Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Care of Adult/Older Exam #3 (5701) > Lower GI Problems > Flashcards

Lower GI Problems Flashcards

1
Q

Appendicitis is commonly caused by?

A

Obstruction of the lumen by feces, foreign bodies, tumor of the cecum or appendix, thickening of lymphoid tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Appendicitis can lead to?

A

Abscess
Gangrene
Perforation
Peritonitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Appendicitis S/S

A
  • Difficult to diagnose
  • Pre-umbilical pain
  • anorexia
  • N/V
  • Pain is continuous and shifts to right lower quad and localizes at McBurney’s point
  • Localized tenderness
  • rebound tenderness
  • muscle guarding
  • pain worsens with coughing, sneezing, and deep breathing
  • Wants to lay still-right leg flexed
  • May have fever
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Older Adults S/S of Appendicitis?

A
  • Discomfort –R iliac fossa
  • Pain is less severe
  • Slight fever
  • Diagnosis often delayed
    • Higher incidence of ruptured appendix and peritonitis
    • Higher fatality due to co-morbidities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Appendicitis Diagnostics

A
  • WBC-mildly to moderately elevated
  • Urinalysis-r/o GU problems
  • US
  • CT preferred
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Treatment of Appendicitis?

A
  • Immediate-Urgent Appendectomy
  • NPO
  • Treat pain
    • ice pack & medications
  • Antibiotics & IVF before surgery and after
    • 6-8 hours before OR if possible – prevent sepsis and dehydration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Preferred diagnostic procedure for appendicitis?

A

CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Patient Teaching for Appendicitis?

A
  • Patients with suspected appendicitis should NOT use laxatives or enemas
    , or apply heat to the painful area
  • Can result in perforation or rupture of appendix
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Post Op Nursing Interventions

A
  • Watch for peritonitis (can occur with or without perforation)
  • Ambulate day of surgery
  • Assess incision
  • Advance diet as tolerated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Localized or generalized inflammatory process of the peritoneum

A

Peritonitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Causes for Primary Peritonitis?

A
  • blood-borne organisms
  • genital tract organisms
  • cirrhosis with ascites
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Causes for Secondary Peritonitis?

A
  • Peritoneal dialysis-HIGH risk;
  • ruptured appendix
  • diverticulitis rupture
  • ischemic bowel
  • pancreatitis
  • perforated peptic ulcer
  • gun shot or knife wounds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Pathophysiology – organ ruptures, spills contents; chemical peritonitis initially followed by bacterial peritonitis in?

A

6 -8 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

S/S of Peritonitis

A
  • Abdominal pain
  • rebound tenderness
  • Pt lies still with shallow respirations
  • spasm
  • Abdominal distension or ascites
  • fever
  • tachycardia
  • tachypnea
  • N/V
  • altered bowels habits
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Complications of Peritonitis?

A
  • Hypovolemic shock
  • sepsis
  • intra-abdominal abscess
  • paralytic ileus
  • respiratory distress
  • Can be fatal if not treated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Peritonitis Diagnostics

A
  • CBC-elevated WBC count
  • Abdominal Xray
  • Ultrasound
  • CT scan
  • Paracentesis (peritoneal aspiration)
  • Peritoneoscopy
  • Cell count of peritoneal dialysis drainage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What does it indicate if a patient with suspected Peritonitis has an ABD x-ray showing free air?

A

perforation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What does it indicate if a patient with suspected Peritonitis has an ABD x-ray showing dilated loops?

A

parylytic ileus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What does it indicate if a patient with suspected Peritonitis has an ABD x-ray showing air and fluid?

A

obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Treatment of Peritonitis?

A
  • Treat the cause
  • Surgery to correct inflammation and drain purulent fluid
  • Medical
    • if mild or pt poor candidate for OR, start an NG & antibiotics – hope tear repairs self
  • Antibiotics-almost all patients
  • NPO/NG suction
  • Analgesics, antiemetics, sedatives
  • Position - knees flexed
  • IV fluids
  • Monitor I&O
  • Drain care-if present after OR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Nursing Assessments for Peritonitis?

A

focused on Pain, abdominal, VS, urine output, hypovolemic shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Nursing Interventions for a patient with Peritonitis?

A
  • IV (fluid replacement and antibiotics)
  • NG monitoring and care
  • I&O
  • N/V
  • drain monitoring
  • incision and drain site care
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Types of Inflammatory Bowel Disease (IBD)

A

Crohn’s disease and ulcerative colitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What part of the GI is affected in a patient with Crohn’s disease?

A

can occur anywhere in the GI tract (mouth to anus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Crohn’s disease most often affects the?

A

terminal ileum and colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Crohn’s affects which layers of the bowel wall?

A

all of them

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Inflammation and ulceration of the colon and rectum

A

Ulcerative colitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Pathology of Ulcerative colitis?

A

starts in the rectum and moves towards the cecum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Ulcerative colitis affects which layers of the bowel wall?

A
  • the mucosal layer or inner most layer, which is why uclers are rare
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Signs and Symptoms IBD (Crohn’s and UC)

A 
Diarrhea
Bloody stool
Fatigue
Abdominal pain
Weight loss
Fever
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Main symptoms of Crohn’s?

A
  • Diarrhea
  • Colicky abdominal pain (comes and goes)
  • Fever
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

symptoms of crohns if the small intestine is affected?

A
  • weight loss due to malnutrition

- nutritional problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Main symptoms of UC?

A
  • Bloody diarrhea if severe
  • Abdominal pain
  • Rectal bleeding
  • Severity can range from 1-20 stools per day
34
Q

IBD: Diagnostic Studies

A
  • Rule out other diseases
  • H & P
  • Blood studies
    • CBC-iron deficiency or blood loss
    • WBC-toxic megacolon or perforation
    • Serum electrolyte levels
    • Serum protein levels
    • Serum albumin levels
  • Stool cultures
    • Blood
    • Pus
    • Mucus
35
Q

IBD: Diagnostic Procedures

A
  • Sigmoidoscopy w/ biopsy
  • colonoscopy w/ biopsy (preferred)
  • Double-contrast barium enema
    • Identifies areas of ulceration
  • Capsule endoscopy
  • CT, MRI, transabdominal US, small bowl series
36
Q

Which diagnostic procedure has the greatest sensitivity for diagnosing Crohn’s Disease?

A

Capsule Endoscopy

37
Q

IBD: Complications

A
  • Nutritional deficits
  • Hemorrhage
  • Strictures
  • Perforation (with possible peritonitis)
  • Fistula with Crohn’s
  • Perineal abscess with Crohn’s
  • Toxic megacolon with Ulcerative Colitis
38
Q

What are S/S of Toxic Megacolon?

A
  • Dilation and paralysis of the colon, associated with perforation.
  • Abdominal pain, distension and tenderness
  • Tachycardia
  • Loss of bowel sounds
39
Q

In Crohn’s fistulas can develop where?

A

between the bowel and bladder, and the bowel and vagina

40
Q

IBD Systemic Complications

A
  • Inflammation of joints, eye, mouth, kidneys, bone, vascular, and skin due to an increase in circulation of cytokines
  • Increase risk of liver failure – sclerosing cholangitis develops
41
Q

IBD Treatment

A
  • Hemodynamically stable
  • Monitor H/H, Vital signs
  • res to the bowels
  • Hydrate-IVF
    • Monitor electrolytes
  • Pain control
  • Nutritional support (TPN in severe cases)
  • May need surgery
42
Q

Diet for IBD when they can tolerate it?

A

high calorie, high vitamin, high protein, low residue, lactose free diet when eating

43
Q

Drug Therapy for IBD?

A
  • Aminosalicylates
  • Antimicrobials
  • Corticosteroids
  • Immunosuppressants
  • Biologic and targeted therapy
44
Q

Complications related to an exacerbation of IBD?

A
  • Massive bleeding
  • Perforation
  • Strictures and/or obstruction
  • Toxic megacolon
  • Tissues changes indicating dysplasia or carcinoma
45
Q

Post Op Care for IBD?

A
  • I&O
    • Initial ileostomy output 1500-1800/2000mL per 24hr
    • Normal 500mL/day
  • Assess Stoma –shrinkage, output
  • Assess for:
    • Fluid & electrolyte imbalance
    • Hemorrhage
    • Abdominal abscess
    • SBO (no bowel sounds, vomiting, no BM’s)
    • Dehydration
46
Q

Teaching for IBD?

A
  • Rest
  • Dietary modification`
  • Smoking cessation
  • Stress reduction
  • Medication adherence
  • Supplements as needed
    • Ca, Iron, Zinc
  • Stoma care-if stoma present
  • Perianal skin care
47
Q

2nd peak of IBD after what age?

A

60 y/o

48
Q

Causes of Intestinal Obstruction?

A
  • Mechanical- detectable occlusion commonly in the small intestine
  • Non-mechanical
49
Q

Causes of Mechanical Intestinal Obstruction?

A
  • Surgical adhesions
  • hernia
  • strictures from Crohn’s
  • diverticulitis
  • tumor
50
Q

Causes of Non-Mechanical Intestinal Obstruction?

A
  • Paralytic ileus
  • lack of peristalsis
  • absence of bowel sounds
51
Q 
Clinical Manifestations of poximal SBO?
A) Onset
B) Vomitting
C) Pain
D) Bowel movement
E) Abd distention
A 
A) rapid
B) frequent & copious
C) colicky, cramping occurs at frequent intervals
D) feces for a short time
E) minimal
52
Q 
Clinical Manifestations of LBO?
A) Onset
B) Vomitting
C) Pain
D) Bowel movement
E) Abd distention
A 
A) gradual
B) late or absent
C) low-grade, persistent cramping abd pain
D) absolute constipation
E) Increased
53
Q

Early common S/S of Intestinal Obstruction?

A
  • N/V, abdominal pain & distension
54
Q

Late common S/S of Intestinal Obstruction?

A

inability to pass flatus, constipation, may show s/s of hypovolemia

55
Q

Diagnostics for Intestinal Obstruction?

A
  • Absent or high pitched BS above obstruction
  • CT Scan and abd Xray
  • Sigmoidoscopy or colonoscopy to visualize obstruction
56
Q

What does it indicate if a patient with suspected Intestinal Obstruction has an ABD x-ray showing the following:
A) Presence of air on scan
B) Dilated loops
C) Air and fluid

A

A) perforation
B) paralytic ileus
C) obstruction

57
Q 
Clinical Manifestations of Distal SBO?
A) Onset
B) Vomitting
C) Pain
D) Bowel movement
E) Abd distention
A 
A) rapid
B) less frequent
C) colicky, cramping occurs intermittently
D) gradual constipation
E) increased
58
Q

diagnostic labs for an Intestinal Obstruction?

A
  • CBC
  • Electrolytes
  • BUN
  • Creatinine
  • ABG
  • Stool-occult blood
59
Q

An elevated WBC in a patient suspected of having an Intestinal Obstructions indicates?

A

strangulation or perforation

60
Q

A decrease H/H in a patient suspected of having an Intestinal Obstructions indicates?

A

hemorrhage or strangulation

61
Q

Intestinal Obstruction Treatment?

A
  • NPO
  • Hydrate IVF- watch for fluid over load
  • NG tube
    • Oral care
    • Patency
    • Skin breakdown
  • Total Parenteral Nutrition
  • May need to prep pt for surgery
    • Resection
    • Resection with ostomy if obstruction is extensive or necrosis is present
62
Q

Nursing Assessments for Intestinal Obstruction?

A
  • Monitor for dehydration and electrolyte imbalances
  • Assess pain
  • Assess emesis (if present) - Bowel sounds
  • is pt passing gas
  • when was last BM
  • Abd distension-look for abdominal scars & masses
  • Measure abdominal girth
  • Strict I&O
63
Q

If waiting for intestinal obstruction to resolve on own assess for _______ and report an urine output of _______?

A
  • changes in urine output, VS, BS, rising BUN/Cr, increase in pain or distention
  • urine output < 0.5mL/kg/hr
64
Q

Intestinal Obstruction Complications?

A
  • Severe reduction in circulating blood volume and electrolyte deficiencies
    • Hypotension
    • Hypovolemic Shock
    • Cardiac dysrhythmias
  • Intestinal strangulation or intestinal infarction
65
Q

Intestinal strangulation or intestinal infarction can cause?

A
  • Inadequate blood flow
  • Edema
  • Cyanosis
  • Gangrene
  • Can lead to peritonitis
66
Q

created when the intestine is brought through the abdominal wall and sutured to the skin

A

stoma

67
Q

Major types of Ostomies?

A
  • End stoma
  • Loop stoma
  • Double barreled stoma
68
Q
  • Assess stoma q______ and color should be?

-

A
  • q4 hrs & PRN

- pink

69
Q

Stoma colors:
A) Dusky blue = ___?
B) Brown-black = ___?

A

A) ischemia

B) necrosis

70
Q

How often should a stoma pouch be change and should be empty when it is _______?

A
  • q 4-7 days

- 1/3 full

71
Q

Output amount from a:
A) colostomy
B) Ileostomy

A

A) mimic normal output

B) 1000-1800mL initially, then an average daily amount 500mL

72
Q

How long surgery can a patient with an ostomy resume ADL?

A

6-8 weeks but should avoid heavy lifting

73
Q

When should colostomy irrigation be used and why?

A
  • only when the stoma is from the distal colon or rectum

- to promote regular evacuation of stool

74
Q

how to perform a colostomy irrigation?

A
  • hold Irrigation bag 18 – 24 inches above stoma
  • use 500 – 1000mL warm water flow in over 5-10 minutes – 750mL is norm
  • If cramping occurs, slow down rate, may stop water but do not stop the process
  • Wait ½ to 1 hour and empty reservoir bag
  • Initial evacuation occurs after 15 minutes
75
Q

Ostomy Complications?

A
  • Skin breakdown
  • Infection
  • Electrolyte imbalances
76
Q

Electrolyte imbalances are seen more often in which type of ostomy?

A
  • ileostomy
    • K
    • NA
    • Fluid volume deficits
77
Q

divides the bowel. Proximal end to skin. Distal end removed or left in place (Hartman’s pouch)

A

end stoma

78
Q

loop of bowel up to surface – anterior portion = feces, distal portion = mucus drainage

A

loop stoma

79
Q

2 separate stomas – works like loop stoma-usually temporary

A

double barreled stoma

80
Q

In a loop stoma, the anterior portion = _____, distal portion = _________

A

1) feces

2) mucus drainage

Care of Adult/Older Exam #3 (5701) (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions