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Maria > Nausea Vomiting &Diarrhea > Flashcards

Nausea Vomiting &Diarrhea Flashcards

1
Q

How is diarrhea defined?

A

inc freq of bowel movements (>3 a day), inc amount of stool (>200g/day), and altered consistency (such s inc liquidity) of stool

•often assoc w urgency, perianal discomfort, incontinence, or combo of these factors

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2
Q

What causes diarrhea (general categories)?

A
  • conditions that cause inc intestinal secretions, dec mucosal absorption, or altered motility can prod diarrhea
  • often caused by IBS, lactose intolerance

meds, some tube feeding formulas, metabolic and endocrine disorders (DM, addisons, thyrotoxicosis), bacterial and viral infections, nutritional and malabsorptive disorders (celiac)…..

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3
Q

Is diarrhea an acute or chronic problem?

A
  • can be acute (often assoc w infection, self limiting usually, lasts up to 7-14days
  • or chronic (>2-3wks and may return sporadically)
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4
Q

5 types of diarrhea?

A

secretory, osmotic, malabsorptive and exudative, infectious

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5
Q

Secretory diarrhea?

A

is usually high volume. Often assoc w bacterial toxins and neoplasms. Caused by inc prod and secretion of water and lytes by the intestinal mucosa into intestinal lumen

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6
Q

Osmotic diarrhea?

A

when water is pulled into intestines by the osmotic pressure of unabsorbed particles which slows water reabsorption may be caused by lactase deficiency, pancreatic dysfx, intestinal hemmorhage

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7
Q

Malabsorptive diarrhea?

A

combined mechanical and biochemical actions which inhibits absorption of nutrients.

See markers of malnutrition such as hypoalbuminuria, which leads to intestinal mucosa swelling and liquid stool

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8
Q

What is the most commonly identified cause of antibiotic-associated diarrhea in the hospital?

A

C. Diff

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9
Q

Cause of exudative diarrhea?

A

caused by changes in mucosal integrity, epithelial loss, or tissue destr by radiation or chemo

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10
Q

Term for intestinal rumbling?

A

borborygmus

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11
Q

Term for ineffective straining?

A

Tenesmus

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12
Q

Manifestations of diarrhea?

A
  • inc freq
  • fluid stools
  • abdominal cramps
  • distension
  • intestinal rumbling (borborygmus)
  • anorexia
  • thirst
  • on defecation painful spasmodic contractions of the anus and ineffective straining (tenesmus) may occur
  • other symp may relate to lytes, fluid balance, dehydration
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13
Q

Voluminous greasy stools suggest?

A

intestinal malabsorption

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14
Q

Presence of blood, pus, mucus suggests?

A

inflm enteritis or colitis

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15
Q

How does size of the bowel relate to characteristics of diarrhea?

A

• watery stools are char of sm bowel disorders.
• Semisolid stool are assoc w disorders of lg bowel.
(this is talking about small vs large intestine?)

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16
Q

Oil droplets on the toilet water are almost aways diagnostic of?

A

pancreatic insufficiency

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17
Q

Nocturnal diarrhea may be a mnft of?

A

diabetic neuropathy

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18
Q

What is it important to investigate in all unexplained diarrhea in pts recently taking Abx?

A

C. Diff

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19
Q

Dx when cause of diarrhea not obvious

A

o CBC
o Serum chemistries
o Urinalysis
o Routine stool exam and exam for infection/paratistes, bacterial toxins, blood, fat, lytes, WBCs
o Endoscopy or barium enema may help id the cause

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20
Q

Complications of diarrhea?

A
  • Potential dysrhythmias d/t fluid and lyte loss

* Chronic diarrhea can result in irritant dermatitis (prevent w wet wipe, dry, barrier cream)

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21
Q

What conditions regarding symptoms and potassium level must be reported in individuals with diarrhea (as indicates risk for potential cardiac complications)?

A

• Urinary output of

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22
Q

Gerantological considerations r/t digoxin use and diarrhea?

A

Elderly dehydrate quickly, more susceptible to hypokalemia

Teach if on digoxin abt hypokalemia and dehydration (they occur v fast) and signs & symp of hypokalemia
–> need to know symptoms of hypokalemia because low K levels potentiate digoxin action and thus inc risk of digitalis toxicity

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23
Q

Geriatric considerations regarding what to look for as a nurse?

A
  • Observe pt for mnfts of muscle weakness, dysrhythmas, dec peristaltic motility that may lead to paralytic ileus
  • Esp sensitive to excoriation of perianal area
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24
Q

Medical management of diarrhea?

WHat is often the med of choice?

A

• Control symp, prevent complic, elim cause
- Abx, anti-inflm, antidiarrheals used
• Often loperamide (imodium) is the med of choice as it has less side effects than diphenoxylate (Lomotil)

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25
Q

How to assess perianal area?

A

pt either standing and bent forward ont he exam table or ling on left side w left leg extened and right leg flexed (sims).
Spread buttocks and ask pt to bear down. Look for lesions, hemmorhoids, warts, rectal fissures

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26
Q

Nursing assessments r/t diarrhea?

A
  • Assess and monitor the characteristics and pattern of diarrhea
  • Pmhx should include med therapy, med and surg hx, dietary pattern and intake, recent exposure, travel
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27
Q

If acute diarrhea episode, what should nurse do?

A

encourage bed rest, intake of liquids and foods w low bulk (restriction may be nec eg no dairy, veggies, grains etc for several days)

When eating start w bland, semisolid and solids.

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28
Q

what kind of food to encourage in pt with diarrhea?

What not to eat?

A
  • When eating start w bland, semisolid and solids.

* No: caffeine, carbonation, v hot or v cold (they stimulate intestinal motility)

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29
Q

What is Hyperemesis gravidarum?

A

aka pernicious or presistent vomiting)
= n+v that lasts past wk 16 of regnancy or thats so severe it results in dehydration, ketonuria and significant wt loss (>5%) occur within the first 12wks of pregnancy

•Often stops abruptly at ~13 weeks (end of first trimester) d/t change in hormones from placenta

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30
Q

How common is HG?

Cause?

A
  • 2% incidence

* Unknown cause, may relate to inc thyroid stim from high hCG levels or maybe r/t H. Pylori

31
Q

What sort of changes are seen in blood of woman with HG?

A
  • May have elevated hct due to inability to retain fluid leading to hemoconcentration-can lead to thromboemboism
  • d/t low intake may have dec sodium, potassium and chloride.
  • hypokalemic alkalosis may result from loss of HCL from stomach

Metabolic disorders (ketosis)

32
Q

Physical manifestations of HG for mother and baby?

A
  • Wt loss can be severe
  • ataxia (loss of control of body movements) and confusion can occur as result of vitamin B1 deficiency
  • if not treated she may get so dehydrated she cant give fetus nutrients for growth resulting in preterm birth or intrauterine growth restriction
33
Q

Assessment of woman with HG?

A
  • how much N and V is the women having should always be determined
  • ask her to describe the previous day
  • how much food could she eat
  • how late did the N last? How often did she V and how much?
34
Q

Management/interventions of HG?

How will a woman presenting with this be treated in hospital?

A
  • women w this must be hospitalized 24hrs to monitor and document their I/O (measure vomitus etc), blood chemistries and to restore hydration
  • oral food and fluids are withheld for first 24hrs. If no V after 24hrs they can start clear fluids and progress on to crackers etc then reg diet but if V resumes then she may be put on TPN to ensure adequate nutrition
  • Give ringers lactate w vitamin B1 for hydration
  • may give metoclopramide (preg class B) for V
35
Q

What are the initial goals of nursing care of woman with HG?

A

• main challenge initially is dehydration then lack of nutrition
Some need counselling for psychological distress r/t this condition

36
Q

Important consideration for monitoring if woman is on TPN?

A

check blood glucose twice daily

  • -> if high, shows can’t process as much sugar as is being admin’d
  • -> if ketones present, may need more
37
Q

Does HG have long term ramifications?

A

if caught early, doesn’t lead to problems

  • IF not treated, can cause death!
38
Q

How to manage n and V for woman with HG (r/t food characteristics)

A
  • enc small portions and limit exposure to aromatic foods if hypersensitive to smells
  • Serve hot foods hot, and cold foods cold
39
Q

Common cause of vomiting in children?

A

•many kids who V are suffering from mild gastroenteritis (infection). Some develop persistent or cyclic vomiting

40
Q

Vomiting assessment components?

A

o timing
o is it forceful projected 1ft from infant or up to 4ft (often assoc w pyloric stenosis)
o duration
o amount
o description eg colour, smell, blood tinged etc
o distress

•use accurate descriptors such as on table on 1315 (comparing regurgitation and vomiting) as diff conditions have diff types of V

41
Q

Should a child be fed after vomiting?

How should introduction of food progress?

A

• often parents feed kids after vomiting but it is best to give the stomach a rest as if it is empty the child wont vomit.

3-6hrs is often enough of a rest for the stomach.

Initially offer ice chips, water by tbsp, or use popsicles. Then give clear liquids, then broths and milk then crackers or toast
• By day 2 the kid can be on soft diet

42
Q

Resuming intake in infant that is vomiting?

A

W infant have them fast 3hrs then give 1 tbsp q15mins for 2hrs then 1oz water q2hrs for 12-18hrs, then clear fluid then breast milk. Can use rehydration soln

43
Q

Are children typically given anti-emetics?

Which are appropriate?

A

• Acute gastroenteritis is self limiting so its rare to give kids antiemetics

if nec use Ondansetron or promethazine (ask abt herbal remedies theyve given the kid first)

44
Q

Why is diarrhea so dangerous in infants + children?

A

d/t their small ECF reserves

45
Q

Common Causes of diarrhea in children?

A
  • Giardia lamblia often causes protozoan infction.
  • Viruses=adenovirus and rotaviruses are common
  • Campylobacter jejuni, salmonella, c diff, e coli are common bacterial
  • These can be easily spread from public change areas etc
46
Q

What is the relationship between breast milk and diarrhea?

A

actively prevents diarrhea by providing more Abs

47
Q

How does mild diarrhea manifest in children and infants?
What does it look like?
What physiological changes will you see?

A
  • Kids w diarrhea appear unwell and often have a fever 38.4-39
  • Diarrhea contains 2-10 loose watery BMs/day
  • Unlike normal infant stool which is yellow diarrheal stool is green and is effortless to pass, more acidic, sweet or foul smelling
  • Skin is warm and mucous memb are dry but skin turgor wont be dec yet. Urine output normal
  • Pulse may be rapid
48
Q

Therapeutic mgmt of diarrhea in children

-

A
  • Rest the gi tract for a short time
  • After 1hr can give rehydrating soln
  • If infant is breastfed have them continue
  • Can give probiotics
  • May need to treat fever
49
Q

Can parents give OTC drugs to children for diarrhea?

What deficiency occurs in infants following diarrhea?

A
  • Have parents contact dr before beginning OTC drugs eg loperamide (immodium) etc as toxic levels can occur quick
  • Infants can get temporary lactase deficiency after diiarrhea
50
Q

How do kids present with severe diarrhea?

Temp?

A
  • Kid appears v unwell

* Rectal temp can be 39.5-40. Pulse and resps weak and rapid, skin cool and pale

51
Q

How do infants with severe diarrhea present?

What does the diarrhea look like?

A
  • Infants can be listless, apprehensive and lethargic
  • Will have obvious signs of dehydration eg depressed fontanelles, sunken eyes,poor skin turgor
  • Diarrhea is often green, every few minutes and mixed with mucus and blood
  • Urine output will be concentrated and small
52
Q

How will labs appear for child with severe diarrhea?

A
  • will show hemoconcentration –> inc Hct, Hb, + protein levels d/t dehydration
  • Electrolytes will show metabolic acidosis
53
Q

How would fetal growth restriction be assessed in pt with HG?

A

fundal height and U/S

54
Q

How can fluid loss be determined in children?
What parameters indicate mild dehydration?
When is immediate tx necessary for infants?

A

Is difficult…

Can be best assessed by weighing kid. Loss of 2.5%-5% of body weight suggests mild dehydration
•Infants that have lost >10% of body weight require immed Tx

55
Q

How do you intervene with child with severe diarrhea?

A

Focus on regulation of electrolyte and fluid balance by giving GI tract rest, oral or IV rehydration and figuring out the organism responsible for the diarrhea

  • -> oral rehydration therapy is ideal, but may give IV NS or 5% glucose in NS
  • Measure intake/output
56
Q

What is typically done if child’s diarrhea persists for more than 24 hours?

Are antibiotics typically used right away?

A

take a stool culture (from diaper, bed pan or rectum)

As abx can cause diarrhea the pt shouldn’t be put straight on them without figuring out which organism it is

57
Q

What labs are taken for child with diarrhea?

A
  • Hct + Hb (to show dehydration and anemia)
  • WBC (infection?)
  • ## PCo2, Cl-, Na+, K+ and pH (to establish electrolyte needs)
58
Q

Children tend to have potassium depletion with diarrhea. What must first be established prior to giving IV fluid with K+?

A

MUST FIRST establish that child is not in renal failure

- Child must void first (indicating proper kidney fx)

59
Q

What to do with infants while on NPO status?

A

Wet lips with moisturizing cream or jelly
offer pacifier for comfort (will want to suck if thirsty and also want to feed because interpret intestinal cramping as hunger)

60
Q

Should you take a rectal temp on an infant when they are having diarrhea?

A

No, use other method as this stimulating anal sphincter may cause more diarrhea

61
Q

Weight equivalent of 1mL of fluid in diaper?

A

1g

62
Q

Why is diarrhea green

A

lack of time for bile to be modified by intestine

63
Q

What measurement of stool indicates acute diarrhea?

A

Presence of sugars and ph below 7.0
(sugar normally should be rapidly absorbed in intestine but not having time to do so)

  • as diarrhea improves, sugar and acidity will decrease
64
Q

Why is diarrhea acidic?

A

??

65
Q

When to change diapers for infant with diarrhea?

What to do if irritation already exists in area?

A

Immediately!
Is very irritating to skin
Clean area thoroughly and if agency protocol allows, put on Vaseline or A&D ointment

  • If already excoriated, exposing to air + using ointment can help
66
Q

Causes of chronic diarrhea

A

tumours, AIDS, diabetes, hyperthyroidism, Addisons disease and IBS

67
Q

Why are children at increased risk of dehydration

A
  • Immature kidneys, less concentrated urine
  • Greater body surface area= greater insensible losses
  • Infants and children become dehydrated FAST (infants can lose 40% ECF in 24 hours)
  • Dehydration becomes a medical emergency can lead to kidney failure, cardiac collapse, death
68
Q 
Key nursing concerns for woman with HG?
(class slides)
A
  • FVD/Dehydration
  • Malnutrition
  • Vitamin deficiencies (especially B), weight
  • Metabolic disorders (ketosis)
  • Stress and extreme fatigue (impaired coping)
  • Fetal Growth Restriction (fundal height and U/S)
  • DVT (r/t increased HCT and immobility/fatigue)
  • Inability to perform ADL’s, loss of role in home
  • Anxiety r/t fear for fetus
69
Q 
Medical interventions for woman with HG?
(class slides)
A

—Antiemetics: ondansetron, metoclopramide
—medical cannabis
— folic acid, thiamine (B6), B1
— LMWH

70
Q

Key nursing interventions for woman with HG?

A

 Consult w SW, neonate, pharmacy
 Therapeutic Communication and active listening
 Reduce odours, noises, provide fresh air, “breezes”, encourage woman to move slowly, provide socialization and contact as directed by patient to avoid isolation/depression
 Monitor weight and electrolytes, nutritional profile and contact physician if worsening
 IV rehydration (B1 + B6 added)
 Possible TPN in severe cases

71
Q 
Early signs of dehydration in peds 
(class slides)
A

Dry mouth

72
Q 
Late signs of dehydration in peds
(class slides)
A 
Sunken fontanelles in babies
Loss of tears
Sunken eyes
Rapid, deep respirations (acidosis)
Cold extremeties
Rapid weak pulse
Cyanosis
Loss of skin turgor
Coma
73
Q

Why are the elderly at increased risk as result of vomitting + diarrhea?

A
  • Less body water overall–> more rapid dehydration
  • Kidneys function declines –> less able to concentrate urine + regulate Na excretion, etc
  • ## Less functional reserve of all organs –> water + electrolyte imbalance means organs cannot compensate as quickly, more prone to fail
74
Q

What is the most pertinent sign of dehydration in children?

A

Weight loss

Maria (14 decks)

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