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MedSurg 2 > Week 4 > Flashcards

Week 4 Flashcards

1
Q

What contributes to IBS?

A

smoking
NSAIDS
family history
high fat diet
alcohol
caffeine stress
female
dairy product

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2
Q

Is IBS tied to what?

A

effective disorders like depression

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3
Q

what are some clinical manifestations of IBS?

A
  1. abd cramping and bloating
  2. abd pain and changes in bowel pattern
  3. nausea w meals
  4. belching
  5. Tenesmus
  6. Mucus in stool
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4
Q

what is tenesmus

A

the feeling of needing to pass stool despite having empty bowels

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5
Q

What is the Rome 3 criteria?

A
  1. Recurrent abd pain and change in bowel habits for at LEAST 6 months
  2. S/S for 3 days during a month in the past 3 months
  3. Stool appearance/frequency
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6
Q

Drug therapy for IBS?

A
  1. loperamide (antidiarrheal)
  2. Alosetron
  3. Lubiprostone
  4. Linaclotide
  5. Bulk agents
  6. Probiotics
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7
Q

What is important to know about IBS?

A

IBS is a diagnosis of exclusion

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8
Q

What is Alosetron (Lotronex) ?

A

antagonizes serotonin receptors in the stomach to reduce abdominal cramping and discomfort in persons whose main IBS symptom is diarrhea

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9
Q

Why is alosetron a last resort med?

A

Last resort medication due to risk of ischemic colitis (inflammatory response that narrows GI vessels and compromises perfusion)

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10
Q

What is Lubiprostone (Amitiza)?

A

chloride channel activator that creates a “slip-and-slide” effect in the colon to relieve constipation

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11
Q

Is lubisprostone okay to use for opioid constipation?

A

yeeeep, effective for opioid-induced constipation as well

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12
Q

What is Linaclotide (Linzess)?

A

increases intestinal lumen volume and transit to relieve constipation related to IBS or idiopathic, chronic constipation

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13
Q

what are some side effects of a pt taking Linaclotide (linzess)?

A

rectal bleeding, tachycardia, decreased urine output

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14
Q

what can too much fiber too quickly cause?

A

GI discomfort related to gas, bloating, and cramping

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15
Q

What is the difference between crohns disease and ulcerative colitis?

A

Crohn’s disease –> mouth to anus

Ulcerative colitis –> colon and rectum

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16
Q

What is toxic megacolon?

A

a life-threatening condition where inflammation is so severe that it affects the neuromuscular function of the colon (loss of haustration), causing it to stop working

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17
Q

How does toxic megacolon occur?

A

Fluid, toxins (if related to infection), and gas begin dilating the colon, which will ultimately lead to rupture/perforation and subsequent hypovolemic shock

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18
Q

What are Mesalamine (Delzicol) and sulfasalazine (Azulfidine) are examples of?

A

5-aminosalicylic acid medications

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19
Q

What isCyclosporine (Gengraf) typically used for?

A

used to prevent transplant rejection events.

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20
Q

What are Methotrexate and azathioprine examples of?

A

DMARDs

akaDisease-modifying antirheumatic drugs

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21
Q

How doMonoclonal antibodies work?

A

by redirecting the pathway of TNF-alpha, which results in reduced pro-inflammatory responses

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22
Q

What do the medications used to treat IBD that reduce immune system activity place recipients at risk for?

A

developing cancer and opportunistic infections

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23
Q

What are the combination opioid agonists and anticholinergics/acetylcholine production suppressors to treat IBD-related diarrhea?

A

The medications diphenoxylate/atropine (Lomotil) and loperamide (Imodium)

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24
Q

Which med is used to tx C diff?

A

Metronidazole (Flagyl)

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25
Q

What defines diverticulitis?

A

The diverticula (small pouch like protrusions in the large intestines) become INFLAMED

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26
Q

if the diverticula ruptures, what can that cause?

A

pertionitis

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27
Q

What are S/S of acute diverticulitis?

A

N/V
Fever
Abd pain (LLQ)
change in bowel habits
painless Hematochezia

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28
Q

What tests are done to find out if you have diverticulitis?

A

CT scan abd
CBC: leukocytosis and elevated CRP

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29
Q

If your client has diverticulitis what should be done?

A

Pt on bedrest
NPOOOOO
IV fluids/antibiotics
analgesics

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30
Q

If your pt with nausea, vomiting, diverticulitis has a bowel obstruction, what should you do?

A

NG tube and set on low intermittent suction

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31
Q

What should you report to HCP on a pt with diverticulitis?

A

DECREASED H&H
Tachycardia
Hypotension

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32
Q

Would a pt need a blood transfusion with diverticulitis? If so, under what value?

A

yes, IF hemoglobin drops below 7

33
Q

What is a KEY finding of peritonitis?

A

Rebound tenderness

34
Q

Are you going to give your pt with diverticulitis a laxative or enema?

A

NO DO NOT LOL

35
Q

What nutrition factors would your pt with diverticulitis need to focus on?

A

high fiber (apples, whole wheat, bananas, legumes)

at least 2L water a day

Decreased meat consumption

Nuts are a good source and are okay to eat

36
Q

What are Paralytic ileus and cathartic colon are examples of?

A

neurogenic intestinal obstruction

37
Q

What do large bowel obstruction cause?

A

impairs fluid reabsorption, which leads to renal insufficiency and subsequent hyperkalemia (the kidneys are responsible for actively excreting K+)

38
Q

What is
IBD?

A

inflammatory bowel diseases

aka autoimmune diseases

39
Q

what characterized IBD?

A

chronic, recurrent inflammation of the intestinal tract

40
Q

what causes IBD

A

exact cause is unknown

but could be autoimmune, genetics, or enviromental

41
Q

What is IBD classified as?

A

Crohns or ulcerative colitis

42
Q

What are signs of ulcerative colitis?

A
  1. inflammation in the rectum
  2. no “skip” areas
  3. pseudopolyps form
43
Q

where is ulcerative colitis mainly seen in regards of the GI tract?

A

descending colon

44
Q

where does inflammation begin for ulcerative colitis?

A

in the rectum.

45
Q

what do bowels look like for someone who has ulcerative colitis?

A

bloody/ watery diarrhea

46
Q

Why is crohns known as “mouth to anus”?

A

because lesions can be ANYWHERE in the GI tract

47
Q

what is specific to Crohn’s disease?

A

It has transmural lesions, meaning the lesions eat through the colon which will cause holes leading to peritonitis

48
Q

Which IBD has a “cobblestone” appearance?

A

Crohns disease

49
Q

What are some manifestations of ulcerative colitis?

A
  1. severe/constant abd pain
  2. Diarrhea
  3. Rectal bleeding **
  4. Tenesmus
  5. fever during acute attacks
50
Q

What are some manifestations of Crohn’s disease?

A
  1. cramping
  2. Steatorrhea (oily stool)
  3. Fever
  4. Malabsoprtion
  5. weight loss
51
Q

How can you easily tell if its ulcerative colitis or Crohn’s disease?

A
  1. Ulcerative colitis= anal/rectal symptoms
  2. Crohn’s= Upper GI symptoms
52
Q

What are some complications of IBD?

A
  1. hemorrhage
  2. colorectal cancer
  3. C. diff infection
  4. perforation
  5. perineal abscess/fistulas
  6. Strictures
    y. Toxic megacolon
53
Q

What are strictures?

A

scar tissue in a hollow space that causes an obstruction

54
Q

If the pt has a perforation (transmural) what do you do?

A

Crohns : palpate for rebound tenderness for peritonitis

55
Q

in an X-ray what does a toxic megacolon show? What does this feel like?

A

gas and fluid in the abd (feels like an elephant sitting on the colon)

56
Q

If someone has low albumin what are they ar risk for?

A

shock

57
Q

What are some diagnostic studies for IBD?

A
  1. magnetic resonance enterography
  2. Sigmoidoscopy and or colonoscopy
  3. CT scan
    $. Barium enema
58
Q

What are the different drug therapies for IBD?

A
  1. Anti-inflammatory
  2. Immunosuppressants
  3. Immunomodulators
  4. Antidiarrheal
  5. Antimicrobial
59
Q

What are the anti-inflammatory meds for IBD?

A
  1. 5-ASA (Bental)
  2. Corticosteroid
60
Q

What are the immunosuppressants for IBD?

A
  1. Cyclosporine
  2. Methotraxate (Nephro toxic)!!! drink plenty of water
  3. Azathioprine
61
Q

What are the different immunomodulators for IBD?

A
  1. Infliximab
  2. Adalimumab
  3. Natalizumab

YOUR MABS
MAB PPL MAKE MOBS

62
Q

With immunomodulators what should we monitor for?

A

HYPOTENSION

within 15 min the systolic can drop like 15 mm

63
Q

What are some antidiarrheals for IBD?

A
  1. Diphenoxylate/atropine
  2. Loperamide
64
Q

What are some antimicrobials for IBD?

A

Metronidazole

65
Q

What is important to know about Metronidazole? (Antimicrobial)

A

txs C diff

use mouthwash with no alcohol!!

66
Q

What is SUPER important for nurses to do if the pt has IBD?

A
  1. assist client in identifying food triggers
  2. Monitor I&Os
67
Q

What are S/S of DIVERTICULOSIS?

A
  1. Symptoms are usually asymptomatic
  2. Bloating
  3. Flatulence
  4. Changes in bowel habits
68
Q

What are S/S of DIVERTICULITIS?

A
  1. Acute pain in LLQ
  2. Abd distention
  3. Fever/chills
  4. Tachycardia
  5. N/V
69
Q

Which analgesic disrupts the GI motility the least?

A

morphine

70
Q

What would the diet be for someone who has Diverticulitis?

A
  1. clear liquid diet
  2. Low-fiber when solid foods are tolerated
  3. High fiber when inflammation resolves
  4. limit fat intake
71
Q

why should enemas be avoided with Diverticulitis?

A

causes strain and irritation

72
Q

What are the two types of intestinal obstructions?

A
  1. mechanical
  2. Neurogenic
73
Q

What is an example of a neurogenic intestinal obstruction?

A

cathartic colon: bowel is no longer responding

as well as hypokalemia and opioids

74
Q

What are the contributing factors to an intestinal obstruction?

A
  1. Fecal impaction
  2. Surgical procedures
  3. Crohns disease
  4. Carcinomas
  5. Hypokalemia
  6. Opioids
  7. Diverticulitis
  8. Radiation
75
Q

What are some manifestations of intestinal obstructions?

A
  1. abd distention
  2. HYPERactive above obstructions
  3. HYPO below obstruction
76
Q

Manifestations of a small bowel obstruction

A
  1. sporadic colicky pain
  2. Peristaltic waves
  3. Profuse, projectile vomitus with fecal odor
77
Q

Manifestations of a large bowel obstruction

A
  1. Diffuse
  2. Abd distention
  3. Fecal fluid around the impaction
78
Q

What is an expected finding post of a transverse colostomy?

A
  1. Small semi-liquid with some mucus
  2. Blood can be present in the first few days **

MedSurg 2 (5 decks)

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