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Adult Health I Test IV > Non-Inflammatory Bowel Disorders > Flashcards

Non-Inflammatory Bowel Disorders Flashcards

1
Q

Non Inflammatory Bowel Disorders

A
  • Can cause pain, changes in bowel pattern, bleeding, and malabsorption
  • Group of disorders includes hemorrhoids, cancer, hernia, IBS, and intestinal obstruction
  • A hernia that cannot be moved back into place w/ gentle palpation is considered irreducible and requires immediate surgical evaluation
    • In a hernia that is strangulated, blood supply is cut off to a portion of the bowel, increasing the risk for obstruction, necrosis, and perforation
    • Manifestations:
      • Abdominal distention
      • Tachycardia
      • Vomiting
      • Abdominal pain
      • Surgical intervention is necessary
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2
Q

hemorrhoids

A
  • Distended or edematous intestinal veins resulting from inc intra-abdominal pressure
    • Straining, obesity, prolonged sitting or standing, constipation, weight lifting
    • Pregnancy inc risk of hemorrhoids
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3
Q

bowel herniation vs/ incisional hernias

A
  • Bowel herniation: displacement of the bowel thru a weakness of the abdominal muscle into other areas of the abdominal cavity
  • Incisional hernias: occur as a postsurgical complication due to inadequate healing of the incisional site from malnutrition, infection, or obesity
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4
Q

hernia: risk factors

A
  • Male sex: indirect inguinal hernia can be large and descend into scrotum
  • Advanced age: direct hernia
  • Inc intra-abdominal pressure due to pregnancy or obesity: femoral, adult acquired umbilical hernia
  • Genetics: congenital umbilical hernia
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5
Q

hernia: expected findings

A

Protrusion or lump at involved site: groin area, umbilicus, healed incision

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6
Q

hernias: nursing actions

A
  • If hernia does not require surgery, instruct client to wear a truss pad w/ hernia belt during waking hours to prevent the abdominal contents from bulging into hernia sac
  • Inspect skin under pad daily
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7
Q

hernia: post op education

A
  • Instruct client to avoid inc intra-abdominal pressure for 2-3 weeks
    • Avoid coughing, straining, and lifting objects greater than 10 lbs
  • Apply ice as prescribed
  • Inspect and report redness/swelling at incisional site
  • Prevent constipation by inc fiber and fluids
  • Rest for several days and return to work when surgeon OKs it: usually 1-2 weeks post op
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8
Q

IBS

A
  • Disorder of the GI system that causes changes in bowel function–>chronic diarrhea, constipation, bloating, and/or abdominal pain
    • Etiology of IBS is uncertain, but it is thought that environmental, immunological, genetic, hormonal and stress influence the development and course of dz
      • Food intolerances worsen the manifestations
  • Environmental factors: dairy projects, caffeinated beverages, infectious agents
  • Immunological factors: cytokine genes (pro-inflammatory interleukins), TNF alpha
  • Stress related factors: anxiety, depression
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9
Q

IBS: health promotion and dz prevention

A
  • Avoid trigger foods: dairy, wheat, corn, fried foods, alcohol, spicy foods, and aspartame
  • Avoid alcohol and caffeinated beverages
    • Avoid foods with fructose and sorbitol
  • Consume 2-3 L of fluid per day from food and fluids
  • Inc fiber to 30-40 g/day
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10
Q

IBS: risk factors

A
  • Female sex
  • stress
  • Eating large meals w/ a large amount of fat
  • Caffeine intake
  • Alcohol intake
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11
Q

IBS: expected findings

A
  • Cramping pain in abdomen
  • Abdominal pain: left lower quadrant–>due to changes in bowel pattern and consistency
  • Nausea w/ meals or passing stools
  • Anorexia
  • Abdominal bloating
  • Belching
  • Diarrhea: diarrhea predominant IBS
  • Constipation: constipation predominant IBS
  • Hyperactive or hypoactive bowel sounds
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12
Q

IBS: lab tests

A

CBC, serum albumin, and ESR, and occult stools: typically all w/in expected reference range

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13
Q

IBS diagnosis

A
  • difficult to diagnose
  • Based on presence of specific tests
  • Including abdominal pain, accompanied by changes in bowel patterns, abdominal distention, feeling that defecation is not complete, and presence of mucus w/ stools
  • Other criteria can include recurrent abdominal pain for 3 days during a month in the past 3 mos and 2 or more of the following
    • Improvement when the client moves his or her bowels
    • Onset when there is a change in frequency of stools
    • Onset when there is a change in appearance of stools
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14
Q

IBS: hydrogen breath test

A
  • Client is asked to exhale into a hydrogen analyzer before and after ingesting test sugar
    • Positive test: indicates excess hydrogen in the bloodstream from bacterial overgrowth or malabsorption
  • Client edu:
    • Instruct client to remain NPO at least 12 hr prior to test, except for sips of water
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15
Q

IBS: nursing care

A
  • Reduce stress
  • Limit intake of irritating agents: gas forming foods, caffeine, alcohol
  • Encourage diet high in fiber and fluids
  • Instruct client to keep a food diary to record intake and bowel patterns to adjust diet to prevent exacerbations
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16
Q

diarrhea predominant IBS (IBS-D): meds

A
  • loperamide
  • psyllium
  • alosetron
  • Nursing Considerations:
    • Contraindications:
      • Hx of bowel obstruction
      • Crohn’s dz
      • UC
      • Impaired intestinal obstruction
      • Thrombophlebitis
  • Client Edu:
    • Manifestations should resolve in 1-4 weeks
      • d/c after 4 weeks if manifestations persist
    • avoid concurrent use of psychoactive drugs and antihistamines
    • Report constipation, fever, inc abdominal pain, fatigue, dark urine, bloody urine, or rectal bleeding immediately b/c alosetron can cause ischemic colitis
      • d/c if these manifestations
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17
Q

loperamide

A
  • Dec peristalsis and inc bulk
  • Can cause drowsiness
  • d/c if no response after 48 hr
18
Q

psyllium

A
  • Bulk forming laxative
  • d/c for abdominal cramping, rectal bleeding, and vomiting
  • Monitor for electrolyte imbalance
19
Q

alosetron

A
  • An IBS selective medication that selectively blocks 5-HT3 receptors that innervate the viscera
    • Expected result: inc firmness in stools and dec urgency and frequency of defecation
  • Indicated for IBS-d in women that has lasted more than 6 mos and is resistant to conventional mgmt
    • Use w/ caution in women and only as a last resort
20
Q

constipation predominant IBS (IBS-C): meds

A
  • lubiprostone
  • linaclotide
21
Q

lubiprostone

A
  • an IBS specific medication that inc fluid secretion in the intestine to promote intestinal motility
    • Indicated for IBS-C in women
  • Nursing Considerations:
    • Contraindicated: clients who have known or possible bowel obstruction
    • Not effective for men w/ IBS
  • Client edu:
    • Take w/ food and water
22
Q

linaclotide

A
  • Inc fluid and motility in the intestine
  • Can relieve pain and cramps
  • Client edu:
    • Instruct the client to take daily about 30 min before breakfast
23
Q

intestinal obstruction: mechanical vs. non-mechanical

A
  • Mechanical obstruction: occurs when the bowel is blocked by something outside or inside the intestines
    • Ie. adhesions, tumors, hernias, fecal impactions, strictures due to Crohn’s dz, and diverticulitis
    • Complete mechanical obstructions should be addressed surgically
  • Non-mechanical obstruction: caused by diminished peristalsis w/in the bowel (paralytic ileus)
    • Can occur post op due to the handling of the intestines during surgery
  • Tx: focuses on fluid and electrolyte balance, decompressing the bowel, and relief/removal of obstruction
24
Q

mechanical obstructions: risk factors

A
  • Encirclement or compression of intestines by adhesions, tumors, fibrosis (endometriosis), or strictures (Crohn’s dz, radiation)
    • Post surgical adhesions are often the cause of small bowel obstructions
    • Carcinomas are often the cause of large intestine obstructions
  • Older adults: diverticulitis, fecal impaction, and tumors are common causes of obstruction
    • Bowel regimens can be effective in preventing impactions
  • Hernia: bowel becomes trapped in weakened area of abdominal wall
  • Volvulus (twisting) or intussusception (telescoping) of bowel segments
25
Q

non mechanical obstruction: risk factors

A
  • Results from dec peristalsis secondary to the following
    • Neurogenic disorders: manipulation of the bowel during major surgery and spinal frx
    • Vascular disorders: vascular insufficiency and mesenteric emboli
    • Electrolyte imbalances: hypokalemia
    • Inflammatory responses: peritonitis or sepsis
  • Manifestations of nonmechanical obstructions: diffuse, constant pain; significant abdominal distention; frequent vomiting
26
Q

small bowel and large intestine obstructions: expected findings

A
  • Obstipation: inability to pass a stool and/or flatus for more than 8 hr despite feeling the urge to defecate
  • Abdominal distention
  • High pitched bowel sounds above site of obstruction (borborygmi) with hypoactive bowel sounds below, or overall hypoactive
    • Absent bowel sounds later in process
27
Q

small bowel obstructions: expected findings

A
  • Severe fluid and electrolyte imbalance
  • Metabolic alkalosis
  • Visible peristaltic waves (possible)
  • Epigastric or upper abdominal distention
  • Abdominal pain, discomfort
  • Profuse, sudden projective vomiting w/ fecal odor
28
Q

large intestine obstructions: expected findings

A
  • Minor fluid and electrolyte imbalance
  • Metabolic acidosis (possible)
  • Significant lower abdominal distention
  • Intermittent abdominal cramping
  • Infrequent vomiting
  • Diarrhea or ribbon like stools around an impaction
29
Q

intestinal obstructions: lab tests

A
  • Inc Hgb, BUN, creatinine, and Hct–>indicate dehydration
  • Inc serum amylase and WBC count–>can occur w/ strangulating obstructions
  • ABGs indicate metabolic imbalance, depending on obstruction type
  • Chemistry profiles reveal dec sodium, chloride, potassium
30
Q

intestinal obstruction: diagnostic procedures

A
  • X-ray: flat plate and upright abdominal x-rays evaluate the presence of free air and gas patterns
  • Endoscopy determines cause of obstruction
  • CT scan determine cause and exact location of obstruction
31
Q

non mechanical obstruction: nursing care

A
  • NPO w/ bowel rest
  • Assess bowel sounds
  • Provide oral hygiene
  • Administer IV fluids and electrolytes: potassium
  • Manage pain: once diagnosis identified
  • Encourage ambulation
  • Place in semi fowler’s
32
Q

mechanical obstruction: nursing care

A
  • Prepare for surgery and provide preop care
  • w/hold intake until peristalsis resumes
33
Q

intestinal obstructions: meds

A
  • Prokinetics: promote gastric motility (octreotide) in paralytic ileus or partial obstruction
  • Broad spectrum abx: esp with suspected bowel strangulation
34
Q

intestinal obstruction: NG tube w/ a vent

A
  • (to prevent damage to the stomach mucosa during continuous suctioning)
    • Inserted to decompress the bowel
  • Nursing actions:
    • Maintain intermittent suction as prescribed
    • Assess NG tube patency and placement
    • Irrigate Q4
    • Monitor and assess gastric output
    • Monitor nasal area for skin breakdown
    • Provide oral hygiene Q2
    • Monitor V/S, skin integrity, weight, I&O
35
Q

intestinal obstruction: surgical interventions

A
  • Varies based on cause of obstruction
  • Can include lysis of adhesions, colon resection, colostomy creation (temporary or permanent), embolectomy, thrombectomy, resection of gangrenous tissue, or complete colectomy
  • Exploratory laparotomy:
    • Determine cause of obstruction and rectify if possible
    • Nursing Actions:
      • Ensure client understands type of procedure: open or laparoscopic
      • Monitor for hemodynamic instability
      • Administer IV fluid replacement
      • Monitor bowel sounds
      • Maintain NG tube patency and measure output
      • Clamp NG tube as prescribed to assess the client’s tolerance prior to removal
      • Advance diet as tolerated
        • Begin w/ clear liquids
        • Clamp tube after eating for 1-2 hour
      • Instruct client to report intolerance of intake following NG tube removal: n/v, inc distention
36
Q

intestinal obstruction: list complications

A
  • dehydration
  • electrolyte imbalance
  • metabolic alkalosis
  • metabolic acidosis
37
Q

intestinal obstruction: dehydration as a complication

A
  • (small bowel obstruction):
  • Cause: persistent vomiting
  • Nursing actions:
    • Assess hydration thru evaluation of Hct, BUN, orthostatic V/S, skin turgor/mucous membranes, urine output, and SG
      • Notify provider of fluid imbalance
    • Administer IV fluids
38
Q

intestinal obstruction: electrolyte imbalance as a complication

A
  • small bowel obstruction
  • Cause: persistent vomiting
  • Nursing Actions:
    • Monitor electrolytes (esp K)
    • Notify HCP of electrolyte imbalance
    • Administer IV fluids
39
Q

intestinal obstruction: metabolic alkalosis as a complication

A
  • small intestinal obstruction
  • Cause: persistent vomiting, leading to loss of gastric hydrochloride
  • Nursing Actions:
    • Monitor for hypoventilation (confusion, hypercarbia) which is a compensatory action by the lungs
    • Obtain ABGs
    • Notify provider if labs are unexpected
    • Replace fluids and electrolytes
    • Provide oral hygiene to alleviate inc thirst response
      • Thirst response: dec in older adult
      • Provide oral hygiene routinely to ensure maintenance of moist mucous membranes
40
Q

intestinal obstruction: metabolic acidosis

A
  • large bowel obstruction
  • Cause: lower level obstruction
  • Nursing Actions:
    • Monitor for deep, rapid respirations (compensatory action by the lungs), confusion, hypoTN, flushed skin
    • Obtain ABGs
    • Notify if unexpected lab findings

Adult Health I Test IV (10 decks)

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