Exam 3 Study Guide - NonInflammatory Disorders

Question 1

Irritable Bowel Syndrome (IBS)

define
etiology

Answer 1

• Functional GI disorder tht causes chronic or recurrent diarrhea, constipation, and/or abdominal pain & bloating
• Most common digestive disorder
• Etiology
  > research suggests tht a combination of factors
  > certain food & fluids; carbonated or caffeinated bevs, dairy products
  > immunologic
  > genetic
  > hormonal; 2x more likely in women
  > stress; anxiety & depression can play a role

Question 2

IBS - Assessment

basic

Answer 2

• Hx
  > weight change; usually have a stable weight
  > malaise & fatigue
  > abdominal pain; most common in left lower quadrant
  > changes in bowel pattern & consistency of stools; can have diarrhea or constripation of alternate w/ both
  > passage of mucus
  > nutrition; caffeine, sorbitol or fructose can cuase bloating & diarrhea
  > factors causing exacerbations such as diet, stress, anxiety, food intolerance

Question 3

IBS - Assessment

lab testing
manis

Answer 3

• Lab Testing
  > CBC (normal)
  > Serum albumin (normal)
  > ESR (normal)
  > Stools for occult blood (normal)
  > Hydrogen breath test; will exhale a higher lvl of hydrogen secondary to bacterial overgrowth & malabsorp in small intestines
• CMs
  > LLQ abd pain
  > diarrhea and/or constipation
  > cramping
  > belching or gas
  > anorexia
  > bloating
  > nausea w/ meals

Question 4

IBS - Interventions

teaching
drug therapy

Answer 4

• Health Teaching
  > dietary fiber (30-40g of fiber each day)
  > eating regular meals
  > 8-10 cups of liquid a day
  > chewing slowly
• Drug Therapy depends on symps:
  > constipation predominant: bulk-forming laxative (Metamucil), Lubiprostone (Amitiza) to incr fluid in intestine, Linaclotide (Linzess) to incr fluid in testines & incr intestinal motility
  > diarrhea predominant: antidiarrheal agents like loperamide (Immodium)
  > pain predominant: tricyclic antidepressants (Elavil)

Question 5

IBS - Interventions

complimentary & alternative

Answer 5

• Probiotics to reduce bacteria
• Peppermint oil capsules
• Stress management: relaxation techniques, meditation and/or yoga
• Exercise

Question 6

Hernias

causes
types

Answer 6

• Causes
  > congenital or acquired muscle weakness
  > incrd intra-abd pressure (obesity, pregnancy, lifting heavy objects)
• Most Common Types
  > indirect inguinal (occur mostly in men)
  > direct inguinal (occur more often in older adults)
  > femoral (common in obese or pregnant women)
  > umbilical (congenital or common in obese or pregnancy)
  > incisional or ventral (occurs in ppl who have undergone abd surgery)

Question 7

Reductible Hernias

Answer 7

Contents of the hernial sac can be placed back into abd cavity by gentle pressure

Question 8

Irreducible (incarcerated) Hernias

Answer 8

• Hernia cannot be reduced or placed back into abd cavity
• Requires immediate surgical evaluation

Question 9

Strangulated Hernias

Answer 9

• Blood supply to the herniated segment of bowel is cut off by pressure from hernial ring
• Can lead to necrosis of bowel & possible bowel perforation
• Symprtoms:
  > abd distension
  > N/V
  > pain
  > fever
  > tachycardia

Question 10

Hernias - Assessment

Answer 10

• Observe for bulging or protrusion ove rinvolved area
• Inspect when lying & standing
  > if reducible it may disappear when lying flat
• Assess for bowel sounds
  > absent bowel soubds may indicate obstruction or strangulation

Question 11

Hernia - Nonsurgical Intervention

Answer 11

• Treatment of an inguinal hernia
• Truss (pad made w/ firm material); held in place over hernia w/ a belt
• Applied after hernia has been reduced

Question 12

Hernias - Surgical Interventions

Answer 12

• Surgical option for inguinal hernia repairs:
• Minimally Invasive Inguinal Hernia Repair (MIIHR)
  > laproscopic herniorrhaphy
  > recover more quickly, have less pain, fewer postop complications
• Open Herniorrhaphy (open incision)
  > follow general postop care of pts
  > assess for difficulty in voiding

Question 13

Hernias - PostOp Teaching

Answer 13

• Avoid coughing
• Elevation of scrotum w/ a soft pillow to prevent & control swelling
• Ice bags to prevent & control swelling
• Follow surgeon’s recommendation for returning to usual activities
• Avoid straining & lifting for several weeks
• Observe for fever, chills, wound drainage, redness or separation of incision & incring incisional pain
• Keep wound clena & dry w/ antibacterial soap & water

Question 14

Colorectal Cancer - Etiology/Risk Factors

Answer 14

• Older than 50yrs
• Genetic predisposition
• Personal or family hx of cx
• Diseases tht predispose the pt to cx
  > familial adenomatous polyposis
  > Crohn’s disease
  > Ulcerative colitis
• Infectious agents
  > H. pylori
  > Human papilloma virus (HPV)
• Long term smoking
• Obesity
• Physical inactivity
• Heavy alcohol consumption
• HIgh-fat diet

Question 15

Colorectal Cancer - Assessment

basic

Answer 15

• Hx
• Physical Assessment/CMs
  > rectal bleeding
  > anemia
  > change in stool consistency or shape
  > possible abd pain
  > possible abd distention or visible mass

Question 16

Colorectal Cancer - Assessment

psychosocial
lab

Answer 16

• Psychosocial
  > especially important after diagnosis
• Lab
  > positive FOBT
  > elevated carcinoembryonic antigen (CEA): normal is 5ng/mL
  > dcrd H/H
  > liver func tests may be elevated if metasis to liver has occured

Question 17

Colorectal Cancer - Imaging

Answer 17

• Colonscopy (definitive test for diagnosis)
• Double-contrast barium enema
• Sigmoidoscopy
• Abdominal computerized tomography (CT)
• Abdominal magnetic resonance imaging (MRI)

Question 18

Colorectal Cancer - Nonsurgical Interventions

Answer 18

• Type of intervention is based on pathologic staging of disease
• Radiation Therapy
  > can be used pre or post op for either local control or for pain management
• Adjuvant chemotherapy post op
• Important to help pts w/ side effects of radiation & chemotherapy

Question 19

Colorectal Cancer - Surgical Interventions

Answer 19

• Type of intervention is based on pathologic staging of disease
• Surgical removal of tumor w/ margins free of disease is best method
• Type of surgery is based on size of tumor, location, extent of metastasis, integrity of bowel, & condition of pt

Question 20

Most Common Surgies for Colorectal Cancer

Answer 20

• Colon Resection: removal of tumor & regional lymph nodes
• Colectomy: colon removal w/ colostomy or ileostomy
• Abdominoperineal (AP) Resection: performed when rectal tumors are present; removal of sigmoid colon, rectum, & anus

Question 21

Mechanical Intestinal Obstruction

Answer 21

• Partial or complete
• Bowel is physically blocked
• Problems outside the intestine: adhesions
• In the bowel wall: Crohn’s
• In the intestinal lumen: tumors
• Most common causes in pts over 65: diverticulitis, tumors, fecal impaction

Question 22

Nonmechanical Intestinal Obstruction

Answer 22

• Partial or complete
• Paralytic ileus: peristalsis is dcrd or absent as a result of neuromuscular disturbance, resulting in slwoing of movement or backup of intestinal contents
• Most common cause: handling of intestins during abdominal surgery

Question 23

Stangulated Intestinal Obstruction

Answer 23

• Partial or complete
• Obstruction w/ compromised blood flow

Question 24

Small Bowel Obstruction - CMs

Answer 24

• Abd discomfort or pain
• Upper or epigastric abd distention
• Nausea & early, profuse vomiting
• Possible visible peristaltic waves in upper & middle abdomen
• Obstipation (no passage of stool)
• Severe fluid & electrolyte imbalances

Question 25

Large Bowel Obstruction - CMs

Answer 25

• Intermittent lower abdominal cramping
• Lower abdominal distention
• Minimal or no vomiting
• Obstipation or ribbon-like stools
• No major fluid & electrolyte imbalances
• High pithed bowel sounds transitioning to absent bowel sounds

Question 26

Intestinal Obstruction - Assessment

lab

Answer 26

• WBC usually noraml unless a strangulated obstruction present or perforation
• H/H, creatinine, BUN values are often elevated bc of dehydration
• Na, Cl, K dcrd bc of loss of fluid & electrolytes
• Amylase may be elevated w/ strangulated obstructions
  > can cause damage to pancreas

Question 27

Intestinal Obstruction - Assessment

imaging

Answer 27

• Abd computerized tomography scan (CT)
• Abd ultrasound
• Sigmoidoscopy or colonoscopy
  > not used when perforation or complete obstruction is suspected

Question 28

Intestinal Obstruction - Nonsurgical Interventions

Answer 28

• NPO
• NGT
  > placed to low intermittent suction
• Assess the NGT for proper placement, patency, & output q4
• Assess & record passage of flatus & character of BMs daily
• Assess & treat nausea
• IV fluid replacement & maintenance
  > parenteral nutrition may be indicated if pt has chronic nutriontional problems or has been NPO for an extended period
• Monitor VS, weight, I&Os
• Monitor pain
  > incr or change may indicate perforation of intestine or peritonitis
  > opioid analgesics may be temporarily withheld so CMs of perforation or peritonitis are not masked
  > discomfort if generally less w/ nonmechanical obstruction
• Assist pt to obtain a position of comfort w/ frequent position changes to promote incrd peristalsis
  > semi-fowler’s position may help alleviate pressure of abd distention on chest

Question 29

Intestinal Obstruction - Surgical Interventions

Answer 29

• In mechanical obstruction, surgical intervention is necessary to relieve obstruction
• Exploratory Laparotomy
  > surgical opening of abd cavity to investigate cause of obstruction
• More specific surgical procedures depend on cause of obstruction
  > lysis of adhesions
  > tumor resection
  > colon resection w/ temporary or permanent colostomy
  > embolectomy or thrombectomy
  > colectomy
• Pts have either minimally invasive surgery (MIS) via laparoscopy (most common) or cenventional open approach
• Post op care
  > NG tube in place
  > slow introduction of PO intake
  > assess for bowel sounds, flatus, & stoo indicating peristalsis return