Lower Gastrointestinal Problems Flashcards by Brina Quintanilla Reyes

What is diarrhea?
What is acute (days)
What is persistent (days)
What is chronic (days)

The passage of 3 loose or liquid stools per day
14 days or less
More than 14 days
More than 30 days

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Etiology and pathophysiology
The primary cause of diarrhea is ?
What is the most common?
E.coli caused what?
Giardia Lamblia causes what?
Clostridium difficult is ?

Infectious organisms
Viruses
Bloody diarrhea
Intestinal parasite
Hospital acquired

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How is the transmission of diarrhea? (2)

Contaminated food or water
Fecal to oral route

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Susceptibility of getting diarrhea?
(5)
Explain or example or each one

Age - older adults

Gastric acidicity
- proton pumps inhibitors decrease stomach acid and organisms survive

Intestinal micro flora
- microbial barrier altered by antibiotics
( c.diff infection - most serious )

Immune status
- immunocompromised due to disease or jenjuni enteral feedings

Laxatives, cealic disease, large amounts of carbohydrates

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Clinical manifestations of diarrhea in upper gI tract (6)

Large volume
Watery stools
Cramping
Periumbical pain
Nausea/ vomiting
Low grade or no fever

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Lower gi tract clninucal manifestations of diarrhea are (2)

Small volume
bloody diarrhea

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Can the stool contain leukocytes blood and mucus ? True or false

True

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Severe diarrhea manifestations are ? (3)

Dehydration ( life threatening )
Electrolyte imbalance ( K+)
Acid base imbalances ( metabolic acidosis )

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Clostridium difficle infections causes (2)

Colitis and intestinal perforation

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What are diagnostic studies we can for diarrhea? (7)

Stool cultures
- blood, muscus, wbc, infectious organisms

Blood cultures
- sepsis and immunocompromised

Wbc

Anemia
- iron and folate deficiency

Bun, creatinine, electrolytes, ph, osmolatoy

Stool fat, protein

Gi hormones

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C.diff can live up to how many days?
What type of precautions?
Prophylaxis or adjunct therapy of what?

70 days
Contact

Lactobacillus

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What’s the treatment of c.diff?
(2) and how long?
What’s the alternate?

Oral vancomycin or fidaxomicin for 10 days

Metronidazole

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If it c.diff recurring what is it called that we can do for them?

Which is?
How can it be given? (3)

Concern when doing is?

Fecal microbitota transplantation
Donor feces administered
Enema, nasoenteral tube, colonoscopy

Infection

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Nursing implentstion for diarrhea is? (6)

Consider all diarrhea infections until known
Meticulous hand hygiene
Flush vomit and stool in toilet
Teach and caregiver
- hygiene, PPE, proper food handling

Contact isolation
Disinfection 10% bleach or c.diff sporicidal

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Fecal incontinece is what?

Involuntary passage of stool related to motor or sensory dysfunction

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Diagnostic studies for fecal Incontience are? (3)

H&P( health & physical )
Rectal examination
Anorectal : manometry, ultrasound or electromyography

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What does encopresis mean?

Constipation with leakage

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Management of fecal incontience is? (8)
Examples of foods are (5)

Depends on the cause
- bowel movement program
- regular dedication high fiber
- increase fluids

fiber supplements
bulk forming laxatives
reduce irritating diarrhea producing foods

( coffee, sweets, diary producing, gas producing vegs ( beans ) & vegs with insoluble fiber )

Remove fecal impaction

Anti diarrheal angents

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Nursing assessment for fecal Incontience is? (6)

Previous and current bowel patterns
Bristol’s stool scale
Sensation or urgency to Defecate
Interference with daily activities, diet, family
Perineal irritation or breakdown
( Incontience associated dermatitis )

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Nursing implantation for fecal Incontience is that you are going to want to do these things
What program?
Maintain skin integrity how?

Bowel training program

Prompt cleaning, moisturizing; skin protecting

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Patient education on fecal Incontience is?

Reduce episodes
Coping strategies
Identify triggers

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What are characteristics of constipation? (3)

Difficulty or infrequent bowel movements

Excessive exertion

Feeling of incomplete evacuation

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Constipation is a what and not a ??

Symptom not a disease

Acute constipation?
Chronic constipation is?

Less than 1 week
More than 3 months

Risk factors of constipation are? (6)

Low fiber diet Decrease physical activity Ignore urge to defecate Emotions anxiety depression Conditions that slow transit Medications - opioids

What are symptoms of constipation ? (5)

Discomfit Hard, dry stools Abdominal distention Fecal impaction Perforation

Diagnostic studies for constipation are? (4)

Health and physical exams Abdominal perianal and rectal areas Bloody stools, anemia weight loss Abdominal X rays, barium enema, colosnocpy

What is diverticula? Common mainly in?

Saccular dilations or outpouching of the mucosa in the colon Older adults

What is diverticulosis? (2)

Multiple Noninflammated diverticula

What is diverticulitis?

One or more inflamed diverticula

Complications of diverticula is? (4)

Perforation Abscess Fistula Bleeding

Diverticula mainly happens where? Develops at weak points like? Main factors are (2) Other factors are ? (4)

Left descending sigmoid colon Blood vessels pass through muscle layer Constipation & dietary fiber Obesity; inactivity, smoking, ETOH, NSAID

Diverticulosis is mainly asymptotic But can show clinical manifestations of? (4) Serious would be? (2)

Abdominal pain Bloating Flatulence Changing in bowel habits Bleeding & diverticulitis

Diverticulitis manifestations are? (6) Older adults will have? (3)

Acute pain in LLQ Distention Decreased/absent bowel sounds Nausea Vomiting Systemic symptoms of infections Afebrile Normal WBC Possible abdominal tenders

Complications of diverticula are? (5)

Erosion of bowel wall Perforation Abscess Peritonitis Bleeding

What are diagnostic studies of diverticula? (8)

Sigmoidoscopy/colonoscopy CT scan Occult blood CBC urinalysis Barium enema Blood culture X ray

Prevention of diverticula is ? (2)

High fiber diet ( no fat or red meat ) Physical activity

Goal of acute diverticula is ? By having ? (3)

Bowel rest to reduce inflammation Clear liquid, bed rest and analgesic

If severe symptoms, systemic infection or comorbities happen you are going to want to do what for diverticula patients? (6)

NPO NGT BED REST IV FLUID& ANTIBIOTICS OBSERVE SIGNS OF ABSCESS,BLEEDING, PERITONITIS advance diet as tolerated

If diverticulitis is reoccurring you are going to want to do what? (2)

Surgical resection with anastomos Temporary colostomy

Patient eduction on diverticula is? (4)

Explain condition High fiber diet Fluids : 2 L a day Avoid increase intraabdominal pressure

What is a fistula?

Abnormal tract between two hollow organs or hollow organ and the skin

Fistula complication is?

Increase morbidity and mortality Extended. Length of stay and increase cost

Fistula simple is? Fistula complex is ?

1 short direct tract Multiple organs, abscess, opens into base of wound

Output of a fistula is ? Low Moderate Greater

200ml 200-500ml 500ml

Early signs of fistula are? (2)

Fever and abdominal pain

Nursing and Interprofessional & management of fistulas are? (7) Explain the last one Most heal sponganeoulsy but some require surgery ( notes )

Identify tract Maintain fluid’s&electrolytes Control infection protect the skin Manage I&O Nutritional support ( high calorie, protein )

What is a hernia ? Most occur in the ___ and who?

Protrusion of intestine through an opening or weakened area in the cavity wall Abdomen and men

Hernia reducible means Irreducible/incarcerated means?

Easily returns to abdominal cavity Cannot be placed back into abdominal/ trapped

When we have irreducible or incarcerated hernias, we can have 3 things happen

Strangulated - blood supply compromised intestinal obstruction - gangrene & necrosis

What are the 4 types of hernias?

Inguinal Umbilical Femoral Incisional

What are manifestations of a hernia? Can it be visible?

Pain ( increase with activities that increase intraabdominal pressure ) Yes

Strangulated manifestations of hernia are? (5)

Severe pain Vomiting Cramping Abdominal pain Distention

Diganosis of hernia is? Treatment?

History and physical exam Imagining - ct scan Surgery

Post operative care for hernia is? (6)

Monitor voiding & i&O Scrotal edema - ice and elevation Deep breathing Splitting Cough and sneeze mouth open No heavy lifting (6-8 weeks) No more than 10 pounds