Lower GI Disorders

Question 1

Pre-operative care for a patient with an Appendicitis?

Answer 1

• Administer IV fluid and analgesia
• Prevent complications
  
  • Keep NPO
  • Monitor VS
  • Antiemetics

Question 2

Care for Appendicitis?

Answer 2

• Keep NPO
• Administer IV fluid as prescribed
• Prepare patient for OR
  
  • Informed consent
• Provide comfort measures
• Position patient supine with HOB elevated
• Advance diet as tolerated after surgery

Question 3

What are some ways to diagnose for a patient with Gastroenteritis?

Answer 3

Stool culture (fecal leukocytes)

Question 4

Care for Gastroenteritis?

Answer 4

• Infection prevention
  
  • Hand hygiene, proper PPE if indicated
• Administer IV fluids
• Give clear liquids
• Allow uninterrupted rest periods
• Venous thromboembolism prophylaxis
• Meticulous perineal care
• Frequent oral care

Question 5

What are different types of IBD (Inflammatory Bowel Disease)?

Answer 5

• Crohn’s Disease
• Ulcerative Disease

Question 6

Initial treatment for Crohn’s disease?

Answer 6

• Biologic therapy
• Corticosteroid

Question 7

Therapeutic treatment for a patient with Crohn’s disease?

Answer 7

• W/ acute exacerbation, NPO; then encourage smaller frequent meals
• Encourage mealtime with family
• Encourage periods of rest
• Establish therapeutic relationship
• Pain management
• Provide meticulous skin care; safety
• Post-operative care

Question 8

Why do patients with IBD have nutrition problems?

Answer 8

• Decreased oral intake
  
  • Inflammatory mediators reduce appetite
  • Try to reduce diarrhea
• Blood loss
  
  • Iron-deficiency anemia and zinc deficiency; need oral supplements; parenteral nutrition
• Impaired absorption
  
  • Depends on location of inflammation
  • Bile acids

Question 9

Foods to avoid for IBD?

Answer 9

• spicy meats
• raw fruits/vegetables
• brown rice
• fatty/fried foods

Question 10

Drug therapy to help nutrition problems in patients with IBD?

Answer 10

• Sulfasalazine or methotrexate (MTX)
  
  • Daily folic acid supplements to prevent deficiency
• Corticosteroids
  
  • Calcium supplements to prevent osteoporosis
  • Potassium supplements

Question 11

Nutrition therapy during acute exacerbations?

Answer 11

• Regular diet may not be tolerated
• Liquid enteral feedings are preferred
  
  • High in calories and nutrients
  • Lactose free
  • Easily absorbed
  • Help achieve remission and improve nutrition
• Regular foods are reintroduced gradually
  
  • Keep a diary to help identify foods to avoid

Question 12

What are different types of Intestinal Obstructions?

Answer 12

• Small bowel (SBO) or large bowel (LBO)
• Partial—some contents get through
• Complete—total occlusion; surgery
• Simple—intact blood supply
• Strangulated—no blood supply

just know that SBO is an intestinal obstruction

Question 13

Treatment for Intestinal Obstruction?

Answer 13

• Treatment goal – regain intestinal patency
• Treatment depends on cause
  
  • Emergency surgery—strangulation or perforation
  • Resection of obstructed segment with anastomosis
  • Partial or total colectomy or ileostomy—obstruction or necrosis
  • Colonoscopy—remove polyps, dilate strictures, laser destruction and removal of tumors

Question 14

Care for Intestinal Obstruction?

Answer 14

• Maintain NPO
• Frequent mouth care
• Accurate output documentation
• Pain management
• Pre/Post-operative care