week 6 Flashcards by Garrett Anderson

_________ WITH _________

Can visualize oropharynx, esophagus, stomach, and small intestine via fluoroscopy and x-ray (upper GI and small intestines)

procedure
- Patient swallows contrast/medium (Barium or Gastrograffin)
- positioned various ways
- with SBFT – take pics every 30 mins until contrast/medium reaches terminal ileum (the end of the small intestine)
- movement of contrast/medium is observed with fluoroscopy and x-rays

Upper GI/barium swallow WITH Small bowel series/small bowel follow through(SBFT)

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Upper GI/barium swallow WITH Small bowel series/small bowel follow through(SBFT)

nursing care
pre-procedure
- diet?
- smoking?
Post-procedure
- Prevent?
- white stool - expected or unexpected?

nursing care
pre-procedure
- NPO 8 hours
- No smoking after midnight
Post-procedure
- Prevent constipation
- Teach expected s/e – white stool

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_________ or _________

Both procedures involve drinking a liquid contrast material (barium) and taking X-rays to more thoroughly exam esophagus (compared to the upper GI tract)

which one specifically designed to evaluate swallowing function. This may involve using a modified barium mixture with different consistency or observing the patient’s swallowing mechanics more closely during the procedure.

Upper GI/barium swallow or modified barium swallow

modified barium swallow

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pt with:
-Dysphagia – maybe stroke pt
-Non-cardiac chest pain – rule out GI pain
-Painful swallowing
-GERD

indicated for which radiology test - Upper GI/barium swallow and modified barium swallow
OR
- Upper GI/barium swallow WITH Small bowel series/small bowel follow through(SBFT)

Upper GI/barium swallow and modified barium swallow

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Upper GI/barium swallow and modified barium swallow

nursing care
pre-procedure
- diet?
- smoking?
Post-procedure
- Prevent _________
- white stool expected or unexpected?
- when can they start eating again?

nursing care
pre-procedure
- NPO 8 hours
- No smoking after midnight
Post-procedure
- Prevent constipation
- Teach expected s/e – white stool
- If test is passed = can start eating again

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which test?

________________
X-ray examination used to visualize the large intestine.

Procedure
- Contrast/medium (barium)
- X-rays are taken to examine the colon and rectum (lower GI)

Lower GI/barium enema

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Lower GI/barium enema
Nursing care
Pre-procedure
- Enemas until _______
- diet? (2)
Post-procedure
- Cathartics (bowel cleanse) PRN
- white stool - expected or unexpected?

Nursing care
Pre-procedure
- Enemas until bowels are clear
- Clear liquids night before procedure
- NPO 8 hours
Post-procedure
- Cathartics PRN
- Teach expected s/e – white stool

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upper or lower GI
1. barium swallow
2. small bowel series/small bowel follow through
3. modified barium swallow
4. barium enema
5. EGD (Esophagogastroduodenoscopy)
6. Colonoscopy

upper - 1,2,3, 5
lower - 4, 6

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which test?

Patient eats a cooked egg containing radioactive metal
Images are taken at 0, 1, 2 and 4 hours later

Gastric emptying studies

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which test?
Indicated for
- Want to assess ability of stomach to empty solids
- PUD
- Ulcer surgery
- Diabetes
- Gastric malignancies or functional disorders – gastroparesis

Gastric emptying studies
Patient eats a cooked egg containing radioactive metal
Images are taken at 0, 1, 2 and 4 hours later

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Gastric emptying studies
Patient eats a cooked egg containing radioactive metal
Images are taken at 0, 1, 2 and 4 hours later

Nursing care
- Only _______ amounts of radioactive substances – little to no danger
- position during scanning?

Nursing care
- Only trace amounts of radioactive substances – little to no danger
- Must lie flat during scanning

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MRI vs CT
__________
- Radiologic exam
- Noninvasive
- Allows for exposure at different depths
- With or without contrast
-Contrast accentuates density differences
-Must assess for iodine/shellfish allergy
____________
- Radiofrequency and magnetic field used
- Noninvasive
- Contraindicated for metal implants and pregnancy

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MRI vs CT?

Contraindicated for
1. metal implants
2. pregnancy

both MRI

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This procedure uses a flexible tube with a camera to examine the esophagus, stomach, and duodenum. UPPER GI

EGD (Esophagogastroduodenoscopy)

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Indications for which procedure?
- To directly visualize upper GI tract
- Looking for:
- upper GI bleed
- tumors
- varices
- mucosal inflammation
- hiatal hernia
- polyps
- ulcers
- obstructions

EGD (Esophagogastroduodenoscopy)
This procedure uses a flexible tube with a camera to examine the esophagus, stomach, and duodenum. UPPER GI

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which procedure

therapeutic/treatment purposes
- cauterize bleeding
- open strictures
- band esophageal varices

EGD (Esophagogastroduodenoscopy)
This procedure uses a flexible tube with a camera to examine the esophagus, stomach, and duodenum. UPPER GI

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EGD (Esophagogastroduodenoscopy)
This procedure uses a flexible tube with a camera to examine the esophagus, stomach, and duodenum. UPPER GI

nursing care
pre-procedure
- diet?
- Consent form?
Post-procedure
- NPO until _______
- Assess for _____

nursing care
pre-procedure
- NPO 8 hours
- Consent form
Post-procedure
- NPO until gag reflex returns 2-4 hours
- Assess for signs of internal bleeding – vitals

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This procedure uses a flexible tube with a camera to examine the colon (lower GI)

Colonoscopy

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Colonoscopy
This procedure uses a flexible tube with a camera to examine the colon (lower GI)

nursing care
pre-procedure
- bowel prep?
during procedure
- sedated?
- _________ - introducing air or gas into a body cavity or organ to distend it and improve visibility during an examination or surgery
Post-procedure
- Assess for signs of internal bleeding and perforation
o _______
o _______
o _________

nursing care
pre-procedure
- bowel prep
during procedure
- sedated
- air insufflation - introducing air or gas into a body cavity or organ to distend it and improve visibility during an examination or surgery
Post-procedure
- Assess for signs of internal bleeding and perforation
o vitals
o bleeding through colon
o tender abdomen

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fecal tests:

This test examines a stool sample for abnormalities such as blood, parasites, or inflammation.

This test is used to identify bacteria or other microorganisms that may be causing infection, including c.diff

Fecal analysis

Stool culture

Fecal tests can also check stool for ova and parasites

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Fecal analysis - This test examines a stool sample for abnormalities such as blood, parasites, or inflammation.

Keep diet free of _______ for 24-48 hours pre-test – could give false positive

red meat

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Weight reduction surgery, Surgery on stomach or intestines to help a person with extreme obesity lose weight

Bariatric surgery

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Criteria for bariatric surgery
- BMI __
- BMI __ with 1 or more severe obesity related medical complications – HTN, DM, HF, OSA
- Requires psychological, physical and behavior screening

Criteria
- BMI 40
- BMI 35 with 1+ severe obesity related medical complications – HTN, DM, HF, OSA
- Requires psychological, physical and behavior screening

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Bariatric surgery Types
1. __________ = less food is eaten (Sleeve gastrectomy and Intragastric balloon)
2. ___________ = less food absorbed b/c length of small intestine is decreased
3. Combination _________ and ____________ (Roux-en-Y procedure – most common)

Malabsorption, Restrictive, malabsorptive and restrictive

Types
1. Restrictive = less food is eaten
a. Sleeve gastrectomy
b. Intragastric balloon – minimally invasive, temporary
2. Malabsorption = less food absorbed b/c length of small intestine is decreased
3. Combination restrictive and malabsorptive
a. Roux-en-Y procedure – most common

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restrictive, malabsorption, or combination?

Sleeve gastrectomy

Roux-en-Y procedure

Intragastric balloon

restrictive =
sleeve and intragastric ballon

combination =
Roux-en-Y procedure

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which bariatric surgery?

Most of the greater curvature of the stomach is removed
A tubular stomach remains (creates a smaller food reservoir)
Permanent

Restrictive = less food is eaten
Sleeve gastrectomy

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which bariatric surgery?

Soft saline filled balloon inserted in stomach, makes person feel satiated
- 400-700 mL
- Temporary - Max 6 months, longer = risk for leakage
- minimally invasive

Restrictive = less food is eaten
Intragastric balloon

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Intestines are not taken out, just rerouted so the stomach and parts of the small intestine are no longer used in digestion
- Restricts intake and lessens absorption
- “Stomach” is now a 15 ml pouch – serves purpose of food reservoir
- Gold standard
- Most common
- Avg hospital stay – 2-3 days
- Permanent

combination malabsorptive and restrictive
Roux-en-Y procedure

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Bariatric surgery outcomes
Good outcomes
- __creased glucose tolerance
- __creased DM, BP, cholesterol/triglycerides, GERD, sleep apnea
Adverse outcomes
- Absorption issues
- __creased absorption of iron, vitamin b12, folic acid, calcium
- ____________ – concentrated sugary foods cause fluid shift out of the body and diarrhea, temporary hypovolemic s/s

Bariatric surgery outcomes
Good outcomes
- Increased glucose tolerance
- Decreased DM, BP, cholesterol/triglycerides, GERD, sleep apnea
Adverse outcomes
- Absorption issues
- Decreased absorption of iron, vitamin b12, folic acid, calcium
- Dumping syndrome – concentrated sugary foods cause fluid shift out of the body and diarrhea, temporary hypovolemic s/s

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what causes dumping syndomre?

what procedure is it associated with?

what happens?

concentrated sugary foods cause fluid shift out of the body

adverse outcome of bariatric surgery

causes diarrhea and temporary hypovolemic s/s
hypotension
palpitations
diaphoresis
borborygmi - hyper active bowel sounds

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Bariatric surgery
Post-op nursing care
- mobility?
- Pain?
- Risk for wound ________ and _____________– esp in obese patients
- Resumption of liquids and foods gradually – pt and family teaching
- Decompress (empty) stomach and rest stomach
1. NG to LWS
2. ____ or _____ liquids
3. High ______ liquids
4. Pureed diet 2 weeks
5. Solid foods 4-6 weeks

Bariatric surgery
Post-op nursing care
- Enhance mobility
- Pain management
- Risk for wound infection and dehiscence – esp in obese patients
- Resumption of liquids and foods – pt and family teaching
- Decompress (empty) stomach and rest stomach
o NG to LWS
o Water or sugar free liquids
o High protein liquids
o Pureed diet 2 weeks
o Solid foods 4-6 weeks

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Long term recommended diet for post op bariatric surgery patients

DASH diet = Dietary approach to stop HTN

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Drug therapy for upper GI problems
____________
o Decrease acid
o Not a solution, just treats symptoms short term
o take before meals and at bedtime
____________
o Decrease acid
o OTC or prescription
________________
o Coats the stomach for protection
o Sucralfate
____________- – for GERD
o Enhances gastric emptying
o Metoclopramide

Cytoprotective agent, Antacids, H2blockers, Prokinetic agent

Antacids
o Decrease acid
o Not a solution, just treats
symptoms short term
o take before meals and at
bedtime
H2blockers
o Decrease acid
o OTC or prescription
Cytoprotective agent
o Coats the stomach for
protection
o Sucralfate
Prokinetic agent – for GERD
o Enhances gastric emptying
o Metoclopramid

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GERD
Backward flow “reflux” or very acidic stomach contents into esophagus
happens b/c ______ is loose

LES -Lower esophagus sphincter is loose

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s/s
- heartburn
- regurgitation – burp up stomach contents
- respiratory symptoms

GERD

respiratory symptoms – stomach contents goes into lungs

hiatal hernia presents similar to GERD

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SATA

complications of GERD
- esophagitis – inflammation
- barrett’s esophagus (esophageal metaplasia) – long period of time, cellular level changes
- hemorrhage/internal bleed
- respiratory s/s – cough, bronchitis

esophagitis – inflammation
barrett’s esophagus (esophageal metaplasia) – long period of time, cellular level changes
X - hemorrhage/internal bleed
respiratory s/s – cough, bronchitis

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for GERD

diagnostic studies
- barium swallow
- EGD
but often…

barium swallow – checking for reflux when swallow contrast
EGD – scopy
(but often we just give anyone with symptomatic GERD dose of PPI, to avoid the cost/discomfort of the diagnostic study tests, if the PPIs work/help than they just stay on it and we skip the diagnostic tests)

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Upper GI/barium swallow
- Patient swallows contrast/medium
o Barium
o Gastrograffin

which is used if we suspect perforation has occurred?

Gastrograffin

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GERD and HH Treatment
Lifestyle modifications
- Avoid _________
- Quit smoking – improves ____ function

Treatment:
Lifestyle modifications
- Avoid triggers
- Quit smoking – improves LES function

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GERD and HH treatment:
Nutritional therapy
- Avoid _______ foods
- Small frequent meals
- when to drink fluid?
- Avoid ________ snacks
- _______ 2-3 hours after meals
- Weight loss – decreased intra-abdominal pressure

Nutritional therapy
- Avoid fatty foods
- Small frequent meals
- with no fluid (only fluid between meals, not during meals) helps reduce distention
- Avoid late night snacks
- Elevate HOB 2-3 hours after meals
- Weight loss – decreased intra-abdominal pressure

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GERD and HH treatment
Procedure options – if the lifestyle modifications and nutritional therapy doesn’t help
_______________
o Endoscopic procedure
o Augments the LES with a ring made of magnets
o Strengthens the LES closure
_______________
o Endoscopic (no incision) or open procedure (requires incision)
o Suture a collar around the LES which strengthens it

Fundoplication, LINX device insertion

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Fundoplication
LINX device insertion
for what issues?

GERD and HH

LINX device insertion
o Endoscopic procedure
o Augments the LES with a ring made of magnets
o Strengthens the LES closure
Fundoplication
o Endoscopic (no incision) or open procedure (requires incision)
o Suture a collar around the LES which strengthens it

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Herniation of a portion of the stomach into the esophagus, through an opening in the diaphragm

Hiatal hernia
“diaphragmatic hernia” or “esophageal hernia”

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what Causes HH

Structural pressure on LES – maybe from Pregnancy or obesity

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s/s
- Asymptomatic
- Similar to GERD:
- heartburn
- regurgitation – burp up stomach contents
- respiratory symptoms – stomach contents goes into lungs

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Barrett’s Esophagus
T/F
1. Everyone with HH has or will get Barrett’s Esophagus
2. Confirm BE with biopsy
3. BE seriously increases chance of esophageal cancer

X 1. Not everyone with HH has Barrett’s Esophagus
2. Confirm BE with biopsy
3. BE seriously increases chance of esophageal cancer

barretts esophagus - condition in which the lining of the esophagus becomes damaged.
associated with what issues?

GERD and HH

The digestive action of HCl acid and pepsin causes erosion of GI mucosa, and sores or ulcers in the lining of the stomach or duodenum (the first part of the small intestine).

Peptic ulcer disease (PUD)

Causes
- H. pylori = triggers inflammation
- Drugs = NSAIDS
- H. pylori and NSAID use = double risk
- Alcohol
- Smoking
- Family hx
- Stress (aggravates exisiting issue, doesnt cause it)

PUD

Gastric ulcer vs Duodenal ulcer 1. in Stomach
2. Associated with H. pylori
3. in First part of the small intestine
4. Most common

Gastric ulcer
- Stomach

Duodenal ulcer
- First part of the small intestine
- Most common
- Associated with H. pylori

Acute ulcers vs Chronic ulcers
- Short duration ?
- More common ?
- Resolves quickly ?
- Deeper ?

Acute ulcers
- Short duration
- Resolves quickly

Chronic ulcers
- Deeper
- More common

PUD

Diagnostic studies
- EDG
- colonoscopy
- Tests to confirm H pylori
o Noninvasive – urea breath testing and stool testing
o Invasive – biopsy of antral mucosa and testing for urease
- CBC
- Stool for occult blood
- gastric emptying
- barium enema

EDG
X- colonoscopy
Tests to confirm H pylori
o Noninvasive – urea breath testing and stool testing
o Invasive – biopsy of antral mucosa and testing for urease
CBC
Stool for occult blood
X- gastric emptying
X- barium enema
EDG – most accurate diagnostic procedure
Tests to confirm H pylori
o Noninvasive – urea breath testing and stool testing (urea is a byproduct of metabolism of H pylori bacteria)
o Invasive – biopsy of antral mucosa and testing for urease – gold standard for diagnosis
CBC – checking for anemia r/t PUD internal bleeding
Stool for occult blood – invisible blood

PUD
1. most accurate diagnostic procedure
2. gold standard for diagnostic test that confirms H pylori
3. why check CBC
4. why is urea a way to confirm H pylori?

EDG
invasive – biopsy of antral mucosa and testing for urease
checking for anemia r/t PUD internal bleeding
(urea is a byproduct of metabolism of H pylori bacteria)

PUD complications
- Most common
- Assess/investigate changes in vital signs
- Change in amount and/or redness of gastric aspirate
- Pain may decrease with this complication
- NG tube to LWS – decompresses stomach

PUD

H - Hemorrhage

____complications
H -
O -
P -

PUD
hemorrhage
obstruction
perforation

PUD complications
- Can happen at anytime
- Most likely occurs if ulcer is located close to pylorus sphincter
- Gradual onset of symptoms
- NG to LWS until resolved, irrigate per protocol

O - Obstruction

PUD complications
- most lethal complication
- Sudden and dramatic onset
- Pain
o Sudden
o Severe
o Abdominal pain – radiates to back
o Not relived by food or antacids
- Rigid board like abdomen
- Respiration – shallow and weak
- Pulse – weak and tachy
- Bowel sounds – absent

P - Perforation
ulcer goes through all layers of stomach into peritoneum,
- Peritonitis can occur within 6-12 hours

Treatment PUD
- Adequate rest – helps decrease stress response
- Stop smoking
- Dietary modification – individualized
- Drug therapy
o Stop ____ and ____ for 4-6 weeks
o If ASA and/or NSAIDS are indicated – give with ____
o If h pylori – ___
o PPI
o Cytoproctive – sucralfate
- Surgical option
o Billroth – decreases secretion of acid

Treatment
- Adequate rest – helps decrease stress response
- Stop smoking
- Dietary modification – individualized
- Drug therapy
o Stop ASA and NSAIDS for 4-6 weeks
o If ASA and/or NSAIDS are indicated – give with PPI
o If h pylori – abx
o PPI
o Cytoproctive – sucralfate
- Surgical option
o Billroth – decreases secretion of acid

Bolus of hypertonic foods dump into small intestines
Fluid quickly shifts from plasma to GI tract

Dumping syndrome

s/s
- Weakness
- Sweating
- Palpitations
- Dizzy
- Abd cramping
- Borborygmi - rumbling or gurgling sounds that you hear in your abdomen.
- Urge to BM
- Diarrhea
- 15 mins of eating hyperosmolar meal
- hypotension

dumping syndrome - Bolus of hypertonic foods dump into small intestines
Fluid quickly shifts from plasma to GI tract

can be associated with tube feeds, bariatric surgery, GI things

Complication of ________
- hypoglycemic 2 hours After eating meal (postprandial)

Dumping syndrome
Bolus of hypertonic foods dump into small intestines
Fluid quickly shifts from plasma to GI tract

Treatment for dumping syndrome
- small or large meals?
- Fluids when?
- Avoid ?
- Proteins and fats encouraged or avoided?
- Rest period after eating ?
- s/s self-limiting or requires further treatment?

Treatment
- 6 small meals/day
- Fluids between meals, not during meals
- Avoid concentrated sweets
- Proteins and fats encouraged to promote rebuilding tissue post-op
- Rest period after eating
- s/s self-limiting (go away on their own) – months to a year

upper GI bleed
Hematemesis - _______
o Bright red color - “frank” or “gross” = indicates _____ or _____
o Coffee ground color/look = indicates _________

Hematemesis – bloody vomit
o Bright red color - “frank” or “gross” = indicates recent or ongoing GI bleed
o Coffee ground color/look = indicates a significant bleed has stopped

Upper GI bleed
Bloody stool
o Black, tarry, malodorous stools – “melena” = indicates bleeding is coming from higher or lower in the GI tract?
o “occult blood” = ________

Bloody stool
o Black, tarry, malodorous stools – “melena” = indicates transit time > 8 hours (it means that the blood has been in the digestive tract for more than 8 hours before being passed out of the body as a stool. This suggests that the bleeding is likely coming from a higher part of the digestive tract, such as the stomach or duodenum, where the blood has more time to be digested and darkened before being excreted)
o Not visible by the naked eye – “occult blood” = we would only know there is blood in stool by doing a guaiac test and results would be positive

melena

o Black, tarry, malodorous stools – comes from higher in the GI tract, been digested

what Causes upper GI bleeds
__________
___________

Esophageal varices
stomach or duodenal ulcers (50% of Upper GI bleeds are from ulcers)

GI bleeds
can be caused by
stomach or duodenal ulcers
related to
1 -
3 drugs -
1 -

H pylori!!!
NSAIDS, ASA (salicylates) and steroids!!!
stress related mucosal disorders/SRMD

protrusions in esophagus, like hemorrhoids but in esophagus
occurs with severe portal hypertension/cirrhosis

esophageal varices

esophageal varices complications

if the varices opened pt could have uncontrollable bleeding and die

esophageal varices active bleeding - emergency treatment

emergency/ICU thing to treat a bleeding esophageal varices = sengstaken-blakemore tube – catheter that goes down their esophagus and when the balloon is blown up it applies pressure to the site of bleeding to stop it

upper GI bleed nursing interventions
1. monitor vitals
2. assess for s/s of _____volemia
3. Assess for what in abdomen that could indicate perforation/peritonitis?
4. Monitor labs – ____ and _____
5. Anticipate giving ______– start large bore IV access
6. NG ___avage (wash out) to rid stomach of blood
7. Assess emesis and stool for?
8. Admin meds
9. Prep for procedures like endoscopy/endotherapy/hemostasis – all first line management of UGI bleed

1. monitor vitals
1. assess for s/s of hypovolemia
1. Assess for tense, rigid, board like abdomen, distention, guarding – could be perforation/peritonitis
1. Monitor labs – H&H and BUN (GI bleeding is a reason for high BUN)
1. Anticipate giving PRBCs – start large bore IV access
1. NG lavage (wash out) to rid stomach of blood
1. Assess emesis and stool for blood – check for occult blood
1. Admin meds
1. Prep for endoscopy/endotherapy/hemostasis – all first line management of UGI bleed1.

s/s of hypovolemia
o HR __crease
o __creased thirst – r/t hyperosmolar and low blood volume
o hot or cold skin?
o Restlessness

assess for s/s of hypovolemia
o rapid loss in blood volume could lead to hypovolemic shock
o HR increase
o Increased thirst – r/t hyperosmolar and low blood volume
o Cold clammy skin
o Restlessness – r/t hypoxia, or others

Inflammatory bowel diseases:

crohn’s and UC

Both, crohn’s, or UC?
- chronic inflammation of intestine
- periods of remission/exacerbation
- unknown cause/autoimmune
- no cure (except just removing organ)
- s/s – diarrhea, weight loss, abdominal pain, fever and fatigue
- hospitalization is indicated if no response to drug therapy or complications arise

both

removing organ - UC

treatment for IBD
includes meds?
includes surgery?

o sulfasalazine (aminosalicylates) – decrease _______
o corticosteroids – decrease ________
o antimicrobials – prevent/treat secondary _________
o immunosuppressants – suppress immune_______
o biologic and targeted therapy (immunodulators) – inhibit cytokine tumor necrosis factor (TNF) and prevent migration of leukocytes from blood stream to inflamed tissue

treatment includes meds and/or surgery
o sulfasalazine (aminosalicylates) – decrease inflammation
o corticosteroids – decrease inflmmation
o antimicrobials – prevent/treat secondary infection
o immunosuppressants – suppress immune response
o biologic and targeted therapy (immunodulators) – inhibit cytokine tumor necrosis factor (TNF) and prevent migration of leukocytes from blood stream to inflamed tissue

goals of treatment: IBD
- control inflammation and maintain remission
- combat infection
- correct malnutrition
- alleviate stress
- provide symptomatic relief using drug therapy
- improve quality of life

when flare up occurs = _____

NPO - rest bowel
fluids

complications
o hemorrhage
o strictures
o perforation

IBD

patient teaching
o rest and diet management
o perianal care
o drug action and s/e
o symptoms of recurrence of disease
o when to seek medical care
o use of diversional activities to reduce stress

IBD

UC vs Crohn’s
Pattern of progression – uniform and continuous
Thickness of inflammation – submucosa or mucosa (superficial)
Rectal bleeding – common
Malabsorption and nutritional deficiencies – not common
Complications – perforation (b/c of toxic megacolon rupture)
Risk for colon cancer – colorectal cancer
Surgery – curative (total removal of colon)
80% of the time drug therapy induces remission
20% require surgery

Ulcerative colitis
Site of origin – rectum/colon
Bottom up

Surgery for UC or crohn’s?
- total proctocolectomy (remove colon) AND illeal anal reservoir (IPAA)
- total proctocolectomy (remove colon) AND permanent ileostomy (stool bag)
- total proctocolectomy (remove colon) AND continent ileostomy/kock pouch (pt catheterizes them self, liquid stool)

Surgery UC
1. which one is a 2 stage surgery, Most common?
2. which one is a one stage surgery with a permanent ileostomy?
3. which one has continent ileostomy?

total proctocolectomy AND illeal anal reservoir (IPAA)
total proctocolectomy AND kock pouch
total proctocolectomy AND permanent ileostomy

total proctocolectomy (remove colon) AND illeal anal reservoir (IPAA)
o 2 stage surgery
o Most common
total proctocolectomy (remove colon) AND permanent ileostomy (stool bag)
o one stage surgery
total proctocolectomy (remove colon) AND continent ileostomy/kock pouch (pt catheterizes them self, liquid stool)

T/F
post colon surgery patient teaching is important b/c there is a high rate of post op complications

T
UC surgery

post colon surgery
patient education
call HCP if
T/F
- wound drainage
- wound opening
- wound redness
- wound changes in the appearance of the surrounding skin or around the ostomy
- no bowel movement for more than 24 hours
- lack of gas/stool from the rectum for more than 24 hours
- increased abdominal pain
- vomiting
- abdominal swelling
- high ostomy output
- dark urine
- no urine
- fever > 101.5
- patient is not able to take anything by mouth for > 24 hours

all

post colon surgery
patient education
call HCP if
- 4 wound
- 5 output
- 2 pain
- 1 temp
- 1 intake

wound drainage
wound opening
wound redness
wound changes in the appearance of the surrounding skin or around the ostomy
high ostomy output
dark urine or no urine
vomiting
no bowel movement for more than 24 hours
or lack of gas/stool from the rectum for more than 24 hours
abdominal pain and swelling
fever > 101.5
patient is not able to take anything by mouth for > 24 hours

uc or crohn’s

Pattern of progression – “skip” lesions, irregular
Thickness of inflammation – transmural (deep)
Rectal bleeding – not common
Malabsorption and nutritional deficiencies – common
Complications – perianal abscesses, fistula fissures, perforation (b/c inflammation involves entire bowel wall)
Risk for colon cancer – small intestines cancer
Surgery – for complications such as strictures, most need surgery at some point

“cobblestone appearance”

Site of origin – mouth to anus
Top down

Surgery uc or Crohn’s
- not curable by surgery
- surgery r/t complications like fistulas, strictures, obstructions and bleeding
- recurrence after surgery very high
- intestinal resection with anastomosis of healthy bowel

crohn’s

Why nutrition is compromised (both but mainly, crohn’s)
- __creased food intake
- n/v
- malabsorption
- __creased metabolic rate (increased energy consumption at rest) b/c of chronic disease process

Why nutrition is compromised (both but mainly, crohn’s)
- decreased food intake
- n/v
- malabsorption
- increased metabolic rate (increased energy consumption at rest) b/c of chronic disease process

nutritional therapy
- during flare up (acute phase) =
- Consider ________ feedings when very malnourished, can’t use GI tract, or resting gut
- When the gut works use it EXCEPT if resting gut ____ may be indicated
- Diet – ____ calorie, ____ protein, ____ residue (ruffage/fiber), vitamin and iron supplements
- Food triggers are individualized or universal?
- Avoid smoking

nutritional therapy
- NPO during flare up (acute phase)
o Consider enteral/parenteral feedings when very malnourished, can’t use GI tract, or resting gut
o When the gut works use it EXCEPT if resting gut TPN may be indicated
- Diet – high calorie, high protein, low residue (ruffage/fiber), vitamin and iron supplements
- Food triggers are individualized (not universal) – food diary can help identify triggers
o Ex: Cold food, high residue, lactose
- Avoid smoking

TPN – total parenteral nutrition
T/F
- Allows for positive nitrogen balance while resting the bowels
- contains All comprehensive diet – vitamins, minerals, electrolytes, glucose, amino acids, etc. can be added
- Lipid emulsion usually infused as a separate solution
- Highly hypertonic
- HIGH dextrose – may require insulin coverage
- TPN uses dedicated central venous line/access device – via peripheral line would eat up the vein
- Not using the gut will cause intestinal mucosal atrophy – bacteremia and infections
- Start TPN slowly and end TPN slowly – pancreatic cells need time to adapt to increasing/decreasing insulin output
- PPN – partial parenteral nutrition
- aseptic technique

all true

Intestinal obstruction:
non-mechanical vs Mechanical

_______ - caused by a physical blockage within the intestines.

_________ – cause by a functional impairment of the intestinal muscles.

Mechanical - caused by a physical blockage within the intestines.

Non-mechanical – cause by a functional impairment of the intestinal muscles.

Intestinal obstruction:
non-mechanical vs Mechanical
1. Most common
2. Most often in small intestine
3. Surgical adhesions days to years post op – most common
4. Hernias
5. Strictures – from crohn’s
6. Paralytic ileus

Mechanical - caused by a physical blockage within the intestines.

Non-mechanical – cause by a functional impairment of the intestinal muscles.

Care for ___________
-Decompress intestine - NG to LWS = keep intestines empty
- Correction/maintenance of fluid and electrolytes
- Pain control
- Removal of obstruction (mechanical)
- rest gut and wait until peristalsis starts back up (non-mechanical)

Intestinal obstruction

surgical procedure in which a portion of the intestine is removed and the remaining ends are reconnected.

Bowel resection with an end-to-end anastomosis

cancer that begins in the colon (large intestine) or rectum (final part of large intestine)

Colorectal cancer

colorectal cancer
risk factors
- Diet high in ____ meat or ______ meat
- Obesity
- Physical inactivity
- Alcohol
- Long term smoking
- ____ intake fruits and veg
- Genetic/familial and history of IBD

risk factors
- Diet high in red meat or processed meat
- Obesity
- Physical inactivity
- Alcohol
- Long term smoking
- Low intake fruits and veg
- Genetic/familial and history of IBD

s/s - Varies by location of primary lesion (beginning of colon vs end of colon)

Insidious – doesn’t appear until disease is advanced
Iron deficiency anemia
Rectal bleeding
Blood in stool
Abdominal pain
Rectal pain
Change in bowel habits
Intestinal obstruction/perforation
Mass

colorectal cancer

colorectal cancer Diagnostic
1. Regular screening
2. Regular removal of pre-cancerous polyps
3. _________ – gold standard for CRC screening
4. colonoscopy for Average risk patient – age 50, 60, 70, 80 etc.
5. colonoscopy for _______ – age 45, 55, 65, 75 etc.
6. colonoscopy for risk patient – earlier and more frequent
7. ______________ – less favorable but acceptable if patient is unwilling to do the colonoscopy, once yearly

colonoscopy
black people
Fecal occult blood test

Care for colorectal cancer
-Surgery for_______ cancer - resection and maybe ostomy
- surgery for ______ cancer - Local excision, Abdominal-perineal resection (APR) w/ permanent colostomy, Low anterior resection (LAR)
-Radiation and chemo

rectal, bowel (colon)

bowel/colon

rectal

rectal cancer surgery
- ___________– small area of tissue is removed
- ____________ w/ permanent colostomy - removing the rectum, anus, and part of the colon. A permanent colostomy is created, diverting stool out of the body through an opening in the abdomen.
- _____________ – removing the lower part of the rectum and part of the colon. The remaining colon is then connected to the anus, preserving sphincter function and maintaining normal control over defecation

Abdominal-perineal resection (APR),
Local excision,
Low anterior resection (LAR)

 Local excision – small area of tissue is removed
 Abdominal-perineal resection (APR) w/ permanent colostomy - removing the rectum, anus, and part of the colon. A permanent colostomy is created, diverting stool out of the body through an opening in the abdomen.
 Low anterior resection (LAR) – removing the lower part of the rectum and part of the colon. The remaining colon is then connected to the anus, preserving sphincter function and maintaining normal control over defecation

Ostomies -
Can be temporary or permanent

-________ : A surgical opening in the small intestine.
- __________: A surgical opening in the large intestine (colon).
-__________: A surgical opening in the urinary tract, usually created to divert urine away from the bladder.

Ileostomy: A surgical opening in the small intestine.
Colostomy: A surgical opening in the large intestine (colon).
Urostomy: A surgical opening in the urinary tract, usually created to divert urine away from the bladder.

consistency of the ostomy output?

depends on location
- can be anywhere along large intestine/colon – ascending, transverse, descending
- ileostomy which is in the ileum (small intestine)

ostomies at beginning of GI tract =
ostomies at end of GI tract =

liquid
almost normal

ostomy at the descending colon
T/F
- located at the beginning of the GI tract
- will be liquid
- might need irrigation for descending or sigmoid ostomies
- irrigate q 1-2 days whatever normal bowel pattern was
- similar to enema, except it’s through the stoma
- large bag placed to gather contents

X- located at the end of the GI tract
-X will be almost normal
- might need irrigation for descending or sigmoid ostomies
- irrigate q 1-2 days whatever normal bowel pattern was
- similar to enema, except it’s through the stoma
- large bag placed to gather contents

which one?
- slices the intestine
- brings out the proximal end as a single stoma (part of the intestine is closer to the stomach.)
- distal portion (part of the intestine is closer to the anus.)
o surgically removed – permanent
o oversewn and left in mesentery – “hartmann’s pouch” – temporary, it is possible for the bowel to be re-anastomosed in the future “take down”

3 types of ostomies
- end stoma
- loop stoma
- double barrel stoma

end stoma

which one?

bringing a loop of bowel to the skin surface
sliced open, not completely (enterotomy)
folded back over its self
held in place by plastic rod and sutures
2 stomas
o Proximal opening (part of the intestine is closer to the stomach.) – stool
o Distal opening (part of the intestine is closer to the anus.) – mucus
Posterior wall separates the 2 openings
Usually temporary

3 types of ostomies
- end stoma
- loop stoma
- double barrel stoma

loop stoma

which one?
- Slices the intestine
- Both the proximal and distal ends are brought through the abdominal wall as 2 separate stomas
o Proximal opening (part of the intestine is closer to the stomach.) – functioning, stool
o Distal opening (part of the intestine is closer to the anus.) – non-functioning, mucus
- Usually temporary

3 types of ostomies
- end stoma
- loop stoma
- double barrel stoma

Double barrel stoma

Post op ____ care
- Assess color, edema, and bleeding
- Wash skin with mild soap, rinse with warm water, apply skin barrier
- Pouch – snug fit, use measuring card
- WOC nurse

stoma

ostomy care
T/F
- ________ stoma – may still pass stool/mucus through anus
- Empty bag frequently
- ostomy bag contains stool and gas
- No sphincter
- Plenty of towels on hand
- Control facial expressions – odor
- Food doesn’t effects stoma output
- Patient teaching – go slow, may be complicated by emotional response

Care
- Double barrel stoma – may still pass stool/mucus through anus
- Empty bag frequently
- stool and gas
- No sphincter
- Plenty of towels on hand
- Control facial expressions – odor
X - Food effects stoma output – odor producing, gas producing, diarrhea causing, potential for obstructions
- Patient teaching – go slow, may be complicated by emotional response

_______ – the presence of out-pouching of the intestinal mucosa
_________ – flare up, one or more pouches become inflamed or infected

Diverticulosis
Diverticulitis

___________
- Asymptomatic
- Abdominal pain
- Bloating
- Flatulence
- Change in bowel habits

___________
- Acute pain LLQ
- Palpable abdominal mass
- s/s of infection
- Older adult may be afebrile, no change in WBC, little pain

Diverticulosis
Diverticulitis

Diverticulosis/diverticulitis
Education
Prevention
- _____ fiber
- ___ fat
- ____ red meat
- ____ levels of physical activity

High fiber
Low fat
Low red meat
High levels of physical activity

Diverticulosis/diverticulitis
Once disease is present
- ______ fiber
- avoid nuts or seeds?
- Weight reduction
- Avoid factors that _____ like constipation

Once disease is present
- High fiber
- Don’t need to avoid nuts or seeds
- Weight reduction
- Avoid factors that increase abdominal pressure like constipation

Acute diverticulitis
- Goal = rest bowel with ____ and decrease inflammation
- If severe = hospitalization, _____ and _____
- Monitor for abscess, bleeding, and peritonitis r/t rupture
- Surgery if complications – may involve resection/temporary ostomy

Acute diverticulitis
- Goal = rest bowel with NPO and decrease inflammation
- If severe = hospitalization, IVF, and abx
- Monitor for abscess, bleeding, and peritonitis r/t rupture
- Surgery if complications – may involve resection/temporary ostomy

Brainscape's Knowledge GenomeTM

week 6 Flashcards

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