week 7 GI p1

Question 1

what is the most reported type of pain?

Answer 1

abdominal pain
-includes complaints of abdominal tenderness, nausea, vomiting, diarrhea, constipation, flatulence, fatigue, fever, and abdominal distension

Question 2

what can be used to help diagnose abdominal pain?

Answer 2

-complete health history and physical exam (including rectal and pelvic exam
-complete PQRST
-CBC - WBC count, looking for infection or bleeding
-urinalysis
-abdominal X-ray (check for fecal impaction)
-ECG (when abd pain is with SOB, always check heart)4
-Preggo test (rule out pregnancy)
(sometimes egg will implant in fallopian tube - as embryo grows tube can burst, cause massive bleed)

Question 3

what is a Laparoscopy?

Answer 3

a procedure that allows operative exploration in the abdomen

-can also be done through an open midline wound, called a laparotomy

Question 4

what should a nurse remember when palpating a painful abdomen?

Answer 4

palpate gently

Question 5

bowel sounds that are diminished, absent, or hyperactive in a quadrant may indicate what?

Answer 5

a complete bowel obstruction, acute peritonitis, or paralytic ileus

Question 6

what should a nurse look for when inspecting the abdomen?

Answer 6

distension, masses, abnormal pulsations, and scars

Question 7

what might an elevated temperature indicate?

Answer 7

inflammatory or infectious process

Question 8

what should be checked immediately when a pt presents with abdominal pain?

Answer 8

vital signs (pulse and bp) - determines hypovolemic changes

Question 9

examples of a nurse diagnosis?

Answer 9

Acute pain related to inflammation of the peritoneum and abdominal distension
-risk of deficient fluid volume related to anorexia, vomiting, intraabdominal bleeding

Question 10

what does a pt need before going into surgery?

Answer 10

• blood type (in case pt loses lots of blood during surgery
• last time they ate
• consent
• CBC to check hemoglobin -want baseline
• catheterization and IG tube may be placed

Question 11

what should a nurse be checking the NG tube for?

Answer 11

assess drainage, if there are blood clots, bowel sounds, skin integrity
-should be checked regularly for patency, the tube may become obstructed with mucus, sediment, or blood clots

Question 12

what does post operative care depend on?

Answer 12

the type of surgical procedure performed

Question 13

what is the purpose of an NG tube after surgery?

Answer 13

-is to empty the stomach of gastric secretions and gas to prevent gastric distension

Question 14

characteristics of drainage?

Answer 14

-drainage of the NG tube may be dark bornw to dark red for the first 12 hours, later should be slightly yellow
“coffee grounds” apperance of drainage is owing to presense of small amounts of blood

Question 15

what should the nurse assess when a pt received prolonged gastric suctioning?

Answer 15

nurse should assess electrolytes and acid-base balance because the prolonged gastric suctioning can result in loss of sodium, chloride, potassium, water and hydrochloric acid

Question 16

what is common after abdominal surgery?

Answer 16

nausea and vomiting
-abdominal distension and gas pains are also common because of swallowed air and impaired peristatlis resulting from immobiltiy, manipulation of abdominal contents during surgery, and adverse effects of anaesthsia

Question 17

what is short bowel syndrome?

Answer 17

• results from extensive resection of the small intestine
  (a section of the colon is removed, and the healthy ends are sewn together)
  -this surgery is necessary for bowel infraction because of vasular thrombus or insufficiency, abdominal trauma, cancer radiation enteritis, or crohns disease

Question 18

characteristcs of short down syndrome?

Answer 18

rapid intestinal transit, impaired digestive and absorption processes and fluid and electroyle losses

Question 19

what is short bowel syndrome?

Answer 19

Short bowel syndrome (SBS, or simply short gut) is a malabsorption disorder caused by a lack of functional small intestine.
Causes are: birth defects, surgical removal from damaged intestines from cancer tx, or Crohn’s disease, a disorder that causes inflammation, or swelling, and irritation of any part of the digestive tract

Question 20

what are some clinical manifestations of Short bowel syndrome?

Answer 20

diarrhea, weight loss, malnutrition, and mulitple vitman and mineral deficiencies
-in the period immediately follwoingg massive bowel resection, pts receive TPN (total nurtrition through IV) to replace fluid, electroyle and nutrition losses

Question 21

what kind of diet is recommended for someone with short bowel syndome?

Answer 21

a diet high in carbohydrates and low in fat

Question 22

how many meals should a pt with SBS be encouraged to eat?

Answer 22

6-8 meals a day to increase the overall time food is present in and in contact with the intestine

Question 23

what is intestineal obstruction?

Answer 23

occurs when a partial or complete obstruction of the intestine contents from passing through the GI tract, it requires prompt tx
-surgial emergancy, is intestines are getting blood flow, it will die -cause is either mechanical or nonmechanical

Question 24

what is a mechanical obstruction?

Answer 24

may be caused by an occulsion of the lumen of the intestinal tract
-most often in the small intestine, in the ileum

Question 25

what are some possible mechanical obstructions?

Answer 25

adhesions: account of 50% of cases
hernias: 15%
neoplams: 15%

Question 26

what is the most common cause of large bowel obstuction?

Answer 26

carcinoma
-followed by volvulus (disorder of pediatrics, intestines loop around eachother = results in obstruction - requires immediate surgery

Question 27

what is a non mechanical obstruction?

Answer 27

may result from a neuromuscular or vascular disorder

Question 28

what is the most common form of a mechanical obstruction?

Answer 28

ex, paralytic ilues (lack of intestinal peritstalsis) is most common form of non mechanimcal obstruction- occurs if pts doesnt get up and move
early feeding such as jello as soon as possible after surgery will help prevent paralyic ileus (it can occur after any abdominal surgery

Question 29

how many liters of fluid normally enter the small bowel daily?

Answer 29

6-8 L of fluid

Question 30

what can retension of fluid in the intestine lead to?

Answer 30

can lead to severe reduction in circulating blood volume and result in hypotension and hypovolemis shock

Question 31

if an obstruction is high ( in in the pylorus -the opening from the stomach into the duodenum small intestine), what could result?

Answer 31

metabolic alkalosis may result from loss of hydrocholic acid from stomach through vomiting or NG intubation

Question 32

when an obstruction is located in the small intestine, what happens rapidly

Answer 32

rapid dehydration

Question 33

what clinical manifestations may present of intestinal obstruction?

Answer 33

manifestations may vary, depends on location of the obstruction, can include nausea, vomiting and abdominal pain, distention, inability to pass flatus and obstipation (severe or complete constipation)
-vomiting often releives abd pain because in high intestial obstructions, built uo bowel is getting empties and releives stress on obstruction)

Question 34

what is a common manifestation of intenstial obstruction?

Answer 34

abdominal distension

Question 35

what does auscutation of the bowel sounds reveal?

Answer 35

high pitch sounds from the area of obstruction

Question 36

what tx are there for abdominal issues?

Answer 36

• directed toward decompression of the intestine by removal of gas and fluid, correction and maiteneces of fluid and electrolyte balance, and releif or removal of obstruction

Question 37

what can be used to decompress (removal of contents) the bowel?

Answer 37

an NG tube

Question 38

what should be given to maintain fluid and electrolyte balance?

Answer 38

IV infusions of normal saline and potassium

Question 39

how are mechanical obstructions treated?

Answer 39

surigically (cancerous mass, adhesion from scar tissue)

-this surgery may involve resecting the obstructed segment of bowel and anastomosing the remaining healthy bowel

Question 40

what may be required when extensive obstruction or necrosis is present?

Answer 40

partial or total colectomy, colostomy, or ileostomy

Question 41

what is important to do once an NG tube is placed?

Answer 41

• confirm placement of tube
• ensure the tube is properly secured
• provide appropriate nasal and mouth care

Question 42

what is colorectal cancer?

Answer 42

• a malignant disease of the colon, the rectum, or both
• usually symptoms are present in early stages
• clear genetic predisposition on the development of this cancer
• risk increases with age

Question 43

what are commone sites of metastasis for colorectal cancer?

Answer 43

regional lymph nodes, liver, lungs, and peritoneum
-since venous blood leaving the colon and rectum flow through teh portal vein and inferior rectal vein, the liver and lungs are common sites of metastatsis

Question 44

what are some clinical manifestations of colorectal cancer?

Answer 44

• rectal bleeding, the most common symptom of colorecatl cancer, is most often seen with left-sides lesions
• alternating constipation and diarrhea
• cancers pf the right side of the colon are usually asymptomatic

Question 45

what diagnostic tools are there for colorectal cancer?

Answer 45

the digital rectal examination is the most important aspect of the physical exam because rectal cancers are witin reach of the finger

• the fecal occult blood test (FOBT) once a year and flexible sigmoidoscopy every 5 years beginning at age 50 are important aspects
• pts need to be taught to avoid red meat, ASA and NSAIDs (if medically safe) before testing to avoid false positives