(Non)/Inflammatory Bowel Diseases Flashcards
A bowel obstruction will cause
Decreased
Peristalsis, secretions, distention
T or F
F
These will increase
Hypovolemia from a bowel obstruction will directly cause these two problems
Acute kidney injury
Shock
A stricture is…
Comply found in crohns or with radiation
Narrowing of the bowels
Small & large bowel obstructions
Colorectal cancer
IBS
HERNIA
Hemorrhoids
Are all examples of…
Non-inflammatory bowel disease
With a bowel obstruction why does fluid leak into the peritoneal cavity
The bowel becomes edematous
Describe Volvulus
A twisting of the bowel
Strangulation
Describe Intussusception
Telescopic bowel movement going inside self
Non mechanical bowel obstruction
Post op….
Vascular insufficiency is called….
Paralytic ileus
Bowel ischemia
Vascular insufficiency can progress to
Bowel infraction, gangrene, sepsis, ….
Shock
Small or Large bowel obstruction
Upper/middle abdominal pain
Small bowel
Small or Large bowel obstruction
Intermittent lower ab cramping
Large
Small or Large bowel obstruction
Possible peristalsic waves
Small
Small or Large bowel obstruction
Upper or epigastric distention
Vs
Lower abdominal distention
Small: Upper or epigastric distention
Large: Lower abdominal distention
Small or Large bowel
Nausea and early, profuse vomiting
Small
Small or Large bowel obstruction
Obstipation
Vs
Obstipation/ Ribbon-like stools
Small: Obstipation
Large: Obstipation/ Ribbon like stools
Small or Large bowel obstruction
Severe fluid & electrolyte imbalance
Vs
No major fluid/electrolyte imbalance
Small: Severe
Large: No major
Small or Large bowel obstruction
Metabolic Alkalosis
Vs
Metabolic acidosis
Small: Alkalosis
Large: Acidosis
Reread preop cards
Good idea
Small Bowel obstruction causes dehydration
Describe the following labs
WBC:
K / NA
Hgt/ Hct
Metabolic (Acidosis/ Alkalosis)
WBC: elevated with strangulation
K / NA : K (down) NA (down)
Hgt / Hct: both elevated
Metabolic Alkalosis
Posistion for NG tube
Semi fowlers
Alvimopan is used in hospital settings only for what?
To block the stomach opoid receptors and recover bowel movements
Metoclopramide may cause you to develop a muscle problem called tardive dyskinesia.
Muscles in your face in unusual ways
Metoclopramide speeds up the movement of the bowels
It also
Relieve heartburn
Speed the healing of ulcers and sores in the esophagus GERD
Assess NG tube every ___ hours
Placement (aspirate)
Tube patency
Output
Assess for peristalsis sounds how?
Turn off suction
Exploratory laparotomy
(Explores for obstruction)
May perform ____ of adhesions
Tumor or diverticulitis may require…
May requiere Embolectomy, thrombectomy, or resection for….
Lysis
Colon resection
Intestinal infraction: gangrene of the bowels
Med management for Post Ab op
Oral opoid analgésico + laxative with stool softener
Name laxative + stool softener
Docusate + senna
Colorectal cancer screening
Age >45 w/ history
____ yearly
_____ every 5 years
_____ every 10 years
Fecal Occult blood test
Sigmoidscopy or CT colongraph
Colonoscopy
CEA is….
Normal levels
Carcinoembryonic antigen
Protein found in the blood of adults at very low levels
0 –2.5 nanograms per milliliter (ng/mL). NORMAL
The Ileo-Anal Pullthrough Procedure, (also known as the Ileal Pouch Anal Anastomosis procedure or IPAA) is….
Which diseases
What does the process consist of…
Operation teatment of UC or familial polyposis
IPAA cures these diseases by removing the diseased large bowel
Abdominoperineal resection (APR) is a surgical procedure that…
Ostomy?
removes the anus, rectum, and part of the sigmoid colon to treat certain types of cancer, such as rectal cancer. The procedure involves creating a permanent opening (colostomy) in the abdominal wall for the elimination of waste
Colostomies - which side?
Ascending Colostomy
Right
Colostomies - which side?
Transverse
No side
Double stoma
Colostomies - which side?
Descending Colostomy
Left sided tumor
Colostomies - which side?
Sigmoid
“Left side”
Done for rectal tumora
Bleeding ulcers is found in this inflammatory bowel disease
UC
Difference between Colostomy & ileostomy is…
Colostomy is large intestine
Ileostomy is small intestine
Describe type of feces found in
Colostomy
Ileostomy
Colostomy= firm / Brown
Ileostomy = soft / Yellow Green
Ileostomy is found in this Quadrant
Colostomy…
Ileostomy = RLQ
Colostomy = LUQ
Most frequent complications for immediate post op Ileostomy
Fluid & Electrolyte imbalance
Stoma appearance assessment
Post surg
Long term
Post: Red Beefy
Long term: Pink
Moist & Shiny
Discoloration of stoma is an immediate notify HCP
T or F
T
Colostomy Post opp
Avoid which kinds of foods for first 4 - 6 weeks
High fiber, Hard to digest, Gassy Foods
No
Broccoli/ Cauliflower
Beans
Multigrain bread
Eggs, Dairy
Popcorn
Seeds / nuts
Fluid intake post colostomy
3,000 mL
Irrigate with (Ileostomy/ colostomy)
Use .5 - 1L of warm tap water
Place bag above ostomy
Colostomy
Empty colostomy when
1/3rd full
Abdominal obstruction is diagnosed how?
If obstructed
NPO?
NG tube why
CT w/ contrast
NPO Yes
NG tube to decompress stomach
Nursing intervention for colostomy
Check… (3) levels
I & O
Electrolyte levels
Acid-Base balance
Most important teaching you can give a new stoma receptient
Monitor stoma for healthy red / pink color.
Moist and shiny
How big to cut the ostomy wafer in relation to the stoma size?
No more than 1/8 bigger
Abdominal/ Pelvic surgery
Peritonitis
Ab / Pelvic infections
Endometriosis
Are all main causes of
Adhesion
Which cause bowel blockage
Double Lumen Salem Sump NG tube is used for
Decompression
Small bore single Lumen tube DobHoff is used for…
NG. Meds and feeds
IBS
Women or men
Women
An erythrocyte sedimentation rate (ESR) test, also known as a sed rate test, measures how far red blood cells settle in a test tube in one hour.
Used to measure
Inflammation in the body
Used to IBS test
A hydrogen breath test is used to…
detect bacterial overgrowth in the small intestine, carbohydrate malabsorption, and how quickly food passes through the small intestine
IBS health teachings
____ fiber daily
___ glasses of water
30 - 40
8 -10
Psyllium hydrophilic mucilloid
Lubiprostone
Linoclotide
Are used for this IBS…
IBS-C
Constipation
Psyllium hydrophilic mucilloid
(Used for both Constipation & Diarrhea)
Adenocarcinoma from polyps is most common cause of…
Colorectal cancer
Highly treatable if caught early
Crohns, UC, diverticulitis, cancer or obstruction are all valid reasons to have a colostomy
T or F
T
Colostomy locations
Descending:
Ascending:
Transverse:
Sigmoid:
Descending: Left upper
Ascending: Right
Transverse: Middle Abdominal
Sigmoid: Left Lower
Double barrel stomas function
Proximal
Distal
Proximal: Functional Connected to GI tract Drains Stool
Distal: Mucus
This ostomy is locat3d in the right lower quadrant
Ileostomy
Immediate post op
Stoma is large, swollen and beefy red
What should be the nurses reaction
Nothing
Normal finding
Stool consistency
Ascending
Transverse
Descending
Ascending: Liquid
Transverse: Lose to partially formed
Descending/ Sigmoid: Formed
Irrigation is done with these types of colostomies
Descending/ Sigmoid
Change entire colostomy pouching system how often.
Which time of day?
3 - 5 days
Morning before breakfast
Why don’t you give enteric-coated / sustained release medication to colostomy patients
Won’t desolve properly
NEVER CRUSH
Best way to clean a stoma
Water possible mild soap
Loperamide (Immodium)
Alosetron (SSRI)
Psyllium
Antibiotic
Rifaximin
This type of IBS
Ibs D
Linoclotide has this Black Box warninf
Serious risk dehydration in children
Linaclotide: Treat IBS w/ constipation & chronic constipation
Bowel sounds in chest area is this disease
Hiatal hernia
Management of Hiatal Hernia is similar to this disease
GERD
No lay down 1 hr after eating
Small, frequent meals
HOB elevated
Avoid these medications with GERD / HH
Anticholinergic
Delay gastric emptying
Client is having x rays for upper gi tract. Which should they do post op?
Take laxative
Follow clear diet
Admin enema
Take antimetic
Laxative
Due to taking Barrium which must be eliminated quickly
______ is another common type of hernia that you acquire during your lifetime. It happens when the small intestine pushes through the abdominal wall
A hiatal hernia
An ( direct/indirect) inguinal hernia is the most common type that usually happens in premature births
whereas a (direct/ indirect) inguinal hernia happens mostly in adults and increases with their age
An indirect inguinal hernia is the most common type that usually happens in premature births
whereas a direct inguinal hernia happens mostly in adults and increases with their age
It passes thorugh the inguinal canal.
It bulges from the posterior wall of inguinal canal.
Direct vs indirect
InDirect / Direct
Descends into the scrotum
Doesn’t descend into scrotum area
Indirect / Direct
This defect id not palpable as it lies behind the fibersof external oblique muscles of abdomen.
Here, the defect is palpable as it lies in the abdominal wall, right above pubic tubercle.
Direct vs Indirect
Indirect / direct
Commonly see in children and young adults
Mostly occurs in old age
Indirect / direct
femoral hernia is a protrusion of a loop of the _____ through a weakened ______, located in the lower abdomen near the thigh
intestine / abdominal wall
Ventral hernias usually happen how?
From surgery
Hernia
Reducible
Irreducible
Strangulates
Reducible: can be pushed back inside
Irreducible: cannot be pushed back inside
Strangulated: serious medical emergency
For a nurse to assess a hernia ask the patient to perform the Valsalva maneuver and watch for bulging
T or F
F
Only PCP can do this
Non surgical intervention for inguinal hernia
Truss. Belt with hardened pad
Herniorrhaphy / hernioplasty is…
Ambulatory procedure to correct hernias
Most are inguinal
Prevent Constipation
No heavy lifting/ straining
Fluid increase 1500- 2500
Avoid cough
For …
Hernia surgery
Docusate is….
Stool softener
1st post po bowel movement has this nursing precaution
Monitor patient while in bathroom
May have a vasovagal response and passout (syncope)
What do
Peritonitis
Appendicitis
Gastroenteritis
UC
Crohns
Diverticulitis
Have in common
All inflammatory bowel disorders
Life-threatening acute inflammation and infection of the lining of the abdominal cavity
Peritonitis
Perforation from appendicitis
Penetraiting wounds
Ascending infection of genital tract
Can cause this serious problem
Peritonitis
Hallmark S/S of appendicitis is
Right lower quad pain @ Mcburney’s Point
Appendicitis happens when
The opening of the appendix becomes blocked
Inflammation/ Ischemia
Type of tenderness associated with appendicitis
Rebound tenderness
Diagnosis appendicitis how
CT scan
Appendectomy can normally be preformed how?
If appendix burst?
Laparoscopicly
Open surgery
If a patient has sever right lower quadrant pain that suddenly goes away, What could be the reason
Appendix ruptured
When is an intra-abdomonal lavage done?
When an organ ruptures to clean out the area
N/V 1st before ab pain maybe (appendicitis/ gastroenteritis)
Ab pain first then N/V maybe (appendicitis/ gastroenteritis)
N/V 1st before ab pain maybe Gastroenteritis
Ab pain first then N/V maybe Appendicitis
In appendicitis a WBC >20,000 =
Perforación
Mcburney’s point is located
Between Umbilicus & Anterior illiac crest
Heating pads are the first intervention a nurse should attempt with a suspected appendicitis
False
This will improve blood flow and worsen the problem
Gastroenteritis is commonly causes by…
Fecal-Oral transmission
Norovirus (food born)
November- April
Can Gastroenteritis causes by Norovirus become airborne ?
Yes via vomiting
Why would a person with Gastroenteritis have Cardiac Dysthymia
Loss of K from vomiting
S/S
Colicky(severe) Lower ab pain
Tenesmus (feel like gotta poop, but you dont)
Family History
Recently exposed to antibiotics
NSAID use (flare ups)
UC
A raise in erythrocte sedimentation rate is a clue that this disease is possible
UC
UC will do this to electrolyte levels
Lower from diarrhea
MRE
fast 4 - 6 hrs
Drink contrast medium
Glucagon SubQ to slow bowel activity
UC
Fulminant UC consists of
> 10 bloody bowle movements daily
Anemic
Sulfasalazine (GI anti inflammatory)
Corticosteroids (-one)
Cyclosporine (Immunesuppressant)
Anti-diarrheal with caution
Used to treat
UC
Why can Crohns disease cause Fistulas and UC not?
Crohns affects all layers of the GI tract not only the mucosa. Making fistula formation more likely
Aminosaliclates
Sulfasalazine
Mesalamine
Do what
Reduce inflammation in GI tract
Glucocortidicoids
Prednisone
Budesonide
Suppositories or retention enemas
Do what
Suppress immune system and decrease inflammation
immunomodulators
Infliximab
Adalimumab
Do what
Suppress or increase the immune system.
In response to UC & crohns they decrease it
What dangerous inadvertent effect can anti-diarrheal have on UC
Toxic Megacolon
Osteoporosis is more likely in (UC or Crohns)
Crohns
Natural orifice transluminal endoscopic surgery NOTES
Is for…
UC
It’s a MIS
Describe type of surgery used for UC
Restorative protocolectomy with ileo pouch-anal anastomosis (RPC-IPAA)
Remove colon, make a stoma with small intestine, reverse stoma, poop out the small intestine
Total proctocolectomy with permanent ileostomy is a surgery for UC.
Describe location of stoma
RLQ
Metronidazole is used…
To treat skin infections
Metronidazole is an antibiotic. It’s used to treat skin infections, rosacea and mouth infections, including infected gums and dental abscesses.
It’s also used to treat conditions such as bacterial vaginosis and pelvic inflammatory disease
What can a patient do if ostomy stops draining
Remove Pouch, lie down, knee-chest posistion, abdominal massage, apply moist towels to abdomen, drink hot tea
Men under 50: ≤15 mm/hr
Men over 50: ≤20 mm/hr
Women under 50: ≤20 mm/hr
Women over 50: ≤30 mm/hr
Children: ≤10 mm/hr
Newborns: 0–2 mm/hr
These are normal values for which test
Erythrocte sedimentation rate
(Inflammation)
atropine.
benztropine.
glycopyrrolate.
scopolamine.
trihexyphenidyl.
diphenhydramine.
clinidium.
flavoxate.
Which type of drugs
Which affect
Which GI patient should avoid them
Anticholinergic
Drying of mucus membrane
GERD / HH Avoid
