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Perioperative Nursing Exam #2 > Lower GI Disorders > Flashcards

Lower GI Disorders Flashcards

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0
Q

Define the word Syndrome

A

A Syndrome is a group of symptoms that occur together

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1
Q

Which nutrients are absorbed/digested in the following parts of the GI tract:

1) Stomach
2) Duodenom
3) Jejunum
4) Ileum
5) Colon

A

1) Stomach - Water and alcohol
2) Duodenom - Iron, calcium, fats and sugars
3) Jejunum - Sugars and proteins
4) Ileum - Bile salts, Vit B12 , and chloride
5) Colon - Water and electrolytes

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2
Q

What are the 7 Lower GI disorders dthat were discussed in class?

A

1) IBS
2) IBD
3) Diverticulosis
4) Peritonitis
5) Gastroenteritis
6) Obstruction
7) Colon cancer

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3
Q

What are the 5 SxS of IBS?

A

1) Diarrhea
2) Constipation
3) Alternating diarrhea and constipation
4) Abdominal distention and pain - this pain is sometimes started by eating and relieved by pooping.
5) Excessive flatulence

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4
Q

In addition to the 5 SxS of IBS, what 4 other signs are common in IBS patients?

A

1) Anxiety and panic disorder
2) Depression
3) PTSD
4) Abuse story

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5
Q

What is the Rome III Criteria?

A

Method used to diagnosed IBS. Since Dx of IBS includes confirmation of certain symptoms and ruling out of other disorders, the 3 following criteria must be present to have a definite Dx of IBS:

1) Abd pain and discomfort lasting at least 3 months
2) Starting at least 6 months ago
3) The pain must have two of the following characteristics:
a) Relieved by deification
b) Onset associated with change in fx of stool
c) Onset associated with change in stool appearance

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6
Q

What are the 4 symptoms that should not/are not associated with IBS that were discussed in class?

A

1) Anemia
2) Fever
3) Rectal bleeding
4) Weight loss

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7
Q

Which 8 Gas-producing foods should patients with IBS eliminate from their diet?

A

1) Brown beans
2) Brussels sprouts
3) Cabbage
4) Cauliflower
5) Raw onions
6) Grapes
7) Plums
8) Raisins

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8
Q

What are the 3 foods that an IBS patient should add to their diet?

A

1) Yogurt
2) Fiber
3) Probiotics

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9
Q

What are the 5 characteristics of Irritable Bowel Disease (IBD)?

A

1) Characterized by chronic, recurrent inflammation of the intestinal tract
2) There are periods of remission and exacerbation
3) Cause is unknown
4) There is no cure - Tx relies on meds to treat inflammation and maintain remission
5) There are two types: Ulcerative colitis and Crohn’s disease

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10
Q

(T/F) The presence of Ulcerative Colitis is highest in Caucasians and people of Jewish heritage.

A

True

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11
Q

What are the 7 characteristics of Ulcerative Colitis?

A

1) Inflammation spreads from rectum and ascends up the colon
2) Inflammation and ulcerative occur in the mucousa and submucousa
3) Inflammation of the colon can occlude bowel
4) Abcesses may develop and break through the mucousa, leaving ulcerations
5) Ulcerations destroy epithelium, causing b,ending and possible perforation
6) Scar tissue develops making it hard to absorb nutrients in that area
Occurs in the teens and 20’s with recurrence in the 50’s

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12
Q

What are the 9 clinical manifestations of Ulcerative Colitis?

A

1) Anorexia
2) Diarrhea (may contain blood and fat)
3) Fatigue/Malaise
4) Abdominal tenderness/cramping
5) Weight loss
6) Fever
7) Dehydration and electrolyte imbalance
8) Anemia
9) Vit K deficiency
10) Passage of 10-20 liquid stools per day

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13
Q

What kind of diet would you instruct your patient to eat who has Ulcerative Colitis?

A

A diet including low-residue (low-fiber), high-protein, vitamins, iron and supplements.

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14
Q

What are the 5 characteristics of Crohn’s Disease?

A

1) Chronic inflammatory Bowen disorder with “skip Lesions”, meaning their are segments of normal bowel between diseased portions.
2) Most often seen in the Ileum
3) Can affect any part of the GI tract from the mouth to the anus
4) Inflammation involves all layers of the bowel wall
5) There is narrowing of the omen with stricture development which can lead to an obstruction
6) There may be microscopic leaks of bowel contents

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15
Q

What are the 8 clinical manifestations of Crohn Disease?

A

1) Anorexia, N&V
2) Diarrhea (may contain pus and mucous)
3) Cramp-like colicky pain after meals
4) Abdominal distention
5) Weight loss
6) Fever
7) Dehydration
8) Anemia

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16
Q

Which 8 methods are usually involved in the Diagnostic study of IBD?

A

1) H & P
2) Ruling out other diseases
3) Differentiating between Ulcerative Colitis and Crohn’s Disease
4) Blood studies: CBC, serum electrolyte levels, and serum protein levels
5) Stool Cultures: Pus, blood, mucous
6) Sigmoidoscopy and colonoscopy (large intestine) - taking biopsy specimens
7) Double-Contrast barium enema (Air and barium) - looking for granular inflammation
8) Capsule Endoscopy (small intestine) - no biopsy taken, used for Crohn’s disease.

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17
Q

What are the 5 methods used to treat IBD?

A

1) Resting the bowel
2) Control inflammation
3) Combat infections
4) Correct malnutrition
5) Alleviate stress

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18
Q

What are the 5 types of drugs used to treat IBD?

A

1) Aminsalicylates (5-A-S-A) - topical
2) Antimicrobials - Flagyl and Cipro
3) Corticosteroids
4) Immunosupressants
5) Immunomodulaters

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19
Q

What are the 2 appropriate teachings for patients taking Aminsalicylates (5-A-S-A) for treatment of IBD?

A

1) Avoid sunlight

2) Avoid OTC NSAIDs

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21
Q

What are the 4 characteristics of the Aminsalicylates (5-A-S-A) used to treat IBD?

A

1) They are the main drugs used to treat IBD
2) ⬇ GI inflammation
3) Effective in achieving and maintaining remission
4) Used for mild to moderately severe attacks

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22
Q

What are the 3 drugs included in Aminsalicylates (5-A-S-A) class and used for the treatment of IBD?

A

1) Sulfasalazine (AAzulfidine)
2) Mesalamine (Asacol, Pentasa, Canasa)
3) Olsalazine (Dipentum)

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23
Q

What are the 3 types of Antimicrobials used to prevent or treat secondary infections associated with IBD?

A

1) Metronidazole (Flagyl)
2) Ciprofloxacin (Cipro)
3) Clarithromycin (Biaxin)

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24
Q

What are the 3 Side Effects of the Antimicrobials used to treat IBD?

A

1) Depressed Appetite
2) N&V
3) Suppressed absorption of nutrients

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25
Q

What are the 3 appropriate teachings for patients taking Antimicrobials for treatment of IBD?

A

1) Avoid sunlight
2) Avoid dairy products, antacids or iron preparations because they reduce the effectiveness
3) Take 1 hour before or 2 hours after meals

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26
Q

What are the 3 characteristics of the Corticosteroids used to treat IBD?

A

1) ⬇ Inflammation
2) Used to achieve remission but cannot maintain remission
3) Helpful for acute flare ups

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27
Q

What are the 6 types of Corticosteroids used to treat IBD?

A

1) Prednisone
2) Entocort
3) Methyprednisone
4) Hydrocortisone
5) Corifoam
6) Cortenema

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28
Q

What are the 3 side effects of the Corticosteroids used to treat IBD?

A

1) ⬇ effect of Anticoagulants
2) ⬇ effect of Anticonvulsants
3) ⬇ effect of Antidiabetics

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29
Q

What are the 4 appropriate teachings for patients taking Corticosteroids for treatment of IBD?

A

1) Potassium and blood sugar must be assessed
2) I&O and daily weights must be monitored
3) Meds must be taken with food or milk
4) Do not discontinue corticosteroids abruptly

30
Q

What are the 4 Side Effects of the Aminsalicylates (5-A-S-A) used to treat IBD?

A

1) N & V
2) Diarrhea
3) Anemia
4) ⬆ Anticoagulant effects

31
Q

What are the 3 types of Immunosuppressant drugs used in the treatment on IBD?

A

1) Azathiopine (Imuran)
2) 6-Mercaptopurine (6-MP)
3) Cyclosporine

32
Q

What are the 4 characteristics of the Immunosuppressants used to treat IBD?

A

1) Supresses the immune system
2) They are most useful to those who do not respond to Aminosalicylates, Antimicrobials and Corticosteroids.
3) Take 3-6 months for effectiveness
4) Requires regular CBC monitoring

33
Q

What are the four side effects of the Immunosuppressants used to treat IBD?

A

1) N&V
2) Bleeding
3) Fever
4) Infection

34
Q

What are the 3 characteristics of the Immunomodulater drug Infliximab (Remicade) used to treat IBD?

A

1) Inhibits tumor necrosis factor
2) Induce and maintains remission
3) Given via IV to induce and maintain remission in PTs with active Crohn’s Disease or have a draining fistula

35
Q

What are the 3 things you should monitor for a patient taking the Immunomodulater drug Infliximab (Remicade) used to treat IBD?

A

1) Secondary infection
2) CBC
3) Liver enzymes

36
Q

What is the prognosis for patients with Crohn’s Disease and Ulcerative Colitis in regard to surgery?

A

1) Crohn’s - 75% eventually require surgery (produces remission, recurrence rates are high)
2) Ulcerative - 25-40% require surgery (can be curative)

37
Q

What are the 5 indications for surgery in patients with IBD?

A

1) Failure to respond to Tx
2) Frequent/debilitating exacerbations
3) Massive bleeding or obstruction
4) Development of Dysplasia or carcinoma
5) Perforation

38
Q

Define Diverticulum. What are the 3 characteristics associated with Diveticulosis?

A
  • Diverticulum: A dilation or out-pouching of the mucousa through the circular smooth muscle of the intestinal wall. 3 characteristics of Diverticulosis are:
    1) Can occur anywhere in the GI tract, but most common in sigmoid colon
    2) Often occurs d/t ⬇ fiber intake and ⬇ muscle mass caused by age
    3) Common in both sexes over 45 yrs old
39
Q

What is Diverticulitis?

A

An infection of the the diverticular sacs

40
Q

What are the 8 SxS of Diverticular disease?

A

1) Alteration in bowel habits
2) Localized pain (often in the LLQ)
3) Rectal bleeding
4) Mucous in stool
5) Bloating
6) Flatulence
7) Fever
8) ⬆ WBC

41
Q

Which 7 methods can be used to Dx Diverticular disease?

A

1) CBC
2) Urinalysis
3) X-ray
4) U/S
5) CT scan
6) Barium enema
7) Colonoscopy to r/o polyps

42
Q

During the chronic phases of Diverticular disease, what 3 methods are used for treatment?

A

1) High fiber diet
2) ⬇ Red meat
3) ⬆ Physical activity

43
Q

During the Acute phases of Diverticular disease, what 4 methods are used for treatment?

A

1) Allow colon to rest
2) NPO then progress from clear fluids to regular diet
3) Antibiotics
4) Monitor WBC and electrolytes

44
Q

What are the 7 SxS of Peritonitis?

A

1) Pain - Includes, tenderness, rebound tenderness, muscular rigidity, and spasms.
2) Shallow respirations d/t pain
3) Abdominal distention d/t ascites
4) Fever
5) N&V
6) Tachycardia and Tachypnea
7) Absence of bowel sounds

45
Q

Which 5 methods are used to Dx Peritonitis?

A

1) CBC, ⬆ WBC
2) Peritoneal aspiration
3) Abd X-ray
4) Ultrasound/CT
5) Peritoneoscopy

46
Q

What are the complications that can result from Peritonitis?

A

1) Hypovolemic Shock - Fluid not in vascular space
2) Sepsis
3) Intra-abdominal abscess
4) Paralytic Ileus - Because the GI stops working
5) Acute RDS - Because fluid affects the ability of the lungs to contract and expand

47
Q

What are the 4 non-surgical and 2 surgical means of treatment used for Peritonitis?

A

1) Non-Surgical - Antibiotics, NG suction/NPO, Analgesics, IV fluids
2) Surgical - Drain fluid, repair perforation

48
Q

What is the difference between a mechanical and a non-mechanical obstruction?

A

1) Mechanical Obstruction - Physical blockage caused by things like Tumors, adhesions, volvulus, Intussusception and hernias.
2) Non-Mechanical Obstruction - Stoppage caused by things like neuromuscular or vascular disorders.

49
Q

What are the 2 SxS of a high obstruction in the small intestine?

A

1) Rapid onset of N&V and pain

2) Bile stained projectile vomiting

50
Q

What are the 3 SxS of a distal obstruction in the small intestine?

A

1) Gradual onset of N&V, and rapid onset of pain
2) Orange/brown vomitus
3) Foul smelling feces d/t bacterial overgrowth

51
Q

What are the 2 SxS of obstruction in the large intestine?

A

1) Gradual pain, vomiting is rare d/t absorption in the small intestine
2) Constipation

52
Q

Which 7 methods are used to Dx Intestinal Obstruction?

A

1) X-ray
2) Barium Enema - Not used if perforation is suspected
3) Lower GI and Upper GI
4) Sigmoidoscopy & Colonoscopy
5) Ct Scan
6) CBC
7) Stool test for occult blood

53
Q

What are the 6 treatments used for Intestinal Obstruction?

A

1) Bowel rest
2) NPO
3) NG Tube
4) IV Fluids
5) Analgesics
6) Surgery - Only if there is no improvement after 24-48 hours

54
Q

What are the 4 types of surgery used to treat an Intestinal Obstruction?

A

1) Resecting
2) Partial or total colectomy
3) Colostomy
4) Ileostomy

55
Q

Which non-surgical method can be used to treat an Intestinal Obstruction?

A

Colonoscopy - Can be used to remove polyps, dilate strictures, and remove or destroy tumors with lasers

56
Q

What are the 6 risk factor for developing Colon Cancer?

A

1) Increased age
2) Family Hx
3) Obesity
4) Smoking
5) Alcohol
6) High red meat consumption

57
Q

What are the 7 symptoms of Colon Cancer?

A

1) Rectal bleeding
2) Change in bowel habits
3) Abdominal pain
4) Intestinal obstruction
5) Narrow, ribbon-like stool
6) Sensation of incomplete evacuation
7) Iron-deficiency anemia

58
Q

Which 4 methods are used to Dx Colon Cancer?

A

1) Regular screening
2) Colonoscopy (best method)
3) Sigmoidoscopy
4) Stool test for occult blood

59
Q

Which 3 surgeries are used to treat Colon Cancer?

A

1) Polypectomy - Done during colonoscopy
2) Resection
3) Hemicolectomy

60
Q

What are the 4 complications that can result from Appendicitis?

A

1) Perforation
2) Peritonitis
3) Abscess
4) Sepsis

61
Q

What are the 5 SxS of Appendicitis?

A

1) Pain in umbilical area radiating to RLQ (McBurney’s Point)
2) Rosving’s Sign - Pain felt in RLQ when palpating in LLQ
3) Rebound tenderness and Abd rigidity
4) Fever with elevated WBCs
5) Side-laying position, legs flexed and guarding abdomen

62
Q

Which 3 methods are used to Dx Appendicitis?

A

1) WBCs
2) Ultrasound
3) CT Scan

63
Q

(T/F) During acute appendicitis, ice may be applied to the RLQ for pain but heat should not be applied. Why or why not?

A

True - Heat may cause rupture

64
Q

What is Choleccystitis? What is the difference between the acute form and the chronic form?

A

1) Acute Choleccystitis (Cholelithiasis) - Caused by gallstones
2) Chronic Choleccystitis - Caused by insufficient bile emptying and contraction of the bladder.

65
Q

What are the 5 SxS of Cholecystitis?

A

1) N&V
2) Indigestion, belching and flatulence
3) Epigastric pain radiating to the scapula which occurs after eating fatty foods
4) Pain in the RUQ
5) Guarding, rigidity, and rebound tenderness

66
Q

Which 6 lab results will be elevated during Cholecystitis?

A

1) WBC
2) Billirubin
3) Alkaline phosphate
4) ALT
5) AST
6) Serum Amylase (if pancreatic involvement)

67
Q

What are the 3 treatments used for Cholecystitis?

A

1) Cholecystectomy - Removal of the gallbladder
2) Choledocholithotomy - Incision into the common bile duct to remove gallstones.
3) Ice pack to RLQ which ⬇ blood flow

68
Q

Borborygmus Vs. Tenesmus

A

1) Borborygmus - The intestinal rumbling that accompanies diarrhea
2) Tenesmus - The urge to poop (straining) but can’t

69
Q

Volvulus Vs. Neoplasms

A

1) Volvulus - Bowel obstruction where the loop of a bowel has completely twisted around its site of messenteric attachment
2) Neoplasms - An abnormal mass of tissue resulting from an abnormal growth or division of cells

70
Q

What is the most common cause of small bowel obstruction?

A

Adhesions

Perioperative Nursing Exam #2 (8 decks)

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