Noninflammatory Intestinal Disorders Flashcards
Symptoms of IBS
May see cramping, abdominal pain, and bloating.
Women are 2-3X more likely than me to have(hormones play a role).
Symptoms are worse or more frequent during stressful events.
The most common digestive issue(usually diagnosed by testing stool)
Non pharmacological treatment of IBS
Diet and symptom diary Modify the diet Adequate fiber(30-40g) Adequate fluids Stress management Exercise counseling
Drug therapy for IBS-C
Bulk forming laxatives(Metamucil)
Luboproatone(amitiza)
Drug therapy for IBS-D
Antidiarrheals(Imodium)
Alosetron(lotronex) CAUTION
- monitor extremely closely, it can totally stop peristalsis
More meds for IBS
Tricyclic antidepressants(Elavil) -good for abdominal pain
Peppermint oil, probiotics
-restore and maintain health bacteria
Herniations
Weakness in a muscle wall through which something is allow to protrude
Inguinal hernia
(occur mostly in men) often occur in baby boys
Acquired hernias
Just happen, may be doing a lot of lifting, straining, stress, obesity
Ventral hernia
Incisional
Hernia term: reducible
Can be manipulated back through internally back through the muscle. NOT done by standard RN
Hernia term:
Incarcerated(irreducible)
To large or the split in the wall is not big enough to get it back through
Hernia term:strangulated
Not getting enough blood supply
Herniorrhaphy/Plasty
Surgical repair of hernia by MIS(Plasty if they put in mesh)
Elderly are not good candidates to have hernia reduced.
Post hernia surgery care
May use abdominal binder(put on while laying down)
Do not cough your patient.
Often give stool softeners.
Truss: support held against hernia(put on while laying down)(usually given to someone who cannot have hernia surgery)
Colorectal cancer
3rd most contracted cancer
Lower survival rate in African Americans.
Hot spot is the sigmoid.
Usually starts with a pallop(cells go through changes)
Rich blood supply in that area( metastasizes very easily)
Etiology of colorectal cancer(CRC)
HX of ulcerative colitis/cronh's. Family HX of colon cancer. High fat low fiber diet Smoking/alcohol Increased body fat
Assessment finding with CRC
Change in stool consistency and shape. Rectally bleeding Anemia Distention Incomplete evacuation of stool. Fatigue Weight loss
Screening/Disgnosis of CRC
Fecal occult blood test
Serum test CEA level(carcinoembryonic antigen)
Barium enema or CT scan
Colonoscopy and biopsy
Radiation of CRC
Does not work well to improve survival, but helps local control(may use before surgery)
Can be palliative
Chemotherapy of CRC
FOLFOX4, 5-FU,leucivin,eloxatin(can’t tell normal cells from cancer cells, just kills active growing cells)
Avastin: advanced CRC(more targeted to cancer cells and helps reduce blood flow to cancerous tumor.
Colon resection with anastomosis
Cut out the Tumor and out the stomach back together
No colostomy
Remain a patent bowel
Collecting with colostomy or ileostomy
Completely or partially removed colon
Ileostomy: entire colon removed
Colostomy: part of colon removed
Abdominoperineal(AP) resection
For cancer in lower 1/3 of the colon.
Go into abdominal area and remove the rectum
Will have JP drains coming out of rectal area.
Certified wound, ostomy, continence nurse
Ostomy:surgically made opening.
Opening is called the stoma
Loop colostomy
Frequently are temporarily used to divert feces through and area
Colostomy management: teaching tips
Normal appearance of stoma. S/S of complications Measurement of stoma The choice,use,care and application of appropriate alliance to cover stoma Nutrition changes to control odor Resumption of normal activities
Normal appearance of stoma
Pink,rosy,moist(not black)
Most ostomys protrude out 3-4”
When colostomy is formed usually takes 2-3 days to start working
Recognition of potential complication of ostomy
should not bleed, should not have cramping or pain in stoma, is stoma still cuffed?
Mechanics of the bag
Needs to remain covered Measure once a week for six weeks. 1/8"-1/16" cut right around stoma. Wafer can be on up to 7 days. Clean around stoma with soap and water.
Empty bag when 1/2-3/4 full
Skin perfection with ostomy
Often develop fungal infection around stoma.
Don’t let drainage continue over skin.
Ostomy irrigation: garunteed the individual won’t have feces come out for a few hours.
Dietary concerns with ostomy
There are no dietary restrictions
Cranberry juice helps demise the smell of feces
Resuming activities
Should be treated like patient with abdominal surgery.
Restricted weight activities
Driving restrictions
Mechanical obstructions
Adhesions(scar tissue very common,look like bands of tissue)
Hernias
Structures
Tumors
Fecal impactions
Non mechanical obstructions
AKA:paralytic ileus
Temporarily stops working
Abdominal surgery or trauma
Peritonitis
Hypokalemia(peristalsis slows down)
Clues to bowel obstruction
Abdominal pain may be sporadic or constant
Abdominal distention, perhaps perstaltic waves
-may see lateral movement in abdomen
Bowels sound active in early obstruction, absent in later
Hypovolemia/dehydration
Vomiting(may contain fecal matter)
Lack of stools or diarrhea
Management of bowel obstruction
NG tube placement to suction
NPO
IV fluid replacement(especially K)
Surgery(exploratory laparotomy)
Lactose intolerance
A malabsorptive disorder
Lactase deficiency.
S/S: diarrhea,bloating, abd. Discomfort after meals
Enzyme products available(lactaid)
Irritable bowel syndrome
AKA:spastic colon
Bowel motility problem IBS-D(diarrhea) IBS-C(constipation) IBS-A(alternating) IBS-M(mixed)
