Week 5 - Bowel obstruction Flashcards
What are the symptoms of Small bowel obstruction? (SBO)
-Rapid onset
-Frequent copious vomiting that is projectile - dehydration
-Colicky intermittent ABD pain
-BM for a short time
-Mild/moderate ABD distension
What are the symptoms of Large bowel obstruction? (LBO)
-Gradual onset
-Vomiting in late stages
-Low grade cramping ABD pain
-Constipation
-Significant Abd distension
What 2 tests are used to diagnose SBO or LBO?
abdominal xray
CT
What is likely the first order we will see for someone with bowel obstruction?
decompress stomach
-NG tube with intermittent suction
What nursing care do we need to do for someone with SBO or LBO?
-Abd assessment often- measure
-PAIN control- important
-N/G care - esp around the nose and flushing q4-6hrs
-Nutrition/Fluid/Lytes replacement
-Prepare for Surgery if not resolved
-*Monitor for perforation d/t pressure of obstruction
Does SBO or LBO cause severe dehydration and why?
SBO d/t projectile vomiting
LBO takes a while to cause an issue so vomiting occurs later on
What are the risk factors of colorectal cancer?
Age >50,
alcohol,
smoking,
Hx IBD,
colorectal polyps,
family hx,
Crohn’s or UC
obesity,
increased red meat,
low fruits and veggies,
low fibre
Do we see clinical manifestations early in colorectal cancer or later on?
later on
What are the 3 main clinical manifestations of colorectal cancer?
- change in elimination habits (ribbon like stool)
- Gas pains
- blood in stool
What diagnostic tests are used for colorectal cancer?
*Family history- red flag- early testing
*Colonoscopy- best test to visualize and remove polyups
DRE
FOBT - blood in stool ?
CEA - carcinoembryonic antigen (cancer marker)
CT,
Ultrasound
What is the number one red flag to monitor for someone regarding colorectal cancer and why?
Family history - because it presents in late stages so early testing is key through colonoscopy
How often do we screen for colorectal cancer in Canada?
Q 1-2 yrs >age 50
Is colorectal bowel cancer curative?
Yes- if the patient can handle surgery and hasn’t spread
No- if they are not healthy enough for surgery - then chemo and radiation are used in a palliative approach
When is Abdominal Peritoneal (AP) Resection surgery performed?
when cancer is within 5 cm of the anus
What is removed with an Abdominal Peritoneal (AP) Resection ?
Distal sigmoid colon
rectum
anus
What does the patient need to live with and care for post Abdominal Peritoneal (AP) Resection?
A colostomy in LLQ
What are 2 potential complications of Abdominal Peritoneal (AP) Resection and why?
-Delay wound healing and
Infections d/t location (bacteria)
-Urinary incontinence and sexual
dysfunction d/t location of surgery
What two wounds do we need to care for post AP?
Abdominal incision (colostomy)
perineal incision - irrigate with NS
What is most important to remember in terms of positioning post AP?
- NO PRESSURE ON PERINEUM*
- side to side sitting
- pillow for perineum (roho cushion) later on
How do we care for an ostomy post surgery?
- Assess q8 hrs
- very vascular so small amount of bleeding is normal
- 24-48 hours - not much drainage
- > 48 hours we should see gas & stool starting
What do we teach a patient post ostomy surgery?
- Check skin & inspect stoma
- empty pouch when 1/3 full or inflated with gas
- Deodorants as needed
- Avoid food that cause odor gas, diarrhea or obstruction
-Initially low residue diet then increase gradually - Increase fluid intake and observe for S&S of dehydration
- Assess stool consistency (liquid for ileostomy, formed for sigmoidoscopy)
- Support groups for emotional adjustment
- Follow up care
-Report S&S of Fever, diarrhea, constipation, other stoma problems
What is the best non-medical way to help people manage their pain post GI surgery?
Walk to release gas!
What is a big risk factor for GI patients post surgery that we need to be on top of?
Dehydration!
I&O
