intestinal/rectal disorders (final) Flashcards
what are causes of constipation
- blockages
- nerve
- muscular involvement
- hormonal imbalances
- certain meds
- ignoring the urge
what is happening with constipation?
-stool mpving too slowly
-stool unable to be evacuated
labs/tests for constipation
- blood tests
- colonoscopy/sigmoidoscopy
- colonic transit study
what are meds that help with constipation
otc laxatives, stimulants, stool softeners, enemas
prescription lubiprostone, linaclotide
complications of constipation
hemorrhoids
anal fissure
impaction
rectal prolapse
how can nurses help constipation
- diet and activity
- monitor med risk
- EDs
- sit with legs supported
causes of diarrhea
- virus/bacteria
- meds
- food intolerance
- surgery
- digestive disorders
what is the rapid transit of stool through the colon
diarrhea
labs/tests for diarrhea
- CBC
- stool test
- sigmoidoscopy/colonoscopy
meds that can help diarrhea
- antibiotics (parasitic)
- liquids!!!
- atropine/diphenoxylate
cuases of IBS
- strong/weak contractions
- nervous system
- inflammation
- infection
- changes in gut bacteria
how does a client with IBS present?
- abd pain/cramp
- diarrhea/constipation
- mucus shreds in stool
labs/tests for ibs
- stool tests
- lactose intolerance tests
- colonoscopy/sigmoidoscopy
meds for ibs
lubiprostone
linaclotide
complications of ibs
- colon cancer
- social isolation
how can nurses help ibs
- diet/lifestyle
- counseling/relaxation
- fluids/sleep
- avoid triggers
what are causes of appendicitis
- blockages in appendix
- kinked, occluded, tumor
what is heppening in appendicitis
- loss of blood supply
- infalmmation, ischemia, necrosis
- untreated = sepsis/death
what condition has symptoms of…
* periumbilical pain shifting to RLQ
* flu-like symptoms
* pain worse w/ movement
* bloating/flatulence
* aging population
appendicitis
labs/tests for appendicitis
- mcburney’s point (rebound tenderness RLQ)
- CBC
- abd CT
- HCG levels to r/o preg
what meds can help appendicitis
- prophylactic antibiotics
- narcotic pain meds/NSAIDs
what are causes of diverticulitis
- diverticula (holes)
- diverticulum (multiple holes)
- diverticulosis
- weak pockets in colon
what condition is…
* marble-sized protrusions
* tearing of diverticula
diverticulitis
diverticulitis has pain in the _____
LLQ
a client with _____ will present with persistent pain, LLQ pain, tenderness, n/v, constipation
diverticulitis
labs/tests for diverticulitis
* no colonoscopy while inflamed!!
* UA
* CBC
* HBG
* liver enzymes
* stool studies
what are complications of diverticulitis
- abscess
- blockage by scarring
- fistula
- peritonitis
surgical interventions for diverticulitis
- drain
- bowel resection
- temporary/permanent colostomy
meds that can help diverticulitis without complication
- oral antibiotics
- liquids to solids
- acetaminophen and OTC
meds that can help diverticulitis with complication
IV antibiotics (hospitalization)
how can nurses help diverticulitis
- educate on liquid nutrition
- pain control
- fluid promotion
- educate on bulk laxatives
- stool softeners
what are causes of chron’s
- immune system
- heredity
what condition has…
* inflammation of small/large intestine
* affects all layers (transmural)
* inflammation = lack of absorption
* inflammation = perforation/infection
chron’s
what quadrant is chron’s pain
- RLQ and distal ileum
what condition has…
* exacerbation/remission
* pain unrelieved by defecation
* chronic diarrhea
* anorexia/weight loss
* pain after meals
* blood/fat in stool
* extraintestinal manifestations (eyes, joints, skin)
chron’s
labs/tests for chron’s
- CT (cobblestone)
- CBC
- stool studies
- EGD with biopsy
acute interventions for chron’s
- bowel rest/NG
- bowel resection
- possible temporary colostomy
complications of chron’s
- bowel obstruction
- ulcers
- fistula/anal fissures
- malnutrition
- colon cancer
- extraintestinal issues
what meds can help chron’s
- anti-inflammatory (corticosteroids)
- immunosuppressants (methotrexate)
- aminosalicates
- TNF inhibitors (adalimumab)
- antibiotics
- pain reliever
what are causes of ulcerative colitis
- heredity
- autoimmune
what condition has…
* long-lasting inflamamtion
* multiple ulcerations
* desquamation
* ulcers to innermost colon
ulcerative colitis
what quadrant is ulcerative colitis pain
LLQ
what condition has a client presenting with…
* diarrhea
* abdominal pain
* rectal bleeding
* anorexia/weight loss/fatigue
* varies by person
ulcerative colitis
labs/tests for ulcerative colitis
- CBC/BMP
- stool tests
- abd x-ray
- sigmoid/colonoscopy
acute interventions for ulcerative colitis
- bowel resection
- temp. colostomy
- antibiotics
- pain control
complications of ulcerative colitis
- bleeding (may be severe)
- perforation
- dehydration
- extraintestinal
- colon CA
- megacolon
what meds can help ulcerative colitis
** no NSAIDs
** anti-inflamm (corticosteroids)
* TNF inhibitor
* aminosalicates
* antibiotc
* anti-diarrheal
how can nurses help ulcerative colitis
- discuss CA screening
- nutrition
- bowel rest
- pain control/ fluid intake
- prevent breakdown
causes of intestinal obstruction
- adhesions (after surgery)
- chron’s
- infected diverticula
- hernia
- colon CA
what is when…
* stool is unable to pass through GI
* content accumulates above onstruction = distention
* pressure leads to ischemia
intestinal obstruction
labs/tests for intestinal obstruction
- x-ray
- CT
- barium enema
acute interventions for intestinal obstruction
- bowel rest
- surgery
complications of intestinal obstruction
- bowel necrosis / rupture
* fecal emesis - infection -> sepsis
where do most bowel obstructions happen
small bowel
what kind of obstruction usually happens rapidly and resolves with NG rest and decompression
small bowel
what kind of obstruction is usually caused by adhesions and pain is usually around umbilicus or eipgastric pain
small bowel
what kind of obstructions usually happen over time
colon
what kind of obstruction is usually adenocarcinoid tumors, only sx may be constipation, and has a change in stool shape
colon
is there tenderness in colon obstruction
no
can fecal mass be palpated in colon obstruction?
yeah
describe the differences between ileostomy and colostomy
ileostomy
1. ileum cut and connected to opening made through abdominal wall
2. fluid is liquid/semi liquid
colsotomy
1. diseased/damaged aprt of colon removed, linked to opening made through abdominal wall
2. fluid is semisolid to solid
describe the outputs of ileostomy/colsotomy
ileostomy = 500ml-1L
colostomy = 200-300 ml
what makes up the common bile duct of the liver?
hepatic duct and cystic duct
what organ has functions of…
* gluc/protein/fat/drug metabolism
* ammonia conversion
* vitamin and iron storage
* bile formation
* bilirubin excretion
liver
which test…
* helps breakdown of protein
* process of turning food into energy
* in liver cells
ALT
which test…
* found in many body tissues (mostly liver, heart, kidney, brain, RBC
AST
which test…
* is a waste product of colon bacteria
* processed by liver into urea and glutamine
* can cross BBB if not disposed
* is toxic to the brain
ammonia
which test…
* is made when hgb is broken down
* is from the gallbladder
* is turned into bile
* jaundice
serum bilirubin
which test…
* is the msot abundant plasma protein
* holds fluid in bloostream
* carries hormones, vitamins, and enzymes
albumin
what are causes of hep A
- hepatitis A virus (HAV)
- contaminated food/water
- close contact with person/infected object
what is the process of hep A
- virus attacks liver cells
- often self-limiting, rarely chronic
is hep A symptomatic
no
if hep a symptoms are present at all, what are they?
- flu-like symptoms
- abd pain
- clay-colored stools
- jaundice
- pruritis
labs/tests for hep a
- LFTs (ALT/AST)
- Ct/ultrasound
- HAV antibodies
acute interventions for hep a
- rest
- hydration
what is the rare complication of hep a
acute liver failure
what meds can help hep a
antiemetics
how can nurses help hep a
- self-limiting
- rest/hydration/light diet
- discuss transmission / handwashing
- HAV vacc
- avoid alcohol and watch OTC meds
what are causes of hep b
- hep b virus (HBV)
- trasnmission from blood/semen/body fluid
- can be acute/chronic
what is heppening in hep b
virus attacks liver cells
s/sx of hep b
- takes 2 weeks - 1/4 months post transmission to manifest
- flu-like sx
- abd pain (RUQ)
- dark urine
- jaundice
- joint pain
labs/tests for hep b
- (AST/ALT)
- CT/ultrasound
- HBV antibodies
- liver biopsy
acute interventions for hep b
- rest
- nutrition
- antivirals
what are complications of hep b
- cirrhosis
- liver failure / CA
- kidney/vascular issues
- portal HTN -> esophageal varices
what meds can help hep b
- entecavir, tenofovir, lamivudine, adefovir, telbivudine
- interferon alfa-2b
how can nurses help hep b?
- vaccinate
- can fully recover
- discuss liver transplant options
- avoid alc/meds
- wear gloves
- discuss transmission orevention
what causes cirrhosis
- liver disases
- chronic obesity
- certain meds
what is…
* later stage scarring of liver, liver can’t regenerate more
* scar tissue to portal areas
* biliary duct obstruction
* heoatocytes to fat to scarred
cirrhosis
how will a cline with cirrhosis present?
- fatigue
- easy bleeding/ecchymosis
- nausea/anorexia
- edema to lower extremities
- weight loss
- jaundice
- late finding = GI varices and caput medusa
how can nurses help cirrhosis
- vitamin replacement
- assess for varices!!
- pain control
- educate of drinking cessation
- falls/bleeding risk
labs/tests for cirrhosis
- (ALT/inAST)
- INR, BMP
- MRI, CT, US
- biopsy
acute interventions for cirrhosis
- pain control
- nutrition replacement
- complication control
complications of cirrhosis
- portal HTN
- bleeding
- splenomegaly
- edema
- malnutrition
- hepatic encephalopathy
what are causes of esophageal varices
- serious liver diseases
- clot
- scar tissue
what results from…
* collateral circulation
* smaller vessels=too much work
* vessels enlarge = rupture
* life-threatening bleeding
* -portal HTN
esophageal varices
how will a client present with esophageal varices
- vomit large amnts of blood
- melena/coffee ground emesis
- anemia/weakness/dizziness
labs/tests for esophageal varices
- endoscopy
- CT
- doppler US
- CBC
- (ALT/AST)
acute interventions for esophageal varices
- blood transfusion/fluid replacmeent
- emergent suregry
- meds to slow bleeding/flow
- balloon tamponade
complications of esophageal varices
- hypovolemic/hemorrhagic shock
- death
meds that can help esophageal varices
- octreotide / vasopressin (constrict)
- beta-blockers (propanolol, nadolol)
how can nurses help esophageal varices
- NG tube / NPO
- blood transfusion
- reduce anxiety/enhance coping
- obesity management
- no unprotected sex/sharing needles
what stores bile
gallbladder
how much bile does the gallbladder hold?
30-50 ml
what emulsifies fats and contracts when food is in the duodenu,m
gallbladder
what are causes of cholecystitis
- gallstones
- acalculous
- bile duct problems
- tumor/infection
what is…
* inflammation of gallbladder
* blockage from excretion
* infection, perforation, rupture
cholecystitis
what quadrant is cholecystitis
RUQ
characteristics of _ are…
* pain to right shoulder
* pain afetr fatty meal
* n/v or anorexia
* fever
* dark urine / clay colored stool
cholecystitis
labs/tests for cholecystitis
ERCP (scope)
HIDA scan
CT
gallbladder US
CBC BMP LFT
acute interventions for cholecystitis
antibiotics
surgical removal
complications of cholecystitis
infection
perforation
sepsis/death
meds that can help cholecystitis
opioid pain relief
antibiotic
how can nurses help cholecystitis
- discuss danger of rapid weight loss
- maintian healthy weight
- monitor surgical site
causes of pancreatitis
- enzymes inactive while in pancreas
- alcohol/gallstones
- abd suregry/certain meds
- trauma
what is…
* pancreas inflammation
* unable to work properly
* eventual scarring
* acute/chronic
pancreatitis
s/sx of acute pancreatitis
- upper abd pain
- radiates to back
- pain worse after eating
- n/v, anorexia
s/sx of chronic pancreatitis
- upper abd pain
- losing weight
- oily, smelling stools
labs/tests for pancreatitis
- amylase/lipase
- stool tests
- CT/MRI
- abdominal US
- ERCP
acute interventions for pancreatitis
- fasting -> clear liquid -> low fat
- pain meds
- NSAIDs
- IV fluid
surgical interventions forpancreatitis
- ERCP
- surgery to remove tissue, drian fluid
- cholycystectomy (if stones)
what are complications of pancreatitis
- infection
- kidney failure
- breathing rpobs
- diabetes
- malnutrition
- pancreatic CA
meds that can help pancreatitis
- opioids
- pancreatic enzymes
how can nurses help pancreatitis
- pain control
- alc/drug cessation
- nutriotion
- discuss enzyme replacmeennt
- CA screening
- hydrate!
