Week 6 Flashcards
What is the treatment for haemorrhoids?
Fibre and fluid increase
Topical anaesthetic
Surgical - banding, ablation, haemorrhoidectomy
Lower GI bleeding results in different coloured blood depending on location.
Where does black blood indicate bleeding?
Where does frank blood indicate bleeding?
Where does frank red - brown red indicate bleeding?
Upper GI
Lower GI
Large, active bleeding bowel
What are some of the causes of lower GI bleeding?
Ulcerative colitis Crohn's disease Haemorrhoids Trauma Carcinoma Polyps IBD Anorectal disease Diverticulitis
What is the nursing management for bowel conditions?
Review of dietary habits - determine fibre intake Dietician referral Review bowel habits Assess abdomen (IAPP) Assess pain - analgesia Antiemetics if nauseous Antibiotics if prescribed Stool chart (aperients as required) Physio review of mobility an issue Fluid balance - encourage fluids Encourage appropriate dietary intake Postop care Stoma care Perforation observation - increased intense abdominal pain, rigidity, fever, tachycardia, hypotension
How are bowel conditions diagnosed and what is the medical management?
Barium enema/swallow Faecal occult blood test Stool specimen Physical examination NGT aspiration to exclude upper gastrointestinal issues Rectal exam Endoscopy Biopsy to test for cellular changes CT scan Abdominal X-ray
Analgesia Antispasmodics NBM or clear fluids Combination antibiotics (triple combo for cancer or diverticulitis) Corticosteroids Aminosalicylates Immunosuppressants Surgery
What are the risk factors for colorectal cancer?
What are the signs and symptoms?
Where is it most common?
Increasing age Family history of colon cancer or polyps Past history of breast, genital, bowel cancer or polyps Past history of adenomatous polyps History of Crohn's High fat, high protein, low fibre diet
Change in bowel habits Blood in stools Anaemia Anorexia Weight loss Fatigue
Sigmoid colon
What is Crohn’s disease?
Chronic inflammation of all layers of the bowel wall from the intestinal mucosa, which causes ulceration.
What are the signs and symptoms of Crohn’s disease?
Lower right quadrant abdominal pain
Diarrhoea
Cramps and tenderness
Weight loss
Fever
In what sex and age groups is Crohn’s disease most common?
Women
Adolescents/young adults
Older adults 50-80
Where does Crohn’s disease most commonly occur?
Distal ileum and ascending colon
What is diverticulitis?
Inflammation and infection caused by food and bacteria retained in the diverticulum (small hernias of mucosa through muscle wall of bowel)
What are the signs and symptoms of diverticulitis?
Bowel pattern irregularity Soft smelly and frequent bowel motions Episodes of diarrhoea LLQ abdominal cramping Fever
What can contribute to diverticulitis and what complications can diverticulitis cause?
Fatty foods
Perforation Bleeding Access formation Spasticity of colon Peritonitis
What percentage of adults does diverticulitis affect and in what setting is it prevalent?
Affects 45% of adults over 45
Prevalent in aged care >70 years of age
What is malabsorption syndrome and what are the patient indications?
What are some contributing factors to malabsorption syndrome?
Impaired digestion or absorption of nutrients from intestine
History of diarrhoea
Frequent loose bulky foul smelling stools
Stools often greyish in colour
Disease of small intestine Prolonged antibiotic use Diseases of gallbladder and liver Damage to intestine from trauma Radiation therapy
Name 6 diseases of the lower GIT.
Irritable bowel syndrome Crohn's disease Diverticulitis Malabsorption syndrome Colorectal cancer Infections
What are the functions of the small and large intestines?
Small intestine - digestion and absorption
Large intestine - movement, absorption and formation of faeces
What are the 2 causes of a bowel obstruction?
Mechanical obstruction - occurs inside or outside the intestine, obstruction of bowel lumen.
Functional obstruction - tumour mass, impaction, adhesions from surgery, volvulus, ileus, peritonitis, massive ascites
What is the nursing care of a lower GI bleed?
DRABCDE
Reassurance
NBM
IVT for rehydration
Medication
Query prep for surgery
Post op care if applicable
What are the signs and symptoms of a small bowel obstruction?
Anorexia
Early feeling of fullness
Bloating
Tender abdomen
Tinkling bowel sounds +/- visible peristaltic waves
Intermittent cramping pain
Initial diarrhoea followed by constipation
Signs of fluid and electrolyte imbalance (tachycardia, tachypnoea, hypotension)
N&V
Passing of blood and mucous
Fluffy stools
What sort of complications can a small bowel obstruction cause?
Hypovolaemia Renal insufficiency Impairment of pulmonary ventilation Metabolic dysfunction Strangulation of incarcerated hernias
Can also cause bladder obstruction, metabolic acidosis and sepsis
What are the features of a large bowel obstruction?
Luminal contents accumulate
Peristaltic activity can cause colic pain
Accumulating fluid causes distention
Peristalsis interferes with oxygen consumption
Danger of necrosis or perforation
What is the treatment approach for a bowel obstruction?
Conservative approach
Rest and rehydration IVT initially; recommence fluids slowly Treat N&V Analgesia, steroids, laxatives NGT
Surgical intervention
Radiation used to reduce size and release obstruction
What is the nursing management for a bowel obstruction?
Monitor for signs and symptoms of deterioration FBC IV fluids and electrolytes NGT to empty contents Analgesia Antispasmodics Anticolonergics
Somastatin therapy to reduce GI secretions and increase absorption of water and electrolytes
What are three common infections of the GIT?
Bacterial (salmonella, E.coli)
Viral (Hep A, norovirus)
Parasitic
What is the most common cause of infectious diarrhoea in hospital patients?
What is the mortality rate if the infection lasts longer than 30 days?
Clostridium Difficile
As high as 30%
What is the treatment for CDI?
Supportive care Treat symptoms Antibiotic therapy Supplements Prebiotics Probiotics Surgery Faecal transplantation
What is a colostomy and what are the types?
Removal of cancerous tumour mass, sigmoid colon and rectum. Hole is made in abdomen and free end of colon pulled through and stitched.
Ascending
Descending
Transverse
Sigmoid
What is an ileostomy and what are the complications/risks?
End of the ileum (lowest part of the small intestine) is formed into a stoma, usually on the lower right side of abdomen.
Skin breakdown
Liquid stools
Malabsorption risk due to inability to absorb nutrients prior to expulsion.
What is the nursing care for a patient with a new stoma?
Preoperative education with stoma therapist
Check stoma postoperative - will be red with moderate oedema and some bleeding
Care of surrounding skin very important
Counselling services (body image)
