Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MedSurg 2 > Intestinal Problems Student > Flashcards

Intestinal Problems Student Flashcards

1
Q

IBS

A

chronic abdominal pain or discomfort and alteration of bowel patterns

  • diarrhea or constipation
  • no known organic cause
  • psychologic stressors
  • GI infection; adverse reactions to food (dietary intolerances)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

IBS vs IBD

A

IBD = disease, destructive inflammation and permanent harm to the intestines, seen in diagnostic imaging, increased risk of colon cancer

IBS = syndrome (group of symptoms), does not cause inflammation, rarely requires hospitalization, no sign of disease or abnormality during exam of colon, no increased risk for colon cancer or IBD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

IBS: Dietary Intolerances

A

gluten

FODMAPs: fermentable oligo-, di-, and monosaccharides and polyols

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

IBS: Dx

A 
based solely on sx
Rome IV criteria:
- presence of abdominal pain and/or discomfort at least 1 day/wk for 3 months and associated w/:
-change in stool frequency
-change in stool form

look at:

  • health hx including psychosocial factors
  • family hx
  • drug hx
  • diet hx
  • impact on activities/life

r/o other disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

IBS: S/Sx

A

GI Sx:

  • abdominal pain
  • nausea
  • flatulence
  • mucus in stool
  • sensation of incomplete evacuation

Non GI Sx:

  • fatigue
  • HA
  • sleep problems
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

IBS: Tx

A

no single effective therapy

tx considerations:

  • psychological support (CBT, stress management)
  • dietary changes (FODMAP diet)
  • drug to regulate stool and reduce pain (opioid agonists, antispasmodics, antidepressants, antidiarrheals, or laxatives)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Diverticulosis and Diverticulitis

A

diverticula: saccular dilations or out-pouchings of the mucosa in the colon

common in older adults

diverticulosis: multiple, noninflamed diverticula
diverticulitis: one or more inflamed diverticus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Diverticulosis and Diverticulitis: Complications

A

perforation, abscess, fistula, bleeding, erosion of bowel wall, peritonitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Diverticulosis and Diverticulitis: Etiology and Pathophysiology

A
  • common in left (descending, sigmoid) colon
  • develop at weak points; blood vessels pass through muscle layer
  • cause: genetic and environmental factors
  • main factors: constipation and lack of dietary fiber
  • other factors: obesity, inactivity, smoking, excess alcohol use and NSAID use
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

D&D: S/Sx

A

Diverticulosis: mostly asymptomatic

  • abdominal pain, bloating, flatulence, changes in bowel habits
  • serious: bleeding or diverticulitis

Diverticulitis: acute pain in LLQ

  • distention, decreased or absent bowel sounds, n/v, systemic sx of infection
  • older adults: afrebrile, normal WBC, possible abdominal tenderness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

D&D: Dx

A

sigmoidoscopy or colonoscopy

preferred: CT scan w/ oral contrast
- occult blood
- CBC, urinalysis
- barium enema
- blood cultures
- abdominal x-ray or chest (to r/o other causes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

D&D: Intervention

A

prevention:

  • high fiber diet, decrease fat and red meat
  • physical activity

acute diverticulitis: goal = bowel rest to reduce inflammation

  • clear liquids, bed rest, analgesia
  • severe sx: systemic infection, comorbidities, hospitalization, NPO, NGT, bed rest, IV fluid and antibiotics, observe for signs of abscess, bleeding, and peritonitis; advance diet as tolerated.

reoccurring diverticulitis or complications:
-surgical resection w/ anastomosis or temporary colostomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

D&D: Pt Ed

A
  • explain condition and prescribed regimen
  • high fiber diet
  • fluids (at least 2 L/day)
  • avoid increased intraabdominal pressure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Intestinal Obstruction

A

contents can’t pass through intestines

can be:

  • small bowel (SBO) or large bowel (LBO)
  • partial (some contents can get through)
  • complete (total occlusion, needs surgery)
  • simple (intact blood supply)
  • strangulated (no blood supply)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Intestinal Obstruction: Types

A

Mechanical: physical

  • SBO: surgical adhesions, hernias, cancer, strictures from Crohn’s disease, intussusception
  • LBO: colorectal cancer, diverticular disease
  • other: adhesions, ischemia, vovulus, Crohn’s

Non-mechanical: reduced or absent peristalsis d/t altered neuromuscular parasympathetic innervation
-paralytic ileus: abdominal surgery, peritonitis, inflammatory disordes, electrolyte imbalances, thoracic, or lumbar spinal fractures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Intestinal Obstruction: Ischemia

A

inadequate blood flow to bowel

ischemia results in necrosis and perforation

blood flow stops, resulting in edema and cyanosis which results in gangrene (intestinal strangulation or infarction)

requires immediate tx to avoid infection, septic shock and death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Intestinal Obstruction: Location of Obstruction

A

location of obstruction determines fluid and electrolyte and acid-base imbalances

high (upper duodenum): decreased HCl acid results in metabolic alkalosis

small intestine: dehydration occurs quickly

large intestine (below proximal colon): solid fecal material accumulates causing discomfort

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Intestinal Obstruction: S/Sx

A

four hallmark:

  • abdominal pain
  • n/v
  • distention - LBO
  • constipation

order and degree depend on cause, location, and type of obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Intestinal Obstruction: Dx

A
  • imaging: abdominal x-rays, CT scan, contrast enema
  • sigmoidoscopy or colonoscopy
  • blood tests: CBC, blood chemistries
  • increased WBC-strangulation or perforation
  • increased Hct - hemoconcentration
  • decreased Hgb and Hct - bleeding
  • Serum electrolytes, BUN, creatinine - hydration
  • metabolic alkalosis - vomiting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Intestinal Obstruction: Tx

A

depends on cause

  • emergency surgery: strangulation or perforation
  • resection of obstructed segment w/ anastomosis
  • partial or total colectomy or ileostomy - obstruction or necrosis
  • colonoscopy: remove polyps, dilate strictures, laser destruction and removal of tumors

monitor I&O
NGT

postop surgery similar to laparotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Polyps of Large Intestine

A

colonic polyps: arise from mucosal surface and project into lumen

  • sessile: flat, broad-based, attached to wall
  • pedunculated: attached to wall by thin stalk
  • increase incidence with age; especially proximal colon
  • commonly asymptomatic (occult blood & bleeding)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Types of Polyps

A

hyperplastic: non-cancerous; less than 5mm
- no symptoms
- other benign: inflammatory, lipomas, juvenile

adenomatous: neoplastic
- removal decreases risk of cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Familial Adenomatous Polyposis (FAP)

A
  • autosomal dominant and recessive; DNA testing
  • colorectal screening at puberty and annually age 16

may have hundreds or thousands of polyps that will become cancerous by age 40

requires removal of colon and rectum by age 25 (proctocolectomy w/ IPAA or ileostomy)

risk for other cancer (lifetime surveillance required)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Polyps: Dx

A 
colonoscopy
sigmoidoscopy
barium enema
virtual colonoscopy (CT or MRI)
all polyps are abnormal and removed (polypectomy)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Colorectal Cancer

A

third leading cause of cancer related deaths

Hereditary Nonpolyposis Colorectal Cancer (HNPCC) or Lynch Syndrome:

  • autosomal dominant disorder
  • DNA testing available to detect gene mutations
  • increased risk of other organ cancers
  • need annual colonoscopy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

CRC: Risk Factors

A

no single risk factor
highest risk: first degree relatives w/ CRC and people with IBD
-family hx of CRC or familial adenomatous polyposis (FAP)
-hereditary form
-Abnormal KRAS gene (oncogene)

other: obesity, smoking, more than 7 servings red meat/wk, more than 4 alcohol drinks/wk, diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

CRC: S/Sx

A

sx do not usually appear until disease is in advanced stages

  • common: iron-deficiency anemia, rectal bleeding, abdominal pain, change in bowel habits
  • early: none or nonspecific; fatigue, weight loss
  • advanced: abdominal tenderness, palpable mass, hepatomegaly ascites
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

CRC: Dx

A

regular screening for polyps and cancer from ages 45-75 years of age by one of the following exams:

  • flexible sigmoidoscopy every 5 years
  • colonoscopy every 10 years
  • double-contrast barium enema every 5 years
  • CT colonography every 5 years

annual screening primarily for cancer

  • high sensitivity fecal occult blood test (FOBT) or
  • fecal immunochemical test (FIT): test for blood in the stool, must be done frequently to catch intermittent bleeding common with tumors

stool DNA every 3 years - DNA mutations

colonoscopy = gold standard

  • entire colon is examine; biopsy specimens
  • polyps removed and sent to lab
  • every 10 years starting at 45
  • every 5 years starting at 40 if higher risk (1º relative w/ CRC) or 10 years earlier than when youngest relative diagnosed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

CRC: Tx

A

correlates w/ pathologic staging of disease

surgery:

  • resect tumor
  • remove lymph nodes that drain that area

non-resectable tumors or metastasis:

  • surgery is palliative, relieves obstruction or controls bleeding
  • chemo and radiation, control the spread and provide pain relief
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Bowel Resection and Ostomy Surgery: Indications

A
  • remove cancer
  • repair perforation, fistula, or traumatic injury
  • relieve obstruction or stricture
  • treat an abscess, inflammatory disease (Diverticulitis) or hemorrhage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Types of Bowel Surgeries

A
  • total proctocolectomy with IPAA
  • proctocolectomy w/ permanent ileostomy
  • right or left hemicolectomy
  • anterior rectosigmoid resection
  • abdominal-perineal resection
  • low anterior resection
32
Q

Ostomy

A

surgically created opening (stoma) on the abdomen for fecal elimination

named for location ileum-ileostomy (involuntary drainage)
-may be temporary or permanent

33
Q

Permanent Ostomy: Traditional

A

End stoma:

  • distal bowel removed (permanent stoma)
  • distal bowel oversewn (possible reanastomosis and stoma closed)
Loop stoma (usually temporary):
- loop of bowel to abdominal surface; anterior wall opened for fecal diversion; distal opening to drain mucus; plastic rod in place 7 to 10 days

Double-barrel stoma:

  • bowel divided; two stomas created; both proximal and distal ends though abdominal wall
  • proximal: fecal diversion
  • distal: mucus fistula
  • usually temporary
34
Q

Bowel Resection and Ostomy Surgery: Complications

A

delayed wound healing
hemorrhage
fistulas
infection

normal ostomy: pink-red, mild swelling, small amount of blood

35
Q

Bowel Resection and Ostomy Surgery: Postoperative Care

A

Colostomy function:

  • record volume, color, consistency of drainage
  • excess gas common for 2 weeks (temporary)

Ileostomy function:

  • 24-48 hours - minmal
  • peristalsis returns - 1500-1800 ml/day
  • monitor fluid and electrolyte (Na+, K+) balance
  • bowels adapts and increases absorption - feces thickens and volume decreases to 500ml/day

IPAA:

  • 4-6 stools/day
  • adapt in 3-6 months
  • anal sphincter controls defecation

Anal canal:

  • transient incontinence of mucus
  • kegel exercise after 4 weeks
  • perianal skin care
  • phantom rectal pain
36
Q

Colostomy Care

A

diet: balanced w/ adequate fluids; avoid odor, gas, and diarrhea-producing foods

resume ADLs 4 to 6 weeks

empty when 1/3 full to prevent pulling and leaks

change failed pouch immediately

charcoal filters - deodorize and release flatus

37
Q

Ileostomy Care

A

secure pouching - stool is caustic to skin

best pouch = open ended and drainable

fluid intake = at least 2-3 L/day

  • teach about fluid and electrolyte imbalance; esp Na+
  • increased risk of obstruction: narrowed lumen
  • chew thoroughly; especially nuts, raisins, popcorn, coconut, mushrooms, olives, stringy vegetables, foods with skins, dried fruis, and meats with casings
38
Q

Diarrhea

A

passage of 3 or more loose stools/day

  • acute: 14 days or less
  • persistent: more than 14 days
  • chronic: more than 30 days

primary cause: infectious organisms alter intestines by

  • alter secretions and/or absorption of enterocytes in small intestines; no inflammation
  • impair absorption by destroying cells, causing inflammation in the colon, and producing toxins
39
Q

Diarrhea: RF

A
  • age (older adults more susceptible)
  • gastric acidity (proton pump inhibitors decrease stomach acid; organisms survive)
  • intestinal microflora (microbial barrier altered by antibiotics)
  • immune status (immunocompromised d/t disease or jejunal enteral feedings)
40
Q

Diarrhea: S/Sx

A

upper GI tract: large volume, water stools, cramping, periumbilical pain, preceding n/v, low grade or no fever

lower GI tract: small volume bloody diarrhea, fever

stool may contain leukocytes; blood, or mucus

severe diarrhea: dehydration (life-threatening), electrolyte imbalances (K+), and acid-base imbalances (metabolic acidosis)

41
Q

Diarrhea: Dx

A
  • stool cultures (blood, mucus, WBCs, infectious organisms)
  • Blood cultures (sepsis or immunocompromised)
  • WBCs
  • Anemia from iron and folate deficiencies
  • BUN, creatinine, electrolytes, pH, osmolality
  • stool fat, protein
  • GI hormones (polypeptide and gastrin may be elevated)
42
Q

Diarrhea: Tx

A

depends on cause

prevent transmission
replace fluid and electrolytes (oral or IV)
protect the skin

antidiarrheals (CI: prolonged exposure; IBD can result in toxic megacolon)

antibiotics: fluoroquinolone and azithromycin

43
Q

CDI

A

Clostridium difficile Infection
-health care associated infection

Tx: oral vancomycin or fidaxomicin for 10 days
-stop nonessential antibiotics, stool softeners, laxatives, and antidiarrheals

for recurrent: fecal microbiota transplantation (FMT)

  • donor feces administered via enema, nasoenteral tube or colonoscopy
  • concern = transmission of infection
44
Q

Gastroenteritis (Stomach Flu)

A

inflammation of mucosa of stomach and small intestine

features: sudden diarrhea, n/v, fever, abdominal cramping

common foodborne cause (norovirus)

Dx: lab tet for virus

Tx: self-limiting
(oral or IV fluids)

45
Q

Fecal Incontinence

A

involuntary passage of stool related to motor and/or sensory dysfunction

46
Q

Fecal Incontinence: Dx

A

rectal exam

anorectal: manometry, u/s, or electromyography

47
Q

Fecal Incontinence: Tx

A

depends on cause

  • bowel management program (regular defecation, high-fiber diet, increased fluids, elimination 30 min after breakfast)
  • if ineffective, administer bisacodyl, glycerin suppository, or small enema to stimulate anorectal reflex until pattern established. Digital stimulation, tap water irrigation.
  • fiber supplements
  • reduce irritating, diarrhea-producing foods
  • remove fecal impaction
  • antidiarrheal agents
  • mild electrical stimulation
  • dextranomer/hyaluronic gel (narrows anal canal)
  • surgery (sphincter repair or colostomy)
48
Q

Constipation

A
  • difficult or infrequent bowel movements
  • may require excessive exertion to defecate
  • feeling of incomplete evacuation
  • sx, not a disease
  • acute = less than 1 week
  • chronic = greater than 3 months
49
Q

Constipation: RF

A
  • low fiber diet
  • decreased physical activity
  • ignoring urge to defecate (prolonged retention desensitizes muscles and mucosa, stool dries as water absorbed > difficult to expel)
  • emotions, anxiety, depression
  • diseases that slow GI transit
  • drug-induced (opiods)
  • cathartic colon syndrome (chronic laxative use results in dilated, atonic colon)
50
Q

Constipation: S/Sx

A

discomfort
absent or hard, dry stools (difficult to pass)
abdominal distention, bloating, increased flatulence, increased rectal pressure
hemorrhoids
rectal mucosal ulcers; diverticulosis
-obstipation, fecal impaction, perforation

51
Q

Constipation: Dx

A
  • exam of abdomen, perianal, and rectal areas
  • sudden, persistent change in bowel habits (greater than 6 wks), rectal bleeding or bloody stool, anemia, weight loss, pain, personal or family hx of CR or IBD, and palpable mass
  • abdominal x-rays
  • barium enema
  • colonoscopy or sigmoidoscopy
  • anorectal manometry
  • GI transit studies
  • defecography
52
Q

Constipation: Tx

A 
increase dietary fiber, fluids, and exercise
laxatives
enemas
dietary fiber: vegetables, fruits, and grains
adequate fluid-2 L/day
probiotics
proper defecation position
provide privacy
53
Q

Peritonitis

A

inflammation of the peritoneum

causes:
- primary = blood-borne organisms
- secondary = perforation of organs that spill contents into peritoneal cavity

pathophysiology: initial chemical peritonitis progresses to bacterial causing fluid shifts and adhesion

54
Q

Peritonitis: S/Sx

A
  • abdominal pain - most common
  • universal sign = tenderness over area involved
  • rebound tenderness, muscular rigidity, and spasm -peritoneal irritation
  • other: abdominal distention, fever, tachycardia, n/v, altered bowel habits

complications: hypovolemic shock, sepsis, intraabdominal abscess, paralytic ileus

55
Q

Peritonitis: Dx

A 
H&P
CBC, electrolytes
Peritoneal aspiration
Abdominal x-ray, US, or CT scan
Peritoneoscopy
56
Q

Peritonitis: Interventions

A

preoperative/mild cases or poor surgical risk:
-NPO, NG suction, IV fluids, antibiotics, analgesia, antiemetics

surgery - locate source, drain purulent fluid, repair damaged organ

postoperative care: NPO, IV fluid, NG suction, blood, parenteral nutrition, antibiotics, sedatives, opioids, antiemetics

57
Q

Peritonitis: Nursing Implementation

A
  • IV access: fluids and antibiotics
  • Pain management: analgesia and positioning (knees flexed)
  • relieve anxiety; promote rest: sedative
  • monitor VS, I&O, O2
  • antiemetics for n/v
  • NPO; NG tube, if needed
  • drain care
58
Q

Fistulas

A

abnormal tract between two hollow organs or a hollow organ and the skin

  • complication: increased morbidity and mortality, extended length of stay, and increased costs
  • simple: 1 short direct tract
  • complex: multiple organs, abscess, open into base of wound
  • output: low less than 200 ml/day
  • moderate: 200-500 ml/day
  • high: greater than 500 ml/day

early signs = fever and abdominal pain

59
Q

Fistula: Nursing Management

A

Fistula management:

  • identify tract
  • maintain fluid and electrolytes (IV replacement)
  • control infection
  • protect surrounding skin: WOCN consult
  • manage output: monitor I&O drainage
  • nutritional support: dietician; high-calorie, high-protein enteral or parenteral nutrition

most heal spontaneously, some require surgery

60
Q

Hernias

A

protrusion of intestine through an opening or weakened area in the cavity wall
-most occur in abdomen

reducible - easy to return to abdominal cavity

irreducible or incarcerated - cannot be placed back into abdominal cavity; abdominal contents are trapped

  • strangulated: blood supply compromised
  • results in intestinal obstruction; gangrene and necrosis are concerns
61
Q

Types of Hernias

A

inguinal
umbilical
femoral
incisional

62
Q

Hernia: S/Sx

A
  • pain, increases w/ activities that increase intraabdominal pressure
  • may be visible
  • strangulated: severe pain, vomiting, cramping, abdominal pain, distention
63
Q

Hernia: Dx

A

H&P

imaging: u/s, CT, MRI

64
Q

Hernia: Tx

A
  • herniorrhaphy: surgical repair; laparoscopic
  • hernioplasty: reinforce weak area w/ wire, fascia or mesh
  • strangulated: emergency surgery; temporary colostomy
65
Q

Hernia: Postoperative Care

A
  • monitor voiding; I&O
  • scrotal edema - ice and elevation
  • encourage deep breathing
  • splinting
  • cough or sneeze w/ open mouth
  • no heavy lifting (greater than 10 pounds) 6 to 8 weeks
66
Q

Hemorrhoids

A

Dilated hemorrhoidal veins:

  • internal - above internal sphincter
  • external - outside external sphincter

Etiology and pathophysiology:

  • increased anal pressure and weakened connective tissue results in downward displacement, which results in dilation
  • RF: pregnancy, constipation, straining, diarrhea, heavy lifting, prolonged standing and sitting, obesity, and ascites
67
Q

Hemorrhoids: S/Sx

A

internal: bleeding w/ defecation; pain, prolapse (pressure, protruding mass)

external: reddish blue color; itching, burning, edema
- thrombosis: bluish-purple, palpable; pain and inflammation; bleeding w/ defecation

68
Q

Hemorrhoids: Dx

A

external: inspection and digital examination
internal: digital examination, anoscopy, sigmoidoscopy

69
Q

Hemorrhoids: Tx

A
  • high-fiber diet, increased fluids (prevent constipation and reduce straining)
  • ointments, creams, suppositories, impregnated pads, astringents, anesthetics, stool softeners

external: conservative unless thrombosed
internal: rubber band ligation, infrared coagulation, sclerotherapy, laser treatment

Hemorrhoidectomy: surgical excision
-done w/ prolapse or thrombosis

70
Q

Anorectal Abscess

A

perianal collection of pus d/t obstruction of anal glands results in infection which results in abscess

71
Q

Anorectal Abscess: S/Sx

A

local severe pain and swelling, foul-smelling drainage, tenderness, fever; sepsis

72
Q

Anorectal Abscess: Dx

A

rectal examination

73
Q

Anorectal Abscess: Tx

A

surgical drainage; antibiotics

74
Q

Anorectal Abscess: Nursing Care

A

moist heat, positioning, low-fiber diet

Education: wound care, perianal hygiene, follow-up care

75
Q

Anal Fistula

A

abnormal tunnel from anus or rectum to skin, vagina, or buttocks

  • precedes or d/t abscess or complication from Crohn’s disease
  • drainage; bloody, purulent, or fecal

Tx: surgery (fistulotomy), complex (ligation of the intersphincteric fistula tract (LIFT), fibrin glue injections

MedSurg 2 (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions