UNIT 8 Appendicitis, Gastroenteritis, Diverticular Disease CHAPTER 52 Flashcards
What is Gastroenteritis?
Ends in “itis” – Inflammation of stomach
or small bowel from virus or bacteria due
to virus or bacteria
Viral: Norovirus, Rotavirus
Bacterial: Campylobacter, e-coli
Parasitic: Giardia
INFLAMMATION OF STOMACH DUE TO VIRUS
Gastroenteritis is a very common health problem worldwide that causes diarrhea and/or vomiting related to inflammation of the mucous membranes of the stomach and intestinal tract. The small bowel is most commonly affected and can be caused by either viral (more common) or bacterial infection . Table 52.1 lists common types of gastroenteritis and their primary characteristics.
Norovirus (also known as a Norwalk-like virus) is the leading foodborne disease that causes gastroenteritis.
What are the signs and symptoms of Gastroenteritis
Nausea and vomiting typically occur first,
followed by abdominal cramping and diarrhea.
Diarrhea, abdominal pain/cramps, N/V, fever, anorexia,
tenesmus, signs & symptoms of dehydration
For patients who are older or for those who have inadequate immune systems, weakness and cardiac dysrhythmias may occur from loss of potassium (hypokalemia) from diarrhea. Monitor for and document manifestations of hypokalemia and hypovolemia (dehydration).
- Weight loss (unintentional)
- Poor skin turgor
- Fever (not common in older adults)
- Dry mucous membranes
- Orthostatic blood pressure changes (which can cause a fall, especially for older adults)
- Hypotension
- Oliguria (decreased or absent urinary output)
In some cases, dehydration may be severe. It can occur very rapidly in older adults. Monitor mental status changes, such as acute confusion, that result from hypoxia due to dehydration in the older adult. These changes may be the only initial signs and symptoms of dehydration in older adults.
Nursing Intervention for Gastroenteritis
INCREASE FLUID INCREASE DUE TO LOSS OF FLUID THROUGH DIAHRHEA AND VOMITTING
.Teach patients to drink extra fluids to replace fluid lost through vomiting and diarrhea.
Oral rehydration therapy (ORT) may be needed for some patients to replace fluids and electrolytes. Examples of ORT solutions include sports drinks and Pedialyte Gatorade, Powerade.
Depending on the patient’s age and severity of dehydration, he or she may be treated in the hospital with IV fluids to restore hydration.
What would be the treatment for Gastroenteritis?
Would you administer an Antidiarrheal?
A. No
B. Yes
A. No
Treatment: Treat s/s of hypovolemia (dehydration)
Rehydrate! Antibiotics if bacterial, typically NO
antidiarrheals!
Drugs that suppress intestinal motility may not be given for bacterial or viral gastroenteritis. Use of these drugs can prevent the infecting organisms from being eliminated from the body.
How can you prevent the transmission of Gastroenteritis?
Advise the patient to:
* Wash hands well for at least 30 seconds with an antibacterial soap, especially after a bowel movement, and maintain good personal hygiene.
* Restrict the use of glasses, dishes, eating utensils, and tubes of toothpaste
or his or her own use. In severe cases, disposable utensils may be used.
* Maintain clean bathroom facilities to avoid exposure to stool.
* Inform the primary health care provider if symptoms persist beyond 3 days.
* Do not prepare or handle food that will be consumed by others. If you (the patient) are employed as a food handler, the public health department should be consulted for recommendations about the return to work.
What is Appendicitis
Appendicitis is an acute inflammation of the vermiform appendix that occurs most often among young adults. It is the most common cause of right lower quadrant (RLQ) pain.
Where would a pt report pair with Appendicitis
A.LLQ
B. RLQ
C. LUQ
D. RUQ
B. RLQ- McBurney’s point
Acute inflammation leads to blockage,
mucosa secretes fluid increasing
pressure, eventually will rupture
. Initially pain can present anywhere in the abdomen or flank area. As the inflammation and infection progress, the pain becomes more severe and shifts to the RLQ between the anterior iliac crest and the umbilicus. This area is referred to as the McBurney point (Fig. 52.1). Abdominal pain that increases with cough or movement and is relieved by bending the right hip or the knees suggests perforation and peritonitis.
Signs and symptoms of Appendicitis
RLQ pain – McBurney’s point
* Fever, increased WBC
* Cramping pain in abdomen, anorexia, followed by n/v
* Perforation of appendix is life threatening
Abdominal pain/tenderness, N/V, anorexia
Starts as epigastric or periumbilical pain,
eventually radiates to RLQ
Pain in the RLQ (McBurney’s point)
Rebound pain when palpated
Leukocytosis: 10,000-18,000 with appendicitis;
> 20,000 perforated appendix
Low grade fever
N/V
Which of the following statements indicate perforation of the Appendix
A. rigid abdomen and rebound tenderness
B. pain upon removal of pressure rather than application of pressure to the abdomen.
C. steatorrhea in stool
D. Pain that increases with movement and is relieved when the hip flexed
D. Pain that increases with movement and is relieved when the hip flexed
E. Psoas Sign
A. Obturator Sign
What are the 2 signs that is related to the Diagnosis of a ruptured appendicitis? SELECT ALL THAT APPLY
A. Obturator Sign
B. Jupiter Sign
C. Anticholinergic signs
D. Mars Sign
E. Psoas Sign
E. Psoas Sign
A. Obturator Sign
Pain that increases with movement and relieved when
hip flexed indicates perforation and peritonitis
Which WBC level indicated a perforated Appendicitis?
A. 5, 000 WBC
B. 9,000 WBC
C. 23,000 WBC
D. 7,000 WBC
C. 23,000 WBC
Laboratory findings do not establish the diagnosis, but often there is a moderate elevation of the white blood cell (WBC) count (leukocytosis) to
10,000 to 18,000/mm3 with a “shift to the left” (an increased number of
immature WBCs). A WBC elevation to greater than 20,000/mm3 may indicate a perforated appendix.
Nursing Intervention Post Op Appendectomy
Keep the client NPO.
Administer analgesics and
IVF, antibiotics as prescribed.
Semi-fowlers
No laxatives, enemas, or heat
Pre-operative teaching and
obtaining consent.
Is this pt situation a medical emergency?
abdominal pain
that increases with cough or
movement and is relieved by bending
the right hip or the knees
A. Yes
B. No
Notify the provider for abdominal pain
that increases with cough or
movement and is relieved by bending
the right hip or the knees
A. Yes
Should a pt be placed in a supine position while suffering from Appendicitis?
A. Yes
B. No
B. No
For the patient with suspected appendicitis, administer IV fluids as prescribed to maintain fluid and electrolyte balance and replace fluid volume. If tolerated, advise the patient to maintain a semi-Fowler position so that abdominal drainage can be contained in the lower abdomen. Once the diagnosis of appendicitis is confirmed and surgery is scheduled,
administer opioid analgesics and antibiotics as prescribed. The patient with suspected or confirmed appendicitis should not receive laxatives or enemas, which can cause perforation of the appendix. Do not apply heat to the abdomen because this may increase circulation to the appendix and result in increased inflammation and perforation!
What is Diverticular Disease?
Diverticula are pouchlike herniations of the mucosa through the muscular wall of a
any part of the gut, but most commonly the colon.
Diverticulosis is the presence of many abnormal pouchlike herniations (diverticula) in the wall of the intestine.
Acute diverticulitis is the inflammation or infection of diverticula.
Where is the location of pain for a patient with DD?
A.LLQ
B. RLQ
C. LUQ
D. RUQ
A.LLQ
What are the risk factors for Diverticular Disease
Aging
Low fiber diet
Constipation
Signs and symptoms of Diverticular Disease?
LLQ pain
Fever/chills/tachycardia
Distension/rebound tenderness
N/V, abdominal or pelvic mass
Leukocytosis
Bloody stools
Peritonitis, shock
Fistula formation: Pneumaturia/fecaluria
In this chapter under Ulcerative Colitis).
High intraluminal pressure forces the formation of a pouch in the weakened area of the mucosa. Diets low in fiber that cause less bulky stool and constipation have been implicated in the formation of diverticula. Retained undigested food in diverticula is suggested to be one cause of diverticulitis. The retained food reduces blood flow to that area and makes bacterial invasion of the sac easier
Should you use contrast or Enema for a patient with Diverticular Disease?
Absolutely NO contrast enema or colonoscopy during
acute phase! Can cause a perforation
Post Op Nursing Interventions for patients with Diverticular Disease?
NPO
IVF
NGT Suction: For N/V, distension
Broad Spectrum antibiotics
High fiber diet after resolution
Outpatient recommendations for Diverticular Disease
Encourage a high-fiber diet
Adequate hydration (avoid constipation)
Bulk forming laxatives
Avoid foods with seeds (debatable)
Avoid alcohol
Complications of Diverticulitis
Bleeding
Intra-abdominal Abscess: Will Require CT-guided
drainage
Sx: Fever, palpable mass
Purulent/Feculent Peritonitis: Patient will have
guarding, rebound tenderness. Will need surgery:
Laparotomy with resection, colostomy.
Diverticulitis can result in rupture of the diverticulum with peritonitis, pelvic abscess, bowel obstruction, fistula, persistent fever or pain, or uncontrolled bleeding.
Nursing Assessment for Diverticulitis
I
* Provide antibiotics and analgesics as prescribed. Observe older patients carefully for side effects of these drugs, especially confusion (or increased confusion), and orthostatic hypotension.
- Do not give laxatives or enemas. Teach the patient and family about the importance of avoiding these measures.
- Encourage the patient to rest and to avoid activities that may increase intra-abdominal pressure, such as straining and bending.
*While diverticulitis is active, provide a low-fiber diet. When the inflammation resolves, provide a high-fiber diet. Teach the patient and family about these diets and when they are appropriate.
- Because older patients do not always experience the typical pain or fever expected, observe carefully for other signs of active disease, such as a sudden change in mental status.
- Perform frequent abdominal assessments to determine distention and tenderness on palpation.
- Check stools for occult or frank bleeding.
Patient teaching for Diverticular Disease
Laxatives and enemas are avoided because they increase intestinal motility. Assess the patient on an ongoing basis for manifestations of impaired fluid and electrolyte balance .
Teach the patient to rest during the acute phase of illness. Remind him or her to refrain from lifting, straining, coughing, or bending to avoid an increase in intra-abdominal pressure, which can result in perforation of the diverticulum.
Nutrition therapy should be restricted to low fiber or clear liquids based on symptoms.
The patient with more severe symptoms is NPO.
A nasogastric tube (NGT) is inserted if nausea, vomiting, or abdominal distention is severe. Infuse IV fluids as prescribed for hydration. In collaboration with a dietitian, the patient increases dietary intake slowly as symptoms subside. When inflammation has resolved and bowel function returns to normal, a fiber-containing diet is introduced gradually.
The nurse is teaching a client about nutrition and diverticulosis. Which food will the nurse teach the client to avoid?
A. Cucumber
B. peanut butter
C. carrot
D. green juice
A. Cucumber
