Midterm Flashcards
What is the function of the small intestine and the large intestine?
small: absorb nutrients
large: absorb water
What is irritable bowel syndrome (IBS)?
chronic disorder that affects the large intestine
What are the risks factors of IBS?
smoking
caffeine
NSAIDs
stress
family hx
females
high-fat diet
dairy products
alcohol = 1 drink, super bloated
mental/behavioral illness
What are the clinical manifestations of IBS?
recurrent diarrhea, constipation, bloating, and/or ABDOMINAL PAIN
belching
mucus in stool
tenesmus = desire to go poop
What is a main indicator of IBS?
abdominal pain
What medications are given for IBS?
loperamide (standard)
alosetron (last resort)
lubiprostone
linaclotide
bulk agents
probiotics
What can loperamide lead to?
cathartic colon (inability to pass stool)
What should be assessed for the medication alosetron?
constipation
What are lubiprostone and linaclotide used for?
IBS-constipation
lubiprostone: opioid induced constipation, “slip and slide effect”
What should be avoided if a patient who has IBS is taking a bulking agent?
psyllium
If a patient is taking antibiotics and then develops watery diarrhea, what should the nurse do?
initiate contact precautions
possible C.diff
What are nursing interventions for a patient with IBS?
- have a journal of symptoms, diet, and stress levels
- increase fiber and fluid intake
- limit beans, eggs, dairy (yogurt), fruits
- exercise and stress management
- ENCOURAGE PT TO ASK Q’S
What is inflammatory bowel disease (IBD)?
autoimmune disease
chronic inflammation of intestinal tract
classified as:
Ulcerative colitis
or
Crohn’s disease
Describe ulcerative colitis
- inflammation and ulcers in the rectum
- from transverse colon to rectum
Describe crohn’s disease
- inflammation granulomas (bumps) that don’t bleed
- from mouth to anus
- lesions are transmural (burns a hole where contents can leak out and contaminate)
more serious
What are the clinical manifestations of ulcerative colitis?
anal/rectal symptoms
abd pain - severe
diarrhea - common
rectal bleeding - common
tenesmus - common
fever - during acute attacks
can still absorb
weight loss - rare
What are the clinical manifestations of crohn’s disease?
Weakness and fatigue
GI symptoms:
abd pain - cramping
diarrhea - steatorrhea (fatty stool)
rectal bleeding - sometimes
tenesmus - rare
fever - based on flare up
impaired absorption
weight loss - common
Why do patients with ulcerative colitis have a new diagnosis of anemia?
chronic blood loss (not malabsorption)
If a patient has steatorrhea, what should the nurse ask?
have you noticed any recent weight loss?
What are the complications of IBD?
Ulcerative- decreased Hct & Hgb (give blood)
Crohn’s- perforation leads to peritonitis (rigid abd., fever, rebound tenderness)
both:
- fluid/electrolyte imbalance
- colorectal cancer
- C.diff infection
- perineal abscess/fistulas
- strictures (scar tissue leads to bowel obstruction)
- toxic megacolon
What is toxic megacolon?
inflammation that causes the loss of function of the colon
fluid, toxins, and gas dilate the colon and lead to perforation
Describe the lab studies for IBD
increased H&H, WBC, ESR, CRP
decreased K, Mg, Ca
stool for occult blood
crohn’s: decreased albumin
ulcerative: no change in albumin
What are the diagnostic studies for IBD?
sigmoidoscopy
colonoscopy (main tool for dx)
CT scan
barium enema (imaging of lower GI tract)
What medications are used for IBD?
antiinflammatory
immunosuppressants
immunomodulators
antidiarrheal
antimicrobial
What antiinflammatory medications are used for IBD? Why?
corticosteroids (inflammation)
5-ASA (mesalamine and sulfasalazine - (STOPS the body attacking itself)
What immunosuppressant medications are used for IBD? Why?
cyclosporine
methotrexate (DMARD) - drink water bc nephrotoxic
azathioprine (DMARD)
suppress the immune system
What immunomodulator medications are used for IBD?
What should be monitored?
infliximab
adalimumab
natalizumab
monitor hypotension - decrease 20 BP sys
monitor fever bc immune system is suppressed = infection easy
What antidiarrheal medications are used for IBD?
What does it treat? What should be monitored?
diphenoxylate/atropine
loperamide “LOW bowel movements”
treats diarrhea
monitor for cathartic colon
What antimicrobial medication is used for IBD? Why?
What type of mouthwash should be used while on this medication? Why?
metronidazole
first choice in treating C.diff
alcohol free mouthwash
- alc causes reaction
- pt can get N/v, dizzy, irritability
What therapeutic procedures are done for IBD?
bowel resection
Crohn’s:
- strictureplasty: stent to open stricture
- surgical repair of fistulas: cut out and connect (anastomosis)
What are the nursing interventions for IBD?
- promote rest
- monitor I&O
- monitor hypokalemia
- high protein, high calories, low-residue, low fiber diet
- small frequent meals
- food journal
- TPN (short term)
What should a patient with IBD not eat?
oatmeal with cream
What can you give a patient with Crohn’s disease to eat?
toast with jelly
Before giving medications to a patient who has Crohn’s disease, what should be assessed?
fever
What is concerning for a patient with ulcerative colitis who is taking sulfasalazine?
decreased urine output
What should a nurse review for a patient with ulcerative colitis?
review electrolyte values
What should be assessed first for a patient who has ulcerative colitis and has severe diarrhea? Why?
heart rate and rhythm
bc losing potassium
What should a nurse tell a patient who feels that ulcerative colitis controls their life?
“let’s discuss potential factors that increase your s/s”
What is diverticular disease?
diverticulosis
diverticulitis
What are the clinical manifestations of diverticulosis?
diverticulosis
- little pouches of stress bubbles (diverticula)
- asymptomatic
- bloating
- flatulence
- changes in bowel habits
What are the clinical manifestations of diverticulitis?
diverticulitis
- inflammation of diverticula
- left lower quadrant pain
- abd distention
- fever, chill (infection)
- tachycardia
- N/V
What are the risk factors of diverticular disease?
low fiber, high fat, red meat diet
aging
constipation
What is a complication of diverticulitis?
peritonitis (rigid abdomen)
What are the diagnostic studies for diverticulitis?
decreased H&H
increased WBC and ESR
stool for occult blood +
CT w/contrast of abd
colonoscopy
sx if positive bowel perforation
What are the plan of care for the acute phase of diverticulitis?
bowel obstruction will lead to
NPO
NGT (if N/V or abd distention )
IV fluids (PRIORITY) , morphine, antibiotics
Rest
If a patient has diverticulitis with a large bowel obstruction, what should be monitored?
abdominal distention
What are the nursing interventions for diverticulitis?
- clear liquid until symptoms go
- low-fiber then high-fiber when inflammation goes down
- low-fat
- hydration
- NO enemas, laxatives, or colonoscopy
What food can you give to someone with diverticulitis?
grilled chicken with white rice
If a patient has diverticulosis, what can they eat to prevent diverticulitis?
navy bean soup and veggie salad
What is the first intervention for peritonitis caused by a ruptured diverticulum?
administer metronidazole IV
Describe intestinal obstruction
partial or complete blockage of intestine
mechanical: physical impaction
neurogenic: bowel stops responding to stimuli
What are examples of neurogenic obstructions?
hypokalemia
opioids
paralytic ileus
cathartic colon
What are the clinical manifestations of an obstruction?
abdominal distention
hyperactive bowel sounds above obstruction
hypoactive bowel sounds below obstruction
What are the clinical manifestations of a small bowel obstruction?
higher in GI
colicky (sporadic) pain
frequent N/V
What are the clinical manifestations of a large bowel obstruction?
In abdominal area
constant pain
abdominal distention
Fecal fluid around impaction
What are the complications of a small bowel obstruction?
electrolyte imbalance
metabolic alkalosis
fever
What are the complications of a large bowel obstruction?
metabolic acidosis
dehydration
What are the diagnostic studies of bowel obstruction?
decreased H&H and BUN
decreased Na, Cl, K
increased creatinine, WBC, amylase
ABG
CT scan
endoscopy (colonoscopy or sigmoidoscopy)
exploratory laparotomy (risk of infection)
What are the nursing interventions for bowel obstruction?
NPO
NGT
IV fluids
Semi-fowler’s
Pain control (avoid morphine, hydrocodone, hydromorphone)
Antibiotic
Ambulation
For a mechanical bowel obstruction, the patient complains that the intermittent bowel pain turned into constant pain. What should the nurse do?
check bowel sound (always assess first)
What is an ileostomy? What can you see?
opening in the ileum (small intestine) in the RLQ
yellow, green, watery bile
What is a colostomy? What can you see?
opening in the colon
formed feces, brown
What are complications of ostomies?
stomal ischemia - leads to necrosis
intestinal obstruction (assess stoma/monitor)
What should a healthy stoma look like?
red “beefy” - after sx
pink - long term
moist and shiny
What does a bad stoma look like?
stomal ischemia/necrosis - discolored (pale, grey, purple)
When caring for a patient with an ostomy, what should the nurse do?
Can an assistive personnel so this?
drain and measure the output
AP can do this
What food can a person with a colostomy have?
pasta
For a patient with a new colostomy, is bleeding okay?
small amount of bleeding is okay
What is an expected outcome for a person with a new colostomy?
report of empowerment
What medications can a patient not take while having an ileostomy?
enteric coated medications
If a patient if anxious before a colonoscopy, how should the nurse respond?
“before the exam, the provider will give a sedative to make you sleepy”
What type of prevention is a colonoscopy or a family hx of colon cancer?
secondary
What are assessment findings of stroke, MS, and Parkinson’s?
stroke
- orientation status
- speech
MS
- orientation status
- speech
Parkinson’s
- orientation status
- speech
- muscle movement
- facial rigidity
- ambulation pattern
If there is an air leak in a chest tube, what should the nurse do and monitor?
BOWTIE
actions
- palpate for subcutaneous emphysema
- check the tubing on unit
monitor
- respiratory status
- lung expansion exercise
What medications are given for Parkinson’s disease?
levodopa/carbidopa
What clinical manifestations of multiple sclerosis should be monitored?
WEAKNESS (pickin up pencil)
diplopia (double vision)
tinnitus
paresthesia
chronic neuropathic pain
nystagmus (shaking of eyes)
dysphagia (difficulty swallowing)
ataxia (poor muscle control)
cognitive difficulties (word finding)
bowel/bladder problems
sexual dysfunction
depression
What is indicate a positive result for the Tensilon test? What is the antidote?
muscle contraction becomes stronger
antidote: atropine
What is an expected finding for someone who has pleural effusion?
dullness upon percussion over chest
What action should be taken for someone with a water seal chest tube?
keep it below the level of the chest
What task can be delegated for a patient with a paralytic ileus?
apply petroleum jelly
What should a nurse teach a patient who has an MI about having blood drawn?
it will help determine the degree of damage to the heart tissue
What are the nursing interventions for a heart attack?
- morphine, oxygen, nitro, aspirin (MONA)
- semi or full-fowler
- monitor VS and EKG
- IV access
What are the clinical manifestations of a MI?
Diaphoresis
N/V
Tachycardia
A patient with MG is taking pyridostigmine, when should the medication be taken? WHy?
take 45 min before a meal
bc it creates secretions
What are the risk factors of MS?
young adults
women
genetics
What should the nurse tell a patient with PD who is taking bromocriptine?
rise slowly when standing
What is the fastest route for nitroglycerin?
sublingual
For endocarditis, what should a nurse do and monitor?
BOWTIE
action
- obtain sputum culture
- give antibiotics
monitor
- temperature
- neurostatus
