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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
Q

what are some labs and diagnostics for diarrhea

A
  • CBC
  • stool test
  • BMP - low K+
  • sigmoidoscopy/colonoscopy (biopsy if needed)
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26
Q

what meds can help with diarrhea

A
  • antibiotics (parasitic/bacterial)
  • liquids
  • atropine/diphenoxylate
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27
Q

what are some complications of diarrhea

A
  • dehydration
  • electrolyte imbalance
  • skin breakdown
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28
Q

how can nurses help and educate for diarrhea

A
  • 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
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29
Q

what are some causes of irritable bowel syndrome

A
  • strong/weak contractions
  • nervous system
  • inflammation
  • infection
  • changes in gut bacteria
  • genetics
30
Q

whats happening with irritable bowel syndrome

A

disorder affecting frequency and consistency

31
Q

how will the client present with irritable bowel syndrome

A
  • abd cramping/pain/bloating/gas
  • diarrhea/constipation or both
  • mucus shreds in stool
32
Q

whats labs and diagnostics may be used for irritable bowel syndrome

A
  • rule out other conditions
  • stool tests
  • lactose intolerance tests
  • colonoscopy/sigmoidoscopy
  • xray or CT
33
Q

what meds can help with irritable bowel syndrome

A
  • IBS specific meds: lubiprostone and linaclotide
  • fiber supplements
  • laxatives
  • anti-diarrheals
  • anticholinergics
  • TCAs
  • SSRIs
  • nerve specific meds
34
Q

what are some complications of irritable bowel syndrome

A
  • colon cancer
  • social isolation
35
Q

how can nurses help/educate with irritable bowel syndrome

A
  • 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
Q

what are some causes of appendicitis

A
  • blockage in appandix
  • kinked, occluded, tumor, foreign vody
37
Q

whats happening with appendicitis

A
  • loss of blood supply
  • inflammation, ischemia, necrosis/infection
  • untreated = sepsis and death
38
Q

how will the client present with appendicitis

A
  • periumbilical pain shifting to RLQ
  • flu like sx/malaise
  • pain worse w movement
  • abdominal bloating and gas
  • aginign population
39
Q

what are some labs and diagnostics for appendicitis

A
  • Mcburneys point (RLQ) (rebound tenderness)
  • CBC
  • abd CT (definitive)
  • HCG levels (ectopic preg)
  • urinalysis (rule out UTI)
40
Q

what are some acute interventions for appendicitis

A
  • urgent vs emergent
  • antibiotics 60mins prior
  • rupture care
41
Q

what are some complications of appendicitis

A
  • rupture
  • infection
42
Q

what meds may help with appendicitis

A
  • prophylactic antibiotics
  • narcotics and NSAIDs
43
Q

how can nurses help and educate for appendicitis

A
  • incision site care
  • pain control
  • avoid strenuous activity
  • post op care (at home)
44
Q

what are some causes of diverticulitis

A

weak pockets in colon under pressure

45
Q

whats happening with diverticulitis

A
  • marble sized protrusions
  • tearing of diverticula = inflammation and or infection
46
Q

how will the client present with diverticulitis

A
  • perisistent pain
  • LLQ pain
  • N/V, abd tenderness and fever
  • constipation and possible diarrhea
47
Q

what are some labs and diagnostics for diverticulitis

A
  • NO colonoscopy while inflamed
  • UA
  • CBC
  • HCG or UA preg
  • liver enzymes
  • stool studies
  • CT
48
Q

what are some acute interventions for diverticulitis

A
  • antibiotics, rest and liqs
  • surgery (complications)
49
Q

what are some complications of diverticulitis

A
  • abscess
  • blockage by scarring
  • fistula
  • peritonitis
50
Q

what are some surgical interventions for diverticulitis

A
  • drain
  • bowel resection
  • temp/perm colostomy
51
Q

what are some meds that can help with diverticulitis

A

without complications:
- oral antibiotics
- liquids to solids
- acetminophen and OTCs

with complications:
- IV antibiotics (hospitalization)

52
Q

how can nurses help and educate with diverticulitis

A
  • educate on liquid nutrition
  • pain control
  • fluid promotion
  • educate on bulk laxatives
  • use of stool softeners
  • knowing risk factors
  • assessing for complications
53
Q

name two inflammatory bowel diseases

A

crohns (regional enteritis but can affect colon)

ulcerative colitis (inflammation and ulceration of colon)

54
Q

what can make you a higher risk for inflammatory bowel diseases or exacerbate it

A
  • first degree relative with it
  • jewish decent
  • NSAIDs exacerbate
  • smokers

cause is unknown

55
Q

what are some major differences in crohns and ulcerative colitis

A
  • 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
Q

what are some causes of crohns

A
  • immune system
  • heredity
57
Q

whats happening with crohns

A
  • inflammation of small and large intestine
  • affects all layers (transmural)
  • inflammation = lack of absorption, perforation/infection
58
Q

how will the client present with crohns

A
  • 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
Q

what are some labs and diagnostics for crohns

A
  • CT (cobblestone looking intestines)
  • CBC
  • stool studies
  • EGD w biopsy
60
Q

what are soe acute interventions for crohns

A
  • bowel rest and NG
  • bowel resection and possible temp colostomy
61
Q

what are some complications of crohns

A
  • bowel obstruction
  • ulcers
  • fistulas
  • anal fissures
  • malnutrition
  • colon cancer
  • extra intestinal issues
62
Q

what meds can help with crohns

A
  • anti-inflammatories (corticosteroids)
  • immunosuppressants (methotrexate)
  • aminosalicylates
  • TNF inhibitors
  • pain reliever
  • iron and B23 for anemia and malnutrition
  • calcium and vitamin D
63
Q

how can nurses help and educate for crohns

A
  • know when to see doc
  • smoking cessation
  • avoid NSAIDs
  • choose the right foods
  • pain management
  • non pharm measures
  • colostomy and NG care
64
Q

what are some causes of ulcerative colitis

A
  • heredity
  • autoimmune
65
Q

whats happening with ulcerative colitis

A
  • long lasting inflammation
  • multiple ulcerations
  • desquamation
  • ulcers to innermost lining of colon/rectum (NOT transmural)
  • starts at asshole and makes its way up
66
Q

how will the client present with ulcerative colitis

A
  • 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
Q

what are some labs and diagnostics for ulcerative colitis

A
  • CBC/BMP
  • stool testing
  • abd xray/CT (definitive)
  • sigmoidoscopy/colonoscopy (barium enema) later on
68
Q

what are some acute inerventions for ulcerative colitis

A
  • bowel resection (temp colostomy)
  • antibiotics
  • pain control
69
Q

what are some complication of ulcerative colitis

A
  • bleeding (may be sever)
  • perforation)
  • dehydrations
  • extraintestinal
  • colon CA
  • megaclon
  • blood clots
70
Q

what meds may help with ulcerative colitis

A
  • anti-inflammatory (corticosteroids)
  • aminosalicylates
  • TNF inhibitors
  • newer class = mabs
  • antibiotics
  • antidiarrheals
  • pain = tylenol (NO NSAIDS)
  • iron supplements (if chronic bleedings)
71
Q

how can nurses help and educate for ulcerative colitis

A
  • 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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