Lower GI Flashcards
Bowel obstruction: patho
Passage of intestinal material is impaired
- can be complete or partial
- strangulated = no blood supply
Bowel obstruction: non-mechanical cause
paralytic
inflammatory
electrolyte
interrupted blood supply
bowel obstruction: priority labs/diagnostics
Abdominal x-rays CT scan
Scope
CBC- metabolic profile
bowel obstruction: priority interventions
NPO NG IV fluids (LR) I&O Oral care Pre-post surgery care (possibility of stoma)
bowel obstruction: complications
Perforation Strangulated necrotic bowel Septic shock Ostomy Fatality
bowel obstruction: meds
pain- GI (H2 blockers, PPIs)- vasopressors
bowel obstruction: education
Bowel movements- go when you get the urge – schedule
Know symptoms of obstruction
Ostomy care –
Weeks for recovery
Small bowel obstruction: cause
Adhesions
Intussusception (more in infants, bowel folds back on self)
Volvulus
Paralytic ileus
Small bowel obstruction: assess
distention bowel sounds vomiting dehydration pain last BM
Small bowel obstruction: management
Decompression (NG)
Fluid replacement
Surgery
What might you expect will start happening in a client with BO?
eventually start vomiting fecal contents
Constipation: what?
less than 3 stools / week
Constipation: assess
abdominal distention
pain
cramp
don’t feel like they have emptied
Constipation: complications
Hemorrhoids (d/t pressure)
Anal fissures (d/t pressure)
Increase arterial blood pressure
Vagal stimulation (drop HR and BP, syncope)
Megacolon (colon stretches to compensate)
Constipation: treatment
Increase fluid intake Increase dietary fiber Exercise Laxatives- non stimulant first (softeners like colace) Enema last resort
What is considered diarhhea?
more than 3 stools per day or abnormally liquid stool
Diarrhea: cause
meds, metabolic disorders, infectious process, intestinal obstruction
Diarrhea: manifestations
Borborygmus, abdominal cramps, thirst, anorexia, tenesmus (ineffective straining)
Diarrhea: complications
Metabolic acidosis
Hypokalemia
Dehydrations
Diarrhea: elderly
Become dehydrated quick
Digoxin (watch for problems w digoxin because hypokalemia and dig toxicity and really common)
Appendicitis: assess
cough deep breathe sneeze- if no pain not appendicitis
- rebound tenderness
- BP. HR, RR- peritonitis with rupture
Appendicitis: complications
peritonitis
abcess
appendicitis: interventions
Prep for surgery NPO may need NG Bowel Sounds Post op care BP HR RR
Why are we not going to give someone who is constipated a laxative if they already have appendicitis?
may cause appendix to rupture
appendicitis: s/s
Sudden pain RLQ NV Loss of appetite Fever Constipation or diarrhea Abdominal bloating
Appendicitis: meds
analgesics
antiemetics
antibiotics
appendicitis: teaching
Discharge in 24 hours if no complications
Med teaching if on antibiotics
Signs of wound infection
Diverticular disease: patho
Sac-like herniation of the lining of the bowel extending through a defect in the muscle layer
What is diverticulitis vs diverticulosis?
Diverticulosis: outpouching
Diverticulitis: inflammation/infection of the outpouching
Diverticular disease: cause
Low fiber Constipation Obesity ETOH smoking
Diverticular disease: assessment
NV Pain LLQ (worsens w strain, lifting or cough) Flatulence Blood in stool signs of perforation
Acute diverticular disease: s/s
fever, chills, increase in pain
Diverticular disease: tests for acute phase
CT scan
Diverticular disease: tests for chronic
scope
Diverticular disease: tests
CBC
blood cultures
Diverticular disease: complications
perforation peritonitis sepsis fatality ostomy
Diverticular disease: interventions
NPO IV fluids I&O Post op care Advance diet
Diverticular disease: meds
Antibiotics (primarily metronidiazole), stool softeners, laxatives (bulk over stimulant)
Diverticular disease: education
prevention (don’t get constipated)
avoid fat and meats
increase fluids
avoid activity that increase intrabdominal pressure
Crohn’s and Ulcerative colitis: location
Crohn’s: mouth to anus
Ulcerative colitis: Rectum to cecum
Crohn’s and Ulcerative colitis: inflammation
Crohn’s: skilled pattern (cobblestone)
Ulcerative colitis: continuous
Crohn’s and Ulcerative colitis: complications
Crohn’s: abscess peritonitis, narrowed lumen scarring, ulcerative fistulas, small intestine cancer
Ulcerative colitis: Inflamed mucosa prevents absorption of electrolytes and water, Toxic megacolon, colorectal cancer
Crohn’s and ulcerative colitis: Diet
Crohn’s: high fruit, fiber
Ulcerative colitis: high intake vegetables
Crohn’s and ulcerative colitis: tests
C reactive protein WBC CBC stool metabolic profile CT MRI barium enema scopes
Crohn’s and ulcerative colitis: interventions
prep for testing weight assess fluid loss I & O NPO- acute phase IV fluids/electrolytes Nutritional needs Monitor Stools for consistency bowel sounds Hygiene
Crohn’s and ulcerative colitis: surgery
may eventually have all of colon removed
Ileostomy care –> initial output can be up to 1800 ml / 24 hours
Significant for maintaining hydration for client
Crohn’s and ulcerative colitis: education
hygiene high protein, calories, vitamins Stress reduction emotional needs Medication administration
Ileostomy
Creation of opening into ileum
Ileostomy: kock pouch
Continent ileal reservoir
Ileostomy: ileoanal anastomosis
Voluntary defecation is maintained
Ileostomy: nursing care
Stoma should be pink or red and moist Stoma will change sizes post op Drainage should begin in 72 hours Kock pouch will have a catheter for continuous drainage 1-3 weeks post op Fluid loss Skin care
Colorectal cancer: begins as what?
benign polyp
colorectal cancer: risk factors
age and family
colorectal cancer: monitor
monitor minor bowel changes
– blood in bowel / stools
What is a late indicator of colorectal cancer?
abdominal pain
What is an early indicator of colorectal cancer?
blood in stool
Colorectal cancer: CEA levels (cancer antigen levels)
indicate prognosis and should return to normal post tumor resection – if elevated, you have cancer
Colorectal cancer: complications
obstruction by the tumor
Hemorrhoids
Dilated veins in the anal canal
Related to shearing of the mucosa
Hemorrhoids: s/s
itching
pain
bright red bleeding with defication
hemorrhoids: treatment
increase fiber
good hygiene
light exercise
all of these will help improve peristalsis and avoid constipation
