GI Tract Flashcards
Diarrhea: What went wrong?
3 or more lose or liquid stools per day. Often organisms. Contaminated- undercooked food
Diarrhea: Patients signs and symptoms
Large volume stools cramping, dehydration, metabolic acidosis. C-diff in hospital
Diarrhea: Diagnostic tests
Stool cultures. Stool WBC, blood, mucus. Ova and parasites for more than 2 weeks
Diarrhea: Collaberative care and meds
Tx underlying cause. May need IVs. Anti diarrheals contraindicated in infectious diarrhea. C-diff-use antibiotics
Diarrhea: nursing management
Replace fluids, protect skin, prevent transmission. C-diff isolation lives 70 days. Private room
Fecal Incontinence: what went wrong?
Involuntary passage of stool. Nuero/motor/sensory impaction.
Fecal Incontinence: Patient signs and symtpoms
Patient unable to control bowel movements
Fecal Incontinence: Diagnostic Tests
H&P. Recal exam. CT scan or abd x-ray. Colonoscopy or sigmoidoscopy.
Fecal Incontinence: collaborative care and meds
Tx underlying cause. Removal of impaction. Bowel regimen. Surgery for damaged sphincters.
Fecal Incontinence: nursing management
Teach fiber and bulk-forming laxatives. Avoid foods that contribute. Imodium. Bowl training. Skin barrier. Fecal management systmes
Constipation: what went wrong?
Absent or infrequent stools due to diet, decreased fluid intake, meds (opiods). Nuero. and stress
Constipation: Patient signs and symptoms
Discomfort, hard, dry stools, bloating, distention, flatulence. Rectal pressure. Coloic perf.
Constipation: Diagnostic tests
H&P, rectal exam, meds. X-rays, barium enema, colonoscopy, sigmoidoscopy
Constipation: collaborative care and meds
Treat underlying cause. Stool softeners, bulk laxatives, enemas, bowl regimen. Physical activity
Constipation: nursing management
Increase fiber and fluids. Teach to avoid valsalva-bradycardia, decreased CO. Teach fiber and bulk-forming laxatives. Knees higher than hips
Acute abdominal pain: what went wrong?
Recent onset. May be life-threatening cause. Poss. perforation
Acute abdominal pain: patient signs and symptoms
pain, may have nausea, vomiting, fever, bloating, constipation or diarrhea, flatulance
Acute abdominal pain: diagnostic tests
H&P, position. Pain assessment. CBC, x-ray, CT scan, EKG. Urinalysis, pregnancy test
Acute abdominal pain: collaborative care and meds
Identify cause and treat. Possible surgery
Acute abdominal pain: nursing management
Vital signs AAP, determine baseline. I&O, bowl sounds. Full assessment. Poss NG, NPO. Table 43-10
Irritable bowel syndrome: what went wrong?
Common, chronic functional disorder. No organic cause.. FODMAPS. Diet. Stress/PTSD
Irritable bowel syndrome: patient signs and symptoms
Abd pain, constipation or diarrhea. Distention, flatulence, bloating, urgency, incomplete evacuation.
Irritable bowel syndrome: diagnostic tests
H&P. Diagnosis of exclusion. ROME 3 criteria
Irritable bowel syndrome: collaborative care and meds
Psych. intervention. Increase fiber. Imodium for diarrhea. Alosetron for pain and diarrhea. Amitzia and Linzess for constipation. Tricyclic antidepressants
Irritable bowel syndrome: nursing management
Have pt keep diary. Suggest CAM, acupincture, stress management. Teach avoid gas producing foods
Appendicitis: what went wrong?
Inflammation of appendix. Most common cause abd pain. Fecalith. Can have gangrene, perforation, peritonitis
Appendicitis: patient signs and symptoms
Periumbilical pain. Anorexia, N&V. Pain to RLQ- McBurneys point. Rebound tenderness. Increased coughing
Appendicitis: diagnostic tests
Check temp and CBC with diff. Full abd assessment. Urinanalysis. Preg test. CT scan, ultrasound
Appendicitis: collaberative care and meds
Antibiotics and fluids followed by surgical removal. If ruptures, peritonitis serious complication
Appendicitis: nursing management
All patients with abd pain need to see HCP. Keep NPO, no laxatives, enemas, or warm packs. Medicate for pain. Post-op care.
Peritonitis: what went wrong?
Inflammatory process of peritoneum. Infection, perf, peritoneal dialysis, injury, chemical irritation with massive fluid shifts and shock. Can be fatal!
Peritonitis: patient signs and symptoms
Severe abdominal pain. Rebound tenderness. Shallow breaths due to pain. Distention, fever, tachucardia, N&V, shock, ileus, abscess
Peritonitis: diagnostic tests
CBC with diff., aspiration of peritoneal fluids, x-ray, CT scan, ultrasound
Peritonitis: collaberative care and meds
Surgery. May be treated with antibiotics, fluids, NG, analgesics
Peritonitis: nursing management
Very careful assessment. Report changes immediately. IV, pain meds, postion. Oxygen if indicated. I&O. Drains post-op
Gastroenteritis: what went wrong?
Inflammation of mucosa of stomach and small intestine. Norovirus common
Gastroenteritis: patient signs and symptoms
Risk for dehydration in elderly. Diarrhea, N&V, abd pain
Gastroenteritis: diagnostic tests
Determine source. R/O other conditions
Gastroenteritis: collaborative care and meds
IV or oral fluids
Gastroenteritis: nursing management
Electrolytes, pedialyte, cola, antiemetics, may help. Avoid antidiarrheals.
Crohns Disease: what went wrong?
IBD. Genetic link. Autoimmune. Chronic inflammation of GI tract from mouth to anus. Often ileum. Skip lesions
Crohns Disease: patient signs and symptoms
All layers of bowel. Deep ulcerations, cobblestone. Strictures, with obstruction and perf poss. Fistulas. Diarrhea, weight loss. Crampy and pain. Fatigue
Crohns Disease: diagnostic tests
R/O other diseases. CBC, electrolytes, elevated ESR, CRP, stool cultures. Barium enema, contrast small bowell series, ultrasound, CT or MRI scan, colonoscopy, biopsy.
Crohns Disease: collaborative care and meds
Replace bile salts and cobalamin. Screen for small bowel and colon cancer (increased risk). May be hospitalized. Aminosalicylates, antimicrobials, corticosteroids, immunosuppressants, biologic and targeted therapies. Surgery. May need life-time parenteral nutrition. Psychotherapy
Crohns Disease: nursing management
Assess for systematic complications. Risk for post-op obstruction. Assess for anemia. Think nutrition with vitamin and mineral loss. Skin care, rest
Ulcerative Colitis: what went wrong?
IBD. Autoimmune. Starts at rectum and moves up. Perf poss. Fistulas
Ulcerative Colitis: patient signs and symptoms
Bloody diarrhea with abd pain. Dehydration. Up to 20 stools a day. Toxic megacolon. Anemia
Ulcerative Colitis: diagnostic tests
R/O other diseases. CBC, electrolytes, elevated ESR, CRP, stool cultures. Barium enema, contrast small bowell series, ultrasound, CT or MRI scan, colonoscopy, biopsy
Ulcerative Colitis: collaborative care and meds
Screen for increased risk of colon cancer. May be hospitalized. Aminosalicylates, antimicrobials, corticosteroids, immunosuppresesants, biologic and targeted therapies. Proctocolectomy. Permanent ileostomy. Psychotherapy
Ulcerative Colitis: nursing management
Assess for systemic complications. Stoma care post-op. Very high ileostomy output initially. Assess for anemia. Think nutrition with vitamin and mineral loss. Skin care, rest
Intestinal Obstruction: what went wrong?
Fluid, gas and intestinal contents accumulate proximal to the obstruction and distal bowel collapses. Strangulation or perforation, shock and death. partial or complete. mechanical. paralytic ileus
Intestinal Obstruction: patient signs and symptoms
Distention, fluids and electrolytes move into peritoneal cavity. Dehydration, fluid and electrolyte imbalances, pain, N&V. Constipation later. High pitched sounds above, usually absent or below. Borborygmi.
Intestinal Obstruction: diagnostic tests
H&P, full labs, CT scan, colonoscopy or sigmoidoscopy
Intestinal Obstruction: collaborative care and meds
Emergency surgery for strangulation or unresolved with conservative care. may require colostomy. Otherwise, NPO, NG, IVs, stent placement
Intestinal Obstruction: nursing management
Monitor potassium levels (renal failure), pain meds. Very careful assessment and call surgeon if changes. Catheter with I&O. assess kidney function. Oral care!
Colonic Polys: What went wrong?
Growths from mucosal surface. Sessile- flat and broad. Pedunculated- small stalk. Hyperplastic- noncancerous. Ademonatous- increased risk of colon cancer
Colonic Polyps: patient signs and symptoms
Rectal bleeding, occult blood in stool
Colonic Polyps: Diagnostic Tests
Genetic Testing for FAP, Cancer is inevitable-colon removal. Colonoscopy, barium enema, CT/MRI
Colonic Polyps: collaborative care and meds
Remove all polyps and have tested. Observe for bleeding or perforation.
Colonic Polyps: nursing management
Teach about importance of follow up with testing. Suggest increased fruits and vegetables, with exercise
Colorectal cancer: what went wrong?
3rd most common form of cancer. Risk: red meat, obesity, inactivity, alcohol, smoking, low fruits and vegetables, IBO, familial link
Colorectal cancer: patient signs and symptoms
Often no symptoms until advanced. Anemina, rectal bleeding, abdominal pain, change in bowel habits, obstruction
Colorectal cancer: diagnostic testing
Genetic testing for FAP and HPNCC (lynch syndrome). Colonoscopy, simdoidoscopy to begin at 50. 45 for AA. CBC. Barium enema, FOBT, FIT, CT or MRI, LFTs, CEA- follow up care
Colorectal cancer: collaborative care an management
TNM staging. Bowel cleansing pre-op. Surgery to resect, remove lymph nodes. Reanastomosis or colostomy, may be temporary. Rectal cancer usually requires permanent colostomy. Chemotherapy with high risk stage 2, all 3 and 4 stages. 5FU and oral drug Capecitabine. Targeted therapy, “nibs” and “mabs”- Avastin most often. RT may be used
Colorectal cancer: nursing management
Educate re: screening and reporting, post-op APR, pain, wounds, drains, stoma, psych issues. Freq dressing changes. Watch for infection. Sexual dysfunction. Diet to control ostomy or none
Ostomy: what went wrong?
Rectal cancer, advanced colon cancer, trauma, inflammatory bowel disorders
Ostomy: collaborative care and management
End stoma- remove distal bowel or Hartmans pouch for takedown. Loop and double-barrel have distal bowel and usually temporary. Higher ostomy more liquid and difficuly to manage
Ostomy: nursing management
concern about leakage and odor. Watch for dark red, very swollen or bloody stoma. Assess every 4 hours! WOCN, teach patient. May irrigate.
Ileostomy Surgery: collaborative care and treatment
May need psychiatric support for loss and body image changes. United Ostomy Associatin, support groups, partnering. Radiation, partnering. Radiation and chemo can cause severe diarrhea. Sexual dysfunction if nerves damaged
Ileostomy Surgery: nursing management
Frequent drainage. open-ended pouch worn 4-7 days. Think fluid and electrolyte imbalances. Diet. Need 2-3 L/day. Skin care
Diverticulitis: what went wrong?
Decreased dietary fiber.
Diverticulitis: patient signs and symptoms
Abdominal pain, bloating, flatulence. Or no symptoms
Diverticulitis: diagnostic studies
Routine sigmoidoscopy or colonoscopy symptoms
Diverticulitis: collaborative care and management
High fiber diet. Decreased fat and red meat intake. Increased physical activity
Diverticulitis: nursing management
Teach diet, exercise, weight reduction. No straining
Hernias: what went wrong?
Protrusion of internal organ, such as intestine thru weakened area in wall
Hernias: patient signs and symptoms
May be visible. Discomfort. Severe pain if strangulated. Distention, vomiting, cramping
Hernias: diagnostic studies
Reducible or incarcerated by exam
Hernias: collaborative and management
Emergency surgery if strangulated. Lapoorascopic surgery with mesh hernioplasty
Hernias: nursing management
Watch for distended bladder post-op. Scrotal support and ice bag for inguinal hernia. No coughing, no lifting
Celiac Disease: what went wrong?
Autoimmune disorder. Damage to small intestine by wheat, barley, rye. Genetic link
Celiac Disease: patient signs and symptoms
Diarrhea, steatorrhea, abdominal distention, malnutrition, rash. Weight loss, osteoporosis
Celiac Disease: diagnostic tests
Biopsy, serologic testing, genotyping
Celiac Disease: collaborative care and management
Gluten-free diet. Corticosteroids initially
Celiac Disease: nursing management
Avoid wheat, oats, barley, rye. Read labels closely
Short bowel syndrome: what went wrong?
Small intestine doesnt absorb nutrients. Surgery
Short bowel syndrome: patient signs and symptoms
Diarrhea and steatorrhea (fat). Weight loss, kidney stones, vitamin deficiencies
Short bowel syndrome: diagnostic tests
History and physical exam
Short bowel syndrome: collaborative care and management
May need supplements or TPN. H2 blocker or PPI. 6 small meals per day. Opioid antidiarrheals. Transplant
Short bowel syndrome: nursing management
Comfort measures. Teach meds and small meals.
Lactase Deficiency: what went wrong?
Lactase enzyme absent or deficient. Genetic. Intestinal mucosal damage.
Lactase Deficiency: patient signs and symptoms
bloating, flatulence, cramping, diarrhea. Within 30 minutes to hours after ingesting milk
Lactase deficiency: diagnostic tests
Lactose tolerance test
Lactase deficiency: collaborative care and management
Lactose products (Lactaid) or eliminate milk products
Lactase deficiency: nursing management
Teach diet adherence, calcium supplements may be needed
Hemorrhoids: what went wrong?
Internal or external dilated veins from increased pressure
Hemorrhoids: patient signs and symptoms
Rectal bleeding, pruritis, prolapse and pain
Hemorrhoids: diagnostic studies
Digital exam, anoscopy
Hemorrhoids: collaborative care and management
Fiber, fluids, witch hazel, topical steroids, band ligation, surgery
Hemorrhoids: nursing management
Prevent constipation, sitz baths, opioids. Assess for bleeding. Stool softener, enema
Anal Fissure: what went wrong?
crack in lining of anal wall. tissue ischemia
Anal Fissure: patient signs and symptoms
Pain and bright red bleeding. Constipatin
Anal Fissure: diagnostic tests
physical exam
Anal Fissure: collaborative care and management
Fiber, fluids, sitz baths. Topical therapies. surgery
Anal Fissure: nursing diagnosis
Comfort, pain meds, stool softeners
Anal Cancer: what went wrong?
HPV associated many sexual partners, HIV
Anal Cancer: patient signs and symptoms
rectal bleeding, pain, pressure
Anal Cancer: diagnostic tests
anal scope, biopsy or swab. anal ultrasound
Anal Cancer: collaborative care and treatment
Gardasil, or Cervarix. Surgery, radiation, chemotherpay
Anal Cancer: nursing management
Medicate for pain. side-effect management. Teach prevention with condoms and vaccines
Pilonidal Sinus: what went wrong?
Tract under skin filled with hair and epithelial cells
Pilonidal Sinus: patient signs and symptoms
No symptoms unless infected. Pain and swelling
Pilonidal Sinus: diagnostic tests
Physical exam. Culture if infected
Pilondial Sinus: collaborative care and management
Surgery, open or closed. Packing, sitz baths
Pilondial Sinus: nursing management
Medicate for pain, infection. Warm, moist heat, lie on side
