nur 226 gi and coagulaion Flashcards
Constipatio
n* Defined
small, infrequent,
or difficult BM
* Fewer than 3 BMs/week
Constipatio
n
* Causes
Diet (low in fiber)
* Lack of exercise
* Slowed peristalsis
* Pathologic conditions
* Obstruction or
diverticulitis
What is secretory diarrhea associated with?
Vibrio cholerae and Staph aureus can cause this type of diarrhea
infection
secretory
C Diff has what type of diarrhea?
a. acute
b. chronic
c. episodic
d. secretory
e. exudative
d
What disease causes an overgrowth of toxins that attack the GI tract?
C Diff
Causes of C Diff
antibiotics, chemotherapy, bowel surgerym direct contact
S/S of C Diff
secretory diarrhea (= 3 loose stools in 24
hrs), cramping, low grade fever, nausea, anorexia (decreased appetite), Mucus in stool
What is the complete or partial blockage of the SI or LI?
intestinal obstruction
SATA: Which of the following are functional intestinal obstructions?
a. hernia
b. feces
c. peritonitis (narcotics)
d. spinal fracture
e. hypokalemia
f. drugs
g. trauma
c, d, e, f, g
Impaction causes
Unrelieved constipation
* May lead to obstruction
s/s of impaction
May have continuous oozing or diarrhea
* Loss of appetite
* N/V
* Abdominal distention
* Cramping and
Diarrhea
* Defined:
increase in frequency and fluidity of bowel
movements
Diarrhea
* Define
acute, chronic and episodic
Acute
* Infection, emotional stress, some medications,
and liquid stool around an impaction
- Chronic – lasting more than 4 weeks
- Chronic GI infection
- Alterations in motility or integrity
- Malabsorption
- Endocrine disorders
- Episodic
- Food allergy or irritant
Osmotic diarrhea
Secretory diarrhea
Exudative diarrhea
Related to motility
disturbances
Osmotic diarrhea Magnesium sulfate
Secretory diarrhea Vibrio cholerae &
Staphylococcus aureus
Exudative diarrhea Crohn disease & Ulcerative Colitis
Related to motility
disturbances Dumping syndrome & IBS
C. Diff
* Risk Factors
-Age > 65
* Antibiotic
therapy
* Immunocompromised
* Recent
hospitalization
* GI procedure
* Previous C. Diff
infection
C. Diff
* Treatment
-Vancomycin 125 mg, 4 times/day
- Metronidazole
- Probiotics
Irritable Bowel Syndrome
(IBS)
Defined
Possible causes
Defined by diarrhea
and/or constipation
with cramps and no
identified pathology
Possible causes
*Genetics
*Environment (stressors)
*Diet
IBS
* Manifestations
Pharmacotherapy
-Diarrhea, Constipation, Combination
of both
-Cramping abdominal pain
* Nausea
* Mucus in stool
Pharmacotherapy
* Antidiarrheals
* Anticholinergic/Antispasmotics
* Laxatives
Functional vs mechanical blockage
Mechanical obstruction occurs when there is a physical blockage in the intestine, such as a tumor, hernia, or adhesions.
Functional obstruction, on the other hand, is caused by a disruption in the normal muscle contractions that propel food through the intestines, often due to conditions like ileus or intestinal dysmotility.
Abdominal surgery,Severe trauma
* Spinal fracture
* Drugs (narcotics)
An intestinal obstruction can lead to…
increased fluid and gas, distention, water and electrolytes in lumen of SI, decreased perfusion, swelling, increased pressure, fluid in peritoneum
Complications of Intestinal Obstructions
a. vomiting
b. gangrenous tissue
c. hyperkalemia
d. ischemia to bowel
e. sepsis
f. shock (blood leakage)
b, d, e, f
What type of disorder is Dumping Syndrome?
malabsorption
Dumping
Syndrome
(post GI surgery problem)
Dumping of stomach contents
into small intestine
food moves quickly from stomach to small intestine
Dumping Syndrome
Manifestations
- Nausea
- Weakness
- Sweating
- Diarrhea
Dumping Syndrome
drug
AE
- Octreotide (octupus)
- Antidiarrheal
- SE: nausea, vomiting and upset stomach
T/F: a treatment for Dumping Syndrome is to change your diet.
t
What is unreleived constipation called?
impaction
When do you see continuous oozing of diarrhea with abdominal distention and cramping?
impaction
What is commonly found in the stool with exudative diarrhea?
mucus
SATA: Which of the following are mechanical intestinal obstructions?
a. hernia
b. tumor
c. feces
d. trauma
e. drugs
f. intusseception
g. hypokalemia
a, b, c, f
What is the treatment for an intestinal obstruction?
surgery, decompression of bowel, IV
Your patient Joe recently had a part of his SI removed and is coming into the ER with severe diarrhea. What condition does Joe have? How will you treat Joe?
Short Bowel Syndrome, IV fluids
Antidiarrheals
* Used to treat
- Different Groups
diarrhea
- Adsorbants
- Antimotility
(anticholinergics and
opiates) - Probiotics
Adsorbents
name
moa
AE
Caution
bismuth subsalicylate (Pepto-Bismol)
* A form of aspirin
coats the walls of the GI tract
Constipation
* Dark stools and darkening of tongue
* Ringing in the ears
(the constipated moth with black spots and headphones)
- Caution in those with bleeding problems
Antimotility
name
moa
ae
Atropine
* loperamide
Slow peristalsis
* Drying effect*
Urinary retention
* Headache, dizziness, anxiety, drowsiness
* Bradycardia, hypotension
* Dry skin
* Flushing
Probiotics
restores gut flora
Lactobacillius- bacteria in gut
Saccha -C-Diff
Laxatives
- Different Groups
- Bulk-forming
- Emollient
- Hyperosmotic
- Saline
- Stimulant
Bulk-Forming
name
moa
ae
psyllium
similar to dietary fiber
- Absorb water into the intestine, increasing bulk
- Distends bowel to initiate reflex bowel activity
and bowel movement - OK for long term use
- Adverse Effects
- Impaction above strictures
- Fluid/electrolyte imbalance
- Gas formation
- Esophageal blockage
Emollient
names
* MOA
- Adverse Effects
docusate sodium
MOA: lubricates fecal material and walls, promotes fat
Uses: prevent opioid-induced constipation
mineral oil
* MOA: lubricate intestines
* Uses: fecal impactions
Adverse Effects: skin rashes, decreased absorption of
vitamins
Hyperosmotic
names
MOA
use
AE
Glycerin, lactulose and polyethylene glycol
- MOA
- Increasing water content in feces
- Promotes distention, peristalsis, and
evacuation - Uses
- Evacuate bowels before diagnostics and
surgical procedures - Adverse Effects
- Abdominal bloating
- Rectal irritation
- Electrolyte imbalance
Saline
names
- MOA:
- Adverse Effects
Saline
* Magnesium Salts
* magnesium citrate (Citroma)
* magnesium hydroxide (Phillips Milk of
Magnesia)
* magnesium sulfate (epsom salts)
- Sodium Salts
- Fleet enema
- MOA: increase osmotic pressure and draw water
into colon - Adverse Effects
- Magnesium toxicity
- Electrolyte imbalance
- Cramping, diarrhea
Stimulants
names
- Uses:
- Adverse Effects
*
Stimulants
* bisacodyl (Ducolax)
- senna (Senokot)
- Uses: constipation or whole bowel evacuation
- OTC
- Adverse Effects
- Nutrient malabsorption
- Gastric irritation
most abundant number of proteins
Albumin & globulins
* Albumin=57% of plasma protein
most plentiful
clotting factor
Fibrinogen
what is plasma WITHOUT clotting factors
serum
Normal platelet count
150,000-
400,000
Thrombocytopenia=
<100,000
Additional platelets stored in the
spleeen
Excessive hemostasi causes
clot formation
excessive or inappropriate
inadequate hemostasis causes
bleeding
Petechiae
- Purpura
- Ecchymosis
- Telangiectasia
- Menorrhagia
- Epitaxis
- Thrombosis
*
Petechiae
* flat, pinpoint, nonblanching red or purple- capillary hemorrhages in the skin or mucous membranes (<2 mm)
- Purpura
- petechiae in groups or patches (2 mm to 1 cm)
- Ecchymosis
- bruise- blood in the tissue (> l cm)
- Telangiectasia
- small, widened blood vessels on the skin
- Menorrhagia
- excessive menstruation
- Epitaxis (nose bleeds)
- nasal drainage
Thrombosis
* pathologic formation of clot (ex. DVT)
Hematoma
- Hemarthrosis
- Hematochezia or melena
- Hematuria
- Hematemesis
- Hemoptysis
Hematoma
* raised area of bleeding into the tissue
- Hemarthrosis
- bleeding into the joint
- Hematochezia or melena
- blood in feces
- Hematuria
- blood in urine
- Hematemesis
- blood in vomitus
- Hemoptysis
- blood in sputum
