PERIOPERATIVE

Question 1

IBD stands for

Answer 1

Inflammatory bowel disease

Question 2

IBD is an umbrella term for 2 diseases

Answer 2

Crohns and ulcerative colitis

Question 3

Crohns and ulcerative colitis have what in common

Answer 3

characterised by periods of exacerbation and remission

Question 4

S+S and Tx for IBD

Answer 4

S+S - abdo pain, fatigue, diarrhoea.
More common with crohns - weight loss, fever and bloody stools.
TX - surgery, nutritional therapy (TPN), medications

Question 5

Colorectal cancer (CA BOWEL) risk factors?

Answer 5

Male
>55yrs
IBD
Obesity
Smoking

Question 6

How to diagnose CA bowel

Answer 6

abnormal blood results
mass visualised on CT
palpable mass
CEA elevated readings

Question 7

2 operations for CA bowel - state and explain the difference

Answer 7

Colectomy
Removal of partial or entire colon

L Hemi colectomy
Removal of diseased area of bowel, both ends of healthy bowel are anastomosed together by stiching or stapling, wound closed with clips or stitches.

Question 8

Nursing care post CA Bowel surgery?

Answer 8

Pain control
Wound care
FBC for fluid&electrolytes
skin integrity
nutrition status
bristol stool chart

Question 9

Evaluation - how do you know it’s worked? the nursing care post ca bowel

objective and subjective

Answer 9

Objective
Vital signs normal + nil signs of hypovolaemia
skin care intact
fluid and electrolytes restored
bm regular
patient eating and drinking healthy diet
↓ CRP - inflammatory markers

Subjective
pt verbalises relief of pain
acceptance of body appearance
sense of control
understanding of s+s and comlpications [DVT, ileus, atelectasis]

Question 10

Stoma. Two surgeries performed, state both and their indications

Answer 10

Colostomy
Cancer sigmoid colon, IBD, Volvulus, trauma, diverticulitis

Ileostomy - when removal of colon is required more common in IBD

Question 11

Perioperative nursing care for colostomy/ileostomy for stomas.

Answer 11

Manage pain, fluid and electrolytes[ivf], administer prescribed medications [antibiotics], prep pt for surgery - they may need bowel prep! teds gown etc.
Emotional support - offer visit from someone who has a stoma or stoma nurse. listen discuss concerns w pt and their family

Question 12

3 common complications for surgery

Answer 12

Atelectasis, DVT, Paralytic ileus

Question 13

Atelectasis is

Answer 13

partial or complete collapse of a lobe or the entire lung - common post op

Question 14

Atelectasis patho

6 steps

Answer 14

↓ventilation or blockage

obstruction of air to and from alveoli

blockage stops further air entering alveoli

area of lung becomes airless

lung collapse

resp distress

Question 15

Paralytics ileus is

Answer 15

hypomobility of GI tract in the absense of mechanical bowel obstruction, occurs post op

Question 16

Patho of paralytic ileus

Answer 16

SNS activated intra operatively + bowel motility inhibited

an ↑ in cytokines and inflammatory mediators ↓ bowel motility

peristalsis then stops

leads to ↓ movement of faecal matter through the bowel

Question 17

Complications of stoma

Answer 17

necrosis, detachment, recession, fistula formation