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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
non mechanical obstruction: risk factors
* 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
small bowel and large intestine obstructions: expected findings
* 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
small bowel obstructions: expected findings
* 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
large intestine obstructions: expected findings
* 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
intestinal obstructions: lab tests
* 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
intestinal obstruction: diagnostic procedures
* 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
non mechanical obstruction: nursing care
* 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
mechanical obstruction: nursing care
* Prepare for surgery and provide preop care * w/hold intake until peristalsis resumes
33
intestinal obstructions: meds
* Prokinetics: promote gastric motility (octreotide) in paralytic ileus or partial obstruction * Broad spectrum abx: esp with suspected bowel strangulation
34
intestinal obstruction: NG tube w/ a vent
* (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
intestinal obstruction: surgical interventions
* 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
intestinal obstruction: list complications
* dehydration * electrolyte imbalance * metabolic alkalosis * metabolic acidosis
37
intestinal obstruction: dehydration as a complication
* (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
intestinal obstruction: electrolyte imbalance as a complication
* small bowel obstruction * Cause: persistent vomiting * Nursing Actions: * Monitor electrolytes (esp K) * Notify HCP of electrolyte imbalance * Administer IV fluids
39
intestinal obstruction: metabolic alkalosis as a complication
* 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
intestinal obstruction: metabolic acidosis
* 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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