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NSG 470 > GI Lecture > Flashcards

GI Lecture Flashcards

1
Q

Irritable bowel syndrome (IBS)

A
  • Functional problem
  • Does not cause intestinal inflammation or damage the bowel
  • Affects muscle contractions and sensitivity to the colon
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2
Q

Irritable bowel Disease (IBD)

A
  1. Ulcerative colitis and crohn’s
  2. Causes inflamation and dmg to the bowel
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3
Q

Symptoms of IBS

A
  • Non inflammatory, characterized by recurrent abdominal pain and altered bowel habits
  • Diarrhea or constipation (or both alternating)
  • Bloating and abdominal pain, distension
  • Tenesmus can occur as well
  • Affects frequency of defecation and consistency of stool
  • Causes are unknown
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4
Q

Symptoms of IBD

A
  • Inflammation or ulceration of the intestional lining
  • Can affect certain segments or entire GI tract
  • Acute and chonic IBD can result in nutritional deficits, Altered bowel elimination , infection, pain and fluids and electrolyte imbalances
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5
Q

IBS diagnosis

A

Recurrent abdominal pain at least 1 day a week for the last 3 mo plus 2 other criteria
* Related to defecation (pain)
* Either increasing or improving pain
* Associated with a change in stool frequency
* Associated with change in stool appearance/ form

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6
Q

Goal of IBS treatment

A

Relive abdominal pain and control diarrhea or constipation

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7
Q

Tenesmus

A

Constant urge to deficate

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8
Q

med Mgmt of IBS

A

Meds IBS with diarrhea
* Loperamide
* Psyllium
* Alosetron
Meds IBS with constipation
* Lubiprostone
* Linaclotide

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9
Q

Nursing mgmt of IBS

A
  • Incourage self care
  • Avoid trigger foods
  • Keep a food and bowel diary
  • Increase fluid intake (Increase natural sources rather than supplements)
  • Increase fiber intake
  • Avoid large heavy meals
  • Good sleep habits/ avoid sleep deprivation
  • Teach stress reduction; yoga exercise regimen, meditation
  • Referral for anxiety depression, CBT
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10
Q

Loperamide

A
  • Decreases peristalsis: Helps control diarrhea and fecal urgency
  • Used in IBS
  • Risk of constipation

Slows motility

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11
Q

Psyllium

A

Bullk forming lax
Giving this with constipation makes the constipation worse
Given for IBS

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12
Q

Alosetron

A
  • IBS specific medication, that specifically blocks 5-HT3 receptors which are responsible for innervation of the viscera
  • Increases firmness in stools and decreased urgency and frequency of defication
  • Decreases peristalsis can cause severe constipation
  • Only really used in severe diarrhea
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13
Q

Low FODMAP diet

A
  1. Fermentable
  2. Oligosaccharides
  3. Diasaccharide
  4. Monosaccharide
  5. and
  6. Polyols

Probably dont need to know

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14
Q

Lubiprostone

A

IBS specific med, for constipation
* Increase fluid secretion in the intestine to promote intestional motility
* Cant be given in a bowel obstruction

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15
Q

Linaclotide

A

Given for IBS with constipation
Increases fluid and motility in the intestine, reliving cramping and pain

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16
Q

What is IBD charecterized by

A
  • Frequent stools
  • Cramping abdominal pain
  • Periods of exasperations and remission
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17
Q

Cause of IBD

A

Unknown,
* Genetic, Ashkenazi jewish
* Altered immune response
* Altered response to bacteria in gut

Basically its autoimmune

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18
Q

Things that trigger IBD

A
  • Environment
  • Food
  • Tobacco
  • Viral illness
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19
Q

Ulcerative colitis: cause

A

Unknown, autoimmune response, genetic

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20
Q

Ulcerative colitis: Location

A

Large intestine only (Rectum and sigmoid most commonly)

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21
Q

Ulcerative colitis: Affected layers

A

Superficial/ inner lining (Mucosa and submucosa)

  • **Abscesses, fistulas and fissures are uncommon bc only the unner layers of the colon are affected **
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22
Q

Ulcerative colitis: Pattern

A

Continious, affected areas are not interupted

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23
Q

Ulcerative colitis: Stools per day

A

15-20
Liquidy, watery loose, bloody

This number seems super high, she said it tho

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24
Q

Ulcerative colitis: Complications

A
  • Toxic Megacolon
  • Hemorrhage
  • Peritonitis
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25
Q

Ulcerative colitis: Surgery

A

Can cure the disease

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26
Q

Ulcerative colitis: Colon cancer risk

A

Very high risk

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27
Q

Crohn’s: Cause

A

Unknown, genetic , auto immune

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28
Q

Crohn’s: Location

A

Anywhere along the GI tract (ileum most commonly affected)

Mouth to anus

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29
Q

Crohn’s: Affected layers

A

All layers down to the serosa

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30
Q

Crohn’s: Pattern

A

Skip lesions, healthy areas of tissue between inflammed areas

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31
Q

Crohn’s: Stools per day

A

5-6, non bloody (Can be bloody but more from rectal bleeding)

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32
Q

Crohn’s: Complications

A
  • Fistulas
  • Fissures
  • Strictures: Scarring leading to tightening
  • Abscess
  • Partial bowel Obstruction: More common in crohns because the deeper tissue layers are affected
  • Perforation or sudden rupture of the bowel
  • Malabsorption and malnutrition: More prone due to a larger area being affected
33
Q

Fistula

A

Symptom of crohns, where the lesion tunnels leading to stool going where it shouldnt, including out the abdomen

34
Q

Crohn’s: Surgery

A

Only useful for mgmt of complications

35
Q

Stricture

A

Narrowing of the intesting

36
Q

Ulcerative colitis (UC)

A

Chronic recurring episodes of inflammation and ulceration in the mucosa and submucosa layers of the colon and rectum
* Bleeding from ulcerations
* Bowel narrows, shortens and thickens (Causing partial bowel obstruction)
* Several episodes and with time it can involve the entire colon

37
Q

Mild UC

A

Less than 4 BM a day

38
Q

Moderate UC

A

4-6 BM a day

39
Q

Severe UC

A

6+ a day with severe bleeding

40
Q

Manifestations of UC

A
  • Diarrhea with pus, mucus or blood (6+ stools)
  • LLQ pain (rectal/sigmoid area)
  • Cramping
  • Intermittent tenesmus
  • Anemia , pallor, fatigue with bleeding
  • anorexia, weight loss (DOesn’t want to eat because symptoms suck)
41
Q

UC Labs

A
  • Hematocrit and hemoglobin: Decreased (Bleeding)
  • WBC: Increased (from inflammation)
  • Erythocyte sedimentation rate (ESR): Increased (Inflammation)
  • C-reactive protein: Increased (Inflammation)
  • Albumin: Decreased (Malnutrition)
  • K+, Na, Mg, Ca, Cl: Decreased (Vomiting and diarrhea)
  • Stool Guiac: Occult blood
42
Q

Toxic megacolon

A

Complication of UC
* Nonobstructive distentsion of the colon from inflammation, extending into the muscle layer (Cant contract)
* Fever, abdominal pain, distension, Vomiting , fatigue
* Treatment needs to happen within 72 hours, ng for suction, IVF, electrolytes, corticosteroids and antibiotics
* May need emergent surgery
* Life threatening

43
Q

Complications of UC

A
  • Toxic megacolon
  • Peritonitis
  • Perforation requring surgery (Stool into peritoneal cavity)
  • Bleeding
  • Colorectal cancer (High risk)
44
Q

Crohns disease

A
  • Inflammation extends through all the layers of the intestine
  • Can affect any part of the GI but most commonly affects distal ileum and ascending colon (RLQ pain)
  • Starts with crypt inflammation and abscesses which develop into ulcers, which deepen and extend seperated by normal tissue, creating a cobblestone appearance
  • Lesions are sporatic and sharply demarcated with normal tissue in between, skip lesions
  • Later into disease bowel thickes, narrows and becomes fibrotic
  • Malabsorption and malnutrition can develop when jejunum and ileum become involved
45
Q

Manifestations of Crohns

A
  • Abdominal pain and cramping (Usually RLQ)
  • Abdominal bloating and distension
  • Tenderness and firmness on palpation/ guarding
  • High pitched bowel sounds (from inflammation)
  • Ulcers (Mouth to anus)
  • Diarrhea (5+ per day with mucus or pus)
  • Rectal bleeding
  • Steatorrhea: Fatty stool (Floats)
  • Fever
  • Anorexia, weight loss
46
Q

Labs of crohn’s

A
  • Hematocrit and hemoglobin: Decreased (Bleeding)
  • ESR: Increased
  • C-reactive protein: Increased
  • WBC: INcreased (Infection)
  • Albumin: Decreased (Malnutrition)
  • Folic acid and B12: Decreased
  • Urinalysis: WBC (Infection)
  • K+, Mg, and Ca: Decreased
47
Q

What form of anemia is Crohns prone to

A

Pernicious anemia, due to Crohns commonely affecting the small intestine, leads to malabsorption of B12

48
Q

Diagnosis for IBD

A
  • Xray: Can see free air, bowel dilation and obstruction
  • Endoscopy, Video capsule endoscopy, proctosigmoidoscopy, sigmoidoscopy and colonoscopy
  • Barium edema: Visualize rectum and large intestine: Can dif UC from other disease processes
  • CT, MRI and Ultrasound can identify the presence of abscesses, thickening
  • Magnetic resonance enterography: Detailed images of small intestine
  • Stool examination: Presence of parasites or microbes

Need to rule out other causes/ etiology

49
Q

Goals of therapy for IBD

A
  • Reduce inflamation
  • Induce and maintain remission
  • improve QOL
  • Prevent and minimize complications
50
Q

Pharm mgmt of IBD: Drugs that are used

A
  • Anti-inflammatories (first line)
  • Corticosteroids
  • Antibiotics
  • Immunomodulators and immunosuppressants
  • Anti-diarrheals
  • Pain relieivers

More than likely depending on the extent of the disease they will be on more than one drug

51
Q

Pharm mgmt of IBD: Anti inflammatories

A
  • 5- aminosalicylic acid: First line treatment for mild to moderate inflamation and is used in long term maintenance, Cant be given with sulfa allergy
  • Sulfa free aminosalicylates: Mesalamine, balsalazide, osalazine
52
Q

5- aminosalicylic acid:

A

First line treatment for mild to moderate inflamation and is used in long term maintenance, Cant be given with sulfa allergy
1. Monitor CBC Kidney and hepatic function (agranularcytosis, thrombocytopenia and all that)
2. Oral and rectal prep
3. Take meds with full glass of water right before or after meals
4. Increase fluid intake
5. Can take 2-4 weeks for theraputic effect
6. Can cause urine and skin to turn orange (Normal)

Anti-inflammatory

53
Q

Sulfa free aminosalicylates

A
  • Mesalamine, Balsalazide, osalazine
  • Effective at preventing and treating recurrence of inflammation
  • may be contraindicated if the pt has a salicylate or sulfa allergy
  • Monitor for kidney tox
  • Adverse effects not as serious as 5 aminosalicylic acid

Anti-inflammatory

54
Q

Pharm mgmt of IBD: Corticosteroids

A
  • Reduces inflammation and pain
  • Used to treat Severe disease
  • Can be given orally or rectally
  • Can cause immunosuppression
  • Used to induce remission
  • Not for long term use due to adverse effects
  • Reduce or slowly taper off: Do not discontinue suddenly for risk of adrenal insufficency
  • Helps immediately

Prednisone, Hydrocortisone, Budesonide

55
Q

Pharm mgmt of IBD: Antibiotics

A

Ciprofloxacin
Metronidazole
Sulfamethoxazole/Trimethoprim

56
Q

Pharm mgmt of IBD: Immunomodulators and immunosuppressants

A
  • Used second line because its expensive
  • Effective in reducing inflammation
  • Decreases need for steroids. hospitalizations and surgery
  • Takes time to be effective (2mo where you might need steroids)
  • Moderate to severe IBD
  • High risk of infection and cancer from immune supression
  • No live vaccines while on these meds
  • Check for TB and Hep prior to starting, can activate latent infections
57
Q

Pharm mgmt of IBD: Immunosuppresants

A
  • Azathioprine
  • Mercaptopurine
  • Thioguanine
  • Methotrexate
  • Cyclosporine

Probably dont need to know

58
Q

Pharm mgmt of IBD: Anti- integrins

A

Vedolizumab

Probably dont need to know

59
Q

Pharm mgmt of IBD: Janus kinase inhibitors

A

Tofacitinib

Probably dont need to know

60
Q

Pharm mgmt of IBD: Anti-tumor necrosis factor (Anti-TNF)

A

Infliximab
Adalimumab
Certolizumab (Crohn’s only)
Golimumab (UC only)

Probably dont need to know

61
Q

Pharm mgmt of IBD: Anti-diarrheals

A

Loperamide: Suppresses the number of stools
* Used to decrease risk of FVD and electrolyte imbalance
* Reduces discomfort
* Use of antidiarheals can lead to toxic megacolon; use cautiously

62
Q

Pharm mgmt of IBD: Pain relivers

A

Tylenol: Avoid Nsaids as this can cause a flare up

63
Q

Surgical therapy in IBD

A
  • Can be curative in UC
  • Used if non surgical methods dont provide relief
64
Q

Surgical indications for UC

A
  • Colon cancer
  • Dysplasia, polyps
  • Toxic megacolon
  • Severe intractable bleeding
  • preforation
  • Strictures
65
Q

Surgical indications in Crohn’s

A
  • Small bowel obstruction
  • Abscess
  • Perforation
  • hemorrhage
  • Fistula formation
  • strictures
66
Q

Stricturoplasty

A

Widens intestine at stricture without resectioning intesting
* Usually for crohns
* Less invasive

67
Q

Protocolectomy and total colectomy with ileostomy

A
  • Resection of the colon and rectum with stoma formation from ileum
  • severely diseased colon and rectum refractory to med treatment
  • Curative in UC not crohns
  • Ileostomy needed for total colectomy or proctocolectomy
68
Q

Restorative protocolectomy with ileal pouch anal anastomosis

A
  • Severe UC: Procedure of choice because it saves the rectum
  • Connects ileum to anal pouch made from small intestine segment
  • temp diverting loop ileostomy when healing, later closed
  • Voluntary defecation and continence preserved
  • Complications: Leaking of stool, stricture, pelvic abscess, fistula, SBO , pouchitis, infertility from pelvic disection
69
Q

Diet in IBD

A
  • High cal high protein, low fiber
  • Avoid fiber
  • Small frequent meals
  • No caffine :(
  • Take supplements with iron, pernicious anemia
  • Avoid hard to digest foods (Nuts popcorn, corn, meats)
  • Avoid triggering foods (Dairy, spicy, fatty foods)
  • Stay hydrated
  • Probiotics might help
  • TPN if severly malnushed, or post surgical
70
Q

Peritonitis

A

Complication of IBD
* Life threatneing inflammation of the peritoneum and lining of the abdominal cavity
* Often caused by bacteria entering the peritoneal cavity (From intestine)

Characterized by rigid or board like abdomen

71
Q

Peritonitis mgmt

A
  • Place pt in fowlers or semi fowlers position to promote drainage of peritoneal fluid and improve lung function
  • Monitor resp status
  • Admin o2
  • NG suction
  • NPO
  • Monitor fluids and electrolyte status
  • IV antibiotics
72
Q

Toxic megacolon mgmt

A
  • NG suction, IV fluids and antibioics
  • Surgery
73
Q

Fluid and electrolyte imbalance IBD

A
  • Occurs from loss of fluid from diarrhea, vomiting and NG suctioning
  • Mgmt is focused on monitoring labs, and giving fluids
  • Monitor weight, I+O and signs of dehydration
74
Q

Nursing interventions: IBD

A
  • Vitals
  • Assess bowel movements (Quantitiy, blood, mucus, formation)
  • Focused GI assessment
  • Bowel sounds
  • NPO
  • IV fluids
  • Treat lyte imbalances
  • I+O monitoring for dehydration
  • Regular colon cancer screenings especially in UC
  • Ostomy care
  • Help pt understand disease
75
Q

A nurse is reviewing the serum laboratory data of a patient who has an acute exacerbation of Crohn’s disease. Which of the following laboratory tests should the nurse expect to be elevated? (Select all that apply):
A. Hematocrit
B. Erythrocyte sedimentation rate
C. WBC
D. Folic Acid
E. Albumin

A

B. Erythrocyte sedimentation rate
C. WBC

76
Q

A nurse is assessing a patient who has been taking Prednisone following an exacerbation of inflammatory bowel disease. The nurse should recognize which of the following findings as the priority?
A. Client reports difficulty sleeping
B. The client’s urine is positive for glucose.
C. Client reports having an elevated body temperature.
D. Client reports gaining four pounds in the last six months

A

C. Client reports having an elevated body temperature.

Elevated temp will kill you faster than increased glucose. While B is concerning, C is priority

77
Q

A nurse is teaching a client who has a new prescription for sulfasalazine. Which of the following instructions should the nurse include in the teaching?
A. “Take the medication two hours after eating.”
B. “Discontinue this medication if your skin turns yellow-orange.”
C. “Notify the provider if you experience a sore throat.”
D. “Expect your stools to turn black.”

A

C. “Notify the provider if you experience a sore throat.”

Immune compromised is a huge concern with these people

78
Q

A nurse in the clinic is teaching a client who has ulcerative colitis. Which of the following statements by the client indicates understanding of the teaching?
A. “I will plan to limit fiber in my diet.”
B. “I will restrict fluid intake during meals.”
C. “I will switch to black tea instead of drinking coffee.”
D. “I will try to eat three moderate to large meals a day.”

A

A. “I will plan to limit fiber in my diet.”

Fiber reduction is part of the plan for UC

79
Q

What type of anemia is UC related to

A

related to blood loss more so than malabsorption

NSG 470 (26 decks)

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