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NURS363 - Practice of Nursing IV > Week 4.5: Obesity and GI > Flashcards

Week 4.5: Obesity and GI Flashcards

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1
Q

What is the BMI of pre-obese, Class I Obesity, Class II Obesity, and Class III Obesity

A

Pre-obese - 25-29.9

Class I - 30-34.9

Class II - 35-39.9

Class III greater than equal to 40

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2
Q

We measure obesity though ___

A

BMI

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3
Q

BMI

A

body mass index

a measure of an adult’s weight in relation to his or her height, calculated by using the adult’s weight in kilograms divided by the square of his or her height in meters

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4
Q

What are some chronic conditions we are at risk for when obesity

A

Alzheimer Disease, Anxiety, Depression, Stroke

Asthma, Obstructive Sleep Apnea, resp infections

Non alcoholic fatty liver disease, liver cancer

thyroid cancer

CAD, MI, heart failure , HTN

Renal cancer

Type II Diabetes and Pancreatic cancer

colorectal cancer

hypercholesterolemia

prostate cancer

osteoarthritis

cholecystitis, cholelithiasis, gallbladder cancer

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5
Q

Treatment Options for Obesity

A

1 is Behavioral Modifications (diet and exercise)

  1. Pharmacological management
  2. Bariatric Surgery
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6
Q

What is the problem with pharmacology management for obesity

A

rarely do patients lose more than 10% of total body weight

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7
Q

Standard Treatment post Behavioral Modification for Obesity

A

Bariatric Surgery

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8
Q

How is bariatric surgery trending over time

A

it is trending upward (13000 in 98 to 278000 in 19)

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9
Q

What are the 2 mechanisms of Bariatric Surgery

A
  1. Restriction

2. Malabsorption depending on the type of surgery / Affect Absorption

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10
Q

Benefits of Bariatric Surgery

A

Total Body Weight Loss

Recovery of Chronic Illnesses

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11
Q

Criteria for Bariatric Surgery

A
  1. BMI greater than or equal to 40 kg/m^2

OR

  1. Patients with BMI greater than or equal to 35 and one or more severe obesity associated comorbid conditions

OR

  1. Patients with BMI greater than or equal to 30 with type 2 diabetes or metabolic syndrome
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12
Q

4 Major Types of Bariatric Surgery

A
  1. Biliopancreatic Diversion w/ Duodenal Switch
  2. Roux En Y Gastric Bypass
  3. Sleeve
  4. Gastric Banding
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13
Q

Biliopancreatic Diversion w/ Duodenal Switch

A

“Sleeve Gastrectomy w/ Duodenal Switch”

Half of stomach is removed, leaving a small area that holds about 60 mL

Jejunum is excluded from the GI tract and connected to the start of the duodenum and then the ileum on the other side

Pyloric Valve is still intact in this one

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14
Q

Is there risk for dumping syndrome with biliopancreatic diversion w/ duodenal switch

A

No there is no dumping syndrome since the pyloric valve is intact

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15
Q

Roux En Y Gastric Bypass

A

horizontal row of staples across fundus of stomach makes a pouch with a capacity of 20-30 mL - the jejunum is then divided and brought to the small pouch and then brought through roux limb

The pyloric valve is bypassed

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16
Q

Is there risk for dumping syndrome in Roux En Y Gastric Bypass

A

yes, the pyloric valve is bypassed entirely

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17
Q

Sleeve

A

Sleeve Gastrectomy

Stomach is incised vertically and up to 85% of the stomach is surgically removed, leaving a “sleeve” shaped tube that retains intact nervous innervation and dose not obstruct or decrease the size of the gastric outlet

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18
Q

The Gastric Sleeve can hold up to __ mL

A

20

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19
Q

Will a pt get dumping syndrome with a sleeve

A

no pyloric valve is left intact

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20
Q

Gastric Banding

A

a prosthetic device is used to restrict oral intake by creating a small pouch of 10-15 mL that empties through the narrow outlet into the remainder of the stomach

the band hangs outside the stomach for adjustment

many pts not successful with this procedure

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21
Q

What kind of bariatric surgery is being phased out

A

Gastric Binding

It is generally unsuccessful and also has lowest level of weight loss

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22
Q

What bariatric surgery leads to most excess weight loss

A

bilopancreatic diversion with DS

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23
Q

What is important to know about fluids and bariatric surgery

A

No fluids with meals, and avoid fluid intake 30 min before a meal and 30-60 min after a meal

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24
Q

Bariatric surgery postop care is similar to gastric resection but …

A

greater risk for complications due to obesity

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25
Q

What is a very important thing to do preop before bariatric surgery?

A

PSYCHOSOCIAL INTERVENTIONS to modify eating behaviors

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26
Q

What is contraindicated following a bariatric surgery

A

an NG tube - risk for perforation from disrupting surgical suture line

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27
Q

Nursing Diagnoses for Bariatric Surgery

A

Deficient knowledge about dietary limitations

Anxiety related to impending surgery

Acute pain related to surgical procedure

risk for deficient fluid volumes related to nausea, gastric irritation and pain

risk for infection related to anastomotic

imbalanced nutrition

disturbed body image

risk for constipation and/or diarrhea

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28
Q

Goals Pre and Post Op for Bariatric Surgery

A

preop and postop knowledge, manage anxiety

post op: manage pain, maintain homeostatic fluid balance, prevent infection, adhere to dietary instructions, vitamin supplements, lifelong follow up, positive body image, and normal bowel habits

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29
Q

T/F: After bariatric surgery, the average pt loses between 25-35% of presurgical body weight within the first 18-24 months post-procedure

A

True - pt will expect to see weight loss following bar surgery if following instructions

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30
Q

T/F: After bowel sounds have returned and oral intake is resumed follow bariatric surgery, 6 small feedings consisting of a total of 600 to 800 calories per day should be consumed

A

True

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31
Q

T/F: Traditionally, the term morbid obesity applies to adults whose body mass index (BMI) exceeds 40 kg/m^2

A

True

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32
Q

Risk Factors for GI Disorders

A

Family Hx

Lifestyle - stress, poor diet, alcohol, tobacco, smoking can all lead to these disorders - many of the disorders are associated with lifestyle behaviors

Domino Effect

Previous abdominal surgeries or trauma

Neurologic disorder

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33
Q

What can GERD lead to?

A

Barret’s esophagus –> predisposition for esophageal cancer

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34
Q

What can chronic gastritis lead to?

A

predisposition of gastric cancer

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35
Q

What can previous abdominal surgeries lead to

A

potential adhesions –> potential obstructions

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36
Q

What can neurological disorders like MS/Parkinsons can impair what

A

pt ability to move and have peristalsis which impairs movement of waste products

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37
Q

GERD

A

Backward movement of gastric or duodenal contents

makes pt feel like they are having heartburn and these episodes occur more than 2 times a week

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38
Q

What is the major cause of GERD

A

relaxation or weakness of LES (lower esophageal sphincter)

obesity can also cause GERD

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39
Q

Things that Trigger LES Relaxation

A

Fatty Food

Caffeinated Beverages

Carbonation

Chocolate

Milk

Chocolate Milk

Tobacco

Spearmint

Progesterone therapy and in surgery

NG tube also permanently impairs function

Medications: NSAIDS, Calcium Channel Blockers, Blood Pressure Meds, Nitroglycerine for chest pain

Pyloric Stenosis

Mucosal irritants - tomato’s and citrus

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40
Q

What to do prior to laying down for the night when you have GERD

A

do not eat 3 hours prior to laying down - no supine if you do

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41
Q

What is a classic symptom of GERD

A

“Waking up in the middle of the night feeling a pain in their throat or feeling heartburn”

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42
Q

Clinical Manifestations of GERD

A 
Pyrosis
Dyspepsia
Sour Taste
Hypersalivation
Dysphagia
Ordynophagia
Eructation
Fullness (even when eating a v small amount of food) - Early Satiety
Nausea
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43
Q

Pyrosis

A

burning in the esophagus / heartburn

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44
Q

Dyspepsia

A

pain in the upper abdomen

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45
Q

Dysphagia

A

difficulty swallowing

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46
Q

Ordynophagia

A

Painful swallowing

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47
Q

Eructation

A

belching

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48
Q

When do symptoms worsen for GERD

A

worsens lying down, bending over, and occurs 30 min to 2 hours post meal

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49
Q

Non Surgical Interventions

A

Dont let the sphincters relax

Promote gastric emptying and avoid gastric distention

Watch those acidic foods

Medications

(eat small meals, lose some weight, stop smoking, keep HOB elevated after a meal, avoid tight clothing, avoid lying down after eating)

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50
Q

Surgical Intervention for GERD

A

Nissen Fundoplication

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51
Q

Nissen Fundoplication

A

takes the fundus and wraps it around the LES to reinforce the closing function of the sphincter

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52
Q

Risks of surgery of Nissen Fundoplication

A

Hemorrhage, Bleeding, Infection, Obstruction (If too tight)

Short bouts of temporary dysphagia

Bloating and gas buildup

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53
Q

Does Nissen Fundoplication cure GERD

A

no they still need to follow non surgical recommendations

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54
Q

Barretts Esophagus

A

w/ prolonged GERD acid erodes lining of the esophagus and turns cells of esophagus to look like the lining of the intestines

alterations can lead to esophageal cancer

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55
Q

Hiatal Hernia

A

when the opening through the diaphragm where the esophagus passes becomes enlarged and part of upper stomach moves into lower portion of the thorax

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56
Q

Risk Factors for Hiatal Hernias

A

Age

Obesity

Women more at risk

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57
Q

Concerns of Hiatal Hernias

A

Obstructions and Strangulations

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58
Q

What are the two types of Hiatal Hernias

A
  1. Sliding

2. Rolling

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59
Q

Sliding Hiatal Hernia

A

Gastroesophageal jxn is compromised

the stomach sits right in the esophagus

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60
Q

Rolling Hiatal Hernia

A

Gastroesophageal junction is intact or compromised

the stomach is pushed through the diaphragm and sits next to esophagus

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61
Q

How does a Sliding Hiatal Hernia present

A

can be asymptomatic

GERD symptoms

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62
Q

How does a Rolling HIatal Hernia Present

A

can be asymptomatic

GERD symptoms

breathlessness after eating

chest pain that mimics angina

feeling of suffocation

worse lying down (SOB)

since it is pushing on resp tract

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63
Q

Which type of hiatal hernia has a higher risk for strangulation?

A

Rolling Hiatal Hernia

Piece of stomach can be strangulated - leading to higher risk for strangulation

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64
Q

Interventions for Hiatal Hernias

A

limit or eliminate foods that relax LES

promote gastric emptying or avoid gastric distention (this also helps prevent movement of the hernia)

limit or eliminated foods that add fuel to the acid fire d/t acidic content (tomato and citrus)

medication reconcilliation

sleep in low fowlers position

Reglin to promote mobility and peristalsis

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65
Q

Gastritis

A

lining of the stomach is inflamed or swollen - disrupted stomach lining

over time the mucosa can erode due to this

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66
Q

Gastritis can be ___ or ___

A

acute or chronic

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67
Q

How long is acute gastritis compared to chronic gastritis

A

Acute = few hours to days

chronic = repeated exposure/recurrent episodes

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68
Q

What is the cause of non erosive acute gastritis

A

H pylori

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69
Q

What is the cause of erosive Gastritis

A

NSAIDS, motrin, ASA< Alcohol use

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70
Q

Why can H Pylori lead to pernicious anemia

A

Chronic Gastritis caused by H Pylori can destroy the parietal cells of the stomach leading to a lack of intrinsic factor production which is needed for VitB12 absorption –> therefore chronic gast. pts may need VitB12 injections lifelong

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71
Q

What makes gastritis worse

A

stress

caffeinated beverages

any triggers for GERD: smoking, spicy or highly se4asoned food, alcohol etc

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72
Q

What are some s/s of gastritis

A

acute: anorexia, epigastric pain, hemtaemesis, hiccups, melena or hematochezia, NV

Chronic: belching, early satiety, intolerance to fatty or spicy foods, NV, pyrosis, sour taste in mouth, vague epigastric discomfort relieved by eating

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73
Q

What are the goals for patients hospitalized for gastritis

A

relieving pain (abdominal)

promote fluid balance

reduce anxiety

promote optimal nutrition

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74
Q

Why is nutrition balance and fluid balance impaired with gastritis

A

they become essentially NPO and are not consuming enough calories so they arnt getting the food they need or are drinking and risk dehydration

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75
Q

Interventions to Treat Chronic Gastritis

A

If caused by H Pylori –> Combo of antibiotics

NSAIDS/Alcohol –> collaborate with health care team, educate patient, refer

smoking cessation

stress management

avoid trigger foods

focus on the mind-gut connection

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76
Q

Peptic Ulcer Disease (PUD)

A

sores in the lining of the GI system and these sores can erode at the mucosa

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77
Q

How does gastritis and PUD differ

A

Gastritis only effects the stomach lining while peptic ulcers are localized sores that can erode past the mucosal layer at least half a centimeter (deeper than gastritis)

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78
Q

A patient with H Pylori induced chronic gastritis is at high risk for developing

A

PUD

79
Q

What are the 4 locations peptic ulcers can be found

A

Duodenum

Stomach

Pylorus

Esophagus

80
Q

___ is the most common location for a peptic ulcer, and ___ is the second most common

A

Duodenum; Stomach

81
Q

Risk Factors for PUD

A

age

genetics

stress

NSAID use

diet

82
Q

Main Underlying Cause of PUD

A

H Pylori and Excessive secretion of hydrochloric acid

83
Q

PUD Chief Complain

A

Dull gnawing burning pain in the mid epigastric area that can radiate into the back

due to radiation to the back rule out other potential causes

84
Q

Nursing Management and Interventions for PUD

A

Dietary Modification

Smoking cessation

Pharmacologic therapy

surgical management

85
Q

How is PUD diagnosed

A

via an upper endoscopy - provider will visualize the ulcer, lesion and inflammation

86
Q

What is the drug regimen like for H Pylori infection

A

triple or quadruple therapy (with quadruple adding bismuth salts)

87
Q

What is the timing of pain like for PUD depending on if it is duodenal or gastric

A

Duodenal (farther down so takes longer): 2-3 hours after a meal, occurs at night, relieved by food

Gastric - Immediately after a meal or 30-60 min after a meal, rarely at night, worse with food

88
Q

What is the stomach acid secretion like for PUD depending on if it is duodenal or gastric

A

Duodenal - Hypersecretion

Gastric - Hypo or normal

89
Q

What is weight change like with PUD depending on if it is duodenal or gastric and why?

A

Duodenal - Weight Gain - since food relieves the pain

Gastric - Weight Loss - since it becomes worse with food

90
Q

4 Types of Surgical Interventions for PUD

A

Vagotomy

Pyloroplasty

Biliroth I

Biliroth II

91
Q

When is surgical intervention for PUD done

A

if the obstruction or perforation or ulcer wont heal over 12-16 weeks

92
Q

Vagotomy

A

Surgical Intervention for PUD

Involves severing the vagus nerve to decrease gastric acid making them less responsive to gastrin which can help prevent PUD

93
Q

Pyloroplasty

A

Surgical Intervention for PUD

widens the opening of the lower part of the stomach so contents pass easier into the duodenum

94
Q

Biliroth I (Gastroduodenostomy)

A

PUD Surgery

Lower portion of stomach (gastrin release area) and a small part of the duodenum and pylorus are removed and then what remains is resewn to the duodenum

Removes the pylorus so risk for dumping syndrome

95
Q

Biliroth II (Gastrojejunostomy)

A

PUD Surgery

Removes lower portion of stomach and connects it to the jejunum

Can have dumping syndrome here

96
Q

Nursing Dx for PUD

A

Pina

Fluid and Nutrition Balance

Anxiety

Home and Community Based Care

97
Q

What are some common complications of PUD

A

Hemorrhage

Perforation and Penetration

Gastric Outlet Obstruction

98
Q

___% of PUD pts hemorrhage and present with bloody stool or emesis

A

15%

99
Q

What does perforation and penetration with PUD cause

A

erode the serousa –> gastric contents leak into peritoneum (peritonitis) –> EMERGENCY

100
Q

When does gastric outlet obstruction from PUD occur

A

Area near pyloric sphincter is scarred and stenosed from healing ulcers over time meaning the sphincter cannot function right leading to scar tissue and obstruction

101
Q

T/F: Most pepetic ulcers result from infection with the gram negative bacteria H pylori which may be acquired through ingestion of food and water

A

True

102
Q

Currently the most commonly used therapy for peptic ulcers is a combination of ___, proton pump inhibitors, and bismuth salts that suppresses or eradicates H Pylori

A

Antibiotics

103
Q

Chronic Constipation

A

Fewer than 3 BMs weekly or hard, dry, small, and difficult to pass based on normal BM schedule

104
Q

Clinical manifestations of chronic constipation

A

straining

pain or pressure

sensation of incomplete evacuation

lumpy hard stools

fewer stools

105
Q

Causes of Chronic Constipation

A

diet - low fiber

holding in poop

inadequate fluid intake (<8 glasses)

being a couch potato / lack of exercise

too active leading to being too busy and forgetting or not having time to BM

medications: pain meds, chronic laxative use

Hypothyroidism and Spinal Cord Injuries

106
Q

Nursing Management for Chronic Constipation should focus on what

A

education and controlling any pain

107
Q

Ways to prevent constipation

A

high residue high fiber diet

making sure pt is consuming enough fluids unless contraindicated

exercising

diet

108
Q

Diarrhea

A

increased frequency of BM (more than 3 / day) and alternative consistency of the stool

109
Q

When is diarrhea considered chronic

A

when changed consistency and 3/day stools persist 2-3 weeks or more

110
Q

Clinical Manifestations of Diarrhea

A

Urgency

Perianal discomfort from frequency of BM and skin irritation around anus

abdominal cramping and distention

rumbling in the stomach or intestinal region

111
Q

Causes of Diarrhea

A

stool softeners

antibiotics

tube feedings

C Diff

diabetic neuropathy or pancreatic insufficiency

inflammation

112
Q

Complications of Diarrhea

A

dehydration!!

cardiac dysrhythmias

low potassium

skin irritation around anus

113
Q

What is nursing management of diarrhea focused on

A

Dehydration!!!

But also:

Lyte Balance
Skin Integrity
Accurate Health Hx
Exploring Diet and IV Hydration / Lyte Replacement

114
Q

Small bowel disorder leads to what stool characteristics

A

watery

115
Q

Large bowel disorders leads to what stool characteristics

A

loose, semi solid

116
Q

Malabsorption syndrome leads to what stool characteristics

A

voluminous, greasy

117
Q

Inflammatory disorders leads to what stool characteristics

A

blood, mucus, pus

118
Q

Pancreatic Insufficiency leads to what stool characteristics

A

oil droplets

119
Q

Diabetic neuropathy leads to what stool characteristics

A

nocturnal frequency

120
Q

C Diff leads to what stool characteristics

A

diarrhea, unexplained, and they are on antibiotics which can alter things

121
Q

Diarrhea is defined as the increased frequency of more than 3 bowel movements per day

A

true

122
Q

Inflammatory Bowel Disease (IBD)

A

A group of chronic disorders: Ulcerative colitis and Crohns disease

123
Q

Ulcerative colitis

A

IBD

recurrent ulcerations that affect the mucosa and submucosa layers of the colon and rectum (particularly the transcending and descending colon

ulcers are often continuous/contiguous and are connected to one another

124
Q

Crohn’s disease

A

IBD - AKA: Regional enteritis

Subacute and chronic inflammation of the GI tract that spreads deep into the tissue layers (deeper than UC) of the affected bowel tissue

Can happen anywhere mouth to anus but is typically found in the ileum and ascending colon

Has a cobblestone appearance because it does go deeper into the bowel layers

125
Q

IBD is most common in what age group

A

15-30 year olds

Young people!: HS Students, College Students, Young Adults

Some links to smoking and active smoking for UC but needs more research

126
Q

Location of UC v CD

A

UC - Colon

CD - Mouth to anus

127
Q

What are the lesions like in UC v CD

A

UC - Contiguous

CD - Cobblestone / Not contiguous

128
Q

What are the exacerbations like in UC v CD

A

UC - Exacerbations and remissions

CD - Prolonged bouts

129
Q

What is the diarrhea like in UC v CD

A

UC: More severe (10-20 bouts QD)

CD: Less severe (5-6 bouts of QD)

130
Q

Symptomology of UC v CD

A

UC: LLQ pain (where descending colon is), passage of mucus and pus, tenesmus (ineffective painful straining), rectal bleeding, anorexia

CD: RLQ crampy pain (ileum here), eating stimulates cramps, anorexia, steatorrhea, fever

131
Q

Bleeding of UC v CD

A

UC: Common and severe

CD : not common and mild

132
Q

Fistulas in UC v CD

A

UC: Rare

CD: Common

133
Q

Other Complications in UC v CD

A

UC - Perforation, Toxic Megacolon –> Bowel perforation

CD: Bowel obstruction, abscesses, colon cancer

134
Q

Surgery in UC v CD

A

UC: Curative (since removal can cure)

CD: Non curative (since it can be anywhere it cannot be cured)

135
Q

What sort of pharmacologic treatments are done for IBD

A

corticosteroids and antibiotics

136
Q

Big concern with IBD is ….

A

nutritional imbalance

the anorexia - IBD often underweight, malnutrition, malnourished - so its common (esp in CD) to see Parenteral nutrition - GI will need rest and anorexia

137
Q

Biggest complication concerns of IBD

A

electrolyte imbalance

cardiac dysrhythmias related to electrolyte imbalances

GI bleeding with fluid volume loss

perforation of the bowel

138
Q

Nursing Goals of IBD

A

bowel elimination

pain management

fluid volume

nutrition

fatigue

anxiety (v bad they are young)

coping

skin (frequent BM)

knowledge (deficit about IBD)

self health management

complications

139
Q

Nursing Interventions for IBD

A

Diet, activity and stressors - nutritional therapy

ready access to restroom

pain management

fluid volume and low residue diet –> low gas diet easy to digest

rest

anxiety and coping

skin

understanding and self care

140
Q

Irritable Bowel Syndrome (IBS)

A

chronic functional disorder associated with pain and disordered BMs

diagnosed s/s

141
Q

What differentiates IBD and IBS

A

IBD - the doctor can do an endoscopy and visually see the ulcers

IBS - functional disorders means there is no diagnostic finding on colonoscopy (scope shows nothing) - diagnosed based on s/s

142
Q

Clinical Manifestations of IBS

A

Disorder of frequency and consistency of stool - diarrhea to constipation back and abdominal pain/pain assoc with change in stool and stool appearance and frequency

143
Q

Interventions for IBS

A

Education

Dietary Habits

Chew and Dont Drink with Meals - Fluid cause distention

Stress Management

144
Q

T/F: The patient with IBS should select foods low in fiber in order to minimize intestinal irritation

A

False - want them to have high fiber foods

145
Q

In Crohn’s disease, the clusters of ulcerations on the intestinal mucosae have a ___ appearance

A

Cobblestone

146
Q

What are the 3 subclasses of Intestinal Obstructions be

A

Mechanical v functional

small bowel v large bowel

partial v complete

147
Q

Mechanical Intestinal Obstruction

A

Caused from pressure on the intestinal wall and the pressure leads to adhesions, intussusception, inguinal hernia, hernia, or tumor

148
Q

Functional Intestinal Obstruction

A

“Paralytic Obstruction”

When intestinal musculature cannot propel food, cannot do peristalsis, cannot propel weight

149
Q

Common causes for Intestinal Obstructions

A

Endocrine Disorders and Neurological Disorders

150
Q

What is the difference between partial and complete intestinal obstructions

A

Parial means only part of the movement is occluded; complete means nothing can move

151
Q

A patient with intestinal obstruction is at significant risk for what

A

fluid imbalance - critically imbalanced

We want to maintain the fluid and lyte balance, insert and NG tube as orders, and be NPO

152
Q

S/S of Intestinal Obstruction

A

Pain

May or may not have BM reported

potential mucus of blood in stool

abdomen distended!!!! (large and firm)

emesis

weakness

potential weight loss

153
Q

Nursing Interventions for Bowel Obstructions

A

IV fluids

NG tube decompression

fluid and lyte replacement

surgery - if tissue is strangulated

fix root cause - ex: hernia

anti nausea meads- not PO, IV or suppository’s

154
Q

T/F: Decompression of the bowel through a nasogastric tube is necessary for all patients with a small bowel obstruction

A

True - if the pt is obstructed they are getting an NG tube

155
Q

General Nursing Considerations Post GI Surgery

A
  1. Resuming enteral intake (PO) - get them back up and moving
  2. Dysphagia
  3. Gastric Retention
  4. Bile Reflux (when pylorus removed/broken)
  5. Dumping Syndrome (when pylorus removed/broken)
  6. Vit and Min Deficiencies
156
Q

Intestinal Diversion

A

Allows stool to leave the body when there is disease or injury

It is a pouch with a stoma that is from the wall of the colon or ileum v- brought to surface and fused with it

157
Q

Ostomy location depends on…

A

disease and condition location - depends on where in the GI system is affected

158
Q

What changes based on ostomy location

A

stool consistency

159
Q

Colostomies

A

Sigmoidostomy

Descending Colon Ostomy

Transverse Colon Ostomy

Ascending Colon Ostomy

160
Q

Ileostomy Stool

A

ostomy that bypasses the entire large intestine, so stools are liquid, frequently contain digestive enzymes, and must be pouched at all times

has lots of digestive enzymes so can be irritating to skin

161
Q

How do the colostomy stools compare

A

Sigmoid - stool may be more solid - water absorbed

Descending - semisolid, less solid than sigmoid

Transverse - more mushy than descending

Ascending - liquid stool

162
Q

Ileostomy byupasses what

A

colon, rectum, and anus

163
Q

Which ostomy has fewest complications

A

Ileostomy

164
Q

Colostomy

A

diverts colon to a stoma

165
Q

Ileoanal Reservoir

A

essentially a “new rectum”

large intestine removed but anus remains intact and disease free

colon like pouch from last several inches of ileum

stool collects and exits during bowel movement

166
Q

Continent Ileostomy (K Pouch)

A

For pts, with rectal or anal damage who do NOT want ostomy pouch

large intestine removed and a Kock pouch is made from the end of the ileum

effluent is then drained by inserting a catheter into a valve

167
Q

Ostomy Care education should include

A

basic assessments

size

strict I&O

effluent monitoring

skin care and pouch care

diet and medications

monitor and report increase or decrease of effluent, stomal swelling, abdominal cramping and distention

168
Q

When does effluent post ostomy surgery appear

A

not until 24-48 hours after surgery

169
Q

Nursing Dx for Ostomy Care

A

Disturbed body image

Risk for impaired skin integrity r/t to irritation of the peristomal skin by the effluent

Imbalanced nutrition: less than body requirements r/t avoidance of foods

Anxiety r/t to the loss of bowel control

Risk for deficient fluid volume

Sexual dysfxn

Deficient Knowledgeo

170
Q

Ostomy Irrigation

A

to stimulate emptying at scheduled times

note always in routine care but can help stop unplanned bowel movements or fecal drainage in social situations

gives pts control

171
Q

T/F: The pt with an ileostomy with a Kock Pouch will not need to use an external collection bag

A

True

172
Q

What is the main risk factor for esophageal cancer

A

barrets esophagus

173
Q

what gender is more likely to get esophageal cancer

A

men

174
Q

what race is more likely to get esophageal cancer

A

African American

175
Q

Risk factors for esophageal cancer

A

smoking

ETOH use

gender

age

comorbidities

176
Q

One of the number one complaints about esophageal cancer is what

A

dysphagia - trouble swallowing

sensation in throat or something is getting stuck

*also weight loss and weakness

177
Q

by the time esophageal cancer symptoms appear

A

the cancer has advanced

178
Q

Diagnostics for Esophageal Cancer

A

biopsy and endoscopy

179
Q

Treatments for Esophageal cancer

A

chemo

radiation

re-sectioning esophagus with part of small intestine

180
Q

What gender and races are more likely to get gastric cancer

A

men > women

native america, hispanic, african american > caucasian

181
Q

Risk Factors for Gastric Cancer

A

poor diet

smoking

alcohol use

gastritis

182
Q

How does gastric cancer present

A

clinical manifestations present like PUD

undiagnosed until CT scan

183
Q

Diagnostic for Gastric Cancer

A

CT Scan

184
Q

Treatments for Gastric Cancer

A

chemo and radiation - may be palliative not curative

total gastrectomy if it hasnt spread and is caught early

185
Q

Duodenal Tumors

A

Usually benign and diagnosed incidentally

present asymptomatic

if severe, intermittent pain and occult bleeding occurs

can be removed with surgery

186
Q

3rd most common cause of cancer death is via ____ cancer

A

colorectal

187
Q

chief sign for colorectal cancer

A

change in bowel habits!!!’

*second most common manifestation is blood in stool

188
Q

____ is the most prevalent cancer diagnosis in colorectal cancers

A

adenocarcinomas

189
Q

How is colorectal cancer diagnosed

A

via colonoscopy and biopsy

190
Q

Tenesmus

A

recurrent inclination to evacuate bowels - can be painful or spasming sensation

191
Q

Risk Factors for colorectal cancer

A

increasing age - >50 yo

family hx of colon cancer or polyps

high consumption of ETOH

cig smoking

obesity

hx of gastrectomy

hx of inflammatory bowel disease

high fat, high protein (with high intake of beef), low fiber

genital cancer (endometrial CA< ovarian CA) or breast CA (in women)

192
Q

S/S of Colorectal Cancer

A

Right Sided Lesions - Dull abdominal pain and melena

Left Sided Lesions - abdominal pain, cramping, narrowed stools, constipation, distention, bright red blood

Rectal lesion - tenesmus, rectal pain, feeling of incomplete evacuation after a BM. alternating constipation and diarrhea, bloody stool

193
Q

The etiology of cancer of the colon and rectum is predominantly (90%) ____, a malignancy arising from the epithelial lining of the intestine

A

adenocarcinoma

NURS363 - Practice of Nursing IV (17 decks)

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