intestinal and rectal disorders Flashcards
what are some causes of intestinal obstruction
- adhesions (after surgery)
- crohns
- infected diverticulitis
- hernia
- colon CA
- paralytic ileus
whats happening with intestinal obstruction
- stool unable to pass through GI
- content accumulate above obstruction = distention
- pressure on colon wall = hypoxia -> ischemia -> death of area
how will the client present with intestinal obstruction
- crampy abdominal pain
- loss of appetite
- constipation/unable to pass gas
- vomiting literal shit
- abdominal swelling
what are some labs and diagnostics for intestinal obstruction
- xray
- CT (best)
- barium enema (take pics with xray)
what are some acute interventions for intestinal obstruction
- bowel rest (NG)
- surgery
what are some complications for intestinal obstruction
- bowel necrosis
- bowel rupture
- fecal emesis
- infection -> sepsis
what are some meds that can help with intestinal obstruction
- pain control
- antibiotics
whats some education for intestinal obstruction
- NG tube discomfort
- pain control
- anxiety reduction
- oral care
- abdominal surgery care (check for paralytic ileus)
- NPO
describe SBO
- 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
describe colon obstruction
- 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
what are some manifestations of colon cancer
- change in bowel habits (most common)
- blood in stools (second most common)
- unexplained anemia, anorexia, weight loss, fatigue
describe ileostomy
- ileum cut and connected to opening in abd wall
- effluent (shit): liquid - semi liq
- 500-1L per day
describe colostomy
- 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)
what are some causes of constipation
- blockages in rectum or colon
- nerve (dont even know you gotta go)
- muscular involvement
- hormonal imbalances
- certain medications
- ignoring the urge
whats heppening with constipation
- stool moving too slwly
- stool unable to be evacuated
how will the client present with constipation
2 or more for 3 months:
- <3 stools/week
- lump/hard stools
- straining
- incomplete emptying
- needing digital disimpaction
what are some labs/dignostics for constipation
- blooc tests (hormone imbalances)
- colonoscopy/sigmoidoscopy
- colonic transit study (see how long it takes to get through the colon)
what OTC meds can help with constipation
laxatives, fiber supplements, GI stimulants, osmotic laxatives, lubes, stool softeners, enemas/suppositories
whats prescription meds can help with constipation
- lubiprostone and linaclotide
- misoprostol, botox, and metoclopramide
what are some complications of constipation
- hemorrhoids
- anal fissure
- impaction
- rectal prolapse
how can nurses help and educate for constipation
- 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”
what are some causes of diarrhea
- virus, baceria, parasite
- meds
- food intolerance
- surgery (cholecysyectomy)
- digestive disorders (IBS, IBD)
whats happening with diarrhea
rapid transmit of stool through colon
how will the client present with diarrhea
- loose, watery stools
- abd cramps and pain
- fever
- blood and or mucus in the stool
- bloating/nausea
- urgency
what are some labs and diagnostics for diarrhea
- CBC
- stool test
- BMP - low K+
- sigmoidoscopy/colonoscopy (biopsy if needed)
what meds can help with diarrhea
- antibiotics (parasitic/bacterial)
- liquids
- atropine/diphenoxylate
what are some complications of diarrhea
- dehydration
- electrolyte imbalance
- skin breakdown
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
what are some causes of irritable bowel syndrome
- strong/weak contractions
- nervous system
- inflammation
- infection
- changes in gut bacteria
- genetics
whats happening with irritable bowel syndrome
disorder affecting frequency and consistency
how will the client present with irritable bowel syndrome
- abd cramping/pain/bloating/gas
- diarrhea/constipation or both
- mucus shreds in stool
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
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
what are some complications of irritable bowel syndrome
- colon cancer
- social isolation
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)
what are some causes of appendicitis
- blockage in appandix
- kinked, occluded, tumor, foreign vody
whats happening with appendicitis
- loss of blood supply
- inflammation, ischemia, necrosis/infection
- untreated = sepsis and death
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
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)
what are some acute interventions for appendicitis
- urgent vs emergent
- antibiotics 60mins prior
- rupture care
what are some complications of appendicitis
- rupture
- infection
what meds may help with appendicitis
- prophylactic antibiotics
- narcotics and NSAIDs
how can nurses help and educate for appendicitis
- incision site care
- pain control
- avoid strenuous activity
- post op care (at home)
what are some causes of diverticulitis
weak pockets in colon under pressure
whats happening with diverticulitis
- marble sized protrusions
- tearing of diverticula = inflammation and or infection
how will the client present with diverticulitis
- perisistent pain
- LLQ pain
- N/V, abd tenderness and fever
- constipation and possible diarrhea
what are some labs and diagnostics for diverticulitis
- NO colonoscopy while inflamed
- UA
- CBC
- HCG or UA preg
- liver enzymes
- stool studies
- CT
what are some acute interventions for diverticulitis
- antibiotics, rest and liqs
- surgery (complications)
what are some complications of diverticulitis
- abscess
- blockage by scarring
- fistula
- peritonitis
what are some surgical interventions for diverticulitis
- drain
- bowel resection
- temp/perm colostomy
what are some meds that can help with diverticulitis
without complications:
- oral antibiotics
- liquids to solids
- acetminophen and OTCs
with complications:
- IV antibiotics (hospitalization)
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
name two inflammatory bowel diseases
crohns (regional enteritis but can affect colon)
ulcerative colitis (inflammation and ulceration of colon)
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
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
what are some causes of crohns
- immune system
- heredity
whats happening with crohns
- inflammation of small and large intestine
- affects all layers (transmural)
- inflammation = lack of absorption, perforation/infection
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)
what are some labs and diagnostics for crohns
- CT (cobblestone looking intestines)
- CBC
- stool studies
- EGD w biopsy
what are soe acute interventions for crohns
- bowel rest and NG
- bowel resection and possible temp colostomy
what are some complications of crohns
- bowel obstruction
- ulcers
- fistulas
- anal fissures
- malnutrition
- colon cancer
- extra intestinal issues
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
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
what are some causes of ulcerative colitis
- heredity
- autoimmune
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
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)
what are some labs and diagnostics for ulcerative colitis
- CBC/BMP
- stool testing
- abd xray/CT (definitive)
- sigmoidoscopy/colonoscopy (barium enema) later on
what are some acute inerventions for ulcerative colitis
- bowel resection (temp colostomy)
- antibiotics
- pain control
what are some complication of ulcerative colitis
- bleeding (may be sever)
- perforation)
- dehydrations
- extraintestinal
- colon CA
- megaclon
- blood clots
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)
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
