Magasjúkdómar - Deniz Flashcards

Question

Stomach (Gastric) Cancer - Clinical Manifestation

Answer 1

* Unexplained weight loss * Abdominal discomfort and pain * Signs and symptoms of anemia

Answer 2

* Upper GI endoscopy * Biopsy * USG, CT, MRI, PET scanning * Blood and stool tests

Answer 3

* Surgical therapy: aim is to remove tumor * Lesion is antrum or pyloric region: Billroth I or II procedure (subtotal gastrectomy) * Lesion is in in the fundus: total gastrectomy with esophagojejunostomy is done * CT and RT * Targeted Therapy

Answer 4

Nursing assessment: nutritional assessment, psychosocial history, physical examination..

Answer 5

impaired nutritional intake, impaired nutritional status, acute pain, anxiety

Answer 6

* Have minimal discomfort * Achieve optimal nutritional status * Maintain spiritual psychologic well-being

Answer 7

* Health promotion: early detection * Acute Care: * Emotional and physical support * Pt can be malnourished * The pt can better tolerate several small meals * Pre-op teaching and post-op care * CT and RT instructions

Answer 8

* Stomach cancer * Polyps * Perforation * Chronic gastritis * PUD

Answer 9

* Partial gastrectomy-gastroduodenostomy, gastrojejunostomy * Gastrectomy-anastomos: esophagus and jejunum * Vagotomy: decrease gastric acid secretion * Pyloroplasty-surgical enlargement of pyloric sphincter

Answer 10

* Acute: bleeding * Long term; 1-Dumping syndrome 2-Postprandial hypoglycemia 3-Bile reflux gastritis

Answer 11

* Direct result of surgical removal of a large part of stomach and pyloric sphincter * Normally gastric chyme enters the small intestine in small amount * After operation, stomach cannot control it and large amount of gastric chyme enter to small intestine * Symptoms starts 15-30 minutes after eating * Patients have general weakness, sweating, palpitation, dizziness * Pt may have abdominal cramps, audible abdominal sounds, urge to defecate * Short rest period after each meal reduce the chance of dumping syndrome

Answer 12

* A variant of dumping syndrome * Result of uncontrolled gastric emptying of a bolus of fluid high in carbohydrate into the small intestine * Concentrated carbohydrate -----hyperglycemia----release excess amount of insulin into circulation---hypoglycemia * Symptoms are similar to hypoglycemic reaction * Sweating, weakness, mental confusion, palpitation, tachycardia, anxiety * 2 hours of eating—symptoms occur

Answer 13

* Prolonged contact with bile causes damage to the gastric mucosa , chronic gastritis, PUD * Continuous epigastric distress—increase after meal

Answer 14

* Teaching patient about surgery * Include: 1. pain relief 2. Coughing and breathing exercises 3. NG tube 4. IV fluids

Answer 15

* Fluid-electrolyte balance * Preventing respiratory complications * Preventing infection * NG tube—decompression—observe: color, amount, odor * NG tube needs to work—if there is no drainage—blood cloth * Before NG tube removes, pt starts clear liquid—toleration * Anastomotic leak—tachycardia, dyspnea, fever, abdominal pain, anxiety, restlessness

Answer 16

* Long term comp: malnutrition, metabolic bone disease, anemia, weight loss * Wound healing may impair * Pernicious anemia– lack of cobalamin results pernicious anemia and neurologic complications * Meal size needs to reduce (6 small feeding)—not to drink with meals * First weeks after surgery; soft bland foods with low fiber and high carb and protein * Teach the pt to AVOID: simple sugar, lactose, fried foods, extreme temperature in food

Answer 17

An inflammation of the gastric mucosa

Answer 18

* Result of breakdown in normal gastric mucosal barrier * Mucosal barrier protects stomach tissue from the corrosive action of HCI and pepsin * When the barrier broken, HCI and pepsin can diffuse back into the mucosa * Result in; tissue edema, disruption of capillary wall, hemorrhage

Answer 19

* Drug-related gastritis: especially NSAID and corticosteroids * Diet: alcohol, spicy irritating foods * Helicobacter pylori * Other risk factors: infections, reflux of bile salts from duodenum to stomach, prolonged vomiting, intense emotional response

Answer 20

* Like acute gastritis, sometimes asymptomatic, lack of cobalamin and pernicious anemia

Answer 21

* Anorexia, Nausea, Vomiting, epigastric tenderness, feeling of fullness

Answer 22

* Acute gastritis: diagnosed based on pt’s symptoms * Occasionally, endoscopic examination with biopsy is required

Answer 23

Bloody vomitus, appearing as fresh, bright red blood or “coffee grounds” appearance (dark, grainy digested blood)

Answer 24

Black, tarry stools (often foul smelling) caused by digestion on blood in the GI tract.

Answer 25

Small amounts of blood in gastric secretions, vomitus, or stools not apparent by apperence

Answer 26

* Drug-induced * Erosive gastritis * Polyps * PUD * Stress-related mucosal disease * Stomach cancer

Answer 27

* Esophageal varices * Esophagitis

Answer 28

* Blood dyscrasias (leukemia, aplastic anemia..) * Renal failure

Answer 29

* Abdominal pain * Abdominal rigidity * Hematemesis * Melena * Nausea

Answer 30

* BP (fellur) * Pulse pressure (fellur) * Level of consciousness (fellur) * Urine output * Tachycardia * Cool, clammy skin * Slow capillary refill Emergency Management: Assessment Findings

Answer 31

* If unresponsive—assess circulation, airway and breathing * If responsive– monitor airway, breathing and circulation * Establish IV access with large catheter and start IV fluid replacement, insert second large catheter if shock present * Give Oxygen via nasal canula * Initiate ECG monitoring * Obtain blood * Insert NG tube as needed * Insert indwelling urinary catheter * Give IV PPI therapy * Ongoing monitoring * Monitor vital signs, level of consciousness, bowel sounds, intake/output * Assess amount and character of emesis * Keep patient NPO Emergency Management: Assessment Interventions

Answer 32

* Hepatitis * Cirrhosis * Acute Liver Failure

Answer 33

* Hepatitis is inflammation of the liver * Most common cause is viruses * It can be caused by substances (alcohol, medications, chemicals), autoimmune diseases, and metabolic problems

Answer 34

* There are 5 main hepatitis viruses, types A, B, C, D and E. * These 5 types are of greatest concern because of the burden of illness and death they cause and the potential for outbreaks and epidemic spread. * Types B and C lead to chronic disease in hundreds of millions of people and, together, are the most common cause of liver cirrhosis and cancer

Answer 35

is present in the feces of infected persons and is most often transmitted through consumption of contaminated water or food * Fecal-oral contamination * Certain sex practices can also spread HAV * Infections are in many cases mild, with most people making a full recovery and remaining immune from further HAV infections * However, HAV infections can also be severe and life threatening * Most people in areas of the world with poor sanitation have been infected with this virus. Safe and effective vaccines are available to prevent HAV.

Answer 36

is transmitted through exposure to infective blood, semen, and other body fluids * HBV can be transmitted from infected mothers to infants at the time of birth or from family member to infant in early childhood * Transmission may also occur through transfusions of HBV-contaminated blood and blood products, contaminated injections during medical procedures, and through injection drug use * HBV also poses a risk to healthcare workers who sustain accidental needle stick injuries while caring for infected-HBV patients * Safe and effective vaccines are available to prevent HBV.

Answer 37

is mostly transmitted through exposure to infective blood * This may happen through transfusions of HCV-contaminated blood and blood products, contaminated injections during medical procedures, and through injection drug use * Sexual transmission is also possible but is much less common * There is no vaccine for HCV

Answer 38

infections occur only in those who are infected with HBV * The dual infection of HDV and HBV can result in a more serious disease and worse outcome * HDV is transmitted like HBV * Hepatitis B vaccines provide protection from HDV infection

Answer 39

is mostly transmitted through consumption of contaminated water or food * Fecal-oral route * HEV is a common cause of hepatitis outbreaks in developing parts of the world and is increasingly recognized as an important cause of disease in developed countries * Safe and effective vaccines to prevent HEV infection have been developed but are not widely available

Answer 40

* Anorexia * Clay-colored stool * Dark urine * Decreased sense of taste and smell * Diarrhea or constipation * Fatigue, lethargy, malaise * Flu-like symptoms * Hepatomegaly * Low-grade fever * Lymphadenopathy * Nausea, vomiting * Pruritus (itching-intense, systemic) * Right upper quadrant tenderness * Splenomegaly * Weight loss * Jaundice (icteric)

Answer 41

* ALT, AST elevation * Ascites and lower extremity edema * Asterixis (“liver flap”) * Bleeding abnormalities (thrombocytopenia, easy bruising, prolonged clotting time) * Fatigue * Hepatic encephalopathy * Hepatomegaly * Increased bilirubin * Palmar erythema * Spider angiomas * Jaundice (icteric)

Answer 42

* History and physical examination * Liver function test * PT time and INR * Hepatitis testing * FibroScan (like usg, to measure damage) * FibroSure (Fibro test)

Answer 43

Management Acute and Chronic * Well-balanced diet * Vitamin supplements * Rest * Avoiding alcohol and drugs Chronic HBV an HCV * Drug therapy

Answer 44

* Impaired nutritional intake * Activity intolerance * Risk for bleeding

Answer 45

* Have relief of discomfort * Be able to resume normal activities * Return to normal liver function without complications

Answer 46

* Hand washing * Proper personal hygiene * Environmental sanitation * Control and screening of food handlers * Serologic screening * Active immunization: HAV vaccine

Answer 47

* Early administration (1-2 week after exposure) * Prophylaxis for travelers

Answer 48

* Wash hands * Use infection control precautions

Answer 49

* Screening of donated blood * Use of disposable needles and syringes * Sexual Transmission * Acute exposure: HBIG administration to sexual partner (HBsAG+ person) * HBV vaccine series (uninfected sexual partner) * Condom use

Answer 50

* Hand washing * Avoid sharing toothbrushes and razors * HBIG administration for one time exposure * Active immunization: HBV vaccine

Answer 51

* Use infection control precautions * Reduce contact with blood and secetions * Dispose of needles properly

Answer 52

* Assess the presence and degree of jaundice (sclera of eyes and skin) * Adequate nutrition * Mouth care, antiemetics * Adequate fluid intake * Rest * Comfort measures to relieve itching, headache

Answer 53

* Cirrhosis is the end stage of liver disease * It is characterized by extensive degeneration and destruction of the liver cells * This results in the replacement of liver tissue by fibrosis (scar tissue)and regenerative nodules

Answer 54

* Excess alcohol use * Non-alcoholic fatty liver disease (NAFLD) * Hepatitis B and C

Answer 55

fatigue, enlarged liver, diagnose is made later

Answer 56

* jaundice, * peripheral edema, * ascites, * skin lesions: spider angiomas, palmar erythema * hematologic problems, * endocrine problems, * peripheral neuropathies

Answer 57

* Portal hypertension: increased pressure within the liver’s circulatory system– splenomegaly, large collateral veins, ascites, varices * Esophageal and gastric varices: enlarged veins—can bleed easily * Peripheral edema * Abdominal ascites: serous fluid in peritoneal or abdominal cavity * Hepatic encephalopathy: neuropsychiatric manifestation- impaired consciousness, inappropriate behavior * Hepatorenal syndrome: type of renal failure

Answer 58

* Rest * B-complex vitamins * Avoiding alcohol * Minimizing or avoiding aspirin, NSAID

Answer 59

* Low-sodium diet * Diuretics * Paracentesis

Answer 60

* Endoscopic band ligation or sclerotherapy * Balloon tamponade * Transjugular intrahepatic portosystemic shunt (TIPS)

Answer 61

* Drug therapy—antibiotics

Answer 62

* Impaired nutritional status * Ineffective tissue perfusion * Activity intolerance * Fluid imbalance

Answer 63

* Relief of discomfort * Ave minimal to no complication * Return to normal lifestyle

Answer 64

* Reducing risk factors: alcohol use, malnutrition, viral hepatitis, obesity etc

Answer 65

* Bed rest: take precautions to protect pt form side effects of complete bed rest * Nutritional support: oral hygiene and modifications on meals * Itching—relieve * Follow: urine and stool * Assessment edema and ascites, recording intake-output, daily weight * Semi-fowler’s position—dyspnea * Skin care * ROM exercises * Elevation of lower extremity—if scrotal edema is present, support is necessary

Answer 66

* Observe hematemesis and melena * If hematemesis occurs, call the MD—usually ICU necessary * Maintain pt’s airway * Keep monitoring pt

Answer 67

* Maintain safe environment * Pt confused, risk for fall and other injuries * Assess pt: level of responsiveness, sensory and motor abnormalities, fluid and electrolyte imbalance * Assess neurologic status– every 2 hours * Have emergency equipment ready * Measures to minimize constipation is important (reduce ammonia production) Patient and caregiver education

Answer 68

* Acute inflammation of the pancreas * the degree of inflammation varies

Answer 69

* Gallbladder diseases * Chronic alcohol use * Drug reactions * Pancreatic cancer * Hypertriglyceridemia * Auto digestion of panaceas

Answer 70

* Abdominal pain—left upper quadrant –or mid-epigastric * Severe, deep, piercing, and continuous or steady * Nausea and vomiting * Low grade fewer * Leukocytosis * Hypotension * Tachycardia * Abdominal tenderness

Answer 71

* History and physical examination * Serum amylase and lipase * Blood glucose * Serum calcium * Serum triglycerides * Abdominal USG * Endoscopic USG * ERCP * CT

Answer 72

* NPO with NG * Albumin * IV calcium gluconate * Lactated Ringer’s solution

Answer 73

Drug Therapy * Pain medication * PPI (eg omeprazole) * Antibiotics

Answer 74

* Acute pain * Fluid imbalance * Electrolyte imbalance * Impaired nutritional intake

Answer 75

* Relief pain * Normal fluid and electrolyte balance * Minimal to no complications * No recurrent attacks

Answer 76

* During the acute phase—monitor vital signs * Monitor response to IV fluid * Monitor fluid-electrolyte balance * Assess respiratory function * Monitor hypocalcemia symptoms: Chvostek’s or Trousseau sign * Pain relieve * NPO- NG tube—oral and nasal care * Blood glucose level * Surgery can be necessary for some cases

Answer 77

* Cholelithiasis—stone in gallbladder * Cholecystitis-inflammation of gallbladder wall

Answer 78

* Pain * Tenderness in the right upper quadrant * Pain attacks often occurs 3-6 hours after a high fat meal or patient lies down * Total obstruction—clay colored stool, bleeding tendency, dark, amber color urine, fewer and chills, intolerance for fatty foods, pruritus

Answer 79

* History and physical examination * USG * ERCP * Liver function test * White blood cell count * Serum bilirubin

Answer 80

* LAP cholecystectomy * Open cholecystectomy

Answer 81

* IV fluid * NPO with NG tube * Antiemetics * Analgesics * Fat soluble vitamins (A,D,E,K) * Antispasmodics * Antibiotics * ERCP

Answer 82

* Acute pain * Lack of knowledge

Answer 83

* Relief of pain and discomfort * No complications postoperatively * No recurrent attacks

Answer 84

* Pain medication—as ordered * Nausea and vomiting—NG necessary * Oral care, input-output * Observation of blockage signs * Monitoring vital signs

Answer 85

* Monitoring complications: bleeding * Pain to the shoulder—normal because of LAP surgery—CO2 * Clear liquids * Walking * Pain medication * Open surgery—respiratory complications

Answer 86

* Constipation is characterized by difficult or infrequent bowel movements * Constipation is a symptom not a disease * It can be acute, usually lasting less than 1 week, or chronic, lasting over 3 months

Answer 87

* Improper diet * Reduced fluid intake * Lack of exercises * Certain medications Can cause constipation

Answer 88

* Varies from mild to severe * Stools are absent or hard, dry and sifficult pass * Abdominal distention, increased flatulence and increase rectal pressure

Answer 89

* Increase dietary fiber (fruit, vegetable, grains) * Adequate water intake * Exercise * Laxatives and enemas * Management target pt needs: needs further examination

Answer 90

* Assessment: usual bowel habit, stool characteristics, diet, straining etc. * Interventions: Teach patients: * Diet, adequate fluid, regular exercise, * High fiber diet * Regular time to defecate * Discourage the use of laxatives and enemas * Privacy, elevation bed –bedpan use

Answer 91

* IBS is a disorder characterized by chronic abdominal pain or discomfort and alteration of bowel patterns * Patients may have diarrhea or constipation, alternating periods of both

Answer 92

* Has no known organic cause * Psychologic stressors * Pt mostly have GI infection disorders and adverse reaction to food

Answer 93

* Solely on symptoms * Presence of abdominal pain or discomfort, change in stool frequency, change in stool form * Other symptoms: Abdominal distention, nausea, flatulence, bloating, urgency, mucus in stool, sensation of incomplete evacuation * Non GI symptoms: fatigue, headache, sleep problems

Answer 94

* No single therapy * Dealing with psychologic factors, * dietary changes * drugs regulate stool output and reduce discomfort

Answer 95

* Inflammation of the appendix * Appendicitis is the most common reason for emergency abdominal surgery

Answer 96

* Most common in those 10-30 years of age * Most common cause is obstruction of the lumen by fecalith (accumulated feces) * Obstruction results in distention, venous engorgement, accumulation of mucus and bacteria—lead to gangrene, perforation and peritonitis

Answer 97

* Typically begins with dull periumbilical pain, anorexia, nausea, vomiting * Pain is persistent and continuous (localized; halfway between the umbilicus and right iliac crest) * Low-grade fever * Localized tenderness, rigidity, rebound tenderness * Coughing, sneezing and deep inhalation worsen pain

Answer 98

* Examination: complete history, physical examination, differential WBC count * Most pt have high WBC count * Urinalysis * CT scan, USG, MRI * If there is a delay in diagnostic and treatment, the appendix can rupture and resulting peritonitis can be fatal * Standard treatment is an immediate appendectomy (surgical removal of appendix) * Antibiotics and fluid resuscitation are started before surgery

Answer 99

* Managing focus on: preventing fluid volume deficit, relieving pain, and preventing complications * Ensure that stomach is empty * Keep pt NPO * Monitor vital signs * Give IV fluids, analgesics, antiemetics as ordered * Post operative care * Most patients resume normal activities 2-3 weeks after surgery

Answer 100

* IBD is a chronic inflammation of the GI track * Crohn’s Disease * Ulcerative Colitis (UC)

Answer 101

* Do not know exact cause * Autoimmune disease, immune reaction to a person’s own intestinal tract * Environmental factors (diet, smoking, stress) increase susceptibility * Thought: dietary factors of industrialized countries: high intake of refined sugar, total fats ---eating fewer raw fruits and vegetables, omega 3-rich foods, NSAIDs, antibiotics, oral contraceptives---- increase risk

Answer 102

* History and physical examination * Erythrocyte sedimentation rate * Serum chemistries (diarrhea, vomiting) * Testing of stool for occult blood and infection * Capsule endoscopy * Radiologic studies with barium contrast * Sigmoidoscopy and/or colonoscopy with biopsy

Answer 103

* High calorie, high-vitamin, high-protein diet * Drug therapy * Aminosalicylates– (decrease inflammation) * Antimicrobials – (prevent or treat secondary infection) * Biologic therapies—(inhibits cytokine tumor necrosis factor) * Corticosteroids– (decrease inflammation) * Immunosuppressants – (suppress immune response) * Physical and emotional rest * Referral for counseling or support group * Surgical therapy

Answer 104

* Drainage of abdominal abscess * Failure to respond to conservative therapy * Fistulas * Intestinal obstruction * Massive hemorrhage * Perforation * Severe anorectal disease * Suspicion of cancer

Answer 105

* Diarrhea * Impaired nutritional status * Difficulty coping * Chronic pain

Answer 106

* Maintain normal fluid and electrolyte balance * Be free from pain or discomfort * Adhere to medical regiments * Maintain nutritional balance * Improve quality of life

Answer 107

* Hemodynamic stability * Pain control * Fluid-electrolyte balance * Nutritional support * Intake-output record * Monitor stool—blood * Orthostatic hypotension—education * Perineal skin care—because of diarrhea

Answer 108

* Teaching pt: * Importance of rest and diet management * Perianal care * Drug action and side effects * Symptoms of recurrence of disease * When to seek medical care * Ways to reduce stress

Answer 109

* Diverticula are dilations or outpouching of mucosa—develop in colon * Diverticulosis is the presence of multiple noninflamed diverticula * Diverticulitis is inflammation of 1 or more diverticula, resulting in perforation into peritoneum

Answer 110

* Mostly occurs in left colon * Genetic and environmental factors are effective * Main cause constipation and lack of dietary fiber * Uncommon in vegetarians * Obesity, inactivity, smoking, excess alcohol use, NSAID use---risk factors

Answer 111

* Most pt has no symptom * Abdominal pain, bloating, flatulence, and changes in bowel habits * The most common signs of diverticulitis are acute pain in the left lower quadrant, distention, decreased bowel sound, nausea, vomiting and systemic signs of infection

Answer 112

* Typically found during routine sigmoidoscopy and colonoscopy * History and physical examination * CT scan with oral contrast

Answer 113

* High-fiber diet, mainly from fruits and vegetables with decreased intake of fat and red meat * Physical activity

Answer 114

* Goal: let the colon rest and inflammation subside—clear diet can help * Hospitalized pt: NPO, bed rest, IV fluids and antibiotics, input-output record, NG tube ca be necessary * If there is abscess or obstruction---surgery may be necessary—resection of involved colon and anastomosis. Maybe colostomy (temporary) * Pt education: condition and adhere to precautions

Answer 115

* Dilated hemorrhoidal veins * Can be internal or external

Answer 116

* Cause-- increased anal pressure, weakening of the connective tissue Risk factors: * pregnancy, * constipation, * straining to defecate, * diarrhea, * heavy lifting, * prolonged standing and sitting, * obesity

Answer 117

* Bleeding with defecation * Internal hemorrhoids: painless, bright red bleeding with stool, on the toilet paper, or dripping into toilet water. * External hemorrhoids are reddish blue and seldom bleed. Itching, burning and edema

Answer 118

* Visual inspection and digital examination-external hemorrhoids * Digital examination, sigmoidoscopy, anoscopy—internal hemorrhoids

Answer 119

* Dietary advices– if the cause is constipation * Ointments can relieve discomfort * Stool softeners, sitz bath (for pain relieve) * Internal hemorrhoid—nonsurgical: rubber band ligation, laser treatment etc. * Hemorrhoidectomy

Answer 120

* Prevent constipation and avoid prolonged sitting and standing * Severe symptoms (pain, bleeding..) * Sitz bath (15-20 minutes, 2 or 3 times each day) reduce discomfort. Starts 1-2 days after surgery (1-2 week)—warm sitz bath provide comfort and keep clean anal area * Nursing care after hemorrhoidectomy: pain management, wound healing * Pt resists defecation—before pain medication, stool softener can help

Answer 121

* Anal fissure: is a skin ulcer or a crack in the lining of the anal wall * Anal Fistula: is an abnormal tunnel leading from the anus or rectum. It may extend to the outside of the skin, vagina, buttocks * Pilonidal Sinus: is a small tract under the skin between the buttocks in the sacrococcygeal area.

Answer 122

* Colorectal cancer arise from a polyp. * This process begins with an aberrant crypt, evolving into a neoplastic precursor lesion (a polyp), and eventual progressing to colorectal cancer over an estimated 10–15 year period.

Answer 123

* Hereditary colorectal cancer syndromes * Positive family history

Answer 124

* Smoking * Processed meat * alcohol intake * red meat * low intake of vegetables and fruits * body fat and obesity

Answer 125

* Physical activity * Whole grains * Dietary fibre * Dairy products * Fish intake * Tree nuts * vitamins (D, D, and others) * Calcium supplements

Answer 126

* Aspirin or NSAID use * Menopausal hormone therapy * Statin use * ethnicity * Male gender * Type 2 diabetes * Inflammatory bowel disease

Answer 127

Patients can present with a wide range of signs and symptoms such as; * Occult or overt rectal bleeding * Change in bowel habits * Anemia, or abdominal pain * Colorectal cancer is largely an asymptomatic disease until it reaches an advanced stage.

Answer 128

* Colonoscopy * Imaging: CT-Scan, MRI, PET-CT * Laboratory: complete blood count, carcinoembryonic antigen concentrations * Pathology

Answer 129

* Endoscopic treatment- Early stage * Surgical treatment * Radiotherapy- Preoperative, rectal cancer * Chemotherapy- post operative

Answer 130

* Smoking cessation, * Healthy diet, * Regular exercise can prevent the development of colorectal cancer * Physical activity of at least 30 min, * Consumption whole grains, fresh fruits, tree nuts, and vegetables * Intake of calcium and fiber

Answer 131

* Consider starting screening at age 45 * Those with close relatives with colorectal cancer should start screening earlier * Colonoscopy * Testing the stool for blood (hemoccult), fecal DNA * Flexible sigmoidoscopy (shorter scope)

Answer 132

* Routine postoperative care * Post-op care includes: sterile dressing change, care of drains, patient and relatives teaching on ostomy,

Answer 133

* Psychologic support * Ostomy rehabilitation—referral WOCN

Answer 134

1- remove cancer 2- repair perforation, fistula, or traumatic injury 3- relieve an obstruction or stricture 4- treat an abscess, inflammatory disease, or hemorrhage

Answer 135

* Depending on the problem being treated, these procedures may be done; -Total proctocolectomy with IPAA: removes the entire colon and rectum while preserving the anal sphincter, ileal pouch construction and temporary ileostomy * Proctocolectomy with a permanent ileostomy: removal of colon, rectum and anus with closure of the anal opening * Right hemicolectomy: removal of ascending colon * Left hemicolectomy: removal of descending colon and sigmoid colon * Abdominal-perineal resection (APR): removal of rectum and creation of permanent colostomy * Low anterior resection (LAR): removal of rectum and with anastomosis of the colon to the anal canal (maybe temporary stoma)

Answer 136

* Temporary or permanent opening (stoma) is created surgically by bringing part of the intestine out through the abdominal wall * Surgical openings are called an ileostomy or colostomy depend on which part of intestinal tract is used to create the stoma

Answer 137

* End Stoma: an end stoma is made by dividing the bowel and bringing out the proximal end as a single stoma * Loop stoma: a loop stoma is made by bringing a loop of bowel to the abdominal surface and then opening the anterior wall of the bowel to provide fecal diversion * Double-Barreled Stoma: to create stoma, surgeon divides the bowel, and both the proximal and distal ends are brought through the abdominal wall as 2 separate stomas

Answer 138

* Psychologic preparation for the ostomy * Educational preparation * Selecting the best site for the stoma--- WOCN visit

Answer 139

* Assess the incision: sign of infection? Suture integrity? * Assess the wound regularly and record bleeding, excess drainage and unusual odor * Monitor for edema, erythema, and drainage around suture line, high fever, WBC count * Wound care—dressing change, observing drainage * If stoma present, assess the stoma and place a clear pouching system

Answer 140

* Patient Education * Stoma Assessment * Stoma care WOCN

Answer 141

* Surgery performed * Stoma type, duration of the stoma * Stoma site * Color, moisture—color every 4 hours * Stoma height and shape * Peristomal skin * Diameter of the stoma, Rod * Complications

Answer 142

* First, the adapter is separated from the skin from top to bottom * The area around the stoma is wiped with gauze moistened with tap water and dried. * The diameter of the stoma is measured with the help of a stoma ruler. * The appropriate size is a 2mm gap between the edge of the bag and the stoma. * The adapter is cut with the help of scissors according to the diameter of the stoma measured. * The paper on the sticky part of the cut adapter is removed and a toothpaste-like “paste” is applied to the inside. * The paste is a barrier between the stoma and the bag, preventing leakage. The role of the paste is to protect the skin around the stoma from feces. Paste prevents feces from contaminating the skin. * By removing the adhesive papers on the edges, the adapter is fully adhered to the skin. * The stoma bag suitable for the adapter is placed on the adapter in a circular motion starting from a point. * After placing the bag, the clamp of the bag is closed. * Check if the bag is firmly seated in the adapter by pulling it lightly on ourselves. After placing the bag, the clamp of the bag is closed.

Answer 143

* Stoma equipment * Assessment of stoma * Emptying the bag * changing the bag * changing the wafer * paste application * Skin care/cleaning * Complication managenment * drug use * Emergency situations * Daily life activities (bathing, dressing, travel, worship, sexuality, nutrition)