TLO 2.4 Gastrointestinal/Bowel Adult

Question 1

Barium enema, what is it?

Answer 1

X-ray exam where contrast medium is inserted rectally
Identified structural abnormalities of colon and rectum
Generally no sedation
Enemas not sterile

Question 2

Barium enema nursing implications

Answer 2

Pre procedure:
Signed consent
Clear liquids 24 hr prior, NPO 8 hr prior
Bowel prep
Post procedure:
Increase fluid intake
Take laxative if ordered
Stools white until barium expelled

Question 3

Gastrointestinal diagnostic tests

Answer 3

Proctoscopy
Visualized rectum using proctoscope
Air inserted to expand rectum
Evaluate abnormal results from the barium enema
Looks at causes of bleeding and monitor polyp growth

Question 4

Proctoscopy nursing implications

Answer 4

Enema day before or day of the cleanse bowel
Cramping and pressure common during procedure
Normal to feel and hear air escaping during procedure
If cramps continue post= ambulate
Knee chest or left lateral position
Signed consent

Question 5

Sigmoidoscopy what is it?

Answer 5

Provides visualization of anal canal, rectum and sigmoid colon
Rigid metal scope or flexible scope
Usually no sedation

Question 6

Sigmoidoscopy nursing implications

Answer 6

Signed consent
Bowel prep pre policy/order
Clear liquid diet 24-48 hr prior
NPO after midnight prior
May have cramping after
If biopsy done may have some blood traces, avoid high fiber foods for 1-2 days, no heavy lifting for 7 days

Question 7

Colonoscopy, what is it?

Answer 7

Visualization of entire colon to the ileocecal valve using a flexible endoscope
Identifies tumors, polyps and inflammatory bowel diseases
Can dilate strictures

Question 8

Colonoscopy nursing implications

Answer 8

Bowel prep per orders
Diet per order, clear liquids, NPO, no red/purple liquids
Sedation usually given, need consent
if polyps removed: avoid high fiber foods 1-2 days, no heavy lifting for 7 days

Question 9

Hernias, what is it?

Answer 9

A defect in the abdominal wall that allows its contents to protrude out of the abdominal cavity

Question 10

Types of hernias?

Answer 10

Umbilical:
-located by the umbilicus

Inguinal:

• direct: defects and weakness of the posterior inguinal wall, usually affect older adults
• indirect: congenital

Femoral

Strangulated (blocks and obstructs blood flow to intestine). This is a common complication with umbilical hernias

Question 11

Hernia surgical treatment

Answer 11

herniorrhaphy:

involves reinforcing the weakened area with a wire, fascia or mesh

Question 12

Strangulated hernia

Answer 12

Requires exploratory surgery and infarcted bowel resected.

Question 13

Post operative hernia care assessment

Answer 13

Assess:
Bowel sounds
Abdominal distention
Pain
Incision
Lung sounds 
Coughing, deep breathing
Ability to void

Question 14

Factors affecting bowl elimination

Answer 14

Developmental age
Diet
Activity
Psychologic factors
Defecation habits
Medications
Diagnostic procedures
Anesthesia and surgery
Pathologic conditions
Pain

Question 15

Bowel assessment, history and assessment

Answer 15

Obtain history:
Normal bowel habits
Any changes
History of problems or use of aids

Assess:
Bowel sounds
Follow- inspect, auscultate, percuss, palpate

Question 16

Bowel assessment sounds and color

Answer 16

Sounds:
Active- high pitched approx. 5-15 gurgles/min
Hypo- low pitched, infrequent, quiet
Hyper- very high pitched more frequent
Absent- no sounds after 3-5 min
Color:
Normal- brown r/t bile pigment
Light brown- r/t diet high in milk, low in meat
Pale- r/t malabsorption of fat
Black/tarry- r/t iron, upper GI bleed, diet high in red meat

Question 17

Bowel assessment shape and consistency

Answer 17

Shape:
Normal- approx. 1” in diameter about size of rectum
Narrow/pencil like- constriction, obstruction, rapid peristalsis
Small marble- slow peristalsis longer time in intestine
Consistency:
Normal- formed moist and soft
Hard- constipation, dehydration
Liquid- diarrhea, rapid peristalsis, infection

Question 18

Patient teaching for constipation

Answer 18

Increase fluid intake at least 2500 mL/day
Drink glass of warm water before breakfast
High natural fiber diet unless contraindicated
Encourage ambulation or chair exercises
Doctor may prescribe bulk laxatives long term
Laxatives for occasional use not long term
Provide privacy
Keep patient routines

Question 19

Hemorrhoid what are they and causes

Answer 19

Rectal lesion common in adults classified as internal or external

Straining to defecate
Pregnancy
Prolonged sitting
Obesity

Question 20

Hemorrhoid assessment, internal

Answer 20

Internal:
Rarely cause pain
Usually have bleeding that is bright red
Recurrent bleeding may cause anemia
Mucous discharge and feeling of incomplete emptying of stool

Question 21

Hemorrhoid assessment, external

Answer 21

External:
Bleeding is rare
Anal irritation
Feeling of pressure
Difficulty cleaning anal region
Enlargement may cause protrusion through anus
Prolapsed hemorrhoids can be extremely painful

Question 22

Hemorrhoidectomy nursing care

Answer 22

Pain: meds, ice, sitz bath, side laying
Stool softeners as prescribed, constipation common post op
Encourage fluid intake
Report bleeding, fever >100, purulent drainage

Question 23

Bowel obstruction, what is it?

Answer 23

Failure of intestinal contents to move through the bowel lumen. More commonly involving the small intestine

Question 24

Bowel obstruction risk factors

Answer 24

Previous abdominal surgery
Complains of abdominal pain, bloating, constipation
Previous history of bowel obstruction
Inflammatory bowel disease history

Question 25

Bowel obstruction, mechanical

Answer 25

``` Mechanical: Scar tissue (adhesions) Hernias (strangulated) Inflammatory bowel disease Tumors ```

Question 26

Bowel obstruction, funtional

Answer 26

Functional: Peristalsis fails to propel intestinal contents No mechanical causes Paralytic ileus most common following abdominal surgery

Question 27

Assessment of small bowel obstruction, high obstructions

Answer 27

Vomiting (bile and mucus) Abdominal distention minimal Cramping Bowel sounds high pitched and tinkling present in attempt to propel past obstruction Paralytic ileus: bowel sounds diminished or absent Fluid and electrolyte imbalances occur r/t vomiting H2O and sodium drawn into bowel causing vascular fluid losses causing hypovolemia

Question 28

Assessment of small bowel obstruction, low obstruction

Answer 28

Vomiting (fecal matter) Flatus and feces present are expelled then cease Abdominal distention pronounced Cramping Bowel sounds high pitched and tinkling present in attempt to propel past obstruction Paralytic ileus: bowel sounds diminished or absent Fluid and electrolyte imbalances occur r/t vomiting H2O and sodium drawn into bowel causing vascular fluid losses causing hypovolemia

Question 29

Medical treatment for obstructions

Answer 29

Most partial small bowel obstruction treated with NG tube - low suction to decompress abdomen - collects fluids and gas - Allows bowel to rest until peristalsis resumes or obstruction is relieved

Question 30

Surgical treatment for obstructions

Answer 30

Required for complete mechanical obstruction and strangulated obstruction - lysis of adhesions - resection of tumor - foreign body removal - colostomy may be performed to relieve obstruction NG tube inserted prior and IV fluids to repair electrolyte imbalances particularly potassium prior to surgery

Question 31

Why an ostomy?

Answer 31

``` Traumas (gun shot wounds) Inflammatory bowel disorders (colitis, Crohns) Tumors/cancer resections Bowel perforation Necrotic bowel ```

Question 32

Types of ostomy

Answer 32

Precise name of the ostomy depends upon its location of the stoma - ileostomy - cecostomy - ascending colostomy - transverse colostomy - descending colostomy - sigmoid colostomy

Question 33

Permanence ostomy, temporary and permanent

Answer 33

Temporary: Traumatic injury or inflammatory condition Allow the distal portion of the bowel to rest and heal Permanent: Done when anus or rectum is nonfunctional (birth defect, cancer of bowel)

Question 34

Ileostomy information

Answer 34

Opening made in ileum of small intestine Generally colon and rectum removed, anus closed Stool is liquid in nature Loop ileostomy is temporary

Question 35

Continent ileostomy info

Answer 35

Intra-abdominal reservoir constructed and valve formed to prevent leaking Catheter is inserted into pouch to drain stool Not frequently seen

Question 36

Ileostomy nursing care post-op assess

Answer 36

Bleeding- small amounts Stoma viability- healthy is pink, red, moist Function- initial drainage dark green odorless. Later it thickens and is yellow brown Empty- when nor more 1/3 full Include contents as output

Question 37

Ileostomy teaching

Answer 37

Self care Meticulous skin care around peri-stomal area Adequate fluid intake, high risk for dehydration Report increase in stool frequency and amount Low residual diet, no whole grains, seeds, spicy Teach s/s food blockage- cramping, swelling of stoma, no output from stoma 4-6 hours

Question 38

Colostomy stool characteristics

Answer 38

Ascending colostomy: fluid to semi fluid stool Transverse colostomy- mushy stool Descending colostomy- semi solid stool Sigmoid colostomy- more solid stool/common permanent

Question 39

Colostomy nursing care

Answer 39

Assess location of stoma and type of colostomy Stoma appearance and surrounding skin Cleanse around stoma with water, soap if sticky or stool present Skin barriers Empty pouch at 1/3 full Replace bag PRN Small blood post op normal

Question 40

Colostomy teaching

Answer 40

Pouch care, skin management Irrigation attempts to promote regular emptying Provide practice time prior to discharge Use return demo and teach back methods No rectal temps, suppositories, enemas if rectum has been removed No major diet changes: educate on food that cause odor and gas