GI PART 2 Flashcards
What risk factors did this client have?
- Over 50 years of age
- Long term smoking
*Other risk factors: genetics, high fat diet, low activity, high ETOH intake, hx of polyps, crohns, ulcerative colitis, H pylori, HPV, obesity
What are the most common signs/symptoms of colorectal cancer?
- Rectal bleeding
- Anemia
- Change in stool consistency or shape
What types of diagnostic tests would be appropriate to gather more information about Mr. Moore’s condition and what might the laboratory tests show if he has colorectal cancer?
-CBC may show decreased H/H
-Fecal occult blood testing (positive)
-Carcinoembryonic antigen (CEA) may be elevated
-CT scan
-Colonoscopy
*definitive test for the diagnosis
-Liver function tests
*may be elevated if metastasis to the liver has occurred
What health promotion and maintenance interventions should patients practice to avoid a colorectal cancer diagnosis?
- Screening at age 50
- Fecal occult blood testing and colonoscopy every 10 years
- Diet – decrease fat and refined carbohydrates and increase fiber, eat baked or broiled foods
4.Avoid smoking and heavy alcohol consumption
Increase physical activity
Colon Cancer Treatment
- Radiation
- Chemotherapy
- Surgery
*Based on size of tumor, location, metastasis
*Colon resection
-Remove tumor and any lymph nodes
*Colectomy
-Remove colon with a colostomy or ileostomy
*Abdominoperineal (AP) resection
-Remove sigmoid colon, rectum and anus
Colostomy Care
- A clear ostomy pouch will be in place to allow for visualization of stoma
Many different types, will depend on where the stoma is located, how active the patient, size and curve of abdomen
2.Assess the color and integrity of the stoma frequently
Healthy stoma should be reddish or pink and moist and protrude about ¾ inch (2 cm) from the abdominal wall
May be slightly edematous and have a small amount of bleeding initially
3.Should start functioning in 2-3 days
Stool consistency depends on where in the colon the stoma was placed:
Liquid: ascending colon or if has an ileostomy
Pasty: tranverse colon
More solid: descending colon and sigmoid
- Bag should be emptied when 1/3 to ½ full to prevent pulling
5/ Entire Pouch (appliance) should be changed every 3-7 days
Check surrounding skin, keep good seal, good assessment of stoma
6.Lots of education needed
Collaborate with CWON for education and ongoing stoma and pouch care
Describe the causes of mechanical and nonmechanical intestinal obstructions.
Mechanical
Bowel is physically blocked by problems outside the intestine, in the bowel wall or within intestinal lumen
Ex. adhesions (outside) Crohn’s (within bowel walls), tumors (within intestinal lumen)
Most common causes in patients over 65 is diverticulitis, tumors, or fecal impaction
Describe the causes of mechanical and nonmechanical intestinal obstructions.
Nonmechanical
Paralytic ileus
peristalsis is decreased or absent
Most common cause handling of the intestines during abdominal surgery
What signs/symptoms may be present in Mrs. Jump?
Small bowel obstruction
Abdominal discomfort or pain
Visible peristaltic waves
Upper or epigastric abdominal distention
Nausea and early
Profuse vomiting
Obstipation
Versus:
Large bowel obstruction
Intermittent lower abdominal cramping
Lower abdominal distention
Minimal or no vomiting
Obstipation or ribbon-like stools
No major fluid and electrolyte imbalances
High pitched bowel sounds transitioning to absent bowel sounds
What interventions are appropriate for Mrs. Jump’s SBO?
- NPO
- NGT including suction
- Assess and record passage of flatus and character of bowel movements
*Indicative that peristalsis has returned
4.Monitor VS
5.IVF
6.Weight - I/O
*Monitor electrolyte imbalances
8.Assess and treat pain
*Cautiously use opioids to treat pain secondary to slowing movement on GI tract
9.Monitor for complications
*Bowel perforation
*Ischemic bowel
*Peritonitis
Ulcerative Colitis
Creates widespread inflammation of mainly the rectum and rectosigmoid colon but can extend to the entire colon when the disease is extensive
-Etiology: unknown; but genetic, immunologic, and environmental factors likely contribute to disease
Ulcerative Colitis
Creates widespread inflammation of mainly the rectum and rectosigmoid colon but can extend to the entire colon when the disease is extensive
-Etiology: unknown; but genetic, immunologic, and environmental factors likely contribute to disease
What clinical manifestations of ulcerative colitis make Molly at higher risk for decreased oxygenation and fatigue?
A. Bloody stools
B. Fever
C. Electrolyte abnormalities
D. Elevated inflammatory markers
A. Bloody stools
Molly does not have any other GI symptoms at this time. What are some other symptoms she might experience?
CM
10-20 liquid, bloody stools per day
Stool may contain mucus
Tenesmus (an unpleasant and urgent sensation to defecate)
Lower abdominal colicky pain relieved with defecation
Malaise
Anorexia
Anemia
Dehydration
Fever
Weight loss
Anemia
Increased WBC
Elevated C-reactive protein and ESR
Decreased electrolytes
Molly does not have any other GI symptoms at this time. What are some other symptoms she might experience?
CM
10-20 liquid, bloody stools per day
Stool may contain mucus
Tenesmus (an unpleasant and urgent sensation to defecate)
Lower abdominal colicky pain relieved with defecation
Malaise
Anorexia
Anemia
Dehydration
Fever
Weight loss
Anemia
Increased WBC
Elevated C-reactive protein and ESR
Decreased electrolytes
What type of prep is required for a sigmoidoscopy?
Clear liquids typically the day before and sometime NPO the day of the procedure
One to two enemas the day of the procedure
Does not require total bowel cleanse as required for a colonoscopy
What post op procedure instructions should the nurse include post barium enema?
Increase fluids to facilitate the excretion of the barium from the colon
Which clinical manifestation would be concerning to the nurse following the flexible sigmoidoscopy?
B. Rigid abdomen
Which clinical manifestation would be concerning to the nurse following the flexible sigmoidoscopy?
B. Rigid abdomen
What complication does this assess for?
Bowel perforation and possible peritonitis
What are other signs and symptoms?
Abdominal guarding, boardlike abdomen, pain
Molly has been diagnosed with ulcerative colitis. She has been prescribed prednisone, sulfasalazine, and azathioprine. Why is she prescribed these medications?
- Prednisone
Decrease inflammation - Sulfasalazine
Decrease inflammation
3.Azathioprine
Suppress immune system
ULCERATIVE COLITISTreatment
- Drug therapy:
Immunomoduators are given to suppress the immune system
Glucocorticoids are used during exacerbation to decrease inflammation
Aminosalicylates are used to decrease inflammation
Antidiarrheals are given cautiously - Nutrition therapy:
NPO
TPN
Avoid caffeine, alcohol, raw vegetables, high fiber foods, lactose containing foods - Restrict activity
Can reduce intestinal activity, provide comfort, and promote healing - Monitor for GI bleeding
Hbg and Hct
Electrolyte values
VS - Surgery may be required if medical therapies alone are not effective
Removal of colon
ULCERATIVE COLITISTreatment
- Drug therapy:
Immunomoduators are given to suppress the immune system
Glucocorticoids are used during exacerbation to decrease inflammation
Aminosalicylates are used to decrease inflammation
Antidiarrheals are given cautiously - Nutrition therapy:
NPO
TPN
Avoid caffeine, alcohol, raw vegetables, high fiber foods, lactose containing foods - Restrict activity
Can reduce intestinal activity, provide comfort, and promote healing - Monitor for GI bleeding
Hbg and Hct
Electrolyte values
VS - Surgery may be required if medical therapies alone are not effective
Removal of colon
