatigue, blood stools are variable, common malnutrition

Ulcerative Colitis: stool urgency, fatigue, inc bowel movements, mucous, ab pain, blood stools are common, malnutrition less common

21
Q

what are diagnostics of IBD?

A

x ray - need to see free air, bowel dilation, obstruction
barium enema - visualizes rectum + large intestine (can distinguish ulcerative colitis)
CT, MRI, Ultrasound - can identify the presence of abscesses, thickening
magnetic resonance enterography - detailed images of small intestine
stool examination - presence of parasites or microbes

22
Q

what are the goals of therapy?

A

reduce inflammation
induce + maintain remission
improve QoL
prev and minimize complications

23
Q

anti inflammatories

A

dec inflammation

5-aminosalicylic acid (Sulfasalazine) - 1st line treatment for patient w/ mild to mod inflammation + used for long term maintenance = contraindicated in sulfa allergy, mon CBC, kidney, hepatic function, take med w/ full glass of water after meals, inc fluid intake (2 L/day), can take 2-4 wks to see therapeutic effects, can cause urine + skin to turn yellow-orange (norm)

sulfa free aminosalicylates (Mesalamine, Balsalazide, Osalazine) - effective @ prev + treating recurrence of inflammation, mon for kidney toxicity, adverse effects not as serious

24
Q

immunomodulators

A

effective in inflammation reduction, dec steroid use, hospitalizations, surgery
takes time for effectiveness (up to 2 mo) - better for maintainence regimens
*mod to severe IBD
high infection risk + rare form of cancer
no live vaccines!
check for TB + hepatitis prior

25
Q

immunosuppresants

A

(Azathioprine, Mercaptopurine, Thioguanine, Methotrexate, Cyclosporine)

anti-integrins (Vedolizumab)
janus kinase inhibitors (Tofacitinib)
anti-tumor necrosis factor (Infliximab, Adalimumab, Certolizumab - Crohns, Golimumab - UC

26
Q

anti diarrheals

A

Loperamide

suppress # of stools, used to dec risk of fluid vol deficit + electrolyte imbalance
reduce discomfort
use of anti-diarrheals can lead to toxic megacolon (use cautiously)

27
Q

pain relievers

A

Tylenol

avoid NSAIDs bc can cause flare ups

28
Q

indications for surgery (UC)

A

Colon cancer, dysplasia/polyps, Toxic Megacolon, severe intractable bleeding, perforation, strictures

29
Q

indications for surgery (Crohn’s)

A

Small bowel obstruction, abscess, perforation, hemorrhage, fistula formation, strictures

30
Q

stricturoplasty

A

widens intestine at stricture w/out resecting intestine (usually Crohn’s)

31
Q

proctocolectomy (total colectomy)

A

resection of colon + rectum w/ stoma formation from ileum (cures UC not Crohn’s)

32
Q

restorative protocolectomy (IPAA)

A

for severe UC
connects ileum to anal pouch
temp diverting loop ileostomy for healing, closed 3 mo later
voluntary defecation + continence preserved

complications: leakage, stricture @ anastomosis site, pelvic abscess, fistula, SBO, pouchitis, infertility (pelvic dissection)

33
Q

diet education

A

eat high protein, high cal + low residue (low fiber) diet

take vit supplements w/ iron

avoid HIGH fiber

avoid hard to digest foods (nuts, popcorn) + spicy, high fat, dairy, caffeine, alc

small freq meals

stay hydrated

probiotics

enteral or TPN if severe malnutrition

34
Q

peritonitis

A

life threatening inflammation of peritoneum + lining (bacteria)

tx: place pt in fowlers or semi fowlers to promote drainage of peritoneal fluid + improve lung expansion; mon respiratory status, admin O2, NG suction, NPO, mon fluids/electrolytes, IV antibiotics

35
Q

toxic megacolon

A

Massive dilatation of the colon – patient is at risk for perforation

Treatment: NG suction, IV fluids and antibiotics, prep for surgery

36
Q

fluids and electrolytes imbalances

A

due to loss of fluid through diarrhea, vomiting, and NG suctioning

tx: monitor labs, I/Os, weight, assess for dehydration, provide replacement therapy

37
Q

nursing interventions

A

vitals, asess bowels, focused GI assessment, NPO, IV fluids, mon/tx electrolyte imbalances, colon cancer screen (UC), pt education

NSG 470 - Exam 4 (4 decks)

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