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intestinal and rectal disorders Flashcards

1
Q

what are some causes of intestinal obstruction

A
  • adhesions (after surgery)
  • crohns
  • infected diverticulitis
  • hernia
  • colon CA
  • paralytic ileus
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2
Q

whats happening with intestinal obstruction

A
  • stool unable to pass through GI
  • content accumulate above obstruction = distention
  • pressure on colon wall = hypoxia -> ischemia -> death of area
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3
Q

how will the client present with intestinal obstruction

A
  • crampy abdominal pain
  • loss of appetite
  • constipation/unable to pass gas
  • vomiting literal shit
  • abdominal swelling
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4
Q

what are some labs and diagnostics for intestinal obstruction

A
  • xray
  • CT (best)
  • barium enema (take pics with xray)
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5
Q

what are some acute interventions for intestinal obstruction

A
  • bowel rest (NG)
  • surgery
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6
Q

what are some complications for intestinal obstruction

A
  • bowel necrosis
  • bowel rupture
  • fecal emesis
  • infection -> sepsis
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7
Q

what are some meds that can help with intestinal obstruction

A
  • pain control
  • antibiotics
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8
Q

whats some education for intestinal obstruction

A
  • NG tube discomfort
  • pain control
  • anxiety reduction
  • oral care
  • abdominal surgery care (check for paralytic ileus)
  • NPO
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9
Q

describe SBO

A
  • most obstruction are in small bowel
  • usualy happens rapidly
  • may resolve with rest and NG
  • usually caused by adhesions or paralytic ileus
  • pain usually around umbilicus or epigastric pain
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10
Q

describe colon obstruction

A
  • develop over time
  • only sx can be constipation for months
  • change in stool shape bc theyre squeezing around that obstruction
  • lower abd cramps
  • no tenderness
  • polyps
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11
Q

what are some manifestations of colon cancer

A
  • change in bowel habits (most common)
  • blood in stools (second most common)
  • unexplained anemia, anorexia, weight loss, fatigue
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12
Q

describe ileostomy

A
  • ileum cut and connected to opening in abd wall
  • effluent (shit): liquid - semi liq
  • 500-1L per day
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13
Q

describe colostomy

A
  • diseased/damage portion of colon removed; linked to opening made through abd wall
  • effluent (shit): semi solid to solid
  • 200-300/day (less with lower placement)
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14
Q

what are some causes of constipation

A
  • blockages in rectum or colon
  • nerve (dont even know you gotta go)
  • muscular involvement
  • hormonal imbalances
  • certain medications
  • ignoring the urge
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15
Q

whats heppening with constipation

A
  • stool moving too slwly
  • stool unable to be evacuated
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16
Q

how will the client present with constipation

A

2 or more for 3 months:
- <3 stools/week
- lump/hard stools
- straining
- incomplete emptying
- needing digital disimpaction

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17
Q

what are some labs/dignostics for constipation

A
  • blooc tests (hormone imbalances)
  • colonoscopy/sigmoidoscopy
  • colonic transit study (see how long it takes to get through the colon)
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18
Q

what OTC meds can help with constipation

A

laxatives, fiber supplements, GI stimulants, osmotic laxatives, lubes, stool softeners, enemas/suppositories

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19
Q

whats prescription meds can help with constipation

A
  • lubiprostone and linaclotide
  • misoprostol, botox, and metoclopramide
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20
Q

what are some complications of constipation

A
  • hemorrhoids
  • anal fissure
  • impaction
  • rectal prolapse
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21
Q

how can nurses help and educate for constipation

A
  • diet and activity
  • monitor med risks
  • eating disorders
  • sit w legs supported
  • exercises to tighten pelvic floor muscles
  • dont ignore urge to go
  • dont allow complications
  • the patients expectations of “normal”
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22
Q

what are some causes of diarrhea

A
  • virus, baceria, parasite
  • meds
  • food intolerance
  • surgery (cholecysyectomy)
  • digestive disorders (IBS, IBD)
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23
Q

whats happening with diarrhea

A

rapid transmit of stool through colon

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24
Q

how will the client present with diarrhea

A
  • loose, watery stools
  • abd cramps and pain
  • fever
  • blood and or mucus in the stool
  • bloating/nausea
  • urgency
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25
what are some labs and diagnostics for diarrhea
- CBC - stool test - BMP - low K+ - sigmoidoscopy/colonoscopy (biopsy if needed)
26
what meds can help with diarrhea
- antibiotics (parasitic/bacterial) - liquids - atropine/diphenoxylate
27
what are some complications of diarrhea
- dehydration - electrolyte imbalance - skin breakdown
28
how can nurses help and educate for diarrhea
- when to see a doc - proper handwashing - watch what you eat - symptoms of electrolyte disturbances - change attends quickly - maintain appropriate precautions (fall/isolation) - answer call light quickly
29
what are some causes of irritable bowel syndrome
- strong/weak contractions - nervous system - inflammation - infection - changes in gut bacteria - genetics
30
whats happening with irritable bowel syndrome
disorder affecting frequency and consistency
31
how will the client present with irritable bowel syndrome
- abd cramping/pain/bloating/gas - diarrhea/constipation or both - mucus shreds in stool
32
whats labs and diagnostics may be used for irritable bowel syndrome
- rule out other conditions - stool tests - lactose intolerance tests - colonoscopy/sigmoidoscopy - xray or CT
33
what meds can help with irritable bowel syndrome
- IBS specific meds: lubiprostone and linaclotide - fiber supplements - laxatives - anti-diarrheals - anticholinergics - TCAs - SSRIs - nerve specific meds
34
what are some complications of irritable bowel syndrome
- colon cancer - social isolation
35
how can nurses help/educate with irritable bowel syndrome
- diet, lifestyle, and stress reduction - counseling/muscle relaxation - fluids and sleep - meds (if necessary) - probiotic use - peppermint? - avoid triggers like food, stress, hormones?, and fodmaps (fructose, fructans, lactose, glactans)
36
what are some causes of appendicitis
- blockage in appandix - kinked, occluded, tumor, foreign vody
37
whats happening with appendicitis
- loss of blood supply - inflammation, ischemia, necrosis/infection - untreated = sepsis and death
38
how will the client present with appendicitis
- periumbilical pain shifting to RLQ - flu like sx/malaise - pain worse w movement - abdominal bloating and gas - aginign population
39
what are some labs and diagnostics for appendicitis
- Mcburneys point (RLQ) (rebound tenderness) - CBC - abd CT (definitive) - HCG levels (ectopic preg) - urinalysis (rule out UTI)
40
what are some acute interventions for appendicitis
- urgent vs emergent - antibiotics 60mins prior - rupture care
41
what are some complications of appendicitis
- rupture - infection
42
what meds may help with appendicitis
- prophylactic antibiotics - narcotics and NSAIDs
43
how can nurses help and educate for appendicitis
- incision site care - pain control - avoid strenuous activity - post op care (at home)
44
what are some causes of diverticulitis
weak pockets in colon under pressure
45
whats happening with diverticulitis
- marble sized protrusions - tearing of diverticula = inflammation and or infection
46
how will the client present with diverticulitis
- perisistent pain - **LLQ pain** - N/V, abd tenderness and fever - constipation and possible diarrhea
47
what are some labs and diagnostics for diverticulitis
- NO colonoscopy while inflamed - UA - CBC - HCG or UA preg - liver enzymes - stool studies - CT
48
what are some acute interventions for diverticulitis
- antibiotics, rest and liqs - surgery (complications)
49
what are some complications of diverticulitis
- abscess - blockage by scarring - fistula - peritonitis
50
what are some surgical interventions for diverticulitis
- drain - bowel resection - temp/perm colostomy
51
what are some meds that can help with diverticulitis
without complications: - oral antibiotics - liquids to solids - acetminophen and OTCs with complications: - IV antibiotics (hospitalization)
52
how can nurses help and educate with diverticulitis
- educate on liquid nutrition - pain control - fluid promotion - educate on bulk laxatives - use of stool softeners - knowing risk factors - assessing for complications
53
name two inflammatory bowel diseases
crohns (regional enteritis but can affect colon) ulcerative colitis (inflammation and ulceration of colon)
54
what can make you a higher risk for inflammatory bowel diseases or exacerbate it
- first degree relative with it - jewish decent - NSAIDs exacerbate - smokers cause is unknown
55
what are some major differences in crohns and ulcerative colitis
- crohns usually affects small intestine but can affect colon - crohns can be transmural (affect all layers of colon) - ulcerative colitis is of the colon, most commonly sigmoid - ulcerative colitis usually does not penetrate mucosal layer
56
what are some causes of crohns
- immune system - heredity
57
whats happening with crohns
- inflammation of small and large intestine - affects all layers (transmural) - inflammation = lack of absorption, perforation/infection
58
how will the client present with crohns
- exacerbations and remissions - pain (RLQ and distal ileum) unrelieved by shitting - chronic diarrhea - anorexia and weight loss from malabsorption - pain worse after meals - blood and fat in stool - extra intestinal manifestations (mouth sores)
59
what are some labs and diagnostics for crohns
- CT (cobblestone looking intestines) - CBC - stool studies - EGD w biopsy
60
what are soe acute interventions for crohns
- bowel rest and NG - bowel resection and possible temp colostomy
61
what are some complications of crohns
- bowel obstruction - ulcers - fistulas - anal fissures - malnutrition - colon cancer - extra intestinal issues
62
what meds can help with crohns
- anti-inflammatories (corticosteroids) - immunosuppressants (methotrexate) - aminosalicylates - TNF inhibitors - **pain reliever** - iron and B23 for anemia and malnutrition - calcium and vitamin D
63
how can nurses help and educate for crohns
- know when to see doc - smoking cessation - avoid NSAIDs - choose the right foods - pain management - non pharm measures - colostomy and NG care
64
what are some causes of ulcerative colitis
- heredity - autoimmune
65
whats happening with ulcerative colitis
- long lasting inflammation - multiple ulcerations - desquamation - ulcers to innermost lining of colon/rectum (NOT transmural) - starts at asshole and makes its way up
66
how will the client present with ulcerative colitis
- varies by person (nuisance to debilitating to life threatening) - extraintesinal issues - diarrhea (mucus and pus) - abd pain and crmaping (LLQ) - rectal bleeding - anorexia/weight loss/fatigue - fever (with infection)
67
what are some labs and diagnostics for ulcerative colitis
- CBC/BMP - stool testing - **abd xray/CT (definitive)** - sigmoidoscopy/colonoscopy (barium enema) later on
68
what are some acute inerventions for ulcerative colitis
- bowel resection (temp colostomy) - antibiotics - pain control
69
what are some complication of ulcerative colitis
- bleeding (may be sever) - perforation) - dehydrations - extraintestinal - colon CA - megaclon - blood clots
70
what meds may help with ulcerative colitis
- anti-inflammatory (corticosteroids) - aminosalicylates - TNF inhibitors - newer class = mabs - antibiotics - antidiarrheals - pain = tylenol (NO NSAIDS) - iron supplements (if chronic bleedings)
71
how can nurses help and educate for ulcerative colitis
- discuss CA screening - nutrition - rest for bowel - maintain normal elimination - pain control - fluid intake - prevent skin breakdown (diarrhea) - monitor for infection - discuss alternative meds - barium enema = white stool

adults (51 decks)

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