Lower Gastrointestinal Problems Flashcards
What is diarrhea?
Increased frequency of bowel movements (more than 3 per day)
What is the S&S of diarrhea?
- Increased frequency and fluid content of stools
- Lethargy, sunken eyeballs, Dry mucous membranes, ↓ output, concentrated urine, Fever, Malnutrition, Abdominal cramps, distention, Borborygmus, Painful spasmodic contractions of the anus, Tenesmus
What is the complications of diarrhea?
- Fluid and electrolyte imbalances
- Dehydration
- Cardiac dysrhythmias
What is fecal incontinence?
Involuntary passage of stool from the rectum
What is constipation?
What is the S&S of constipation?
Abnormal infrequency or irregularity of defecation; any variation from normal habits may be a problem
What is the complications of constipation?
Hypertension, Fecal impaction, Hemorrhoids, Fissures, Megacolon
What is acute abdominal pain?
- symptom of many different types of tissue injury and can arise from damage to abdominal or pelvic organs and blood vessels.
What is irritable bowel syndrome?
chronic functional disorder characterized by intermittent and recurrent abdominal pain associated with an alteration in bowel function (diarrhea or constipation or both)
What are the symptoms of IBS?
Abdominal distension, excessive flatulence, bloating, urge to defecate, urgency, sensation of incomplete evacuation
What is appendicitis?
appendix becomes inflamed and edematous as a result of becoming kinked or occluded by a fecalith
What is the S&S of appendicitis?
- Local tenderness is elicited at McBurney’s point
- Vague epigastric or periumbilical pain progresses to right lower quadrant pain and is usually accompanied by a low-grade fever and nausea and sometimes by vomiting
- major complication of appendicitis is perforation
What is the nursing management of appendicitis?
- Until seen by a health care provider pt is to be NPO to ensure that the stomach is empty in the event that surgery is needed.
- Local application of heat is not advised because it may cause the appendix to rupture.
- The patient should be observed for evidence of peritonitis.
- Surgery is usually performed as soon as a diagnosis is made.
What is peritonitis?
Inflammation of the peritoneum, the serous membrane lining the abdominal cavity and covering the viscera.
What are the causes of peritonitis?
bacterial infection, trauma, inflammation within body
What are the S&S of peritonitis?
- Location and extent of inflammation
- Diffuse pain becomes constant, more intense near site of inflammation, movement aggravates
- Abdomen becomes tender and distended, ascities
- Muscles become rigid
- Fever, tachycardia, tachypnea
- Rebound tenderness
- Nausea and vomiting
- Temperature and pulse rate increase
What is the assessment and diagnostic findings of peritonitis?
- Leukocyte count elevated
- Hemoglobin and hematocrit low (if blood loss)
- Altered electrolytes: K, Na, and Cl.
- Abdominal X-ray – distended bowel loops.
- CT may show abscess formation.
- Peritoneal aspiration culture and sensitivity.
What is the complications of peritonitis?
SEPSIS
- shock
- bowel obstruction or adhesions
- wound evisceration and abscess formation
What is the medical management of peritonitis?
- fluid, colloid, electrolyte replacement
- analgesics
- antiemetics
- massive antibiotic therapy
What is the nursing management of peritonitis?
- Continuous assessment of: Pain, Vital signs, GI function, Fluid and electrolyte imbalance
- Pain management
- Positioning for comfort (fetal position)
- I/O
- IV fluids
- Drains
What is gastroenteritis?
An inflammation of the mucosa of the stomach and the small intestine
What are the S&S of gastroenteritis?
nausea, vomiting, diarrhea, abdominal cramping, and distension, Fever, increased white blood cells (WBCs), and blood or mucus in the stool may be present.
What is the nursing management of gastroenteritis?
- I/O
- strict medical asepsis and infection control
- proper food handling and prep of food to prevent infections
What is the two inflammatory bowel diseases(IBD)?
- regional enteritis (Crohn’s disease)
- Ulcerative colitis
What is ulcerative colitis?
abnormal reactions of the immune system cause inflammation and ulcers on the inner lining of your large intestine.
What is the cause of ulcerative colitis?
Genetic, ? antigen response,? stress induced
What is the complications of ulcerative colitis?
hemorrhage/perforation, abscess formation, Toxic Megacolon (paralysis & dilation), obstruction, malabsorption, fistulas (between bowel & bladder), Cancer.
What is the management of ulcerative colitis?
- diarrhea: eliminate triggering foods
- medication: salicylate compounds corticosteroids, antidiarrheal;s, immunosuppressants
- diet:low fibre, avoid whole wheat, nuts fresh fruit/veggies
- rest- reduces intestinal activity
What is crohn’s disease?
nflammation of the GI tract, which extends from your stomach all the way down to your anus. Mostly in the distal ileum
What is the cause of crohn’s disease?
unknown
What is the S&S of crohn’s disease?
- Assessment reveals signs similar to appendicitis (tenderness, guarded movement, palpable mass RLQ periumbilical pain after BM).
- Bowel sounds reduced. High pitched or rushing sounds over areas of narrowed bowel loops.
- Most clients have diarrhea, abd pain, low grade fever.
- Steatorrhea (fatty diarrheal stools) common, wt loss.
What is the nursing management of crohn’s disease?
- diarrhea: eliminate triggering foods
- medication:
- diet: low fibre, avoid whole wheat, nuts fresh fruit/veggies
- rest- reduces intestinal activity
What are some age related considerations for IBD?
- older pt with UC, the distal colon is usually involved (proctitis).
- older pt with Crohn’s disease, the colon rather than the small intestine tends to be involved.
- less recurrence of Crohn’s disease in older patients treated with surgical resection.
- degree of inflammation associated with both conditions tends to be less in the older adult than in the younger patient.
What are the two intestinal obstructions?
- small bowel obstruction
- large bowel obstruction
What is the types of intestinal obstructions?
- mechanical
- non-mechanical
What is a mechanical obstruction in the intestine?
Intussusception, polypoid tumours and neoplasms, stenosis/strictures, adhesions, hernias, and abscesses.
What is a nonmechanical obstruction in the intestine?
- Intestinal musculature cannot propel the contents along the bowel.
- Results from neurovascular or vascular disorder
- Paralytic ileus most common
Other causes: Thoracic or lumbar spinal fractures, Acute pancreatitis, Appendicitis, Temporary – manipulation during surgery.
What is a small bowel obstruction?
Intestinal contents, fluids, and gas accumulate above the intestinal obstruction. Distension, pressure within the intestinal lumen increases, decrease in venous and arteriolar capillary pressures.
What is the S&S of a small bowel obstruction?
- Crampy pain – wavelike, colicky.
- Blood and mucus – no fecal matter, no flatus.
- Vomiting occurs.
- Complete obstruction - peristaltic waves, maybe go reverse direction (fecal vomiting).
-** Belching is not a good sign** - Intense thirst, malaise, aching, parched tongue, and mucous membranes.
- Distended abdomen
What is the assessment and diagnostic findings of a small bowel obstruction?
- Symptoms
- X-ray
- Labs – electrolytes, CBC, Dehydration, Loss of plasma volume, Possible infection
What is the medical management of a small bowel obstruction?
- NG – decompression of the bowel.
- Small bowel tube – decompression.
- Surgery: IV therapy, Hernia repair, adhesions, removal of affected part of bowel.
What is a large bowel obstruction?
Accumulation of intestinal contents, fluid, and gas proximal to the obstruction.
What is the S&S of a large bowel obstruction?
- Patient has crampy lower abdominal pain.
- Fecal vomiting develops
- Symptoms of shock may occur.
What is the nursing management of a large bowel obstruction?
- Non-surgical patient
- Maintain NG tube, Measuring output, Fluid electrolyte imbalance, Monitoring nutritional status (NPO), Assess improvement, Report discrepancies I/O, pain worsening, abdominal distension, increased nasogastric output. - Surgery – care similar to other abdominal surgeries.
What is the assessment and diagnostic findings of a large bowel obstruction?
- symptoms
- Abdominal X-ray studies (flat and upright)
- barium studies contraindicated because it would just sit in there and not go anywhere
What is the medical management of a large bowel obstruction?
- Restore intravascular volume, electrolyte imbalance
- Nasogastric aspiration
- Colonoscopy – untwist and decompress
- Cecostomy – surgical opening into the cecum – urgent relief of obstruction.
- Outlet for releasing gas, drainage.
- Surgical resection of obstructing lesion. (Hartman’s Procedure, Hemi-colectomy)
- Temporary/permanent colostomy
- Ileoanal anastomosis
How do you insert an NG tube?
- Measure the distance from the tip of the client’s nose to the earlobe and then to the xiphoid process
- tube just above the oropharynx, instruct the client to flex the head forward. Have the client take sips of water and swallow.
- Continue to advance the tube with swallowing until the tape or mark on the tube is reached.
- anchor the tube, verify tube placement
What is diverticular disease?
a condition that occurs when small pouches, or sacs, form and push outward through weak spots in the wall of your colon
What is diverticulitis?
infection and inflammation of diverticula
What is the S&S of diverticulitis?
Mild or severe pain in lower left quadrant, Nausea, Vomiting, Fever, Chills, Leukocytosis
What do you need to avoid for someone with diverticulitis?
nuts, popcorn hulls, sunflower seeds, pumpkin seeds, caraway seeds, flax seeds, sesame seeds
SEEDS
What is the nursing and collaborative management of diverticulitis?
- high-fibre diet and bulk laxatives, such as psyllium hydrophilic mucilloid (Metamucil).
- goal: rest colon and the inflammation reside
- NPO, antibiotic
What is a polyp of the colon and rectum?
benign growths (noncancerous tumors or neoplasms) involving the lining of the bowel
What are the two types of polyps?
- neoplastic
- nonneoplastic
What are the diagnostic tests for polyps?
history and digital rectal examination, barium enema stu
What electrolyte would you watch for a patient who has diarrhea, vomiting or an NG tube?
potassium
Why would we put an NG tube in a pt?
- obstruction
- no passage of stool
- no peristalsis
How do you know if peristalsis is going the wrong way?
belching, hiccups, vomiting
For a bowel related problem, why would the doctor order NPO?
- no bowel sounds
- give the belly a rest and promote healing
