care of pt. with noninflammatory intestinal disorders

Question 1

types of intestinal obstruction

Answer 1

mechanical

nonmechanical

Question 2

mechanical obstruction

Answer 2

the bowel is physically blocked by problems outside the intestine (e.g., adhesions), in the bowel wall (e.g., Crohn’s disease), or in the intestinal lumen (e.g., tumors)

Question 3

non-mechanical obstruction

Answer 3

Does not involve a physical obstruction in or outside the intestine, peristalsis is decreased or absent because of neuromuscular disturbance, resulting in slowing of the movement or backup of intestinal contents

Question 4

complications of an obstruction

Answer 4

• fluid and electrolyte balance and acid base balance
• Severe hypovolemia results in acute kidney injury or even death
• Bacterial peritonitis with or without perforation
• Closed-loop obstruction (blockage in two different areas) or strangulated obstruction (obstruction with compromised blood flow that can be life threatening)
• Septic Shock
• Sepsis and bleeding can result in an increased intra-abdominal pressure (IAP) or acute compartment syndrome

Question 5

types of mechanical obstruction

Answer 5

telescoping of bowel

intussusception

Question 6

etiology and genetic risk for mechanical obstrcution

Answer 6

• Adhesions (scar tissue from surgeries or pathology)
• Tumors
• Appendicitis complications
• Hernia
• FECAL IMPACTION (especially in order adults)
• STRICTURES (due to Crohn’s disease, a chronic inflammatory bowel disease, or previous radiation surgery)
• Intussusception (telescoping of a segment of the intestine within itself)
• Volvulus (twisting of the intestine)
• Fibrosis (due to disorders such as endometriosis)

Question 7

Etiology and Genetic Risk nonmechanical obstrucution

Answer 7

Handling of intestines during surgery

Question 8

intestinal obstruction history

Answer 8

• GI disorders, surgeries, treatments
• Recent N/V, color of emesis
• Pain (attention to onset, aggravating factors, alleviating factors, and patterns or rhythms of pain)
• Elimination habits
• SINGULTUS (hiccups) is common with all types of intestinal obstruction
• Family history of colorectal cancer (CRC)

Question 9

physical assessment of obstruction

Answer 9

Obstipation (NO PASSAGE OF STOOL), PAIN OR CRAMPING. Vomiting, Distention, alteration in bowel pattern, blood in stool, peristaltic waves, high-pitched bowel sounds (borborygmi), ABSENT BOWL SOUNDS, minimal abdominal tenderness and rigidity

Question 10

lab assessment of intestinal obstruction

Answer 10

• WBC
• Hemoglobin and hematocrit
• Creatinine
• BUN
• Serum sodium, chloride, potassium**
• Serum amylase

Question 10

lab assessment of intestinal obstruction

Question 11

diagnsotic assessment for IO

Answer 11

• CT or MTI
• Abdominal ultrasound
• An ENDSCOPY (sigmoidoscopy or colonoscopy)

Question 12

what does IO have a potential for

Answer 12

Potential for life-threatening complications due to reduced flow or blocked flow of intestinal contents

Question 13

nonsurgical management for IO

Question 13

nonsurgical management for IO

Answer 13

• NASOGASTRIC TUBE
• NPO status
• IV Fluid replacement and maintenance (monitor weight for fluid balance)
• Disempaction and enemas for obstruction due to fecal impaction
• For post-op ileus, alvimopan may be used short term
• MOUTH CARE
• PAIN management
• Turn and reposition
• Antibiotics most likely ordered if strangulation is suspected

Question 14

surgical management for IO

Answer 14

• Exploratory laparotomy (a surgical opening of the abdominal cavity)
• Conventional open surgical approach
• Laparoscopic surgery (MIS)
• Colectomy (surgical removal of the entire colon) in severe cases

Question 15

evaluation of outcomes for IO

Answer 15

• Have relief from the obstruction and no evidence of life-threatening complications. –> rupture, peritonitis, eschema
• Report that he or she has returned to having USUAL bowel habits.

Question 16

colorectal

Answer 16

refers to colon and rectum, which together make up large intestine

Question 17

colonscopy

Answer 17

• CT-guided virtual colonoscopy: noninvasive and includes a CT scan of the rectum and colon
• Sigmoidoscopy: provides visualization of the lower colon using a fiberoptic scope
• COLONOSCOPY (definitive test): provides views of the entire large bowel from the rectum to the ileocecal valve

Question 18

colostomies ascending colostomy

Answer 18

right-sided tumors

Question 19

colostomies tranverse

Answer 19

colostomy—used in emergencies and has two stomas

Question 20

colostomies descending colostomy

Answer 20

left-sided tumors

Question 21

sigmoid colostomies

Answer 21

rectal tumors

Question 22

slef management education colostomy

Answer 22

• Before teaching, teach the patient to avoid lifting heavy objects or straining on defecation to prevent tension on anastomosis site
• Patient should avoid driving and extreme physical activity for 4 to 6 weeks while the incision heals
• Laparoscopy: patient can return to normal activity within 1- 2 weeks

Question 23

IBS

Answer 23

IBS: A functional GI disorder that causes chronic or recurrent diarrhea, constipation, and/or abdominal pain and bloating Most common digestive disorder One in five people in the U.S.

Question 24

``` ibs classdications d c a m ```

Answer 24

IBS-D (diarrhea) IBS-C (constipation) IBS-A (alternating diarrhea/constipation) IBS-M (mix of diarrhea/constipation)

Question 25

assessment findings ibs

Answer 25

- Fatigue, malaise - Cramps - ABDOMINAL PAIN - Changes in bowel patterns (***constipation, diarrhea, or an alternating pattern of both) - Consistency of stools - Passage of mucus - FOOD INTOLERANCE - NAUSEA - Belching, gas, anorexia and bloating

Question 26

health teaching for IBS

Answer 26

dietary fiber and bulk; 30 to 40 g fiber each day; eat regular meals, drink 8 to 10 glasses of water each day, and chewing food slowly help promote normal bowel function

Question 27

drug therapy ibs

Answer 27

bulk-forming or antidiarrheal agents and/or newer drugs to control symptoms such as pain, laxatives

Question 28

complemenatry and integrative health

Answer 28

- probiotics, peppermint oil | - Stress reduction: relaxation techniques, meditation, and/or yoga, counseling, exercise

Question 29

herniation

Answer 29

A weakness in the abdominal muscle wall through which a segment of the bowel or other abdominal structure protrudes Any hernia that is not reducible requires immediate surgical evaluation

Question 30

strangulated hernia

Answer 30

there is ischemia and obstruction of the bowel loop, which can lead to necrosis of the bowel, sepsis and possible bowel perforation. Signs of strangulation are abdominal distention, N/V, pain, fever, and tachycardia

Question 31

assessment hernication

Answer 31

- “Lump” or protrusion - Absent bowel sounds = medical emergency - The hernia is never forcibly reduced; this maneuver could cause strangulated intestine or rupture

Question 32

non surgical management herniation

Answer 32

- Truss: a pad made with firm material - Herniorrhaphy: a minimally invasive inguinal hernia repair (MIIHR) through a laparoscope is the surgery of choice, a conventional open herniorrhaphy performed when laparoscopy is not appropriate

Question 33

hemmrrhoids

Answer 33

Swollen or distended veins in anorectal region Internal, external, prolapsed - Prevention of constipation, straining - Bleeding, swelling, prolapse - Manage pain, increase dietary fiber - Hemorrhoidectomy can be performed if needed