Week 4 Flashcards by Ashley Williamson

What contributes to IBS?

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

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Is IBS tied to what?

effective disorders like depression

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what are some clinical manifestations of IBS?

abd cramping and bloating
abd pain and changes in bowel pattern
nausea w meals
belching
Tenesmus
Mucus in stool

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what is tenesmus

the feeling of needing to pass stool despite having empty bowels

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What is the Rome 3 criteria?

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

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Drug therapy for IBS?

loperamide (antidiarrheal)
Alosetron
Lubiprostone
Linaclotide
Bulk agents
Probiotics

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What is important to know about IBS?

IBS is a diagnosis of exclusion

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What is Alosetron (Lotronex) ?

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

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Why is alosetron a last resort med?

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

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What is Lubiprostone (Amitiza)?

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

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Is lubisprostone okay to use for opioid constipation?

yeeeep, effective for opioid-induced constipation as well

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What is Linaclotide (Linzess)?

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

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

rectal bleeding, tachycardia, decreased urine output

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what can too much fiber too quickly cause?

GI discomfort related to gas, bloating, and cramping

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What is the difference between crohns disease and ulcerative colitis?

Crohn’s disease –> mouth to anus

Ulcerative colitis –> colon and rectum

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What is toxic megacolon?

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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How does toxic megacolon occur?

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

5-aminosalicylic acid medications

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What isCyclosporine (Gengraf) typically used for?

used to prevent transplant rejection events.

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What are Methotrexate and azathioprine examples of?

DMARDs

akaDisease-modifying antirheumatic drugs

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How doMonoclonal antibodies work?

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

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

developing cancer and opportunistic infections

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

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

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Which med is used to tx C diff?

Metronidazole (Flagyl)

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What defines diverticulitis?

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

if the diverticula ruptures, what can that cause?

pertionitis

What are S/S of acute diverticulitis?

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

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

CT scan abd CBC: leukocytosis and elevated CRP

If your client has diverticulitis what should be done?

Pt on bedrest NPOOOOO IV fluids/antibiotics analgesics

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

NG tube and set on low intermittent suction

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

DECREASED H&H Tachycardia Hypotension

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

yes, IF hemoglobin drops below 7

What is a KEY finding of peritonitis?

Rebound tenderness

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

NO DO NOT LOL

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

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

What are Paralytic ileus and cathartic colon are examples of?

neurogenic intestinal obstruction

What do large bowel obstruction cause?

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

What is IBD?

inflammatory bowel diseases aka autoimmune diseases

what characterized IBD?

chronic, recurrent inflammation of the intestinal tract

what causes IBD

exact cause is unknown but could be autoimmune, genetics, or enviromental

What is IBD classified as?

Crohns or ulcerative colitis

What are signs of ulcerative colitis?

1. inflammation in the rectum 2. no "skip" areas 3. pseudopolyps form

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

descending colon

where does inflammation begin for ulcerative colitis?

in the rectum.

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

bloody/ watery diarrhea

Why is crohns known as "mouth to anus"?

because lesions can be ANYWHERE in the GI tract

what is specific to Crohn's disease?

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

Which IBD has a "cobblestone" appearance?

Crohns disease

What are some manifestations of ulcerative colitis?

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

What are some manifestations of Crohn's disease?

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

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

1. Ulcerative colitis= anal/rectal symptoms 2. Crohn's= Upper GI symptoms

What are some complications of IBD?

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

What are strictures?

scar tissue in a hollow space that causes an obstruction

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

Crohns : palpate for rebound tenderness for peritonitis

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

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

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

shock

What are some diagnostic studies for IBD?

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

What are the different drug therapies for IBD?

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

What are the anti-inflammatory meds for IBD?

1. 5-ASA (Bental) 2. Corticosteroid

What are the immunosuppressants for IBD?

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

What are the different immunomodulators for IBD?

1. Infliximab 2. Adalimumab 3. Natalizumab YOUR MABS MAB PPL MAKE MOBS

With immunomodulators what should we monitor for?

HYPOTENSION within 15 min the systolic can drop like 15 mm

What are some antidiarrheals for IBD?

1. Diphenoxylate/atropine 2. Loperamide

What are some antimicrobials for IBD?

Metronidazole

What is important to know about Metronidazole? (Antimicrobial)

txs C diff use mouthwash with no alcohol!!

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

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

What are S/S of DIVERTICULOSIS?

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

What are S/S of DIVERTICULITIS?

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

Which analgesic disrupts the GI motility the least?

morphine

What would the diet be for someone who has Diverticulitis?

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

why should enemas be avoided with Diverticulitis?

causes strain and irritation

What are the two types of intestinal obstructions?

1. mechanical 2. Neurogenic

What is an example of a neurogenic intestinal obstruction?

cathartic colon: bowel is no longer responding **as well as hypokalemia and opioids**

What are the contributing factors to an intestinal obstruction?

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

What are some manifestations of intestinal obstructions?

1. **abd distention** 2. HYPERactive above obstructions 3. HYPO below obstruction

Manifestations of a small bowel obstruction

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

Manifestations of a large bowel obstruction

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

What is an expected finding post of a transverse colostomy?

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