Lower GI: Diverticulitis, Colon Cancer, PCA Flashcards
What is diverticulitis?
- Inflammation of diverticula (small pouches in the intestine)
- Usually occurs in descending colon
What is the path of diverticulitis?
- High intraluminal pressure causes diverticula to form in weak spots in the GI wall.
- Undigested food and bacteria accumulate in the diverticula, leading to inflammation
- If untreated, rupture can occur
What are the risk factors that can lead to diverticulitis?
- Low fiber diet
- Genetics
- Obestity
- Smoking/alcohol
- NSAIDs
- Corticosteroids
What are the s/s of diverticulitis?
- LLQ abdominal pain (descending, sigmoid colon)
- Bloating
- Fever
- N/V
What lab results would indicate diverticulitis?
- ↑ WBCs, ESR
* ↓ Hgb/Hct with bleeding
What dx tests would be ordered for diverticulitis?
- Barium enema
- Colonoscopy
- CT
- Lower GI series
What is the medication treatment for diverticulitis?
- Abx
* Analgesics
What complications need to be monitored for with diverticulitis?
- Perforation
- Peritonitis
- Bleeding
- Fistula
What is the pt teaching for diverticulitis?
- NP or clear liquid diet during exacerbations, then progress to low-fiber diet
- After immediate resolution, move to high-fiber diet
What surgical tx is available for diverticulitis if medication doesn’t work?
• Colectomy
True or False
The pt w/ diverticulitis is at increased risk for cancer.
• True
What lifestyle change can a patient do to help keep the bowel active?
• Exercise
What is used to help clean out the bowel with diverticulitis?
- GoLytely, a common laxative
* Mixed in 3L water and pt needs to drink whole thing
In general, good bacteria like what kind of food?
• Vegetables
In general, bad bacteria like what kind of food?
• Sugars and fats
What screening needs to be done for colon cancer?
- Guaiac test, annually
- Colonoscopy, every 10 yrs
- Sigmoidoscopy, every 5yrs
What are the risk factors for colon cancer?
- Older age
- High-fat diet (especially red meat)
- Genetics
- Smoking/alcohol
- Obesity
- Sedentary lifestyle
What labs and dx tests are done for colon cancer?
- Colonoscopy w/ biopsy (definitive)
- Positive Guaiac
- CT/MRI
What is the tx for colon cancer?
- Chemotherapy/Radiation
- Colon resection
- Colectomy w/ colostomy/ileostomy
Describe stage 1 of colon cancer.
• Cancer has grown through the mucosa layer of the colon/rectum but hasn’t spread beyond the colon/rectum wall
Describe stage 2 of colon cancer.
• Cancer has grown into or through the wall of the colon/rectum, but hasn’t spread to nearby lyph nodes
Describe stage 3 of colon cancer.
• Cancer has invaded nearby lymph nodes, but isn’t affective other parts of the body yet
Describe stage 4 of colon cancer.
• Cancer has metastasized to distant parts of the body
What occurs with a partial colectomy?
- The disease section of the colon is removed
* The cut ends are then re-attached to repair colon
What is a total colectomy?
• The entire colon is removed
What is the Abdominal Perineal Resection procedure?
- Done for distal colon cancer w/ large tumor
- Colon is cut and non-cancerous portion is diverted to abdominal wall colostomy
- Rest of colon and rectum is completely removed and anus is sealed
- A perineal drain is inserted to drain exudate
- No rectal temp may be taken again, as there is no rectum
What is a PCA and what is it used for?
- Patient Controlled Analgesia
* To control severe pain post-surgery
The physician’s order reads…
PCA infusion to administer: 5% Dextrose 100ml w/ 100mg morphine sulfate to infuse as follows: Loading dose: 2mg Maintenance dose: 1mg/hr PCA dosage: 0.5mg Lockout interval: 15 min
This client pushed PCA button every 30mins for your shift after given the loading dose at 9am. Client pushed the first button at 9:30am. How much did the client receive morphine for your 8am – 3pm shift?
Ans: 14
What must be done at setup of the PCA pump?
• Double check with another nurse
What must be assessed hourly for those on a PCA pump?
- Resp status
- Pain
- Mental status
- Adverse effects of morphine (itching, n/v)
