NUR 144 - Week 4 - Low GI Flashcards
Small Intestine
Functions
Sections
Function is absorption
Sections:
- Duodenum
- Jejunum
- Ileum
Large Intestine
Ascending-Transverse-Descending-Sigmoid-Rectum
What is the function of the gut microbiome?
- Breakdown waste
- Vitamin synthesis
- Immune function
Colonization begins at birth and is established by the age of 2
What are factors that influence the gut microbiome?
- Age
- Genetics
- Diet
- Personal hygiene, infections
- Vaccinations, medications (antibiotics)
- Chronic disease
What are lab studies in regards to the lower GI system?
- Colonoscopy (#1 test for colon cancer)
- Serum lab studies
- Stool tests
- Ultrasonography
- Genetic testing
- Imaging studies: CT, PET, MRI, scintigraphy, virtual colonoscopy
- Sigmoidoscopy / colonoscopy
- Lower GI tract study
- GI motility
What is the #1 test for colon cancer?
Colonoscopy
Constipation
What is it?
Causes?
Fewer than three bowel movements weekly; bowel movements that are hard, dry, small, difficult to pass
Cause:
- Most meds
- Chronic laxative use
- Lack of exercise
- Weakness, immobility, fatigue
- Lack on intra-abdominal pressure
- Diet
Constipation
What to assess?
- Fewer than three bowel movements per week
- Hard, dry stools
- Abdominal distention, pain, bloating
- Sense of incomplete evacuation
- Straining at stool
Constipation
What are the complications?
- Decreased cardiac output
- Fecal impaction
- Hemorrhoids (swollen, inflamed blood in anus)
- Fissures (cracks)
- Rectal prolapse (rectum comes out)
- Megacolon (dilated, atonic colon)
Constipation
Diagnostic tests
- Thorough hx and physical examination
- Barium enema, sigmoidoscopy, stool testing
- Sigmoidoscopy, stool testing
Constipation
Management and Teaching
- Correct underlying cause (may require change in pt’s meds)
- Teach normal bowel patterns
- Support legs during bm
- Attempt bm after meals or warm drink
- Increase fiber and fluid
- Exercise + activity (abdominal strength)
- Laxative
Diarrhea
What is it?
Increased frequency of bowel movements, more than three per day
- Usually associated with urgency, perianal discomfort, incontinence
Can be:
1) Acute: Self-limiting; 1-2 days
- Noninflammatory: large volume, noninvasive enteric pathogens
- Inflammatory: small-volume, pathogens that invade mucosa
2) Persistent: 2-4 weeks (often viral or related to meds)
3) Chronic: more than 4 weeks
- Causes: Parasite, c-diff, chemo, cardiac meds
Diarrhea
What to assess for?
- Increased frequency and fluid content
- Abdominal cramps
- Distention
- Borborygmic
- Anorexia, thirst
- Painful, spastic contraction of anus
- Tenesmus
Diarrhea
Diagnostic test
- CBC
- Serum chemistries
- Urinalysis
- Stool examination
- Endoscopy or barium enema
Diarrhea
Treatment
- Antidiarrheal, antibiotics, probiotics
Diarrhea
Complications
- Fluid / electrolyte imbalances
- Dehydration cardiac dysrhythmias
- Chronic diarrhea = skin care issues r/t irritant dermatitis
Diarrhea
Patient teaching
- Rest
- Diet / fluid intake
- I/O
- Avoid irritating foods: caffeine, carbonated beverages, hot and cold foods
- Perianal skin care
- Avoid: milk, fat, whole grains, fruit, veggies
Fecal incontinenacen
Anal sphincter weakness
Causes:
- Traumatic: ex = surgery
- Nontraumatic: ex = scleroderma
- Neuropathy
- Inflammation
- CNS disorders
- Diarrhea, fecal impaction + overflow
Fecal Incontinence
Assessment
- Minor soiling to complete incontinence
- Occasional urgency
- Loss of control
Fecal Incontinence
Diagnosis
- Hx
- Rectal examination
- Endoscopy
- Radiography
- CT scan
Irritable Bowel Syndrome
Chronic functional:
- Recurrent abdominal pain
- associated with disordered bowel movement
- may include: diarrhea, constipation or both
Cause:
- neuroendocrine dysregulation leads to = altered peristalsis
- Chronic stress
- Sleep deprivation
- Surgery
- Infection
- Diverticulitis
Irritable Bowel Syndrome
What to assess for?
- Alteration in bowel pattersn
- Pain
- Bloating
- Abdominal distention
Irritable Bowel Syndrome
Diagnostic tests
- Stool studies
- Contract radiography studies
- Proctoscopy, colonoscopy
- Manometry
Irritable Bowel Syndrome
Teaching
- Mediation management
- Complimentary medicine
- Dietary changes
- Food diary
- Adequate fluid intake
- Avoid alcohol, smoking
Malabsorption
What is it?
s/s?
Inability of the digestive system to absorb one or more major vitamins, minerals, nutrients
s/s:
- Unintentional weight loss
- Muscle wasting
- Weakness, fatigue
- Abdominal bloating, discomfort
- Chronic diarrhea / loose stools
- Gas / flatulence
Malabsorption
What to assess for?
- Diarrhea
- Frequent, loose, high-fat content stools
- s/s similar to IBS
- Weight loss & vitamin, mineral deficiency
Malabsorption
Diagnostic Tests
- Fat analysis
- Lactose tolerance test
- D-xylose absorption tests
Malabsorption
Patient education
- Vitamin replacement
- Dietary therapy
- Probiotics
Celiac’s Disease
What is it?
s-s/what to assess for?
Autoimmune disease with hereditary component; “Body’s immune system attack small intestine when gluten is consumed which = inflammation + damage to the villi.”
s/s / Assessment:
- Diarrhea, steatorrhea
- Constipation
- Failure to thrive, weight loss
- Abdominal distention, bloating
- Poor muscle tone
- Irritability, listlessness
- Dental disorders
- Anemia
Celiac’s disease
Treatment
Interventions
Treatment: Gluten free diet for life
Interventions: Dietary consult, support
Which foods must a patient which Celiac’s disease avoid?
Foods containing gluten
Wheat, Barley, rye, oats
Bread, pasta, cereals, baked goods, beer, gravy (often thickened w/ flour)
Acute abdomen
What is it?
Potential causes?
Or “Surgical abdomen”
Umbrella term for: acute onset of pain without trauma that requires swift surgical intervention
Potential cause:
- Peritonitis
- Cholecystitis
- Pancreatitis
Primary: Spontaneous infection (often w/ liver failure)
Secondary: Follows perforation abdominal organs
Tertiary: Superinfection in immunocompromised patient
Acute abdomen
Treatment
Nursing care
Treatment:
- Control infection
- Fluids
- Meds: Pain, antiemetic, antibiotic therapy (large dose, broad spectrum)
Nursing care:
- Monitor closely for change in bowel function
- Monitor closely for sepsis
Diverticular disease
Diverticular disease is the presence of the diverticula “sacs” in the colon. Inflammation, abscess is not necessarily present
Diverticular disease increases with age; associated with a low-fiber diet
Diverticulum:
Sac-like herniation (or pouch) of the bowel lining
Diverticulosis: Multiple diverticula w/ no inflammation
Diverticulitis: infection and inflammation of diverticula
Diverticular disease
How to diagnose?
Usually diagnosed via colonoscopy
NOT FOR DIVERTICULITIS
Diverticular disease
Assessment
- Bowel irregularity
- Alternating constipation + diarrhea
- Nausea, anorexia, bloating/distention
- Left lower quadrant pain; most common in sigmoid colon
If abscess: - Bleeding
- Tenderness
- Palpable mass
- Peritonitis
Intestinal Obstruction
What is it?
Blockage prevents normal flow of intestinal contents through intestinal tract
Mechanical:
- Intraluminal obstruction or mural obstruction from pressure on intestinal wall
Functional/paralytic obstruction:
- Intestine muscles cannot move contents through the bowel
- can be temporary and the result of manipulation of bowel during surgery
Intestinal Obstruction
Treatment?
Interventions?
Treatment:
- Decompression with NG tube insertion
- Surgical intervention
Interventions:
- Maintain function of NG tube
- Assess & measure NG output
- Assess for fluid/electrolyte imbalance
Inflammatory Bowel Disease (IBD)
What is it?
How to assess for it?
Umbrella term for:
- Crohn’s disease
- Ulcerative colitis
Assessments:
- Health hx to identify: onset, duration, characteristics of pain, diarrhea, urgency, tenesmus, nausea, anorexia, weight l
Crohn’s Disease
Subacute and chronic inflammation of the GI tract wall through all layers
s/s & disease progresion:
- Inflammation –> abscesses –> ulcers & scarring
- CObblestone appearance
- Skip lesions
- Narrowing of bowel lumen (diameter)
Assessment:
- Diarrhea and RLQ pain
- Crampy abdominal pain, tenderness after meals
- Weight loss, malnutrition, anemia
What are the two most common clinical manifestations in Crohn’s disease?
Abdominal pain & diarrhea
Ulcerative Colitis
What is it?
Chronic ulcerative and inflammatory disease of the mucosal and submucosal layers of the colon and rectum
s/s & Disease progression:
- Periods of remission and exacerbations typically starting in the rectum, progressing proximally through the colon
Assessment:
- Abdominal cramps with bloody or purulent diarrhea
- Bleeding is from ulceration
- LLQ pain
- Pallor, anemia, fatigue
- Anorexia, weight loss, fever, vomiting
Treatment: Probiotics
Complications: Toxic megacolon
Inflammatory Bowel Disease (IBD)
Complications
- Electrolyte imbalance
- Cardiac dysrhythmias
- GI bleeding with fluid loss
- Perforation of the bowel
Anorectal Conditions
Proctitis: Inflammation of the mucosa of the rectum
Ulcerative colitis vs crohns
What foods pt with celiacs should avoid
Perylitic obstruction results in no bowel sounds (?) and then produce NG tbue
