Ch. 48 & 49 Flashcards

(61 cards)

1
Q

IBS is

A

irritable bowel syndrome
- F > M; generally younger women

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2
Q

most common digestive disorder

A

IBS
- affects 1/5 people in the US

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3
Q

IBS causes

A
  • diarrhea
  • constipation
  • abdominal pain
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4
Q

causes of IBS

A

unclear
- environmental
- genetics
- stress (stress and anxiety triggers)

  • diet can trigger IBS: wheat, dairy (gluten & lactose)
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5
Q

IBS classifications

A
  • IBS-D: diarrhea
  • IBS-C: constipation
  • IBS-A: alternating diarrhea/constipation
  • IBS-M: mix of diarrhea/constipation
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6
Q

IBS: s/sx

A
  • fatigue, malaise
  • abdominal pain
  • changes in bowel patterns (patient’s own pattern changes)
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7
Q

IBS interventions

A
  • health teaching: high-fiber diet
  • drug therapy- BASED ON THE SX THEY ARE HAVING
  • stress reduction (yoga, meditation)
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8
Q

IBS drug therapy

A
  • metamucil- for constipation
  • loperamide (immodium)- for diarrhea
  • probiotics (for good flora in the intestines)
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9
Q

peritonitis

A
  • Life-threatening, acute inflammation and infection of visceral/parietal peritoneum and endothelial lining of abdominal cavity
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10
Q

causes of peritonitis

A
  • Often caused by contamination of the peritoneal cavity by bacteria or chemicals
  • common bacteria (e coli, strep, staph)
  • chemical: leakage of bile, pancreatic enzymes, gastric acid
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11
Q

peritonitis: incidence and prevalence

A
  • most common cause of death from surgical infections with mortality rate of 50%
  • significant post-op complications with 50% mortality rate
  • occurs most commonly in young adults with appendicitis
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12
Q

peritonitis assessment: history (sx)

A
  • pain, type, location (abdominal pain)
  • fever, N/V
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13
Q

peritonitis assessment: s/sx

A
  • movement may be guarded (hand across abdomen)
  • rigid, board-like abdomen (cardinal sign)
  • abdominal pain, tenderness, distention
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14
Q

peritonitis assessment: pyschosocial

A

anxiety associated with it
- stress related to dx

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15
Q

peritonitis assessment: labs

A
  • WBC elevated** (bc its an infection)
  • Blood cultures: bacteria moved out of peritonitis into blood (septicemia)
  • BUN, creatinine (kidney involvement)
  • Hemoglobin, hematocrit
  • ABG, oxygen saturation
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16
Q

peritonitis assessment: imaging

A
  • abdominal x-rays and ultrasound (shows inflammation of the abdominal peritoneum)
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17
Q

peritonitis: priority problems

A
  • acute pain
  • potential for fluid volume shift
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18
Q

peritonitis interventions

A
  • manage pain: with pain meds
  • treat infection: with antibiotics
  • restore fluid volume balance: NPO, IVF
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19
Q

peritonitis evaluation

A
  • verbalizes relief or control of pain
  • experiences fluid and electrolyte balance (I&Os)
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20
Q

appendicitis

A
  • Acute inflammation of the vermiform appendix
  • RLQ
  • Inflammation occurs when lumen of appendix is obstructed, leading to infection
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21
Q

the classic area for localized tenderness during the later stages of appendicitis

A

McBurney’s point
- located midway between the anterior iliac crest and the umbilicus in the right lower quadrant

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22
Q

appendicitis complications

A
  • abscess
  • gangrene
  • sepsis
  • perforation of intestine
  • peritonitis
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23
Q

appendicitis interventions

A

non-surgical
- keep NPO
- IVF/ IV ABT
- pain meds

surgical
- need to do ASAP
- appendectomy (can usually go home same day or next day)

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24
Q

appendicitis assessment: s/sx

A

Abdominal pain - RLQ
Muscle rigidity
Guarding and rebound
N and V, anorexia

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25
appendicitis assessment: labs/ diagnostics
- moderate elevated WBC- like 20,000 - CT scan to confirm - then going to OR to have it removed *ultrasound may show enlarged appendix
26
gastroenteritis
- very common health problem - diarrhea and vomiting - can be a viral or bacterial infection (viral more common) - self-limiting to 2-3 days - can require medical attention/hospitalization for older adults or patients who are immunosuppressed
27
gastroenteritis: prevention
- norovirus often occurs where large groups of people are in close proximity (cruise ships, nursing homes) - handwashing - sanitize surfaces - proper food and beverage preparation
28
gastroenteritis assessment
- ask about recent travel (think unfiltered water), eating at restaurants or elsewhere (salmonella outbreaks) - GI sx (upper and lower) - fluid volume deficit
29
gastroenteritis interventions
- encourage fluid replacement and oral rehydration therapy (IVF at hospital if vomiting and diarrhea is really bad) - antibiotics may be needed if bacterial cause - viral sort of just works its way out; no ABT needed - NO ANTIDIARRHEAL MEDS: want bug to work its way out of GI tract
30
ulcerative colitis
- Widespread chronic inflammation of the rectum and rectosigmoid colon (mainly in large intestine, spec. colon) - Can extend into entire colon - Has periodic remissions and exacerbations - often confused with Crohn disease
31
causes of ulcerative colitis
- exact cause unknown - genetic: often found in families and twins - immunologic - environmental factors - cellular changes can increase colon cancer risk
32
ulcerative colitis is typically diagnosed at what age
most are diagnosed between 20-35 years old (younger person's d/o)
33
how many people with IBS experience ulcerative colitis too?
about half
34
ulcerative colitis assessment: history
- nutrition and elimination history - when does diarrhea happen? - what is normal elimination pattern?
35
ulcerative colitis assessment: s/sx
- Bloody diarrhea- Frequent Stools containing blood and mucus** - Weight loss** - Abdominal pain - Low grade fever - Fatigue** *Usually findings are nonspecific
36
ulcerative colitis assessment: psychosocial
anxiety
37
ulcerative colitis assessment: labs
- Hematocrit and hemoglobin (decreased- blood loss through bowels) - Increased WBC, C-reactive protein, ESR (may be elevated) - Low sodium, potassium, chloride - Hypoalbuminemia
38
ulcerative colitis assessment: diagnostic tests
- MRE** magnetic resonance enterography: drink oral contrast solution, go in for imaging of contrast going through GI - upper endoscopy: upper GI tract - colonoscopy: lower GI tract; through rectum
39
ulcerative colitis priority problems
- diarrhea - acute or persistent pain - potential for lower GI bleeding - skin breakdown (acid from the diarrhea)
40
ulcerative colitis interventions
- manage diarrhea - manage pain - prevent or monitor for lower GI bleeding (bowels for blood and labs: Hgb&Hct) - nutrition therapy - drugs - surgery- postop ileostomy * pt teaching how to change bag; normal stoma vs inflamed skin, purulent drainage (usually have visiting nurses at home to make sure that they can care for these)
41
ulcerative colitis: drug therapy
5-ASA - mesalamine - sulfasalazine - corticosteriods (7 day course of prednisone to keep the inflammation under control with flare ups) may be on 1 or multiple * meds work well but don't work right away (2-4 weeks to work)
42
ulcerative colitis evaluation
- Experience no diarrhea or a decrease in diarrheal episodes - Verbalize decreased pain - Have absence of lower GI bleeding - Self-manage the ileostomy or ileo-anal pouch (temporary or permanent- usually temporary bag)
43
crohn's disease
- Chronic inflammatory disease of small intestine, (lg intestine) colon, or both - Inflammation that causes a thickened bowel wall
44
complications of crohn's
- hemorrhage - severe malabsorption - malnourishment - debilitation - cancer (although rare)
45
crohn's assessment: s/sx
- Unintentional weight loss - Stool characteristics: frequent (less frequent than ulcerative colitis) soft, loose stools, Steatorrhea – fatty; rarely bloody - Fever, abdominal pain - Assess for distention, masses, visible peristalsis - Fistulas from bowel to other organs - Anemia is common
46
crohn's assessment: labs/ diagnostics
- low hemoglobin and hematocrit - elevated ESR - abdominal x-rays, MRE* - biopsy
47
crohn's disease interventions
non-surgical management - 5 ASA: mesalamine, sulfasalazine surgical management - to fix fistulas
48
crohn's disease (overview)
- Small intestines - Etiology unknown - Peak incidence 15-40y - 5-6 soft, loose stools per day, steatorrhea - Complications: - Fistulas - Nutritional deficiencies - Surgery frequent (to fix fistulas)
49
ulcerative colitis (overview)
- Rectum and Colon - Etiology unknown - Peak incidence 15-25y; 55-65y - Diarrhea 10-20 liquid bloody stools per day - Complications: - Hemorrhage - Nutritional deficiencies - Surgery infrequent
50
crohn's: drug therapy
- sulfasalazine (azullfidine) - corticosteroids
51
crohn's interventions
- manage diarrhea - manage pain - prevent or monitor for lower GI bleeding - nutrition therapy - drugs - surgery
52
crohn's care coordination
- home care management - self-management education - health care resources
53
diverticular disease
- Can occur in any part of the small or large intestine - Diverticula without inflammation usually cause few problems (diverticular vs diverticulitis) - Abscess, peritonitis can develop
54
diverticulosis vs diverticulitis
Diverticulosis- outpouching of walls of intestine - not super serious - take precautions to prevent diverticulitis - no clinical s/x; usually don't know they have it Diverticulitis – inflammation or infection of diverticulum - low grade fever, N/V, abdominal pain LLQ
55
complications of diverticular disease
- Perforation resulting in peritonitis - Hemorrhage - Obstruction
56
diverticular disease diagnostics
- CBC- WBC - Stool for OB - U/s or sigmoidoscopy
57
diverticular disease assessment: s/sx
May have no symptoms May have abdominal pain, fever, tachycardia, nausea, vomiting Abdominal distention, tenderness Diverticulosis – no clinical manifestations Diverticulitis – LLQ abd pain - fever
58
diverticular disease interventions
nonsurgical management - drug therapy - nutrition therapy: - High fiber diet - Fluids - Avoid alcohol surgical management - resection with or without colostomy
59
diverticular disease: drug therapy (diverticulitis)
Antibiotics * - Metronidazole ** - Ciprofloxacin ** Mild analgesics Anticholinergics
60
diverticular disease: patient teaching (diverticulosis)
- High fiber diet - Fluids - Avoid alcohol - S/S of diverticulits: LLQ pain - Avoid laxatives - Care of colostomy
61
foods to avoid with diverticular disease
avoid foods with seeds [can get lodged/stuck in diverticula]: - everything bagel - berries (strawberries, grapes, raspberries) - corn - popcorn - watermelon - nuts