lewis ch 42 lower GI problems

Question 1

risk factors colorectal cancer (5)

Answer 1

• first degree relative with colorectal cancer
• age over 50 yo
• african american
• h/o IBD and/or polyps
• diet (high red meat intake, high alcohol/tobacco use, obesity)

Question 2

S+S colorectal cancer (4)

Answer 2

• prolonged change in bowel habits (N/V)
• weakness or fatigue
• unexplained weight loss
• abdominal/lower back pain

Question 3

what is important to consider when choosing an ostomy site (2)

Answer 3

• visible stoma

- flat surface

Question 4

how often should you assess stoma post-op

Answer 4

q4h

Question 5

what are expected findings post-op for stoma (3)

Answer 5

• rosy pink/red color
• mild-moderate edema
• small amount bleeding

Question 6

what does a dusky blue stoma mean

Answer 6

ischemia

Question 7

what does a brown-black stoma mean

Answer 7

necrosis

Question 8

when should you change pouch for ostomy (2)

Answer 8

• q3-7 days

- empty 1/3 full

Question 9

what can the LPN/LVN assist with for stoma (4)

Answer 9

• monitor ostomy content characteristics
• monitor peristomal skin for breakdown
• provide peristomal skin care
• irrigate colostomy in a stable patient

Question 10

what can the UAP assist with for stoma (3)

Answer 10

• empty ostomy bag and measure amount
• place ostomy pouching system on well-established ostomy
• assist stable patient with self-irrigation of colostomy

Question 11

S+S crohns disease (6)

Answer 11

• abdominal pain
• cramping
• diarrhea
• fever
• nutritional deficiencies
• weight loss

Question 12

S+S ulcerative colitis (4)

Answer 12

• severe constant abdominal pain
• diarrhea
• rectal bleeding
• tenesmus

Question 13

location of crohns disease

Answer 13

anywhere along GI tract (most common is distal ileum)

Question 14

location of ulcerative colitis

Answer 14

starts in rectum and spreads up the colon

Question 15

main concerns with fluid and electrolyte balance concerning crohns/ulcerative colitis (4)

Answer 15

• hypovolemia
• hypernatremia
• hyperkalemia
• metabolic acidosis

Question 16

teaching for patients with crohns/ulcerative colitis (6)

Answer 16

• importance of rest and diet management
• perianal care
• drug action and side effects
• symptoms of recurrence of disease
• when to seek medical care
• ways to reduce stress

Question 17

complications of ulcerative colitis (3)

Answer 17

• perforation
• peritonitis
• increased colon cancer risk after 10 years

Question 18

complications of crohns disease (5)

Answer 18

• fistula
• fissure and abscess
• perforation
• peritonitis
• nutritional deficiencies

Question 19

risk factors peritonitis (3)

Answer 19

• abdominal surgery
• ectopic pregnancy
• perforation (due to trauma, ulcer, appendix rupture, diverticulum)

Question 20

S+S peritonitis (8)

Answer 20

• fever
• N/V
• rebound tenderness
• boardlike abdomen
• decreased bowel sounds
• increased pulse and bp
• dehydration
• increased WBC

Question 21

nursing care for peritonitis (5)

Answer 21

• IV fluids and antibiotics
• semi-fowlers positioning
• NGT suction
• pain meds
• walk

Question 22

complications of peritonitis (2)

Answer 22

• sepsis

- hypovolemic shock

Question 23

S+S bowel obstruction (3)

Answer 23

• vomiting (with fecal odor)
• high pitched bowel sounds then silent
• abdominal distention

Question 24

nursing care for bowel obstruction (4)

Answer 24

• IV fluids
• monitor for metabolic acidosis, electrolyte imbalance, hypovolemia
• pain meds
• positional changes

Question 25

complications bowel obstruction (4)

Answer 25

• infection/septicemia
• bowel gangrene
• bowel perforation and peritonitis
• severe dehydration, hypovolemia