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Chapter 47 ☠️ Flashcards

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1
Q

What is the primary cause of acute diarrhea?

A

Ingesting infectious organisms.

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2
Q

What type of organisms cause most cases of infectious diarrhea in the United States?

A

Viruses.

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3
Q

What are the manifestations of Campylobacter infection?

A
  • Diarrhea
  • Abdominal cramps
  • Fever
  • Sometimes nausea, vomiting
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4
Q

How long does diarrhea from Campylobacter typically last?

A

About 7 days.

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5
Q

What is a common source of Clostridioides difficile infection?

A

Prolonged use of antibiotics followed by exposure to feces-contaminated surfaces.

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6
Q

What symptoms are associated with Clostridium perfringens infection?

A
  • Diarrhea
  • Abdominal cramps
  • Nausea
  • Vomiting
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7
Q

When do symptoms of Clostridium perfringens typically occur after eating contaminated food?

A

6-24 hours.

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8
Q

What are the manifestations of Enterohemorrhagic Escherichia coli infection?

A
  • Watery or bloody diarrhea
  • Abdominal cramps
  • Nausea
  • Vomiting
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9
Q

What is the duration of diarrhea caused by Salmonella infection?

A

4-7 days.

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10
Q

What are the manifestations of Shigella infection?

A
  • Diarrhea (sometimes bloody)
  • Fever
  • Stomach cramps
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11
Q

What is a key characteristic of Staphylococcus infection?

A

Usually mild.

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12
Q

What are the symptoms associated with Cryptosporidium infection?

A
  • Watery diarrhea
  • Abdominal cramps
  • Nausea
  • Vomiting
  • Fever
  • Dehydration
  • Weight loss
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13
Q

How long can Giardia lamblia symptoms last?

A

May last 2 weeks.

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14
Q

What is the typical duration of Norovirus infection?

A

1-2 days.

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15
Q

What are the symptoms of Rotavirus infection?

A
  • Fever
  • Vomiting
  • Profuse watery diarrhea
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16
Q

What is a common transmission route for Norovirus?

A

Fecal-oral route.

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17
Q

What are common sources of waterborne disease caused by Giardia?

A

Swimming pools, lakes, drinking water, food contaminated with feces.

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18
Q

What high-risk groups are common for diarrhea in the United States?

A
  • Travelers
  • Recent immigrants
  • Men who have sex with men
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19
Q

What is the primary transmission route for viral gastroenteritis?

A

Fecal-oral route.

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20
Q

What is the effect of the outer shell of Cryptosporidium?

A

Allows it to live for long periods outside of the body and makes it resistant to chlorine.

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21
Q

What is a common cause of bloody diarrhea in the United States?

A

Bacterial infection with Escherichia coli O157:7

Transmitted by undercooked beef or chicken contaminated with the bacteria or in fruits and vegetables exposed to contaminated manure.

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22
Q

Which organism is the most common GI parasite that causes diarrhea in the United States?

A

Giardia lamblia

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23
Q

How do some infectious organisms, like Rotavirus A and Norovirus, affect the intestines?

A

They change the secretion and/or absorption of enterocytes in the small intestine without causing inflammation.

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24
Q

What is secretory diarrhea?

A

A condition that occurs when ingested pathogens survive in the GI tract long enough to absorb into the enterocytes, leading to oversecretion of water, sodium, and chloride into the bowel.

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25
What are common sources of infection for gastrointestinal pathogens?
Contaminated food and drinking water ## Footnote Examples include Salmonella in undercooked eggs and chicken, and G. lamblia in contaminated lakes or pools.
26
What factors influence a person's susceptibility to gastrointestinal pathogens?
Age, gastric acidity, intestinal microflora, and immune status.
27
Which age group is most likely to experience life-threatening diarrhea?
Older adults
28
How do proton pump inhibitors (PPIs) affect susceptibility to pathogens?
They decrease stomach acid, increasing the chance that pathogens will survive.
29
What is the role of normal flora in the human colon?
They aid in fermentation and provide a microbial barrier against pathogens.
30
What effect do broad-spectrum antibiotics have on normal flora?
They kill normal flora, making the person more susceptible to infections.
31
What is the most serious hospital-associated diarrhea caused by?
C. difficile infection (CDI)
32
Which patients are especially prone to foodborne infections?
Immunocompromised patients receiving jejunal enteral nutrition (EN)
33
What are some non-infectious causes of diarrhea?
Drugs and food intolerances
34
What laboratory tests are important for diagnosing diarrhea?
Stool examination for blood, mucus, white blood cells (WBCs), and parasites; stool cultures; blood cultures.
35
What are signs of fluid deficit in patients with diarrhea?
Increased hematocrit, blood urea nitrogen (BUN), and creatinine levels.
36
What does measuring stool electrolytes, pH, and osmolality help determine?
Whether the diarrhea is from decreased fluid absorption or increased fluid secretion.
37
What is the primary treatment concern for acute infectious diarrhea?
Preventing transmission and replacing fluid and electrolytes.
38
What is the role of antidiarrheal drugs?
They coat and protect mucous membranes, absorb irritating substances, inhibit intestinal transit, decrease intestinal secretions, and decrease CNS stimulation of the GI tract.
39
What is the mechanism of action of subsalicylate (Pepto-Bismol)?
Decreases secretions and has weak antibacterial activity
40
What is the primary use of subsalicylate?
Used to prevent travelers' diarrhea
41
What are the effects of loperamide (Imodium, Pepto Diarrhea Control)?
Decreases peristalsis and intestinal motility
42
What is the mechanism of action of octreotide acetate (Sandostatin)?
Inhibits peristalsis, delays transit, increases absorption of fluid from stools
43
What are the nursing considerations for octreotide acetate?
May cause tinnitus and confusion. Do not use with GI bleeding
44
What is the effect of paregoric (camphorated tincture of opium)?
Suppresses serotonin secretion, stimulates fluid absorption from GI tract, decreases intestinal motility
45
What are some side effects of paregoric?
Blurred vision, dry mouth, drowsiness
46
What caution should be taken with opioid antidiarrheal medications?
Avoid alcohol and use caution with hazardous activities
47
What is the major concern with fecal microbiota transplantation (FMT)?
Potential for transmitting infectious agents in the donor stool
48
What is Clostridioides difficile infection (CDI)?
A particularly hazardous health care-associated infection (HAI)
49
What is the risk factor for contracting CDI?
Receiving antimicrobial, chemotherapy, gastric acid-suppressing, or immunosuppressive drugs
50
What medications are typically used to treat CDI?
Oral vancomycin or fidaxomicin for 10 days
51
What should be done with non-essential antibiotics during CDI treatment?
They should be stopped
52
What is recurrent CDI and its frequency?
Occurs in about 20% of patients with increased risk from additional antibiotics
53
What is the treatment for severe, complicated CDI?
Vancomycin 500 mg 4 times daily orally with IV metronidazole
54
What clinical problems are associated with acute infectious diarrhea?
* Impaired bowel elimination * Fluid imbalance * Electrolyte imbalance
55
How is fecal microbiota transplantation (FMT) prepared?
Feces from the donor is pureed into a liquid slurry consistency
56
What is the purpose of using Lactobacillus probiotics in relation to CDI?
To prevent CDI or as an adjunct therapy to help prevent recurrent CDI
57
What assessments should be made for a patient with diarrhea?
Focus on stool pattern, duration, frequency, character, consistency, and related symptoms
58
What signs of dehydration should be assessed in patients with diarrhea?
Dry skin, low-grade fever, orthostatic changes in pulse and BP, decreased concentrated urine
59
What is the primary nursing management for a patient with diarrhea?
Ensure the patient maintains an adequate fluid intake ## Footnote This includes monitoring for dehydration and replenishing lost fluids.
60
What subjective data should be assessed in a patient experiencing diarrhea?
Health history: Recent travel, hospitalization, infections, stress ## Footnote Other factors include diverticulitis and medications that may affect bowel function.
61
What medications may be administered for diarrhea?
* Antidiarrheal drugs * Antibiotics * Laxatives or enemas * Magnesium-containing antacids * Sorbitol containing suspensions or elixirs * OTC antidiarrheal drugs ## Footnote Specific medications should be given as ordered by a healthcare provider.
62
What are some nursing interventions for maintaining perianal skin integrity in patients with diarrhea?
* Assist the patient with keeping the perianal area clean * Apply a moisturizing skin barrier cream as needed ## Footnote Maintaining skin integrity is crucial to prevent irritation and infection.
63
What is a common functional health pattern associated with diarrhea?
Nutritional-metabolic: Ingestion of fatty and spicy foods, food intolerances. ## Footnote These dietary factors can exacerbate diarrhea in some patients.
64
What are the signs of dehydration in a patient with diarrhea?
* Lethargy * Sunken eyeballs * Fever * Malnutrition ## Footnote These signs indicate a need for immediate fluid replacement.
65
What objective data should be documented in a patient with diarrhea?
* Frequent soft to liquid stools * Altered stool color * Abdominal distention * Hyperactive bowel sounds * Fecal impaction ## Footnote Monitoring stool characteristics helps assess the severity and potential causes of diarrhea.
66
What diagnostic findings may indicate a problem in a patient with diarrhea?
* Abnormal serum electrolyte levels * Anemia * Positive stool cultures * Ova, parasites, leukocytes, blood, or fat in stool * Abnormal sigmoidoscopy or colonoscopy findings ## Footnote These findings can help determine the underlying cause of diarrhea.
67
What is the Bristol Stool Scale Type 1?
Separate hard lumps, like nuts (hard to pass) ## Footnote This type indicates constipation.
68
What is the Bristol Stool Scale Type 7?
Watery, no solid pieces, entirely liquid ## Footnote This type indicates severe diarrhea.
69
What is the definition of fecal incontinence?
The involuntary loss of stool ## Footnote This condition occurs when the structures maintaining continence are damaged or disrupted.
70
What should be considered in the nursing management of patients with acute diarrhea?
Consider all cases of acute diarrhea as infectious until the cause is known ## Footnote Strict infection control precautions are necessary to prevent spread.
71
What hand hygiene practice is essential for limiting the spread of C. difficile?
Meticulous hand washing with soap and water ## Footnote Alcohol-based hand sanitizers are ineffective against C. difficile spores.
72
What isolation precautions should be taken for patients with CDI?
* Put patients in isolation * Ensure visitors and healthcare providers wear gloves and gowns * Provide patients their own disposable stethoscopes and thermometers ## Footnote This helps prevent cross-contamination.
73
What are some measures to make toileting easier for patients with diarrhea?
* Call light in reach * Easy-to-manage clothing * Assistive devices available * Provide privacy for toileting and use a deodorizer ## Footnote Comfort and privacy are important for patient dignity.
74
What is fecal incontinence?
Inability to control bowel movements, leading to involuntary leakage of stool. ## Footnote Fecal incontinence can be embarrassing and uncomfortable, affecting social interactions.
75
What are common causes of fecal incontinence?
* Sphincter weakness * Neurologic diseases * Pelvic floor dysfunction * Physical or mobility problems * Chronic constipation * Fecal impaction ## Footnote Neurologic diseases can include brain tumors, diabetes, and multiple sclerosis.
76
What role does a high-fiber diet play in managing fecal incontinence?
It helps maintain normal stool consistency and promotes regular defecation. ## Footnote A high-fiber diet can include fruits, vegetables, and whole grains.
77
Fill in the blank: Patients may need to reduce the intake of foods that cause diarrhea and rectal irritation, such as _______.
[caffeine, artificial sweeteners, dairy products, high gas-producing vegetables] ## Footnote Foods like broccoli, cabbage, and cauliflower are examples.
78
What is the purpose of biofeedback training in fecal incontinence treatment?
It improves awareness of rectal sensation and coordinates sphincter contraction. ## Footnote Biofeedback requires intact sensory nerves and motivation to learn.
79
True or False: Obstetric trauma is a common cause of sphincter injury in women.
True ## Footnote Aging and menopause also contribute to this issue.
80
What is fecal impaction?
A collection of hardened feces in the rectum or sigmoid colon that cannot be expelled. ## Footnote It often leads to incontinence as liquid stool seeps around the hardened feces.
81
What is the function of dextranomer/hyaluronic acid gel (Solesta) in treating fecal incontinence?
It builds up tissue in the anal area, narrowing the anal canal for better muscle closure. ## Footnote This treatment does not require anesthesia.
82
What diagnostic studies are used for fecal incontinence?
* Health history * Physical assessment * Rectal examination * Anorectal manometry * Anorectal ultrasonography ## Footnote These studies help assess anal canal muscle tone and detect other issues.
83
What are common triggers for diarrhea and rectal irritation?
* Caffeine * Artificial sweeteners * Dairy products * High gas-producing vegetables * Insoluble fiber vegetables ## Footnote Examples of high gas-producing vegetables include broccoli and cabbage.
84
What is the common treatment for fecal incontinence resulting from fecal impaction?
Manual removal of hard feces and cleansing enemas. ## Footnote This approach typically resolves fecal incontinence due to impaction.
85
What is the impact of mobility problems on fecal incontinence?
Mobility problems can prevent prompt access to a toilet, leading to incontinence. ## Footnote This is especially relevant for frail older adults.
86
What is the role of electrical stimulation in fecal incontinence treatment?
It targets communication problems between the brain and nerves controlling pelvic floor muscles and sphincters. ## Footnote Electrical stimulation can improve quality of life for some patients.
87
What is the Bristol Stool Scale used for?
To assess stool consistency ## Footnote The Bristol Stool Scale categorizes stool types based on consistency and appearance.
88
What symptoms indicate incontinence-associated dermatitis (IAD)?
Symptoms include redness, skin loss, and rash ## Footnote IAD is caused by chemical irritants in feces and typically affects the perianal area.
89
What is the primary method of bowel training?
Establishing a regular bowel program based on the patient's usual bowel pattern ## Footnote This includes timing elimination efforts, such as after meals or at specific times daily.
90
List some common risk factors for constipation.
* Low-fiber diet * Decreased physical activity * Ignoring the defecation urge ## Footnote Ignoring the urge can lead to insensitivity of the rectal muscles and mucosa.
91
What are the characteristics of chronic constipation?
Fewer than 3 stools per week, straining, incomplete evacuation, and hard stools ## Footnote Chronic constipation lasts over 3 months.
92
How can digital stimulation aid in bowel management?
It stimulates the anorectal reflex ## Footnote Digital stimulation is often used for patients with neurogenic bowels.
93
What is a stool management system?
A system that funnels liquid stool from the rectum into a containment system ## Footnote Examples include Flexi-Seal and DigniCare, which help reduce skin damage from stool exposure.
94
What are common causes of constipation related to medications?
Many drugs, especially opioids, can cause constipation ## Footnote Opioids slow gastrointestinal transit and can lead to hard stools.
95
Describe the term 'cathartic colon syndrome'.
A condition where the colon becomes dilated and atonic due to chronic laxative use ## Footnote This syndrome can result in an inability to defecate without a laxative.
96
What is the role of perineal skin care in patients with fecal incontinence?
To maintain skin integrity and prevent infections ## Footnote Feces can contaminate wounds and lead to conditions like C. difficile infections.
97
What should be done before administering a suppository or enema?
Check for stool in the rectum and digitally remove it if present ## Footnote This ensures effective stimulation of the anorectal reflex.
98
What is a common feature of stool management systems?
A retention cuff that sits above the anal sphincter ## Footnote This feature helps contain stool and reduces the risk of skin damage.
99
Identify emotional factors that can contribute to constipation.
* Anxiety * Depression * Stress ## Footnote These emotions can affect gastrointestinal function and lead to constipation.
100
What is the best time to schedule bowel elimination for patients?
Within 30 minutes after meals ## Footnote This timing helps establish regular defecation patterns.
101
What is the significance of stool consistency in bowel health?
It helps assess gastrointestinal function and identify issues like constipation ## Footnote Stool consistency can indicate the need for dietary or lifestyle changes.
102
What are the potential complications of fecal incontinence?
* Skin irritation * Incontinence-associated dermatitis * Bladder infections ## Footnote These complications arise from fecal contamination and exposure.
103
What are some colonic disorders associated with constipation?
* Cancer * Intestinal stenosis * Intestinal obstruction * Prolapse * Rectocele
104
Name systemic disorders that can lead to constipation.
* Collagen Vascular Disease * Amyloidosis * Systemic lupus erythematosus * Systemic sclerosis * Chronic renal failure * Diabetes * Hypercalcemia * Hypokalemia * Hypothyroidism * Pheochromocytoma * Pregnancy
105
List neurologic disorders that may cause constipation.
* Autonomic neuropathy (from diabetes) * Hirschsprung megacolon * Multiple sclerosis * Neurofibromatosis * Parkinson disease * Spinal cord lesions or injury * Stroke
106
What are some drugs associated with constipation in the cardiovascular category?
* Antihypertensives (B-adrenergic blockers, calcium channel blockers) * Furosemide * Hypolipidemics (cholestyramine, colestipol, statins)
107
Identify central nervous system drugs that can lead to constipation.
* Antidepressants (tricyclics, selective serotonin reuptake inhibitors) * Antiepileptics (carbamazepine, phenytoin, clonazepam) * Antipsychotics (butyrophenones, phenothiazines, barbiturates) * Benzodiazepines * Antacids containing aluminum, calcium * Antidiarrheals * Proton-pump inhibitors * Supplements (bismuth, calcium, iron) * Analgesics (opiates and derivatives) * Antitussives (codeine, dextromethorphan)
108
What physiological changes occur during the Valsalva maneuver?
* Increased intraabdominal and intrathoracic pressure * Reduced venous return to the heart * Temporary decrease in heart rate * Decrease in cardiac output * Transient drop in arterial pressure
109
What complications can arise from chronic constipation?
* Rectal mucosal ulcers and fissures * Diverticulosis * Obstipation * Fecal impaction * Colonic perforation
110
What diagnostic studies are commonly used for constipation?
* History and physical assessment * Abdominal x-rays * Barium enema * Colonoscopy or sigmoidoscopy * Anorectal manometry * GI tract transit studies * Balloon expulsion test * Defecography
111
Describe the clinical manifestations of constipation.
* Absent or hard, dry stools * Abdominal distention * Bloating * Increased flatus * Increased rectal pressure
112
How can chronic constipation lead to hemorrhoids?
Result from venous engorgement caused by repeated Valsalva maneuvers and venous compression from hard, impacted stool
113
What interprofessional care strategies can help prevent constipation?
* Increasing fiber intake * Increasing fluid intake * Exercise
114
What types of laxatives are recommended for chronic constipation?
* Bulk-forming laxatives (psyllium) * Osmotic laxatives * Stimulant laxatives * Enemas
115
What are the risks associated with the use of enemas?
Can cause electrolyte imbalances in older adults and patients with heart and kidney problems
116
What therapies are available for opioid-induced constipation?
* Peripherally acting opioid receptor antagonists (methylnaltrexone, naloxegol, naldemedine)
117
What is the primary effect of bulk-forming laxatives?
They work like dietary fiber and do not cause dependence.
118
What is the mechanism of action for bulk forming agents in treating constipation?
Absorbs water, increases bulk, thereby stimulating peristalsis ## Footnote Action usually occurs within 24 hours.
119
What are the indications for using bulk forming agents?
Acute and chronic constipation, IBS, diverticulosis ## Footnote Examples include methylcellulose (Citrucel) and psyllium (Metamucil).
120
What is the action of emollients in treating constipation?
Lubricate intestinal tract and soften feces, making hard stools easier to pass ## Footnote Softeners act within 72 hours; lubricants within 8 hours.
121
What are the contraindications for using emollients?
Do not use in patients with abdominal pain, nausea, vomiting, suspected appendicitis, biliary tract obstruction, or acute hepatitis ## Footnote Must be taken with fluids.
122
What is the action of prosecretory drugs?
Increases intestinal fluid secretion through direct action on epithelial cells, speeding colonic transit ## Footnote Action usually occurs within 24 hours.
123
What are saline and osmotic solutions used for?
Cause retention of fluid in intestinal lumen, reducing stool consistency and increasing volume ## Footnote Action occurs within 15 minutes to 3 hours.
124
What are the indications for using stimulant laxatives?
Acute constipation, bowel preparation for diagnostic tests and surgery ## Footnote Examples include anthraquinones (cascara sagrada, senna) and bisacodyl (Dulcolax).
125
What are the potential side effects of stimulant laxatives?
Cause melanosis coli (brown or black pigmentation of colon) ## Footnote Most widely abused laxatives; should not be used in patients with impaction or obstipation.
126
What is the role of nutrition therapy in preventing and treating constipation?
Diet is key; increasing fiber intake from fruits, vegetables, and grains improves symptoms ## Footnote Wheat bran and prunes are especially effective.
127
What is the recommended fluid intake to help with constipation?
Adequate fluid intake of 2 L/day is essential ## Footnote May be contraindicated in patients with heart disease or renal failure.
128
What assessment should be performed for a patient with constipation?
Determine usual defecation patterns, onset and duration of symptoms, stool shape and consistency, difficulty with evacuation ## Footnote Ask about diet, exercise, laxative use, and history contributing to defecation issues.
129
What is emphasized in the implementation phase of nursing management for constipation?
Teach about diet, adequate fluid intake, and regular exercise in preventing and treating constipation ## Footnote Stress the importance of a high-fiber diet and using laxatives as ordered.
130
What is the significance of high-fiber foods in nutrition therapy?
High-fiber foods help prevent constipation and improve bowel function.
131
List some common health history factors associated with constipation.
* Colorectal disease * Neurologic problems * Bowel obstruction * Environmental changes * Cancer * Inflammatory Bowel Disease (IBD) * Diabetes
132
What are the subjective data points to assess in a patient with constipation?
* Health history * Medication use * Dietary changes * Bowel pattern changes * Abdominal symptoms
133
What are the common objective data findings in a patient with constipation?
* Abdominal distention * Hypoactive or absent bowel sounds * Palpable abdominal mass * Fecal impaction * Small, hard, dry stool * Stool with blood
134
What dietary changes can help alleviate constipation?
* Increased fiber intake * Increased fluid intake * Regular meal times
135
What is the recommended seating position for defecation to ease the process?
Sitting on a commode with knees higher than hips.
136
What are some clinical manifestations of acute abdominal pain?
* Nausea * Vomiting * Diarrhea * Constipation * Flatulence * Fatigue * Fever * Rebound tenderness * Bloating
137
What are potential causes of acute abdominal pain?
* Damage to organs * Inflammation * Infection * Obstruction * Bleeding * Perforation
138
What immediate action is required for acute abdominal pain?
Immediate medical attention is required due to potential life-threatening issues.
139
What is the role of hypovolemic shock in acute abdominal conditions?
It occurs from bleeding or obstruction and can lead to peritonitis.
140
What is the first step in diagnosing acute abdominal pain?
A complete history and physical assessment.
141
What should be discussed with patients who have rigid beliefs about bowel function?
Provide information on normal bowel function and the consequences of laxative overuse.
142
What is the impact of abdominal muscle tone on bowel function?
Maintaining abdominal muscle tone can aid in effective defecation.
143
What are some strategies to promote effective defecation?
* Establish a regular defecation schedule * Avoid suppressing the urge to defecate * Use a footstool for proper seating
144
Name some high-fiber foods that can assist in reducing constipation.
* Baked potatoes * Squash * Raw tomatoes * Fruits such as apples and blackberries * Whole wheat bread * Cereals like All Bran
145
Describe the effect of peritonitis on the body.
It leads to irritation of the peritoneum and can result from GI tract perforation.
146
What are the possible diagnostic findings for constipation?
Guaiac-positive stools and abdominal x-ray showing stool in the lower colon.
147
What is the recommended daily fiber intake to manage constipation?
20 to 30 g of fiber per day ## Footnote Gradually increase the amount of fiber eaten over 1 to 2 weeks. Fiber softens hard stool and adds bulk to stool, promoting evacuation.
148
What are some foods high in fiber that can help with constipation?
Foods high in fiber include: * Raw vegetables and fruits * Beans * Breakfast cereals (e.g., All-Bran, oatmeal) * Fiber supplements (e.g., Metamucil, Citrucel, FiberCon) ## Footnote Prunes or prune juice are specifically mentioned as they stimulate defecation.
149
How much fluid should one drink daily to help prevent constipation?
2 L/day ## Footnote Drinking water or fruit juices is recommended, while caffeinated beverages should be avoided as they stimulate fluid loss.
150
What type of exercise is recommended for managing constipation?
Walk, swim, or bike at least 3 times per week ## Footnote Contracting and relaxing abdominal muscles can also help prevent straining.
151
What is a key point regarding the use of laxatives and enemas?
Do not use laxatives and enemas unless ordered ## Footnote They can cause dependence.
152
What should a patient do to record their bowel elimination pattern?
Keep a record of bowel elimination patterns, including frequency and characteristics ## Footnote This can provide vital clues about bowel health.
153
What are some signs that may indicate a problem in the abdomen?
Signs include: * Pain before or after vomiting * Restlessness * Inability to find a comfortable position * Abdominal distention * Changes in pulse strength ## Footnote These signs can help identify the origin of an abdominal issue.
154
What diagnostic tests may be performed for acute abdominal pain?
Tests may include: * Complete blood count (CBC) * Urinalysis * Abdominal x-ray * ECG * Ultrasound or CT scan ## Footnote Women of childbearing age may also need a pregnancy test.
155
What are the overall goals for a patient with acute abdominal pain?
Goals include: * Relief of abdominal pain * Resolution of inflammation * Freedom from complications (especially hypovolemic shock) * Normal nutrition status ## Footnote These goals guide nursing management and patient care.
156
What clinical problems can arise for patients with acute abdominal pain?
Clinical problems include: * Pain * Fluid imbalance * Risk for infection ## Footnote These issues require careful monitoring and management.
157
What should be monitored to assess a patient's risk of shock?
Vital signs should be monitored ## Footnote Increased pulse and decreasing BP indicate impending shock.
158
What are key interventions for managing nausea and vomiting post-surgery?
Provide medication, maintain a calm environment, and assess vital signs, intake and output, and consciousness level.
159
What is the purpose of a nasogastric (NG) tube with low suction after surgery?
To decrease vomiting and relieve discomfort from gastric distention.
160
What changes in NG tube drainage color should be monitored after upper GI surgery?
Initially dark brown to dark red, then light yellowish-brown or greenish tinge due to bile.
161
What does 'coffee-grounds' appearance in NG tube drainage indicate?
Blood has been altered by acidic gastric secretions.
162
What are common causes of nausea and vomiting after a laparotomy?
Surgery, decreased peristalsis, and pain medications.
163
What is recommended to alleviate abdominal distention and gas pains post-surgery?
Early ambulation.
164
What should be included in patient education for discharge after surgery?
Modifications in activity, incision care, diet, and drug therapy.
165
What initial diet is recommended for patients after surgery?
Clear liquids.
166
What symptoms should the patient and caregiver monitor post-surgery?
Fever >101°F, vomiting, pain, weight loss, incisional drainage, changes in bowel function.
167
What are the expected outcomes for a patient with acute abdominal pain?
*Resolution of acute abdominal pain cause* *Relief of pain and discomfort* *Freedom from complications* *Normal fluid, electrolyte, and nutrition status*
168
What are common injuries associated with abdominal trauma?
*Lacerated liver* *Ruptured bladder* *Mesenteric artery tears* *Diaphragm rupture* *Renal or pancreas injury* *Stomach or intestine rupture*
169
What types of trauma can lead to abdominal injuries?
*Blunt trauma* *Penetrating injuries*
170
What is abdominal compartment syndrome?
Excessively high pressure in the abdomen that restricts ventilation and decreases cardiac output.
171
What are classic manifestations of abdominal trauma?
*Guarding and splinting of the abdominal wall* *Hard, distended abdomen* *Decreased or absent bowel sounds* *Abrasions or bruising over the abdomen* *Abdominal pain* *Hematemesis or hematuria* *Signs of hypovolemic shock*
172
What does bruising around the umbilicus (Cullen sign) or flanks (Grey Turner sign) indicate?
Retroperitoneal hemorrhage.
173
What can cause loss of bowel sounds in a patient?
Peritonitis.
174
What does the presence of bowel sounds in the chest indicate?
Possible diaphragm rupture.
175
What does auscultation of bruits indicate in abdominal trauma?
Arterial damage.
176
What are the common diagnostic studies for abdominal trauma?
Abdominal CT and focused abdominal ultrasound ## Footnote These are the most common diagnostic tests used.
177
What is the purpose of diagnostic peritoneal lavage?
To detect blood, bile, intestinal contents, and urine in the peritoneal cavity ## Footnote This procedure is used in cases of suspected abdominal trauma.
178
What initial management is provided for a patient with abdominal trauma?
Volume expanders or blood are given if the patient is hypotensive ## Footnote This is crucial for stabilizing the patient's condition.
179
What is the significance of frequent ongoing assessment in abdominal trauma care?
To monitor fluid status, detect deterioration, and determine the need for surgery ## Footnote Continuous monitoring is essential for patient safety.
180
What should not be done with an impaled object in a trauma patient?
Do not remove it until skilled care is available ## Footnote Removal may cause further injury and bleeding.
181
How is chronic abdominal pain defined?
Pain that may originate from abdominal structures or be referred from another site with similar nerve supply ## Footnote It is often described as dull, aching, or diffuse.
182
What are common causes of chronic abdominal pain?
* Irritable bowel syndrome (IBS) * Peptic ulcer disease * Chronic pancreatitis * Hepatitis * Pelvic inflammatory disease * Adhesions * Vascular insufficiency ## Footnote These conditions can lead to persistent abdominal discomfort.
183
What initial steps are taken in diagnosing chronic abdominal pain?
A thorough history and description of specific pain characteristics ## Footnote Key factors include severity, location, duration, and onset.
184
What diagnostic methods may be used for chronic abdominal pain?
* Endoscopy * CT scan * MRI * Laparoscopy * Barium studies ## Footnote These tests help identify the underlying cause of the pain.
185
What characterizes irritable bowel syndrome (IBS)?
Chronic abdominal pain and altered bowel patterns ## Footnote Patients may experience diarrhea, constipation, or a mix of both.
186
Which demographic is more affected by IBS?
Women are affected 2 to 2.5 times more often than men ## Footnote This highlights a significant gender disparity in prevalence.
187
What psychological factors are associated with IBS?
* Depression * Anxiety * Panic disorders * Posttraumatic stress disorder ## Footnote These stressors can contribute to the development and exacerbation of IBS.
188
What dietary intolerances may contribute to IBS symptoms?
* Gluten * Fermentable oligo-, di-, and monosaccharides and polyols (FODMAPs) ## Footnote These dietary components can trigger symptoms in sensitive individuals.
189
What are examples of oligosaccharides that may affect IBS?
* Wheat * Rye products * Some fruits and vegetables * Onions * Garlic * Legumes * Nuts ## Footnote These foods can exacerbate symptoms in individuals with IBS.
190
What is lactose and where is it found?
A disaccharide found in milk and milk products ## Footnote Lactose intolerance can be a factor in gastrointestinal symptoms.
191
What is fructose and where is it commonly found?
A monosaccharide found in honey, apples, pears, and high-fructose corn syrup ## Footnote Fructose can trigger symptoms in some individuals with IBS.
192
What are polyols and where can they be found?
* Apples * Pears * Stone fruits * Cauliflower * Mushrooms * Artificial sweeteners like sorbitol ## Footnote Polyols can also contribute to gastrointestinal distress.
193
What are the Rome IV criteria for diagnosing IBS?
Presence of abdominal pain and/or discomfort at least 1 day per week for 3 months associated with 2 or more of the following: related to defecation, change in stool frequency, change in stool form.
194
What are the categories of IBS based on stool patterns?
IBS with constipation (IBS-C), IBS with diarrhea (IBS-D), IBS mixed, IBS unsubtyped.
195
List common symptoms of IBS.
* Abdominal distention * Nausea * Flatulence * Bloating * Urgency * Mucus in stool * Sensation of incomplete evacuation * Non-GI symptoms like fatigue, headache, and sleep problems.
196
What key factors should be assessed during the diagnosis of IBS?
* Symptoms description * Health history (including psychosocial factors) * Family history * Drug and diet history * Impact of symptoms on daily activities.
197
What diagnostic tests are used for IBS?
Tests to rule out other disorders such as CRC, IBD, endometriosis, and malabsorption disorders (like lactose intolerance and celiac disease).
198
What are some treatment options for IBS?
* Psychologic support * Diet and lifestyle changes * Drugs to regulate stool output and reduce discomfort.
199
What dietary approach may help patients with IBS?
Following a low-FODMAP diet.
200
What is the role of probiotics in IBS management?
Probiotics can improve symptoms.
201
Which foods should a patient with flatulence avoid?
* Broccoli * Cabbage.
202
What dietary recommendation is suggested for patients with IBS-C?
Encourage a high-fiber diet to produce soft, painless bowel movements.
203
What types of drugs may benefit all patients with IBS?
* Antidepressants * Antispasmodic agents (like hyoscyamine, dicyclomine).
204
What medications are specifically used for IBS-D?
* Rifaximin * Eluxadoline (Viberzi) * Alosetron.
205
What is a significant side effect of alosetron?
Severe constipation and ischemic colitis.
206
What is the most common reason for emergency abdominal surgery?
Appendicitis.
207
What age group is most commonly affected by appendicitis?
Individuals aged 10 to 30 years.
208
What is the primary cause of appendicitis?
Luminal obstruction.
209
What are the initial symptoms of appendicitis?
* Dull periumbilical pain * Anorexia * Nausea * Vomiting.
210
Where does appendicitis pain typically localize?
Right lower quadrant at McBurney point.
211
What signs may indicate appendicitis during physical examination?
* Rigidity * Rebound tenderness * Muscle guarding.
212
What diagnostic signs support the diagnosis of appendicitis?
* Positive psoas sign * Positive obturator sign * Positive Rovsing sign.
213
What type of diagnostic studies are utilized for appendicitis?
Complete history, physical assessment, and differential WBC count.
214
What is appendicitis?
Inflammation of the appendix, often caused by luminal obstruction leading to distention, venous engorgement, and bacteria ## Footnote Appendicitis is a common reason for emergency abdominal surgery.
215
What age group is most commonly affected by appendicitis?
10 to 30 years old ## Footnote Appendicitis is particularly prevalent in this age range.
216
What are the initial symptoms of appendicitis?
Dull periumbilical pain, anorexia, nausea, and vomiting ## Footnote Symptoms typically evolve over time.
217
What is McBurney's point?
The location where pain is typically localized in appendicitis, halfway between the right iliac crest and the umbilicus ## Footnote Tenderness at this point is a classic sign of appendicitis.
218
What are some physical examination signs of appendicitis?
Rigidity, rebound tenderness, positive psoas sign, and pain with coughing or sneezing ## Footnote These signs indicate irritation of the peritoneum.
219
What are common causes of peritonitis?
Blood-borne organisms, cirrhosis with ascites, appendicitis with rupture, blunt or penetrating trauma, diverticulitis with rupture, intestinal cancer, ischemic bowel disorders, pancreatitis, perforated intestine, and perforated peptic ulcer ## Footnote These causes can lead to contamination of the peritoneal cavity.
220
What is the difference between primary and secondary peritonitis?
Primary peritonitis occurs from blood-borne organisms without any intraabdominal problem; secondary peritonitis occurs when abdominal organs perforate or rupture ## Footnote Secondary peritonitis is much more common.
221
What are the clinical manifestations of peritonitis?
Severe abdominal pain, tenderness, rebound tenderness, rigidity, abdominal distention, fever, tachycardia, tachypnea, nausea, vomiting, and altered bowel habits ## Footnote These symptoms can vary in severity.
222
What diagnostic studies are used for peritonitis?
CBC, peritoneal aspiration, abdominal x-ray, ultrasound, CT scans, and peritoneoscopy ## Footnote These studies help determine the cause and extent of peritonitis.
223
What is the most common symptom of peritonitis?
Severe, continuous abdominal pain ## Footnote This pain is often worsened by movement.
224
What complications can arise from untreated peritonitis?
Hypovolemic shock, sepsis, intra-abdominal abscess formation, paralytic ileus, and acute respiratory distress syndrome ## Footnote Peritonitis can be fatal if treatment is delayed.
225
What is the management focus for a patient with appendicitis?
Preventing fluid volume deficit, relieving pain, and monitoring for deterioration ## Footnote Postoperative care is similar to that after a laparotomy.
226
What is the typical recovery time after an uncomplicated laparoscopic appendectomy?
Patients usually resume normal activities within 2 to 3 weeks ## Footnote Patients are typically discharged within 24 hours post-surgery.
227
What is the primary diagnostic assessment for peritonitis?
• History and physical assessment • CBC, including WBC differential • Serum electrolytes • Abdominal x-ray • Abdominal paracentesis and culture of fluid • CT scan or ultrasound • Peritoneoscopy ## Footnote Diagnostic assessments help identify the presence and cause of peritonitis.
228
What are the preoperative or nonoperative management strategies for peritonitis?
• NPO status • IV fluid replacement • NG to low-intermittent suction • O2 PRN • PN as needed ## Footnote These strategies aim to stabilize the patient before any surgical intervention.
229
What types of drug therapy are used in managing peritonitis postoperatively?
• Antibiotic therapy • Sedatives and opioids • Antiemetics as needed ## Footnote Drug therapy is essential to manage pain, prevent infection, and control nausea.
230
What are the key clinical problems associated with peritonitis?
• Pain • Fluid imbalance • Impaired GI function • Risk for infection ## Footnote Identifying these problems is crucial for effective management and treatment.
231
What is gastroenteritis?
An inflammation of the mucosa of the stomach and small intestine characterized by sudden diarrhea, nausea, vomiting, fever, and abdominal cramping. ## Footnote Viruses are the most common cause, with Norovirus being a leading cause of foodborne outbreaks.
232
What is the recommended management for gastroenteritis to prevent dehydration?
Encourage oral fluids containing glucose and electrolytes. ## Footnote Older adults and chronically ill patients may require IV fluid replacement if they cannot consume enough fluids.
233
What differentiates Crohn's disease from ulcerative colitis?
Crohn's disease can involve any segment of the GI tract, while ulcerative colitis is usually limited to the colon. ## Footnote Both are classified under inflammatory bowel disease (IBD) and have distinct clinical manifestations.
234
What is the overall goal for managing a patient with peritonitis?
1. Resolution of inflammation 2. Relief of abdominal pain 3. Freedom from complications (especially sepsis, hypovolemic shock) 4. Normal nutrition status ## Footnote Achieving these goals is critical for the recovery of the patient.
235
What is the etiology and pathophysiology of inflammatory bowel disease (IBD)?
IBD is an autoimmune disease involving an immune reaction to a person's own intestinal tract, resulting from an overactive immune response. ## Footnote The exact cause of IBD remains unknown.
236
What is the usual age at onset for Ulcerative Colitis?
Teens to mid-30s; after 60
237
What type of abdominal pain is common in Crohn's Disease?
Common, cramping
238
During acute attacks, what is the incidence of diarrhea in Ulcerative Colitis?
Common
239
What is the incidence of malabsorption in Ulcerative Colitis?
Minimal incidence
240
How common is rectal bleeding in Ulcerative Colitis?
Common
241
What is the incidence of weight loss in Crohn's Disease?
Common, may be severe
242
Where does Ulcerative Colitis usually start and how does it spread?
Usually starts in rectum and spreads in a continuous pattern up the colon
243
What is the most common site for Crohn's Disease?
Distal ileum
244
What is the characteristic appearance of the mucosa in Crohn's Disease?
Cobblestoning of mucosa
245
What is the depth of involvement in Crohn's Disease?
Entire thickness of bowel wall (transmural)
246
What pattern of inflammation is seen in Ulcerative Colitis?
Continuous areas of inflammation
247
What dietary factors seem to increase the risk for IBD?
* High intake of refined sugar * Total fats * Polyunsaturated fatty acid (PUFA) * Omega-6 fatty acids
248
What dietary factors decrease the risk for IBD?
* Raw fruits * Vegetables * Omega-3-rich foods * Fiber
249
What is a common complication of Ulcerative Colitis?
Cancer
250
What is the incidence of colorectal cancer (CRC) after 10 years of Ulcerative Colitis?
Common (because of toxic megacolon)
251
What genetic mutations are associated with Crohn's Disease?
* NOD2 * ATG16L1 * IL23R * IRGM
252
What do the proteins made from major genes related to Crohn's Disease help the immune system do?
Sense and respond appropriately to bacteria in the lining of the GI tract
253
What is a significant risk factor for developing IBD?
Family history
254
What lifestyle factors can increase susceptibility to IBD?
* Diet * Smoking * Stress
255
How does the pattern of inflammation in Crohn's Disease differ from Ulcerative Colitis?
Crohn's can occur anywhere in the GI tract with 'skip' lesions, while UC is confined to the colon and rectum with continuous inflammation.
256
What are the typical ulcerations in Crohn's Disease like?
Deep, longitudinal, and penetrate between islands of inflamed edematous mucosa
257
What is a common outcome of inflammation in Crohn's Disease?
Bowel obstruction due to strictures
258
What are fistulas and abscesses more common in?
Active Crohn's Disease
259
What layer of the bowel wall is affected in Ulcerative Colitis?
Mucosal layer
260
What is Inflammatory Bowel Disease (IBD)?
A group of inflammatory conditions of the gastrointestinal tract, primarily Crohn's disease and ulcerative colitis.
261
What is toxic megacolon?
A serious complication of IBD characterized by extreme dilation of the colon.
262
What are some complications associated with Crohn's disease?
* Malabsorption * Small intestinal cancer * Rectal bleeding
263
What are the primary problems associated with Ulcerative Colitis (UC)?
* Bloody diarrhea * Abdominal pain
264
What systemic implications can arise from IBD?
* Multiple sclerosis * Ankylosing spondylitis
265
What is the importance of cancer screening in patients with IBD?
Patients with IBD are at increased risk for small intestinal cancer.
266
What are some complications of IBD that require routine liver function tests?
* Primary sclerosing cholangitis * Liver failure
267
What diagnostic studies are used for IBD?
* CBC * Imaging studies (CT, MRI, ultrasound) * Colonoscopy
268
What are the clinical manifestations of Crohn's disease?
* Diarrhea * Cramping abdominal pain * Weight loss due to malabsorption * Rectal bleeding
269
What are the characteristics of mild disease in Ulcerative Colitis?
Diarrhea with no more than 4 semiformed stools containing small amounts of blood.
270
What are the symptoms of severe Ulcerative Colitis?
* Bloody diarrhea * Mucus in stool * 10 to 20 stools daily * Fever * Rapid weight loss * Anemia * Tachycardia * Dehydration
271
What is the goal of treatment for IBD?
* Rest the bowel * Control inflammation * Correct malnutrition * Provide symptomatic relief * Improve quality of life
272
What is a common finding in a CBC for patients with IBD?
Iron deficiency anemia from blood loss.
273
What does a high WBC count indicate in IBD patients?
Possible toxic megacolon or perforation.
274
What is the role of colonoscopy in diagnosing IBD?
Allows examination of the entire large intestine and distal ileum for inflammation, ulcerations, and biopsy.
275
What are pseudopolyps?
Tongue-like projections into the bowel lumen formed from areas of inflamed mucosa.
276
What is the typical stool examination for in IBD?
Presence of blood, pus, and mucus.
277
What is the significance of hypoalbuminemia in IBD?
It indicates severe disease due to poor nutrition or protein loss.
278
What are the five goals of IBD treatment?
* Rest the bowel * Control inflammation * Correct malnutrition * Provide symptomatic relief * Improve quality of life
279
What is the primary goal of drug treatment in IBD?
To induce and maintain remission
280
Name the five major classes of drugs used in IBD treatment.
* Aminosalicylates * Antimicrobials * Corticosteroids * Immunomodulators * Biologic therapies
281
What factors influence the choice of drugs for IBD?
Location and severity of inflammation
282
What is the initial treatment for ulcerative colitis (UC)?
Corticosteroid for symptom relief with an aminosalicylate or a biologic therapy
283
What additional treatment is included in the management of Crohn's disease?
Biologic therapy along with a corticosteroid
284
How do drugs containing 5-aminosalicylic acid (5-ASA) function in treating IBD?
They suppress the production of proinflammatory cytokines and other inflammatory mediators in the intestine
285
What is the effectiveness of 5-ASA drugs for UC compared to Crohn's disease?
They are much more effective for UC
286
How can aminosalicylates be administered?
Orally or rectally
287
What is the advantage of rectal use of 5-ASA?
Delivers the medication directly to the affected tissue
288
What combination of therapy is more effective for IBD treatment?
Combination of oral and rectal therapy
289
What is the mechanism of action of biologics in IBD treatment?
They block specific proteins that play a role in inflammation
290
List the four main classes of biologic therapies.
* Anti-TNF agents * Alpha 4-integrin inhibitors * Interleukin (IL)-12/23 antagonists * Janus kinase (JAK) inhibitors
291
What is the route of administration for infliximab (Remicade)?
Intravenous (IV)
292
What conditions is infliximab used to treat?
UC, Crohn's disease, and patients with draining fistulas
293
How are other anti-TNF agents administered?
Subcutaneously
294
What are the most common side effects of natalizumab (Tysabri)?
Upper respiratory infections, urinary tract infections, headaches, nausea, joint pain, abdominal pain ## Footnote More serious effects include reactivation of hepatitis and tuberculosis (TB), opportunistic infections, and cancers, especially lymphoma.
295
What must patients be tested for before starting treatment with natalizumab or vedolizumab?
Tuberculosis (TB) and hepatitis ## Footnote Therapy must be delayed if an inactive infection is present.
296
What is the mechanism of action of IL-12/23 antagonists like ustekinumab and risankizumab?
They bind IL-12 and IL-23, preventing the activation of T-helper and natural killer cells.
297
How is the first dose of ustekinumab administered?
Intravenously (IV) ## Footnote Followed by injections every 8 weeks.
298
What is the role of JAK inhibitors in treating ulcerative colitis (UC)?
They suppress the immune system by blocking the JAK enzyme, preventing inflammation.
299
What must patients be tested for before starting tofacitinib?
Tuberculosis (TB)
300
What are the dietary recommendations for patients with inflammatory bowel disease?
High-calorie, high-vitamin, high-protein diet ## Footnote Enteral nutrition (EN) during exacerbations.
301
What are the types of diagnostic assessments used for inflammatory bowel disease?
* History and physical assessment * CBC, erythrocyte sedimentation rate * Serum chemistries * Testing of stool for occult blood and infection * Capsule endoscopy * Radiologic studies with barium contrast * Sigmoidoscopy and/or colonoscopy with biopsy * Ultrasound studies
302
What are the common drug therapies used in managing inflammatory bowel disease?
* Aminosalicylates * Antimicrobials * Biologic therapies * Corticosteroids * Immunomodulators
303
What is the primary purpose of corticosteroids in the treatment of inflammatory bowel disease?
To prevent or decrease inflammation of the intestinal mucosa.
304
Why should corticosteroids be given for the shortest possible time?
Due to the side effects related to long-term use.
305
What delivery methods are beneficial for patients with disease in the left colon, sigmoid, and rectum?
Suppositories, enemas, and foams ## Footnote They deliver corticosteroids directly to inflamed tissue with minimal systemic effects.
306
What happens if a biologic therapy is stopped and then restarted?
Infusion reactions are more likely.
307
What type of therapy is recommended for patients with inflammatory bowel disease in addition to drug therapy?
Physical and emotional rest ## Footnote Referral for counseling or support group may also be beneficial.
308
What is the risk associated with biologic therapies regarding immunogenicity?
Patients may develop antibodies against them, leading to acute infusion reactions and delayed hypersensitivity-type reactions.
309
What is the action of 5-Aminosalicylates (5-ASA) in the treatment of Inflammatory Bowel Disease?
Decrease inflammation by suppressing proinflammatory cytokines and other inflammatory mediators ## Footnote Examples include systemic balsalazine, olsalazine, and sulfasalazine.
310
What is the role of antimicrobials in Inflammatory Bowel Disease therapy?
Prevent or treat secondary infection ## Footnote Examples include ciprofoxacin, clarithromycin, and metronidazole.
311
What do anti-TNF agents do?
Inhibit the cytokine tumor necrosis factor (TNF) ## Footnote Examples include adalimumab, certolizumab pegol, golimumab, and infliximab.
312
What is the function of integrin receptor antagonists in Inflammatory Bowel Disease?
Prevent migration of leukocytes from bloodstream to inflamed tissue ## Footnote Examples include natalizumab and vedolizumab.
313
What do IL-12/23 antagonists target?
Bind IL-12 and IL-23, preventing the activation of T-helper and natural killer cells ## Footnote Examples include risankizumab and ustekinumab.
314
What is the mechanism of action of JAK inhibitors?
Block the JAK enzyme, preventing it from activating immune cells that cause inflammation ## Footnote Example includes tofacitinib.
315
What is the primary effect of corticosteroids in managing Inflammatory Bowel Disease?
Decrease inflammation ## Footnote Examples include systemic corticosteroids like prednisone and budesonide.
316
What are faminomodulators used for in Inflammatory Bowel Disease treatment?
Suppress immune response ## Footnote Examples include azathioprine, cyclosporine, methotrexate, and 6-mercaptopurine.
317
Name a type of topical 5-ASA formulation.
5-ASA enema, foam, suppositories ## Footnote These formulations are used for localized treatment in the bowel.
318
List examples of systemic corticosteroids used for severe Inflammatory Bowel Disease.
* Prednisone * Budesonide * Hydrocortisone * Methylprednisolone ## Footnote IV administration is often used for severe cases.
319
What is the purpose of using topical hydrocortisone in Inflammatory Bowel Disease?
To reduce inflammation in localized areas of the bowel ## Footnote Available as suppositories, foam, or enemas.
320
What are the goals of diet management for patients with IBD?
The goals are to: * Provide adequate nutrition without worsening symptoms * Correct and prevent malnutrition * Replace fluid and electrolyte losses * Prevent weight loss
321
What nutrition problems may patients with IBD experience?
Nutrition problems are due to: * Decreased oral intake * Blood loss * Impaired absorption depending on inflammation location
322
What is the recommended dietary approach for patients with IBD?
Patients need a balanced, healthy diet with enough calories, protein, and nutrients. Consult a dietitian for the ideal diet.
323
What type of anemia can develop in patients with IBD?
Iron deficiency anemia can develop due to blood loss and malabsorption.
324
What supplements may be needed for patients with IBD experiencing anemia?
Patients may need: * Oral iron supplements * IV iron for those who cannot tolerate oral iron * Cobalamin injections for those with reduced absorption
325
What is the significance of bile salts in IBD?
Bile salts are important for fat absorption and contribute to osmotic diarrhea.
326
What surgical procedure is considered curative for ulcerative colitis?
Total proctocolectomy is curative for ulcerative colitis.
327
What are the indications for surgery for ulcerative colitis?
Indications include: * Bowel obstruction * Drain abdominal abscess * Fistulas * Inability to decrease corticosteroids * Lack of response to conservative therapy * Massive hemorrhage * Perforation * Severe anorectal disease * Strictures * Suspicion of cancer
328
What is short bowel syndrome (SBS) and how can it occur?
SBS occurs when surgery or disease leaves too little small intestine surface area to maintain normal nutrition and hydration.
329
What is the preferred nutrition method during an acute exacerbation of IBD?
Liquid enteral feedings are preferred over parenteral nutrition.
330
What is the role of cholestyramine in IBD management?
Cholestyramine helps control diarrhea by binding unabsorbed bile salts.
331
What is the common surgical procedure for Crohn's disease?
Resecting the diseased segments with reanastomosis of the remaining intestine.
332
What is a strictureplasty and its benefit in Crohn's disease?
Strictureplasty opens narrowed areas obstructing the bowel, reducing the risk of developing short bowel syndrome.
333
What are common clinical problems for patients with IBD?
Common clinical problems include: * Impaired bowel elimination * Nutritionally compromised * Difficulty coping
334
What should patients with IBD do to identify food triggers?
Patients are typically taught to keep a food diary to identify problem foods to avoid.
335
What are the common subjective data symptoms associated with IBD?
Fatigue, malaise, nausea, vomiting, anorexia, weight loss, diarrhea, blood, mucus, pus in stools, lower abdominal pain, cramping, tenesmus
336
What are the important health history factors for patients with IBD?
Infection, autoimmune disorders, family history of ulcerative colitis, Crohn's disease
337
What are the key objectives for nursing assessment in postoperative patients?
Assess need for nutrition supplements, diet modifications, and general nursing care
338
What medications are commonly used in the management of IBD?
Antidiarrheal drugs
339
What are the general objective data findings for patients with IBD?
Intermittent fever, emaciated appearance, fatigue, abdominal distention, hyperactive bowel sounds, abdominal cramps, pale skin, poor turgor, dry mucous membranes
340
What are common possible diagnostic findings in IBD?
Anemia, leukocytosis, electrolyte imbalance, hypoalbuminemia, vitamin and trace metal deficiencies, guaiac-positive stool, abnormal sigmoidoscopy, colonoscopy, barium enema findings
341
What are the overall goals for a patient with IBD?
* Fewer and less severe acute exacerbations * Maintain normal fluid and electrolyte balance * Be free from pain or discomfort * Adhere to medical regimens * Maintain nutritional balance * Improve quality of life
342
What should be monitored during the acute phase of IBD?
Hemodynamic stability, pain control, fluid and electrolyte balance, nutritional support, intake and output records, number and appearance of stools, presence of blood in stools and emesis
343
What are the expected outcomes for a patient with IBD?
* Decrease in the number of diarrhea stools * Maintain body weight within a normal range * Be free from pain and discomfort * Use effective coping strategies
344
What gerontologic considerations are important for patients with IBD?
A second peak in occurrence in the 6th decade, more common proctitis and left-sided UC, similar cause, natural history, and clinical course as younger patients
345
What emotional support strategies are suggested for patients with IBD?
Seek support through local or online support groups, behavioral therapy to manage feelings about the disease
346
What are some nursing interventions for managing skin care in patients with IBD?
Meticulous perianal skincare, use of plain water, moisturizing skin barrier cream, soothing ointments like dibucaine or witch hazel
347
What is evidence-based practice in the context of ulcerative colitis management?
A synthesis of best available evidence, clinician expertise, and patient preferences and values.
348
What are the key components of self-management education for patients with IBD?
Helps patients effectively address their symptoms, maintain independence, and improve functioning.
349
What is the role of clinician expertise in patient education programs?
To develop standard orientations based on patient involvement and needs.
350
What is a common patient statement indicating openness to management strategies?
"I am open to anything that may help me."
351
What are the implications for nursing practice regarding patient education?
Informally assess patient understanding and monitor the adoption of self-management strategies.
352
What are the challenges of interprofessional care in older adults with IBD?
IBD can be confused with CDI, diverticulitis, or colitis, leading to diagnostic challenges.
353
What are the risks associated with drug therapy and surgery for IBD?
Increased risk for adverse events, hospitalization, and mortality.
354
What is the most common cause of small bowel obstruction (SBO)?
Surgical adhesions.
355
What differentiates a simple bowel obstruction from a strangulated obstruction?
A simple obstruction has an intact blood supply; a strangulated one does not.
356
What are the two main types of bowel obstructions?
Mechanical and nonmechanical.
357
What is a common cause of large bowel obstruction (LBO)?
Colorectal cancer (CRC).
358
What is paralytic ileus?
A lack of intestinal peristalsis and bowel sounds, often occurring after abdominal surgery.
359
What is pseudo-obstruction?
A GI motility disorder that mimics a mechanical obstruction without any imaging-confirmed cause.
360
What are common causes of vascular obstructions in the intestines?
Emboli and atherosclerosis of the mesenteric arteries.
361
What is the typical fluid volume entering the small intestine daily?
About 6 to 8 liters.
362
What happens to fluid and gas when a bowel obstruction occurs?
They accumulate proximal to the obstruction, causing distention.
363
What is the effect of distention on fluid absorption in bowel obstruction?
It reduces fluid absorption and stimulates intestinal secretions.
364
What dietary factors can lead to bowel obstruction?
Mechanical obstructions can result from hernias, cancers, strictures, and intussusception.
365
What are the symptoms associated with pseudo-obstruction?
Symptoms of obstruction without a physical cause found via imaging.
366
What is the significance of the term 'intraluminal bowel pressure'?
It increases as distention occurs in the proximal bowel due to obstruction.
367
What happens to capillary permeability during increased pressure?
Capillary permeability increases, leading to extravasation of fluids and electrolytes into the peritoneal cavity.
368
What occurs when intestinal muscle becomes fatigued during an obstruction?
Peristalsis stops.
369
What are the consequences of fluid retention in the intestine and peritoneal cavity?
Severe decrease in circulating blood volume, leading to hypotension and hypovolemic shock.
370
What happens to bowel tissue if blood flow is inadequate?
Bowel tissue becomes ischemic, then necrotic, and may perforate.
371
What is intestinal strangulation or intestinal infarction?
A dangerous situation where the bowel becomes distended, blood flow stops, causing edema, cyanosis, and gangrene.
372
What are the 4 hallmark manifestations of an obstruction?
Abdominal pain, nausea and vomiting, distention, and constipation.
373
What is the typical onset pattern of colicky abdominal pain in small bowel obstruction?
Occurs at 4- to 5-minute intervals for proximal obstructions.
374
How does the nature of vomiting differ between proximal and distal small bowel obstructions?
Proximal obstruction leads to frequent, copious vomiting that may be projectile and contain bile; distal obstruction leads to more gradual, fecal, and foul-smelling vomiting.
375
What are the signs of large bowel obstruction?
Abdominal distention, either obstipation or a marked change in bowel function, lack of flatus, and persistent cramping abdominal pain.
376
What characterizes bowel sounds in a patient with large bowel obstruction?
Bowel sounds are usually present and become progressively hypoactive.
377
What symptoms indicate strangulation in bowel obstruction?
Severe, constant pain that is rapid in onset.
378
What signs indicate dehydration and sepsis in a patient with bowel obstruction?
Tachycardia, dry mucous membranes, and hypotension.
379
What temperature indicates a potential infection in a patient with bowel obstruction?
Temperature may rise above 100°F (37.8°C).
380
What metabolic imbalance may occur with a high obstruction like in the upper duodenum?
Metabolic alkalosis from loss of gastric hydrochloric acid through vomiting or NG intubation and suction.
381
What happens rapidly in dehydration due to small intestine obstruction?
Dehydration occurs rapidly.
382
What is the primary focus of nursing management for a patient with a bowel obstruction?
Preventing fluid and electrolyte imbalances and early recognition of deterioration in the patient's condition ## Footnote Major concerns include hypovolemic shock, sepsis, and bowel strangulation.
383
What should be documented when assessing a patient with abdominal pain?
Location, duration, intensity, and frequency of abdominal pain ## Footnote The patient is often restless and constantly changes position to relieve the pain.
384
What are the signs of dehydration and electrolyte imbalances to monitor in a patient with bowel obstruction?
Increased thirst, dry mucous membranes, decreased urine output, and changes in vital signs ## Footnote Electrolyte imbalances may also include muscle cramps and fatigue.
385
What does NPO status mean for a patient?
Nothing by mouth ## Footnote This is implemented to prevent further complications in patients with bowel obstruction.
386
What is a key indicator of acute kidney injury related to urine output?
Urine output less than 0.5 mL/kg of body weight per hour ## Footnote This indicates inadequate vascular volume.
387
What is the treatment approach for a bowel obstruction?
Relieve the obstruction and restore normal bowel function ## Footnote Treatment may involve surgery or nonsurgical methods such as colonoscopy.
388
What type of monitoring is important for patients with a high bowel obstruction?
Monitor for metabolic alkalosis ## Footnote This is due to the higher likelihood of vomiting.
389
What clinical problems might a patient with a bowel obstruction experience?
* Pain * Impaired GI function * Fluid imbalance ## Footnote These problems can affect surgical outcomes.
390
What is the role of corticosteroids in the management of bowel obstruction?
They have antiemetic properties that decrease edema and inflammation ## Footnote This can be beneficial with stent placement.
391
What are colonic polyps?
Growths arising from the mucosal surface of the colon that project into the lumen ## Footnote They can be sessile or pedunculated.
392
What is the importance of assessing bowel function in patients with bowel obstruction?
To determine the passage of flatus and stool ## Footnote This helps evaluate the severity and location of the obstruction.
393
What is the recommended action if a patient’s urine output drops below the threshold?
Report the decrease in urine output ## Footnote Less than 0.5 mL/kg/h is critical and indicates potential acute kidney injury.
394
What interventions are included in the nursing management of a patient with bowel obstruction?
* Give IV fluids and electrolyte replacement * Implement pain management measures * Provide frequent oral care * Monitor for signs of dehydration ## Footnote These measures promote comfort and recovery.
395
What might indicate a need for surgical intervention in a bowel obstruction?
Strangulation or perforation of the bowel ## Footnote Surgical options include resection of the obstructed bowel or colostomy.
396
What is the role of imaging in diagnosing bowel obstruction?
To provide direct evidence of the obstruction ## Footnote Imaging can include X-rays or CT scans.
397
What is the significance of measuring abdominal girth in a patient with bowel obstruction?
To assess for abdominal distention ## Footnote This can indicate worsening of the obstruction.
398
What are signs of peritoneal irritation to assess in a patient with bowel obstruction?
* Muscle guarding * Rebound pain ## Footnote These signs indicate potential complications that require immediate attention.
399
What are the two main types of polyps found in the large intestine?
Hyperplastic and adenomatous polyps ## Footnote Hyperplastic polyps are noncancerous, while adenomatous polyps are neoplastic and linked to colorectal cancer.
400
What is the characteristic of hyperplastic polyps?
They are noncancerous, rarely grow larger than 5 mm, and never cause clinical symptoms.
401
What types of adenomatous polyps are there?
* Tubular * Tubulovillous * Villous ## Footnote Villous adenomatous polyps are more likely to develop cancers.
402
What is the genetic disorder associated with familial adenomatous polyposis (FAP)?
It is characterized by hundreds or thousands of polyps in the colon that usually become cancerous by age 40.
403
What surgical procedure is often performed on patients with classic FAP?
Proctocolectomy with an ileal pouch-anal anastomosis (IPAA) or an ileostomy.
404
What is the preferred method for discovering polyps?
Colonoscopy ## Footnote Colonoscopy allows for evaluation of the total colon and removal of polyps.
405
What should be monitored after a polypectomy?
Rectal bleeding, fever, severe abdominal pain, and abdominal distention.
406
What is the incidence of familial adenomatous polyposis (FAP)?
Affects 1 in 7000-22,000 people and causes 1% of all colorectal cancer (CRC).
407
What genetic mutation is involved in autosomal dominant FAP?
Mutations in the adenomatous polyposis coli (APC) gene.
408
What is the role of the APC gene?
It is a tumor suppressor gene involved in DNA repair and prevents polyp development.
409
Who should undergo genetic testing for FAP?
Anyone with a family history of FAP during childhood.
410
What racial groups are most affected by colorectal cancer (CRC)?
Blacks are most likely to develop and die from CRC.
411
At what age does CRC typically occur in Blacks and Hispanics?
It may occur at an earlier age compared to other groups.
412
What is the relationship between obesity and colorectal cancer?
Increasing rates of obesity are thought to contribute to the incidence of CRC.
413
What is the recommended alcohol consumption level to reduce the risk of colorectal cancer?
24 drinks/week ## Footnote Excessive alcohol consumption is a known risk factor for colorectal cancer.
414
List the hereditary conditions associated with a higher risk of colorectal cancer.
* Hereditary nonpolyposis colorectal cancer (HNPCC) * Familial adenomatous polyposis (FAP) ## Footnote These hereditary forms account for a small percentage of colorectal cancer cases.
415
What is the genetic basis of Hereditary Nonpolyposis Colorectal Cancer (HNPCC)?
* Autosomal dominant disorder * Mutations in MSH2, MLH1, MSH6, or PMS2 genes ## Footnote These genes are involved in DNA replication error repair.
416
What percentage of colorectal cancer cases is accounted for by HNPCC?
3%-5% ## Footnote HNPCC significantly increases the risk of developing colorectal cancer.
417
What is the risk percentage for developing colorectal cancer based on genetic mutation in HNPCC?
50%-80% ## Footnote The risk varies depending on the specific genetic mutation.
418
At what age should individuals with HNPCC begin undergoing colonoscopy?
Every 1-2 years ## Footnote Early screening is crucial due to the increased risk of cancer.
419
What lifestyle changes can decrease the risk for colorectal cancer?
* Maintaining a healthy weight * Being physically active * Limiting alcohol use * Not smoking * Eating a diet rich in fruits, vegetables, and grains ## Footnote These lifestyle modifications are associated with lower cancer risks.
420
What is the typical progression timeline for colorectal cancer development from a polyp?
10 to 20 years ## Footnote Most polyps are adenomas that can eventually develop into cancer.
421
What are the stages of colorectal cancer?
* Stage 0: Cancer has not grown beyond the mucosal layer * Stage I: Grown into the submucosa, no lymph nodes involved * Stage II: Grown into the muscle, no lymph node involvement or metastasis * Stage III: Tumor with lymph node involvement but no metastasis * Stage IV: Tumor with lymph node involvement and metastasis ## Footnote Staging is crucial for determining treatment options.
422
What is the common site of metastasis for colorectal cancer?
Liver ## Footnote The cancer can spread from the liver to other organs such as lungs, bones, and brain.
423
What are some common clinical manifestations of colorectal cancer?
* Fatigue * Weight loss * Abdominal pain * Change in bowel habits * Palpable abdominal mass * Hepatomegaly * Ascites ## Footnote Symptoms often do not appear until the disease is advanced.
424
True or False: Hematochezia is more often caused by left-sided colorectal cancer.
True ## Footnote Right-sided cancers are more likely to cause diarrhea.
425
What screening tests are recommended for average-risk individuals starting at age 45?
* Flexible sigmoidoscopy (every 5 years) * Colonoscopy (every 10 years) ## Footnote Regular screening is essential for early detection of colorectal cancer.
426
What are common symptoms of colorectal cancer in the transverse colon?
Pain, obstruction, change in bowel habits, anemia
427
What is indicated by T1 in the classification of colorectal cancer?
Tumor has grown beyond mucosa into the submucosa
428
What symptoms are associated with colorectal cancer in the descending colon?
Pain, change in bowel habits, bright red blood in stool, obstruction
429
What does N0 indicate in lymph node involvement for colorectal cancer?
No regional lymph node involvement is found
430
What are the diagnostic assessments for colorectal cancer?
* History and physical assessment * DRE * Testing of stool for occult blood * CBC * Liver function tests * Barium enema * Sigmoidoscopy and/or colonoscopy with biopsy * Abdominal CT scan, ultrasound, or MRI * Carcinoembryonic antigen (CEA) test
431
What is the role of carcinoembryonic antigen (CEA) in colorectal cancer?
It may be used to detect CRC and monitor for recurrence after surgery or chemotherapy
432
What is the gold standard for colorectal cancer screening?
Colonoscopy
433
What is the recommended screening frequency for colonoscopy in individuals at average risk for CRC?
Every 10 years beginning at age 45
434
What is indicated by M0 in the metastasis classification for colorectal cancer?
No distant metastasis seen
435
What are the management options for colorectal cancer?
* Surgery * Chemotherapy * Targeted therapy * Radiation therapy
436
What screening method should individuals with a first-degree relative who developed colorectal cancer undergo?
Colonoscopy every 5 years beginning at age 10 years
437
What factors worsen the prognosis of colorectal cancer?
* Greater size and depth of tumor * Lymph node involvement * Metastasis
438
What is the frequency of high-sensitivity fecal occult blood test (FOBT) screening?
Every year
439
What does T3 indicate in the classification of colorectal cancer?
Tumor has grown through the muscularis propria
440
What is the recommended screening method for individuals with a second-degree relative who had CRC after age 60?
Colonoscopy every 10 years beginning at age 40
441
What types of cancer can increase CEA levels besides colorectal cancer?
* Gastric cancer * Pancreatic cancer * Breast cancer * Thyroid cancer
442
What is the significance of tissue biopsies in colorectal cancer diagnosis?
They confirm the diagnosis of CRC
443
What imaging tests are used to detect metastases in colorectal cancer?
* CT scan * PET scan * MRI
444
What does M1 indicate in the metastasis classification for colorectal cancer?
Distant metastasis is present
445
What are less favorable but acceptable screening methods for colorectal cancer?
* Stool testing for fecal blood * Stool DNA tests (PreGen-Plus, Cologuard)
446
What does N1 indicate in lymph node involvement for colorectal cancer?
Cancer is found in 1-3 nearby lymph nodes
447
What does N2 indicate in lymph node involvement for colorectal cancer?
Cancer is found in 4 or more nearby lymph nodes
448
What is the 5-year survival rate for T1, N0, M0 colorectal cancer?
>96
449
What is the 5-year survival rate for T2, N0, M0 colorectal cancer?
92
450
What is the 5-year survival rate for T3, N0, M0 colorectal cancer?
87
451
What is the 5-year survival rate for T4, N0, M0 colorectal cancer?
70-80
452
What is the 5-year survival rate for any T, any N, M1 colorectal cancer?
12
453
What surgical procedure is performed when the tumor is in the distal rectum and sphincters cannot be preserved?
Abdominal-perineal resection (APR)
454
What surgical procedure allows for the preservation of sphincters when the tumor is in the mid or proximal rectum?
Low anterior resection (LAR)
455
What is the purpose of neoadjuvant chemotherapy?
To shrink the tumor before surgery
456
What is adjuvant chemotherapy used for?
After bowel resection to prevent recurrence
457
What type of chemotherapy is recommended for patients with stage III tumors?
Adjuvant chemotherapy
458
Which chemotherapy drugs are commonly used in combination for colorectal cancer?
* Oxaliplatin (Eloxatin) * Fluorouracil (FU) * Leucovorin (LV) * Capecitabine (Xeloda)
459
What are angiogenesis inhibitors used for in colorectal cancer treatment?
To inhibit the blood supply to tumors
460
Name two angiogenesis inhibitors used in treating metastatic colorectal cancer.
* Aflibercept (Zaltrap) * Bevacizumab (Avastin)
461
What is the mechanism of action of cetuximab and panitumumab?
They block the epidermal growth factor receptor
462
What is Regorafenib (Stivarga) classified as?
A multikinase inhibitor
463
What is the function of trifluridine in cancer treatment?
It impairs DNA function and angiogenesis
464
What role does tipiracil play in the combination therapy of Lonsurf?
It prevents the rapid metabolism of trifluridine, increasing its bioavailability
465
When might radiation therapy be used in colorectal cancer treatment?
As an adjuvant to surgery and chemotherapy or as a palliative measure
466
What is an important health history factor for colorectal cancer?
Previous breast or ovarian cancer, familial polyposis, villous adenoma, adenomatous polyps, inflammatory bowel disease (IBD) ## Footnote These factors increase the risk of developing colorectal cancer.
467
What types of medications are significant in the assessment of colorectal cancer?
Medications affecting bowel function, e.g., laxatives, antidiarrheal drugs ## Footnote These medications can alter bowel habits and symptoms.
468
What are common nutritional-metabolic issues in colorectal cancer patients?
High-calorie, high-fat, low-fiber diet; anorexia; nausea and vomiting; weight loss ## Footnote These issues can significantly impact nutritional status and quality of life.
469
What changes in elimination are associated with colorectal cancer?
Change in bowel habits, alternating diarrhea and constipation, defecation urgency, rectal bleeding, mucoid stools, black tarry stools, decrease in stool caliber, feelings of incomplete evacuation ## Footnote These symptoms are critical for identifying potential colorectal cancer.
470
What are some objective data findings in colorectal cancer assessments?
Pallor, cachexia, lymphadenopathy, palpable abdominal mass, distention, ascites, hepatomegaly ## Footnote These findings help in diagnosing the extent of the disease.
471
What are possible diagnostic findings for colorectal cancer?
Anemia, guaiac-positive stools, palpable mass on digital rectal exam (DRE), positive sigmoidoscopy, colonoscopy, barium enema, CT scan, positive biopsy ## Footnote These tests confirm the diagnosis and help assess disease spread.
472
What are the overall nursing management goals for colorectal cancer patients?
1. Normal bowel elimination patterns 2. Quality of life appropriate to disease progression 3. Relief of pain 4. Feelings of comfort and well-being ## Footnote These goals guide the nursing interventions for patients.
473
What is a recommended health promotion strategy for colorectal cancer?
Encourage all persons over 45 to have regular colorectal cancer screening ## Footnote Early detection through screening can significantly improve outcomes.
474
What are common clinical problems for patients with colorectal cancer?
Altered bowel elimination, anxiety, difficulty coping ## Footnote Addressing these issues is essential for patient care.
475
What surgical procedures may be performed for colorectal cancer?
1. Remove cancer 2. Repair a perforation, fistula, or traumatic injury 3. Relieve a obstruction or stricture 4. Treat an abscess, inflammatory disease, or hemorrhage ## Footnote Surgical intervention is often necessary for disease management.
476
What are the expected outcomes for patients with colorectal cancer?
1. Minimal changes in bowel elimination patterns 2. Optimal nutrition intake 3. Quality of life appropriate to disease progression 4. Feelings of comfort and well-being ## Footnote These outcomes reflect the effectiveness of nursing interventions.
477
What is a permeal resection (APR)?
Removal of the entire rectum with creation of a permanent colostomy
478
What does a cosignoid resection involve?
Removal of part of descending colon, the sigmoid colon, and upper rectum with the descending colon anastomosed to remaining rectum
479
What is removed during a total colectomy?
Removal of the entire colon with the ileum anastomosed to the rectum
480
What is the surgical procedure involving the removal of the splenic flexure, descending colon, and sigmoid colon?
Transverse colon anastomosed to rectum
481
What is the process of removing the rectum and anastomosing the colon to the anal canal called?
Temporary ileostomy or colostomy may be done to divert stool and allow time for the anastomosis to heal
482
What is created when the end of the terminal ileum is brought out through the abdominal wall?
Permanent ileostomy
483
Describe the two surgeries involved in creating an ileal pouch/anal anastomosis (PAA).
First surgery includes colectomy, rectal mucosectomy, ileal pouch construction, ileoanal anastomosis, and temporary ileostomy; second surgery involves closure of the ileostomy to direct stool toward the new pouch
484
What is an ostomy?
A surgically created opening on the abdomen that allows the discharge of body waste when the normal elimination route is no longer possible
485
What is the visible part of an ostomy called?
Stoma
486
How are ostomies named?
According to their location and type in the colon
487
What type of ostomy is created when the opening is in the colon?
Colostomy
488
What is the difference in output between a sigmoid colostomy and an ileostomy?
Sigmoid colostomy output resembles normal formed stool, while ileostomy output is more liquid
489
What are the two types of ostomies based on permanence?
Temporary and permanent ostomies
490
What are continent ileostomies?
They use 40 to 45 cm of the terminal ileum to fashion an internal pouch, nipple valve, and abdominal stoma
491
What is the capacity of a continent ileostomy pouch?
Around 500 mL of material
492
What are the major types of traditional ostomies?
* End ostomy * Double-barreled ostomy * Loop ostomy
493
What is the stool consistency for an ileostomy?
Liquid to semiliquid
494
Is bowel regulation required for an ileostomy?
Yes
495
What are some indications for ileostomy surgery?
* Ulcerative Colitis (UC) * Crohn's disease * Diseased or injured colon * Familial polyposis * Trauma * Cancer
496
What is the stool consistency for a colostomy in the ascending colon?
Semiliquid
497
Is bowel regulation required for a colostomy in the ascending colon?
Yes
498
What are some indications for ascending colostomy surgery?
* Perforating diverticulum in lower colon * Trauma * Rectovaginal fistula * Inoperable tumors of colon, rectum, or pelvis
499
What is the stool consistency for a sigmoid colostomy?
Formed
500
Is bowel regulation required for a sigmoid colostomy?
No change
501
What are some indications for sigmoid colostomy surgery?
* Cancer of the rectum or rectosigmoid area * Perforation diverticulum * Trauma
502
What is an end stoma?
A stoma made by dividing the bowel and bringing out the proximal end as a single stoma
503
What happens to the distal part of the GI tract in an end stoma?
It is surgically removed or oversewn and left in the abdominal cavity
504
What is a Hartmann pouch?
When the distal bowel is oversewn and not removed, allowing for potential reanastomosis
505
What is a loop stoma?
A stoma created by bringing a loop of bowel to the abdominal surface and opening the anterior wall
506
What is the purpose of a plastic rod in a loop stoma?
To hold the loop of bowel in place for 7 to 10 days
507
What is a double-barreled stoma?
A stoma created by dividing the bowel and bringing both proximal and distal ends through the abdominal wall as 2 separate stomas
508
What is the difference between the proximal and distal stomas in a double-barreled stoma?
Proximal stoma is functioning; distal stoma is a mucus fistula
509
Why is site selection important for ostomy surgery?
To ensure the stoma is in a visible and flat area for easier care and to avoid leakage
510
What are the psychological aspects important for ostomy patients?
* Preparation for the ostomy * Emotional support * Coping with body image changes
511
What color indicates a viable stoma mucosa?
Rose to brick-red
512
What does a pale stoma indicate?
Anemia
513
What can cause a dusky blue or purple stoma?
Inadequate blood supply to the stoma or necrosis
514
What is the normal appearance of a stoma in the initial postoperative period?
Mild to moderate edema
515
What are possible causes of obstruction of the stoma?
* Allergic reaction to food * Gastroenteritis
516
What does oozing from stoma mucosa when touched indicate?
Normal due to high vascularity
517
What should be monitored in postoperative care regarding the wound?
* Delayed wound healing * Hemorrhage * Fistulas * Infections
518
What is the expected drainage consistency from an open wound with packing?
Serosanguineous
519
What should the stoma color be assessed for every 4 hours?
Rosy pink to red
520
What is the typical output volume from an ileostomy when peristalsis returns?
1500 to 1800 mL/24 hr
521
What happens to the drainage consistency from the proximal small bowel over time?
Thickens to a paste-like consistency
522
How many stools may a patient have daily after an IPAA initially?
4 to 6 stools or more
523
What exercises should a patient start about 4 weeks after surgery to strengthen the pelvic floor?
Kegel exercises
524
What is crucial for patient education regarding ostomy care?
Understanding stoma care and output expectations
525
What does excessive gas during the first 2 weeks post-surgery indicate?
Normal temporary condition
526
What should be monitored for in patients after surgery regarding fluid?
Fluid deficits and electrolyte imbalances
527
What is important to protect the epidermis from?
Mucous drainage and maceration ## Footnote Proper skin care includes gentle cleansing and drying.
528
What should patients use to protect the skin?
Moisture barrier ointment and a perineal pad ## Footnote These help in maintaining skin integrity.
529
What are phantom rectal sensations?
Feelings of needing to have a bowel movement despite not having a rectum ## Footnote This sensation is normal and often subsides over time.
530
What can pelvic surgery disrupt?
Nerve and vascular supplies to the genitalia ## Footnote This can lead to sexual function problems.
531
What is a main concern for men after pelvic surgery?
Erection and ejaculation ## Footnote Erection depends on intact nerves and adequate blood supply.
532
What can sympathetic nerve damage in the presacral area affect?
The ability to ejaculate ## Footnote This can occur with the APR procedure.
533
What may women experience due to nerve damage from pelvic surgery?
Vaginal dryness and decreased sensation ## Footnote This can make arousal and achieving orgasm more challenging.
534
What should patients do before sexual activities?
Empty the pouch ## Footnote This helps in managing ostomy concerns during intimacy.
535
What are the two major aspects of nursing care for patients with ostomies?
* Patient and caregiver teaching about ostomy care * Emotional support for body image changes ## Footnote Both aspects are crucial for patient adjustment.
536
What is vital to protect the skin and provide stool collection?
An appropriate pouching system ## Footnote Most systems include an adhesive skin barrier and pouch.
537
What should be assessed and documented for a patient with a new ostomy?
Stoma and peristomal skin appearance ## Footnote This is part of ongoing patient assessment.
538
What should patients be taught about managing their ostomy?
* Changing the pouch * Diet * Getting help for problems ## Footnote Mastering these skills is essential for independence.
539
What is the recommended fluid intake to prevent dehydration for ostomy patients?
At least 3000 mL/day ## Footnote This intake may need to be increased during hot weather or diarrhea.
540
What should patients do if the ostomy pouch is one-third full?
Empty the pouch ## Footnote This helps prevent leakage and maintains a good seal.
541
What type of diet should ostomy patients follow?
Well-balanced diet with supplements as needed ## Footnote This helps prevent nutrition problems.
542
What should patients recognize as symptoms of fluid and electrolyte imbalance?
Fever, diarrhea, skin irritation, stomal problems ## Footnote Recognizing these symptoms is crucial for timely intervention.
543
What community resources should be described to ostomy patients?
Resources for emotional and psychological adjustment ## Footnote Support systems can greatly aid in coping with changes.
544
What is a practical suggestion for women regarding ostomy during sexual activities?
Consider wearing open panties or similar lingerie ## Footnote This can help in feeling more secure during intimacy.
545
What can help men secure the ostomy pouch during sexual activity?
Wearing a wrap or cummerbund around the midsection ## Footnote This can provide additional security and confidence.

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