Care of Patient with Non-inflammatory Intestinal Disorders Flashcards by Kelsey Klipfel

Functional GI disorder that causes/characterized chronic or recurrent diarrhea, constipation (some have both), and/or abdominal pain and bloating associated with it
spasms/contractions in colon
Most common digestive disorder
Symptoms typically appear in young adulthood and continue throughout the patient’s life
Etiology - causes unknown

Irritable bowel syndrome (IBS)

How well did you know this?

Not at all

Perfectly

Research suggests that a combination of factors
Certain food and fluids - exacerbation: Ex. carbonated or caffeinated beverages, dairy products
Immunologic
Genetic
Hormonal: 2 times more likely in women
Stress - precursor: Anxiety and depression can play a role

Etiology - causes unknown - Irritable bowel syndrome (IBS)

How well did you know this?

Not at all

Perfectly

Weight change - not have colorectal cancer
Malaise and fatigue - some
Abdominal pain
Changes in bowel pattern and consistency of stools
Passage of mucus - lot more common
Nutrition
Factors causing exacerbations such as diet, stress, anxiety, food intolerance - keep diary of triggers

IBS assessment - History - rule out other things

How well did you know this?

Not at all

Perfectly

Usually have a stable weight

Weight change - not have colorectal cancer

How well did you know this?

Not at all

Perfectly

Most common in left lower quadrant

Abdominal pain

How well did you know this?

Not at all

Perfectly

Can have diarrhea or constipation or alternate with both - when having; when occurring

Changes in bowel pattern and consistency of stools

How well did you know this?

Not at all

Perfectly

Caffeine, sorbitol or fructose can cause bloating and diarrhea - fake sweetners

Nutrition

How well did you know this?

Not at all

Perfectly

CBC (normal)
Serum albumin (normal)
ESR (normal)
Stools for occult blood (normal)
Hydrogen breath test

IBS assessment - Laboratory testing: - rule out others

How well did you know this?

Not at all

Perfectly

Will exhale a higher level of hydrogen secondary to bacterial overgrowth and malabsorption of nutrients in the small intestines - get into bloodstream and exhale

Hydrogen breath test

How well did you know this?

Not at all

Perfectly

LLQ abdominal pain
Alternating Diarrhea and/or constipation
Cramping
Belching or increased gas
Anorexia
Bloating
Nausea with meals

IBS assessment - Clinical manifestations:

How well did you know this?

Not at all

Perfectly

Dietary fiber (30 to 40 g of fiber each day)
Eating regular meals
8-10 cups of liquid a day - lots fluids
Chewing slowly - help with passage food

IBS interventions - Health teaching:

How well did you know this?

Not at all

Perfectly

Constipation predominant
Diarrhea predominant
Pain predominant

IBS interventions - Drug therapy depends on the symptoms:

How well did you know this?

Not at all

Perfectly

Bulk-forming laxatives, such as Metamucil - fluid into stool
Lubiprostone (Amitiza) to increase fluid in the intestine to offset constipation
Linaclotide (Linzess) to increase fluid in intestines and increase intestinal motility to offset constipation

Constipation predominant

How well did you know this?

Not at all

Perfectly

Antidiarrheal agents, such as loperamide (Immodium)

Diarrhea predominant

How well did you know this?

Not at all

Perfectly

Tricyclic antidepressants (Elavil) - may help with stress/nerve pain

Pain predominant

How well did you know this?

Not at all

Perfectly

Probiotics to reduce bacteria - keeps intestines healthy
Peppermint oil capsules - helps with pain
Stress management such as relaxation techniques, meditation and/or yoga
Exercise

IBS interventions - Complimentary and alternative therapies:

How well did you know this?

Not at all

Perfectly

Weakness in the abdominal muscle through which a segment of the bowel or other abdominal structure protrudes
Causes
Most common types

Hernia

How well did you know this?

Not at all

Perfectly

Congenital or acquired muscle weakness
Increased intra-abdominal pressure (obesity, pregnancy, lifting heavy objects); abdominal weakness

Causes - Hernia

How well did you know this?

Not at all

Perfectly

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 pregnant women)
Incisional or ventral (occurs in people who have undergone abdominal surgery - cut into so weakness)

Most common types - Hernia

How well did you know this?

Not at all

Perfectly

Reducible
Irreducible (incarcerated)
Strangulated

Hernias classifications

How well did you know this?

Not at all

Perfectly

Contents of the hernial sac can be placed back into the abdominal cavity by gentle pressure
Least serious
Reduce them - push them back in without surgery from outside

Reducible - Hernias classifications

How well did you know this?

Not at all

Perfectly

hernia cannot be reduced or placed back into the abdominal cavity
Require surgery
Requires immediate surgical evaluation

Irreducible (incarcerated) - Hernias classifications

How well did you know this?

Not at all

Perfectly

Blood supply to the herniated segment of the bowel is cut off by pressure from the hernial ring
Can lead to necrosis of the bowel and possibly bowel perforation - death of bowel
Surgical intervention
Symptoms:

Strangulated - Hernias classifications

How well did you know this?

Not at all

Perfectly

abdominal distension/perforation if left untreated
N/V
Severe pain
fever
tachycardia

Strangulated hernia - Symptoms:

How well did you know this?

Not at all

Perfectly

Observe for bulging or protrusion over involved area Inspect when lying and standing If reducible it may disappear when lying flat Assess for bowel sounds Absent bowel sounds may indicate obstruction or strangulation

Hernias - assessment

Truss (pad made with firm material) - after hernia reduced; not worn at night; worn when awake Held in place over hernia with a belt Treatment of an inguinal hernia Applied after the hernia has been reduced

Hernias - Nonsurgical interventions

Surgical option for inguinal hernia repairs - often; not reducible or strangulated Postoperative teaching

Hernias - surgical interventions

Minimally invasive inguinal hernia repair (MIIHR) Open herniorrhaphy (open incision)

Surgical option for inguinal hernia repairs - often; not reducible or strangulated

Laproscopic herniorrhaphy Recover more quickly, have less pain, fewer postop complication

Minimally invasive inguinal hernia repair (MIIHR)

Follow general postoperative care of patients Assess for difficulty in voiding

Open herniorrhaphy (open incision)

Avoid coughing - increased intraabdominal pressure - not lifting heavy for awhile Elevation of scrotum for inguinal repairswith a soft pillow to prevent and control swelling Ice bags to prevent and control swelling Follow surgeon’s recommendation for returning to usual activities Avoid straining and lifting for several weeks Observe for fever, chills, wound drainage, redness or separation of the incision and increasing incisional pain - assess for infection Keep wound clean and dry and clean with antibacterial soap and water

Postoperative teaching

Cancer of the colon or rectum Third most common cause of cancer death in the US Most are adenocarcinomas Can metastasize by direct extension or by spreading through the blood or lymph - easily preventable so always educate on how prevent this Complications

Colorectal cancer

Tumors that arise from the glandular epithelial tissue of the colon Colon or rectum

Most are adenocarcinomas - Colorectal cancer

Tumor: Bowel obstruction or can lead to perforation with peritonitis Abscess formation Fistula formation to the urinary bladder or the vagina

Complications- Colorectal cancer

Older than 50 years - preventative after 50 Genetic predisposition Personal or family history of cancer Diseases that predispose the patient to cancer Infectious agents Long-term smoking Obesity Physical inactivity Heavy alcohol consumption High-fat diet Focus on modifiable

Colorectal cancer: etiology/risk factors

Familial adenomatous polyposis - precursor for malignant colorectal cancer Crohn’s disease Ulcerative colitis

Diseases that predispose the patient to cancer - Colorectal cancer: etiology/risk factors

H. pylori Human papilloma virus (HPV) Predispose and strep ones as well

Infectious agents - Colorectal cancer: etiology/risk factors

Big because catch early can get good outcomes People of average risk and without a family history should undergo screening at age 50 Diagnostic screening after 50 Modify diets Avoid smoking Avoid excessive alcohol Increase physical activity

Colorectal cancer: prevention

Fecal occult blood testing (FOBT) - blood in stool big manifestation of colon cancer Colonoscopy every 10 years unless increased risk or double-contrast barium enema every 5 years - barium and air to get pic

Diagnostic screening after 50 - Colorectal cancer: prevention

Decrease fat Decrease refined carbohydrates - simple sugars Encourage high fiber foods Avoid fried food Increase intake of broccoli, cabbage, cauliflower, and sprouts

Modify diets - Colorectal cancer: prevention

History Physical assessment/clinical manifestations Psychosocial assessment Laboratory assessment Imaging:

Colorectal cancer: assessment

Rectal bleeding - fecal occult blood in stools Anemia - losing lot blood shown in bloodwork: H&H Change in stool consistency or shape - mass in there; diff shape good be growing and affecting shape and consistency of stool Possible abdominal pain Possible abdominal distention or visible mass - late stages

Physical assessment/clinical manifestations - Colorectal cancer: assessment

Especially important after diagnosis of cancer; oftentimes need ostomy - lot thoughts in head

Psychosocial assessment - Colorectal cancer: assessment

Positive FOBT Elevated carcinoembryonic antigen (CEA): normal is 5 ng/ml - cancer marker; not specific to colon cancer so can be elevated with other malingnant or benign disease and smokers Decreased Hct and Hbg Liver function tests may be elevated if metastasis to the liver has occurred

Laboratory assessment - Colorectal cancer: assessment

Colonscopy (definitive test for the diagnosis; can biopsy) Double-contrast barium enema Sigmoidoscopy (definitive test for the diagnosis) Abdominal computerized tomography (CT) - mass there Abdominal magnetic resonance imaging (MRI) - mass there

Imaging: - Colorectal cancer: assessment

Potential for colorectal cancer metastasis - big concern and goal treatment remove tumor and prevent spread Grieving related to cancer diagnosis - psychosocial effects Goal of treatment is to remove the entire tumor or as much of the tumor as possible to prevent or slow metastatic spread of the disease

Colorectal cancer: nursing diagnosis/planning: Priority nursing diagnoses:

Type of intervention is based on the pathologic staging of the disease Nonsurgical management - Surgical management

Colorectal cancer: interventions

Radiation therapy: Can be used pre or post op for either local control for cancer or for pain management - palliative care for less pain and symp Adjuvant chemotherapy post op - make sure stage 2 and 3 preventing and minimize metastasis in pats Important to help and talk patients with the side effects of radiation and chemotherapy - lot GI and urinary issues with radiate abd

Nonsurgical management -

best and what want do - remove tumor and margins beyond tumor so not metastasis or spread of disease - getting all removed; depends on stage or metastasized levels Surgical removal of the tumor with margins free of disease is the best method Type of surgery is based on the size of tumor, location, extent of metastasis, integrity of bowel, and condition of patient Most common surgeries

Surgical management

Colon resection (removal of the tumor and regional lymph nodes - can also reanastomose where not have ostomy bag) Colectomy (colon removal with colostomy or ileostomy) Abdominoperineal (AP) resection (performed when rectal tumors are present-removal of sigmoid colon, rectum and anus) Vary on how large tumor and where; may have ostomies temporarily or permanent Let bowel calm down then reastamosis; too much bowel taken then have permanent ostomy

Most common surgeries

Patient informed that a colostomy is possible - so not shock Consult to CWOCN (certified wound, ostomy, continence nurse)or ET (enterostomal therapist) - preop teaching; look at abd and do number things - marks best place for stoma; helps prepare pat Will recommend placement of stoma and provide some pre op instructions Routine preoperative teaching, including nasogastric tube (NG) Bowel preparation per surgeon - bowel as clean as possible Oral or IV antibiotics - decrease risk of peritonitis

Colorectal cancer: Preoperative Care

Similar to other abdominal surgeries - not increase intrabdominal pressure IV pain medication immediately post op - PCA pump NG tube placement initially - wait for peristalsis After NGT removal - after have persitalsis returns Star with clear liquids and progress to solid foods as tolerated Monitor bulb suction drains If ostomy present then extensive education required - teach ASAP Minimally invasive surgery versus open resection– less pain, ambulate earlier, shorter hospital stay, can eat solid foods very soon after the procedure, progress faster

Colorectal cancer: Postoperative Care

A clear ostomy pouch system (also called an appliance) will be in place to allow for visualization of stoma - imp look at the stoma Assess the color and integrity of the stoma frequently May be slightly edematous and have a small amount of bleeding initially - look immediately postop Should start functioning in 2-3 days Stool consistency depends on where in the colon the stoma was placed: Collaborate with CWON for education and ongoing stoma and pouch care - good for nurse and pat

Colostomy management

Healthy stoma should be reddish pink and moist and protrude about ¾ inch (2 cm) from the abdominal wall; beefy; not want be ischemic; protrude from skin

Assess the color and integrity of the stoma frequently

Liquid: ascending colon Pasty: traverse colon More solid: descending colon and sigmoid

Stool consistency depends on where in the colon the stoma was placed:

Partial (better) or complete Mechanical Nonmechanical Strangulated

Intestinal obstruction

Bowel is physically blocked Problems outside the intestine: adhesions - prior surgeries In the bowel wall: Crohn’s - inflammatory disease In the intestinal lumen: tumors/mass/fecal impaction Most common causes in patients over 65: diverticulitis, tumors, fecal impaction

Mechanical - Intestinal obstruction

Paralytic ileus: peristalsis is decreased or absent as a result of neuromuscular disturbance, resulting in a slowing of the movement or a backup of intestinal contents - common postop comp Most common cause: handling of the intestines during abdominal surgery

Nonmechanical - Intestinal obstruction

Obstruction bowel twists with compromised blood flow - emergency; take care of it; necrotic if bowels ischemic for too long

Strangulated - Intestinal obstruction

Abdominal discomfort or pain Upper or epigastric abdominal distention Nausea and early, profuse vomiting - LOT Possible visible peristaltic waves in upper and middle abdomen Obstipation (no passage of stool) - leakage around obstruction as well Severe fluid and electrolyte imbalances - vomiting more

Intestinal obstruction CM: Small-Bowel Obstruction

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

Intestinal obstruction CM: Large Bowel Obstruction

WBC usually normal unless a strangulated obstruction present or perforation - elevated H/H, creatinine, BUN values are often elevated because of dehydration - vomiting Na, Cl, K decreased because of loss of fluid and electrolytes - vomiting; suctioning Amylase may be elevated with strangulated obstructions - damage because of pancreas: Can cause damage to the pancreas

Intestinal obstruction: assessment - Laboratory assessment

Abdominal computerized tomography scan (CT) - most common thing; more definitive diagnosis Abdominal ultrasound Sigmoidoscopy or colonoscopy

Intestinal obstruction: assessment - Imaging

Not used when perforation or complete obstruction is suspected Not lot can do; esp for prep

Sigmoidoscopy or colonoscopy

Try these first - esp those with ileus NPO NGT Assess the NGT for proper placement, patency, and output every 4 hours - output frequently for bowels Assess and record passage of flatus and character of bowel movements daily Assess and treat nausea IV fluid replacement and maintenance - not TPN unless long period timeMonitor VS, weight, I/O and electrolytes because issues Monitor pain - NG tube decreased pain: perforation and peritonitis as well Assist patient to obtain a position of comfort with frequent position changes to promote increased peristalsis - not want straight up; want get bowels moving

Intestinal obstruction: nonsurgical interventions

Placed to low intermittent suction - avoid irritation

NGT

Parenteral nutrition may be indicated if the patient has chronic nutritional problems or has been NPO for an extended period

IV fluid replacement and maintenance - not TPN unless long period time

Increase or change may indicate perforation of the intestine or peritonitis Opiod analgesics may be temporarily withheld so clinical manifestations of perforation or peritonitis are not masked Discomfort is generally less with nonmechanical obstruction treat pain; ileus: cautious opioids and other things - slow down bowel

Monitor pain - NG tube decreased pain: perforation and peritonitis as well

Semi-Fowler’s position may help alleviate the pressure of abdominal distention on the chest

Assist patient to obtain a position of comfort with frequent position changes to promote increased peristalsis - not want straight up; want get bowels moving

If nonsurgical not effective In mechanical obstruction, surgical intervention is necessary to relieve the obstruction Exploratory laparotomy More specific surgical procedures depend on the cause of the obstruction Patients have either minimally invasive surgery (MIS) via laparoscopy (most common today) or conventional open approach Post op care

Intestinal obstruction: surgical interventions

Surgical opening of the abdominal cavity to investigate the cause of the obstruction What going on; risk factors for obstruction is surgery

Exploratory laparotomy - Intestinal obstruction: surgical interventions

Lysis of adhesions - cut and release Tumor resection - remove tumor Colon resection with temporary or permanent colostomy - diverticulitis Embolectomy or thrombectomy - necrotic tissue Colectomy - take out whole colon

More specific surgical procedures depend on the cause of the obstruction - Intestinal obstruction: surgical interventions

NG tube in place - bowel surgeries/nonsurg interventions Slow introduction of PO intake Assess for bowel sounds, flatus and stool indicating peristalsis return - start with clear liquids and move up Not increase intrabdominal pressure to ensure staying good

Post op care - Intestinal obstruction: surgical interventions

Care of Patient with Non-inflammatory Intestinal Disorders Flashcards

(74 cards)