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Nursing 102 > GI exam #2 > Flashcards

GI exam #2 Flashcards

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1
Q

Intestinal obstruction

A
  • impairment of forward flow of intestinal contents

- caused by complete or partial blockage

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2
Q

Intestinal obstruction most often occurs in….

A

the small bowel

–the narrowest part. (ileum)

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3
Q

Mechanical obstruction

A

Congenital

  • stenosis
  • aganglionic
  • megacolon
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4
Q

Acquired obstruction

A

ADHESIONS - scar tissue which inhibits bowel function and increases pressure bc the bowel is not working right. (most common cause)

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5
Q

Hernias

A

intestinal loop protrudes thru weak segment of abdominal wall

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6
Q

Intussusception

A
  • unknown cause
  • -slipping of one part of the intestine into another part just below it.
  • -becomes ensheathed
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7
Q

Volvulus

A
  • unknown cause
  • -twisting of bowel on itself
  • twisted loop may become strangulated
  • most common at ileocecal junction
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8
Q

Other obstructions…

A

tumors, foreign objects, fecal impaction, masses outside intestines, Bezoar

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9
Q

Trico-bezoar/fido bezoar

A

hair ball and undigested veggie fiber

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10
Q

Neurogenic Obstruction

A
  • neurologic impairment of the bowel
  • -**paralytic or adynamic ileus (most common)
  • -** resolves spontaneously after 2-3 days of result of surgery
  • can occur after surgery, may be related to bowel manipulation, abd trauma, electrolyte imbalance
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11
Q

Vascular obstruction

A
  • occurs when blood supply to bowel is disrupted
  • -atherosclerosis, emboli, rare irreversible situation
  • emergency- peristalsis stops and ischemia occurs quickly
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12
Q

Signs and symptoms of an intestinal obstruction

A
  • depends on location of obstruction
  • abdominal distention is common
  • abdominal pain
  • N/V
  • bowel sounds usually increase proximal to obstruction, borborygmi
  • within a few hours, bowel becomes flaccid and bowel sounds cease
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13
Q

Obstruction and stool appearance

A
  • partial obstruction = liquid stool

- complete obstruction = no stools

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14
Q

Diagnosis of bowel obstruction

A
  • flat plate of abdomen
  • abdominal survey
  • blood tests (high H&H, BUN, WBC, and low electrolytes
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15
Q

Treatment for bowel obstruction

A
  • high mortality rate if not treated in 24 hrs
  • surgical emergency
  • NG tube to relieve abdominal distention
  • NPO
  • fluid and electrolyte replacement
  • **pain control, IV antibiotics, surgery (bowel resection)
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16
Q

Nursing care for bowel obstruction

A
  • monitor NG tube (suction, color, amount)
  • monitor I&O
  • pain management
  • good mouth care
  • OOB/ambulation
  • dressings and drains
  • deep breathing, splinting, coughing, IS
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17
Q

Indications for enteral feeding

A
  • physiologic: inability to swallow
  • psychologic: mental disorders that prevent intake of nutrition
  • pathophysiologic: diseases that affect nutrition
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18
Q

Who can not have enteral feedings?

A

GI tract not functioning or on bowel rest

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19
Q

Placement of a enteral tube

A
  • check placement before each feeding or every 8 hours with continuous feeding
  • -aspirate contents
  • -pH meter or paper
  • **x-ray
  • check residual volumes= increased risk for aspiration with increased residual volume (don’t overfill the stomach and aspirate)
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20
Q

incomplete, balanced complete, and optimental formulas

A
  • incomplete: do not provide all nutritional needs
  • balanced complete: contains intact proteins
  • optimental: hydrolyzed proteins or chemically pure amino acids, for patients unable to digest food and/or absorb nutrients
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21
Q

Continuous drip

A
  • continuous feeding 16-24 hours/day
  • best if delivered via pump for constant flow
  • less regurgitation, complications
  • increased absorption, utilization of nutrients
  • follow nutritionist/physician orders on how to start (strength, mls per hr)
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22
Q

Intermittent drip

A
  • 250-400 ml formula over 20-40 minutes five to eight times a day
  • gravity or pump
  • allows freedom between feedings
  • tolerance may be a problem
  • initiate feedings gradually
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23
Q

Bolus feeding

A
  • rapid administration of formula
  • similar to 2-3 meals a day
  • 250-400 ml formula given over a few minutes
  • usually pour in tube via barrel or syringe
  • poorly tolerated
  • result in nausea, diarrhea, aspiration, abdominal distention, cramps
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24
Q

Administration sets (for enteral feedings)

A
  • for gravity or pump use
  • ready-to-hang set good for 48 hours
  • top-fill set good for 24 hours
  • label with date and time when hang
  • rinse container before hanging more formula
  • clean well! may get bacteria in sets
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25
Q

Documenting enteral feeding

A
  • type and rate of feeding
  • volume of formula and water given
  • daily weights
  • I&O
  • frequent oral hygiene
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26
Q

Nursing care for enteral feedings

A
  • HOB 30 degrees
  • care of nares (no pet. jelly, water soluble only)
  • tape tube correctly
  • frequent oral care
  • dressing change
  • skin care
  • comfort measures
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27
Q

GI intubation

A
  • insertion of short or long flexible silicone or plastic tube
  • -into stomach, intestine
  • -by way of nose or mouth, connected to suction
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28
Q

Uses for GI intubation

A
  • decompresses stomach or small intestines by removing gas and fluids
  • administer medications/feedings
  • treat an obstruction or bleeding site
  • obtain gastric contents sampling for analysis
  • diagnose GI motility or disease processes
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29
Q

NG tubes

A
  • short tubes inserted into stomach
  • 2 main types:
  • -single lumen: levine
  • -double lumen: salem
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30
Q

Levine

A

-single lumen
-16-18 FR is most common size
-stomach depression
-instillations
-short term feedings
-***use intermittent suction ONLY with levine tube.
tube will collapse if constant suc.
-80-120 mm/Hg to prevent gastric mucosa damage
-check patency by aspiration or irrigation with saline

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31
Q

Salem Sump

A
  • double lumen
  • blue sump port or “pigtail”
  • -air vent, allows flow of atmospheric air into stomach as contents are suctioned out, prevents damage to gastric mucosa*
  • may use continuous low suction
  • soft hissing sound continuously
  • patency: check suction lumen by aspiration or irrigation with normal saline, check vent lumen by irrigating with saline or air
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32
Q

Insertion of NG tubes

A
  • START with patient teaching
  • high fowlers position
  • lubricate end of tube with water soluble gel to minimize injury to nasal passage
  • tell pt to hold head straight and upright
  • insert tube into nostril aiming tube downward and toward ear closer to nostril
  • advance slowly, when tube reaches nasopharynx, tell pt to lower head slightly to close trachea and open esophagus
  • tell pt to swallow (watch for signs for resp distress)
  • stop advancing when reach marked length
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33
Q

Best way to confirm placement of NG tube

A

X-RAY

-injecting air, aspirate gastric contents and test ph

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34
Q

Removing and NG tube

A
  • explain procedure
  • assess bowel sounds
  • patient in semi-fowlers
  • drape towel across chest, loosen tape from nose
  • ask pt to hold breath to close epiglottis
  • withdraw tube
  • provide tissue and mouth care
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35
Q

Intestinal or nasoenteric tubes

A
  • decompression in bowel obstruction

- cantor tube: single lumen, miller abbott: double lumen, tungsten: weighted

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36
Q

Insertion of intestinal tubes

A
  • done by physicians
  • inserted same as gastric tube
  • tube carried to intestines by peristalsis
  • may take carried to intestines by peristalsis
  • may take several hours to reach ileum
  • monitored daily by x-ray for placement
  • DO NOT secure until desired point in intestines is reached
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37
Q

Once intestinal tube placed…

A

-**once tube is in stomach, patient lies on right side for 2 hours, supine with head elevated for 2 hours, left side for two hours

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38
Q

Removal of intestinal tubes

A
  • remove slowly to prevent damage
  • remove 1-2 inches at a time
  • if tube has passed through the ilececal valve, cut at the nose and remove by peristalsis via the rectum
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39
Q

Nursing care for intestinal tubes

A
  • ensure patency
  • correct suction
  • accurate I&O
  • ***amount irrigated should be aspirated or included in intake
  • irrigate with normal saline
  • with gastric surgery, never irrigate or manipulate the tube without physician order
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40
Q

Preventing oral inflammations

A
  • frequent mouth care
  • ice chips
  • toothettes
  • chapstick
  • never use lemon & glycerine swabs
  • suck on hard candy if not contraindicated
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41
Q

Monitor for complications with intestinal tubes

A
  • *fluid and electrolyte losses (dehydration, hyponatremia/kalemia
  • *aspiration pneumonia (chk breath sounds and placement)
  • *gastric ulceration
  • laryngeal edema and obstruction
  • emotional support
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42
Q

Diarrhea

A

passage of frequent, loose, unformed stool

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43
Q

2 types of diarrhea

A
  • large volume (excess fecal water)

- small volume (without excess fecal water)

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44
Q

Acute Diarrhea

A

usually from infection, self-limiting

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45
Q

Chronic diarrhea

A

at least 4 weeks.

Can be life threatening from dehydration/electrolyte imbalance

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46
Q

Assessment for diarrhea

A
  • Subjective: patient describes change in bowel pattern
  • Objective: timing, stool appearance, foods eaten, medications, stress, weight loss, laxative abuse
  • Assess fluid and electrolyte status: diarrhea can rapidly lead to dehydration, shock, and acid-base imbalance
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47
Q

Treatment for diarrhea

A
  • based on cause
  • replacement fluids and electrolytes
  • medications to decrease motility and relieve diarrhea
48
Q

Tenesmus

A

painful spasm with bowel movement

49
Q

Nursing interventions for diarrhea

A
  • bowel rest - NPO
  • IV fluids and electrolyte replacements
  • strict I&O
  • stool characteristics
  • monitor for weakness, dehydration, cardiac arrhythmias (K+)
  • administer medications as ordered (immodium)
  • perineal skin care
50
Q

Antibiotic related diarrhea

A
  • destroys the bowel’s normal flora
  • permits overgrowth of C-diff
  • pseudomembranous colitis–>whitish membrane forms over damaged areas
51
Q

Pseudomembranous colitis

A

whitish membrane forms over damaged areas

52
Q

Signs and symptoms of Antibiotic related diarrhea

A
  • severe diarrhea
  • fever/chills
  • abdominal distention
  • crampy pain
  • anorexia
53
Q

Diagnosis of Antibiotic related diarrhea

A
  • stool culture

- endoscopy

54
Q

Treatment for Antibiotic related diarrhea

A
  • discontinue implicated antibiotics
  • correct fluid & electrolyte imbalances
  • administer intestinal flora modifiers
  • drug therapy- vancomycin, flagyl
55
Q

Fecal incontinence

A

relaxation of external sphincter resulting in involuntary passage of stools

56
Q

Causes of fecal incontinence

A
  • CNS or spinal cord injury
  • damage or weakness of sphincter
  • fecal impaction
  • —high fiber and fluid diet, bowel training, perineal exercises, skin protection and odor control.
57
Q

How often should a pt have a bowel movement in the hospital

A

at least every 3 days

58
Q

Constipation

A

retention or delay of fecal material in colon results in dry, hard stools

59
Q

Causes of constipation

A
  • inadequate dietary fiber and/or fluid intake
  • ignoring urge to go
  • bowel obstruction
  • inability to increase intra-abd pressure (COPD)/ lack of exercise
  • side effects of meds (narcotics, diuretics, aluminum, antacids)
60
Q

Signs and symptoms of constipation

A
  • abdominal distention, crampy pain
  • increased rectal pressure or flatulence
  • anorexia, nausea, headache, malaise
  • fecal impaction
  • obstipation- so constipated it causes an obstruction
61
Q

Treatment for constipation

A
  • **high fiber diet and increase fluids
  • establish regular bowel pattern
  • increase activity
  • correct body position when defecating
62
Q

Bulk forming agents (laxative)

A

absorbs water, stimulates peristalsis

ex) metamucil, benefiber

63
Q

Stimulants (laxative)

A

irritates colon wall to increase peristalsis

ex) ex-lax, correctol (not on fecal impaction)

64
Q

Stool softeners (laxative)

A

lubricates intestinal tract & softens stool

ex) colace, mineral oil

65
Q

Saline and electrolytes

A

causes retention of fluid in intestinal lumen

ex) Golytely (quick acting)

66
Q

Acute abdomen

A

complex of signs and symptoms suggest emergency surgery

  • abcess or rupture in abdomen
  • bowel obstruction
  • peritonitis
  • ruptured ovarian cyst
67
Q

Signs and symptoms of acute abdomen

A

varied, non-specific

—pain, N/V, bleeding, distention

68
Q

Treatment for acute abdomen

A

goal of treatment is to identify and treat the cause

69
Q

Nursing care for acute abdomen

A
  • prepare for surgery quickly

- post-op- same as for any abdominal surgery

70
Q

Appendicitis

A

acute inflammation of vermiform appendix of cecum

71
Q

Causes of Appendicitis

A

fecalith, tumors, foreign bodies, worms

72
Q

Signs and symptoms of appendicitis

A
  • vague or severe abdominal pain/ pain increases/ localizes to RLQ
  • N/V
  • low grade fever/ increase WBCs
  • rebound tenderness (pain with release of palpate
  • McBurney’s point- tenderness btwn umbil and right anteriosuperior spine
  • like to lay with knees bent
73
Q

Nursing care pre-op (appendicitis)

A

-no laxatives, no heat to abdomen, pain management, prepare for surgery, keep NPO

74
Q

Treatment for appendicitis

A

Surgery

—if appendix ruptures, peritonitis results

75
Q

Post-op care for appendectomy

A

simple: rapid recovery, usually done outpatient through SDS - go home same day

Ruptured appendix: IV antibiotics, NG, NPO for 24-48 hrs, wound drains, observe for S/S peritonitis and abscess formation

76
Q

Peritonitis

A

inflammation of all or part of parietal and visceral surfaces of abdominal cavity

77
Q

Patho of peritonitis

A
  • drainage from perforated or infected area leaks into abdominal cavity = peritoneum becomes inflamed
  • peritoneum attempts to localize infection
  • if contamination persists, peritoneum ability to combat infection is surpassed, peritonitis worsens
78
Q

Systemic effects of peritonitis

A
  • infectious process causes increase blood to area to combat bacteria
  • shallow, rapid respirations due to increase oxygen requirements when patient is unable to adequate ventilate
  • decrease peristalsis causes retention of fluid and air in bowel lumen
  • leads to further decreases circulating blood volume
  • results in hypovolemic shock
  • death
79
Q

Signs ad symptoms of peritonitis

A
  • PAIN is the most consistent symptom
  • tenderness/rebound tenderness/muscle rigidity/abdominal distention
  • N/V, absent bowel sounds
  • fever/WBCs up bc of infection
  • rapid, shallow respirations
  • hiccups rt irritated diaphragm
80
Q

Treatment for peritonitis

A

-* identify and eliminate the cause
-surgery
-IV fluids/antibiotics
-NPO/NG
-oxygen
-analgesics
(infection pulls 6-8L into abd.)

81
Q

Nursing care for peritonitis

A
  • **NPO, I&O, IV antibiotics/NG

- semi-fowlers, pain management, drg &drains resp status

82
Q

Gastroenteritis

A

inflammation of stomach and intestinal tract, primarily stomach/ small bowel

83
Q

Causes of gastroenteritis

A

bacterial, virus, parasite, food poisoning

  • NSAIDs, ASA, steroids
  • transmitted by fecal oral route
84
Q

S/S of gastroenteritis

A
  • N/V / cramping / diarrhea
  • dehydration/hypotension
  • fever/elevated WBCs
85
Q

Treatment for gastroenteritis

A
  • determine cause (stool sample)
  • correct dehydration & electrolytes
  • NPO until vomiting stops then clear liquid diet
  • antibiotics (if bacterial)
86
Q

Dysentery

A

gastroenteritis of large bowel

87
Q

Irritable bowel syndrome

A

chronic, non-infectious irritation caused by spasms of colon (disorder of the bowel)
NO PATHOPHYSIOLOGIC CHANGES TO THE BOWEL
-females bwtn 20-40
-caused by stress and anxiety
-intermittent pain and altered bowel motility
-most common bowel disorder seen clinically

88
Q

IBS: Rome criteria

A

symptom based criteria

  • abd discomfort or pain for at least 3 months
  • relieved with defecation
  • onset associated with changes in stool pattern freq, or appearance
89
Q

IBS signs and symptoms

A
  • intermittent crampy abdominal pain (LQ)
  • diarrhea alternating with constipation
  • pain with defecation
  • bloating/belching/abdominal distention
  • non-specific symptoms
90
Q

Nursing care for IBS

A
  • psychological an dietary
  • stress management
  • individualized balanced diet
  • steroids
  • mild relaxants
  • anticholinergics (bentyl) (slows emptying)
91
Q

3 side effects anticholinergics can cause

A

-dry mouth, urinary retention, visual changes

92
Q

Polyps

A

projection of mucosal surface of the bowel lumen. Benign or malignant

93
Q

pedunculated polyp

A

attaches to intestinal wall by stalk or stem

94
Q

Sessile polyp

A

attaches directly to wall. flat, broad based

95
Q

familial polyposis

A

genetic (thousands of polyps in the intestine so whole bowel is removed and perm colostomy

96
Q

Hyperplastic polyps

A

non-neoplastic growths/never cause clinical symptoms

-rarely bigger than 5 mm in size

97
Q

Adenomatous polyps

A

neoplastic polyps - closely linked to colorectal cancer

98
Q

Cancer of Colon and rectum risk factors

A
  • age, family history, diet, polyps, other colon pathology

- usually asymptomatic so diagnosed late with metastasis (usually to liver first)

99
Q

Left sided tumors

A
  • tumor obstructs flow of solid stool

- thin stool, constipation, rectal bleeding, diarrhea with alternating constipation

100
Q

Right sided tumors

A
  • less change in bowel habits

- tumor bleeds easily (melena, anemia), dull abd pain, anorexia, wt loss, malaise, pain late sign

101
Q

carcinoembryonic antigen (CEA)

A

-protein secreted by tumor cells measured in blood

102
Q

Treatment for Cancer of colon and rectum

A

surgery is primary treatment (depending on location and extent of disease)

  • ***bowel prep necessary prior to surgery to decrease amount of bacteria in bowel to decrease risk of infection (high dose antibiotics)
  • NPO until bowel sound return or pass gas
  • radiation to shrink tumor, chemo
103
Q

diverticulum

A

pouchlike protrusions of intestinal mucosa

104
Q

diverticulosis

A

multiple diverticula exist

105
Q

diverticulitis

A

inflammation of diverticulum

106
Q

Pathology of diverticulitis

A
  • diverticulitis result from obstruction of diverticula by fecalith.
  • causes edema, inflammation = leads to decrease blood supply= increase swelling=abscess, perforation, peritonitis
107
Q

Signs and symptoms of diverticulitis

A

(may be asymptomatic)

  • intermittent LLQ pain/ cramping/ constipation/ diarrhea
  • N/V
  • fever/WBCs up
  • constipation or diarrhea
  • occult bleeding
108
Q

Treatment for diverticulitis

A
  • combination drug and nutrition therapy

- control acute pain, NPO, IV fluids and antibiotics

109
Q

Nursing care for diverticulitis

A

teaching to increase compliance and prevent repeat attacks

  • diet high fiber/high fluid
  • bulk forming laxatives
110
Q

Hernias

A

abnormal protrusion of an organ, tissue, or part of organ through structure that normally contains it.

  • -reducible: can be put back
  • -irreducible: can’t be put back
111
Q

Inguinal hernia

A

weakness in abdominal wall in inguinal canal - where spermatic cord (men) or round ligament (women) emerge. protrusion follows through canal

112
Q

Femoral hernia

A

protrusion thru femoral ring into femoral canal

  • females
  • strangulates easily
113
Q

Umbilical hernia

A

occurs due to weakness of rectus muscle or failure of umbilical opening to close

114
Q

incisional or ventral hernia

A

occurs due to weakness in abdominal wall at site of previous surgeries

115
Q

Assessment for hernias

A

ask patient to raise shoulders and head while in supine position
-contraction of abdominal muscle reveal weakened area

116
Q

Signs and symptoms of hernia

A
  • protrusion of viscera - lump or bulge
  • mild to moderate discomfort
  • severe pain with strangulation
  • change in bowel
  • N/V
117
Q

Main thing with post-op care hernia repair

A

NO COUGHING. splint incision

Nursing 102 (11 decks)

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