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MedSurg GI Tract > GI Tract > Flashcards

GI Tract Flashcards

1
Q

Diarrhea: What went wrong?

A

3 or more lose or liquid stools per day. Often organisms. Contaminated- undercooked food

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2
Q

Diarrhea: Patients signs and symptoms

A

Large volume stools cramping, dehydration, metabolic acidosis. C-diff in hospital

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3
Q

Diarrhea: Diagnostic tests

A

Stool cultures. Stool WBC, blood, mucus. Ova and parasites for more than 2 weeks

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4
Q

Diarrhea: Collaberative care and meds

A

Tx underlying cause. May need IVs. Anti diarrheals contraindicated in infectious diarrhea. C-diff-use antibiotics

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5
Q

Diarrhea: nursing management

A

Replace fluids, protect skin, prevent transmission. C-diff isolation lives 70 days. Private room

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6
Q

Fecal Incontinence: what went wrong?

A

Involuntary passage of stool. Nuero/motor/sensory impaction.

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7
Q

Fecal Incontinence: Patient signs and symtpoms

A

Patient unable to control bowel movements

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8
Q

Fecal Incontinence: Diagnostic Tests

A

H&P. Recal exam. CT scan or abd x-ray. Colonoscopy or sigmoidoscopy.

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9
Q

Fecal Incontinence: collaborative care and meds

A

Tx underlying cause. Removal of impaction. Bowel regimen. Surgery for damaged sphincters.

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10
Q

Fecal Incontinence: nursing management

A

Teach fiber and bulk-forming laxatives. Avoid foods that contribute. Imodium. Bowl training. Skin barrier. Fecal management systmes

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11
Q

Constipation: what went wrong?

A

Absent or infrequent stools due to diet, decreased fluid intake, meds (opiods). Nuero. and stress

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12
Q

Constipation: Patient signs and symptoms

A

Discomfort, hard, dry stools, bloating, distention, flatulence. Rectal pressure. Coloic perf.

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13
Q

Constipation: Diagnostic tests

A

H&P, rectal exam, meds. X-rays, barium enema, colonoscopy, sigmoidoscopy

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14
Q

Constipation: collaborative care and meds

A

Treat underlying cause. Stool softeners, bulk laxatives, enemas, bowl regimen. Physical activity

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15
Q

Constipation: nursing management

A

Increase fiber and fluids. Teach to avoid valsalva-bradycardia, decreased CO. Teach fiber and bulk-forming laxatives. Knees higher than hips

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16
Q

Acute abdominal pain: what went wrong?

A

Recent onset. May be life-threatening cause. Poss. perforation

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17
Q

Acute abdominal pain: patient signs and symptoms

A

pain, may have nausea, vomiting, fever, bloating, constipation or diarrhea, flatulance

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18
Q

Acute abdominal pain: diagnostic tests

A

H&P, position. Pain assessment. CBC, x-ray, CT scan, EKG. Urinalysis, pregnancy test

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19
Q

Acute abdominal pain: collaborative care and meds

A

Identify cause and treat. Possible surgery

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20
Q

Acute abdominal pain: nursing management

A

Vital signs AAP, determine baseline. I&O, bowl sounds. Full assessment. Poss NG, NPO. Table 43-10

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21
Q

Irritable bowel syndrome: what went wrong?

A

Common, chronic functional disorder. No organic cause.. FODMAPS. Diet. Stress/PTSD

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22
Q

Irritable bowel syndrome: patient signs and symptoms

A

Abd pain, constipation or diarrhea. Distention, flatulence, bloating, urgency, incomplete evacuation.

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23
Q

Irritable bowel syndrome: diagnostic tests

A

H&P. Diagnosis of exclusion. ROME 3 criteria

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24
Q

Irritable bowel syndrome: collaborative care and meds

A

Psych. intervention. Increase fiber. Imodium for diarrhea. Alosetron for pain and diarrhea. Amitzia and Linzess for constipation. Tricyclic antidepressants

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25
Q

Irritable bowel syndrome: nursing management

A

Have pt keep diary. Suggest CAM, acupincture, stress management. Teach avoid gas producing foods

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26
Q

Appendicitis: what went wrong?

A

Inflammation of appendix. Most common cause abd pain. Fecalith. Can have gangrene, perforation, peritonitis

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27
Q

Appendicitis: patient signs and symptoms

A

Periumbilical pain. Anorexia, N&V. Pain to RLQ- McBurneys point. Rebound tenderness. Increased coughing

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28
Q

Appendicitis: diagnostic tests

A

Check temp and CBC with diff. Full abd assessment. Urinanalysis. Preg test. CT scan, ultrasound

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29
Q

Appendicitis: collaberative care and meds

A

Antibiotics and fluids followed by surgical removal. If ruptures, peritonitis serious complication

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30
Q

Appendicitis: nursing management

A

All patients with abd pain need to see HCP. Keep NPO, no laxatives, enemas, or warm packs. Medicate for pain. Post-op care.

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31
Q

Peritonitis: what went wrong?

A

Inflammatory process of peritoneum. Infection, perf, peritoneal dialysis, injury, chemical irritation with massive fluid shifts and shock. Can be fatal!

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32
Q

Peritonitis: patient signs and symptoms

A

Severe abdominal pain. Rebound tenderness. Shallow breaths due to pain. Distention, fever, tachucardia, N&V, shock, ileus, abscess

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33
Q

Peritonitis: diagnostic tests

A

CBC with diff., aspiration of peritoneal fluids, x-ray, CT scan, ultrasound

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34
Q

Peritonitis: collaberative care and meds

A

Surgery. May be treated with antibiotics, fluids, NG, analgesics

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35
Q

Peritonitis: nursing management

A

Very careful assessment. Report changes immediately. IV, pain meds, postion. Oxygen if indicated. I&O. Drains post-op

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36
Q

Gastroenteritis: what went wrong?

A

Inflammation of mucosa of stomach and small intestine. Norovirus common

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37
Q

Gastroenteritis: patient signs and symptoms

A

Risk for dehydration in elderly. Diarrhea, N&V, abd pain

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38
Q

Gastroenteritis: diagnostic tests

A

Determine source. R/O other conditions

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39
Q

Gastroenteritis: collaborative care and meds

A

IV or oral fluids

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40
Q

Gastroenteritis: nursing management

A

Electrolytes, pedialyte, cola, antiemetics, may help. Avoid antidiarrheals.

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41
Q

Crohns Disease: what went wrong?

A

IBD. Genetic link. Autoimmune. Chronic inflammation of GI tract from mouth to anus. Often ileum. Skip lesions

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42
Q

Crohns Disease: patient signs and symptoms

A

All layers of bowel. Deep ulcerations, cobblestone. Strictures, with obstruction and perf poss. Fistulas. Diarrhea, weight loss. Crampy and pain. Fatigue

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43
Q

Crohns Disease: diagnostic tests

A

R/O other diseases. CBC, electrolytes, elevated ESR, CRP, stool cultures. Barium enema, contrast small bowell series, ultrasound, CT or MRI scan, colonoscopy, biopsy.

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44
Q

Crohns Disease: collaborative care and meds

A

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

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45
Q

Crohns Disease: nursing management

A

Assess for systematic complications. Risk for post-op obstruction. Assess for anemia. Think nutrition with vitamin and mineral loss. Skin care, rest

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46
Q

Ulcerative Colitis: what went wrong?

A

IBD. Autoimmune. Starts at rectum and moves up. Perf poss. Fistulas

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47
Q

Ulcerative Colitis: patient signs and symptoms

A

Bloody diarrhea with abd pain. Dehydration. Up to 20 stools a day. Toxic megacolon. Anemia

48
Q

Ulcerative Colitis: diagnostic tests

A

R/O other diseases. CBC, electrolytes, elevated ESR, CRP, stool cultures. Barium enema, contrast small bowell series, ultrasound, CT or MRI scan, colonoscopy, biopsy

49
Q

Ulcerative Colitis: collaborative care and meds

A

Screen for increased risk of colon cancer. May be hospitalized. Aminosalicylates, antimicrobials, corticosteroids, immunosuppresesants, biologic and targeted therapies. Proctocolectomy. Permanent ileostomy. Psychotherapy

50
Q

Ulcerative Colitis: nursing management

A

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

51
Q

Intestinal Obstruction: what went wrong?

A

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

52
Q

Intestinal Obstruction: patient signs and symptoms

A

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.

53
Q

Intestinal Obstruction: diagnostic tests

A

H&P, full labs, CT scan, colonoscopy or sigmoidoscopy

54
Q

Intestinal Obstruction: collaborative care and meds

A

Emergency surgery for strangulation or unresolved with conservative care. may require colostomy. Otherwise, NPO, NG, IVs, stent placement

55
Q

Intestinal Obstruction: nursing management

A

Monitor potassium levels (renal failure), pain meds. Very careful assessment and call surgeon if changes. Catheter with I&O. assess kidney function. Oral care!

56
Q

Colonic Polys: What went wrong?

A

Growths from mucosal surface. Sessile- flat and broad. Pedunculated- small stalk. Hyperplastic- noncancerous. Ademonatous- increased risk of colon cancer

57
Q

Colonic Polyps: patient signs and symptoms

A

Rectal bleeding, occult blood in stool

58
Q

Colonic Polyps: Diagnostic Tests

A

Genetic Testing for FAP, Cancer is inevitable-colon removal. Colonoscopy, barium enema, CT/MRI

59
Q

Colonic Polyps: collaborative care and meds

A

Remove all polyps and have tested. Observe for bleeding or perforation.

60
Q

Colonic Polyps: nursing management

A

Teach about importance of follow up with testing. Suggest increased fruits and vegetables, with exercise

61
Q

Colorectal cancer: what went wrong?

A

3rd most common form of cancer. Risk: red meat, obesity, inactivity, alcohol, smoking, low fruits and vegetables, IBO, familial link

62
Q

Colorectal cancer: patient signs and symptoms

A

Often no symptoms until advanced. Anemina, rectal bleeding, abdominal pain, change in bowel habits, obstruction

63
Q

Colorectal cancer: diagnostic testing

A

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

64
Q

Colorectal cancer: collaborative care an management

A

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

65
Q

Colorectal cancer: nursing management

A

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

66
Q

Ostomy: what went wrong?

A

Rectal cancer, advanced colon cancer, trauma, inflammatory bowel disorders

67
Q

Ostomy: collaborative care and management

A

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

68
Q

Ostomy: nursing management

A

concern about leakage and odor. Watch for dark red, very swollen or bloody stoma. Assess every 4 hours! WOCN, teach patient. May irrigate.

69
Q

Ileostomy Surgery: collaborative care and treatment

A

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

70
Q

Ileostomy Surgery: nursing management

A

Frequent drainage. open-ended pouch worn 4-7 days. Think fluid and electrolyte imbalances. Diet. Need 2-3 L/day. Skin care

71
Q

Diverticulitis: what went wrong?

A

Decreased dietary fiber.

72
Q

Diverticulitis: patient signs and symptoms

A

Abdominal pain, bloating, flatulence. Or no symptoms

73
Q

Diverticulitis: diagnostic studies

A

Routine sigmoidoscopy or colonoscopy symptoms

74
Q

Diverticulitis: collaborative care and management

A

High fiber diet. Decreased fat and red meat intake. Increased physical activity

75
Q

Diverticulitis: nursing management

A

Teach diet, exercise, weight reduction. No straining

76
Q

Hernias: what went wrong?

A

Protrusion of internal organ, such as intestine thru weakened area in wall

77
Q

Hernias: patient signs and symptoms

A

May be visible. Discomfort. Severe pain if strangulated. Distention, vomiting, cramping

78
Q

Hernias: diagnostic studies

A

Reducible or incarcerated by exam

79
Q

Hernias: collaborative and management

A

Emergency surgery if strangulated. Lapoorascopic surgery with mesh hernioplasty

80
Q

Hernias: nursing management

A

Watch for distended bladder post-op. Scrotal support and ice bag for inguinal hernia. No coughing, no lifting

81
Q

Celiac Disease: what went wrong?

A

Autoimmune disorder. Damage to small intestine by wheat, barley, rye. Genetic link

82
Q

Celiac Disease: patient signs and symptoms

A

Diarrhea, steatorrhea, abdominal distention, malnutrition, rash. Weight loss, osteoporosis

83
Q

Celiac Disease: diagnostic tests

A

Biopsy, serologic testing, genotyping

84
Q

Celiac Disease: collaborative care and management

A

Gluten-free diet. Corticosteroids initially

85
Q

Celiac Disease: nursing management

A

Avoid wheat, oats, barley, rye. Read labels closely

86
Q

Short bowel syndrome: what went wrong?

A

Small intestine doesnt absorb nutrients. Surgery

87
Q

Short bowel syndrome: patient signs and symptoms

A

Diarrhea and steatorrhea (fat). Weight loss, kidney stones, vitamin deficiencies

88
Q

Short bowel syndrome: diagnostic tests

A

History and physical exam

89
Q

Short bowel syndrome: collaborative care and management

A

May need supplements or TPN. H2 blocker or PPI. 6 small meals per day. Opioid antidiarrheals. Transplant

90
Q

Short bowel syndrome: nursing management

A

Comfort measures. Teach meds and small meals.

91
Q

Lactase Deficiency: what went wrong?

A

Lactase enzyme absent or deficient. Genetic. Intestinal mucosal damage.

92
Q

Lactase Deficiency: patient signs and symptoms

A

bloating, flatulence, cramping, diarrhea. Within 30 minutes to hours after ingesting milk

93
Q

Lactase deficiency: diagnostic tests

A

Lactose tolerance test

94
Q

Lactase deficiency: collaborative care and management

A

Lactose products (Lactaid) or eliminate milk products

95
Q

Lactase deficiency: nursing management

A

Teach diet adherence, calcium supplements may be needed

96
Q

Hemorrhoids: what went wrong?

A

Internal or external dilated veins from increased pressure

97
Q

Hemorrhoids: patient signs and symptoms

A

Rectal bleeding, pruritis, prolapse and pain

98
Q

Hemorrhoids: diagnostic studies

A

Digital exam, anoscopy

99
Q

Hemorrhoids: collaborative care and management

A

Fiber, fluids, witch hazel, topical steroids, band ligation, surgery

100
Q

Hemorrhoids: nursing management

A

Prevent constipation, sitz baths, opioids. Assess for bleeding. Stool softener, enema

101
Q

Anal Fissure: what went wrong?

A

crack in lining of anal wall. tissue ischemia

102
Q

Anal Fissure: patient signs and symptoms

A

Pain and bright red bleeding. Constipatin

103
Q

Anal Fissure: diagnostic tests

A

physical exam

104
Q

Anal Fissure: collaborative care and management

A

Fiber, fluids, sitz baths. Topical therapies. surgery

105
Q

Anal Fissure: nursing diagnosis

A

Comfort, pain meds, stool softeners

106
Q

Anal Cancer: what went wrong?

A

HPV associated many sexual partners, HIV

107
Q

Anal Cancer: patient signs and symptoms

A

rectal bleeding, pain, pressure

108
Q

Anal Cancer: diagnostic tests

A

anal scope, biopsy or swab. anal ultrasound

109
Q

Anal Cancer: collaborative care and treatment

A

Gardasil, or Cervarix. Surgery, radiation, chemotherpay

110
Q

Anal Cancer: nursing management

A

Medicate for pain. side-effect management. Teach prevention with condoms and vaccines

111
Q

Pilonidal Sinus: what went wrong?

A

Tract under skin filled with hair and epithelial cells

112
Q

Pilonidal Sinus: patient signs and symptoms

A

No symptoms unless infected. Pain and swelling

113
Q

Pilonidal Sinus: diagnostic tests

A

Physical exam. Culture if infected

114
Q

Pilondial Sinus: collaborative care and management

A

Surgery, open or closed. Packing, sitz baths

115
Q

Pilondial Sinus: nursing management

A

Medicate for pain, infection. Warm, moist heat, lie on side

MedSurg GI Tract (1 decks)

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