Chapter 47 Lower Gastrointestinal Problems Part 2 Flashcards
(472 cards)
1
Q
What is toxic megacolon?
A
A condition associated with inflammatory bowel disease (IBD), particularly ulcerative colitis, that increases the risk for perforation and may require emergency colectomy.
2
Q
What complications can occur in Crohn’s disease?
A
Complications include perineal abscesses and fistulas, which occur in up to a third of patients.
3
Q
How does CDI relate to IBD?
A
Clostridium difficile infection (CDI) increases in frequency and severity in patients with inflammatory bowel disease.
4
Q
What is the risk associated with IBD regarding cancer?
A
IBD is related to an increased risk for colorectal cancer (CRC) and small intestinal cancer in Crohn’s disease.
5
Q
What systemic complications can arise from IBD?
A
Complications can include multiple sclerosis, ankylosing spondylitis, malabsorption, liver disease (primary sclerosing cholangitis), and osteoporosis.
6
Q
How often should patients with IBD undergo bone density scans?
A
Patients should have a bone density scan at baseline and every 2 years.
7
Q
What diagnostic studies are important for IBD?
A
Diagnostic studies include ruling out diseases with similar symptoms, stool examination, imaging studies, and colonoscopy.
8
Q
What are common clinical manifestations of IBD?
A
Common manifestations include diarrhea, weight loss, abdominal pain, fever, and fatigue.
9
Q
What symptoms are associated with Crohn’s disease?
A
Symptoms include diarrhea, cramping abdominal pain, weight loss due to malabsorption, and occasional rectal bleeding.
10
Q
What symptoms are characteristic of ulcerative colitis (UC)?
A
Characteristic symptoms include bloody diarrhea and varying degrees of abdominal pain.
11
Q
What is the stool output in mild UC?
A
In mild disease, diarrhea may consist of no more than 4 semiformed stools daily containing small amounts of blood.
12
Q
What defines moderate disease in UC?
A
In moderate disease, the patient has up to 10 stools per day, increased bleeding, and systemic symptoms such as fever and malaise.
13
Q
What are the symptoms of severe UC?
A
Severe symptoms include bloody diarrhea occurring 10 to 20 times a day, fever, rapid weight loss, anemia, tachycardia, and dehydration.
14
Q
What local complications can occur in IBD?
A
Local complications include hemorrhage, strictures, perforation, abscesses, fistulas, and Clostridium difficile infection.
15
Q
What laboratory findings may indicate complications in IBD?
A
Findings may include iron deficiency anemia, high WBC count, electrolyte imbalances, hypoalbuminemia, and increased inflammatory markers.
16
Q
What imaging studies are used for diagnosing IBD?
A
Imaging studies include double-contrast barium enema, small bowel series, transabdominal ultrasound, CT, and MRI.
17
Q
What is the goal of treatment for IBD?
A
Goals include resting the bowel, controlling inflammation, correcting malnutrition, providing symptomatic relief, and improving quality of life.
18
Q
Is there a cure for IBD?
A
No, there is no cure for IBD; treatment focuses on managing inflammation and maintaining remission.
19
Q
What is the preferred treatment for Crohn’s disease due to high recurrence rates?
A
Drugs are the preferred treatment due to high recurrence rates after surgical treatment.
20
Q
What indicates the need for hospitalization in IBD patients?
A
Hospitalization is needed if the patient does not respond to drug therapy, the disease is severe, or complications are suspected.
21
Q
A
22
Q
What is the goal of drug treatment in IBD?
A
To induce and maintain remission.
23
Q
Name the five major classes of drugs used in IBD treatment.
A
- Aminosalicyclates
- Antimicrobials
- Corticosteroids
- Immunomodulators
- Biologic therapies
24
Q
What factors influence drug choice in IBD treatment?
A
Location and severity of inflammation.
25
What is the initial treatment for UC?
A corticosteroid for symptom relief with an aminosalicylate or a biologic therapy.
26
What therapies are included in the management of Crohn's disease?
* Biologic therapy
* Corticosteroid
27
Can IBD therapies be used alone or in combination?
Yes, they can be used alone or as combination therapy.
28
What drug class treats both UC and Crohn's disease?
5-aminosalicylic acid (5-ASA).
29
For which condition are 5-ASA drugs much more effective?
Ulcerative colitis (UC).
30
What is the proposed mechanism of action for 5-ASA?
They suppress the production of proinflammatory cytokines and other inflammatory mediators in the intestine.
31
How can aminosalicylates be administered?
* Orally
* Rectally
32
What is the advantage of rectal use of aminosalicylates?
Delivers the 5-ASA directly to the affected tissue.
33
What combination is better for treating IBD: oral and rectal therapy together or alone?
Combination of oral and rectal therapy is better.
34
How do biologics reduce IBD-related inflammation?
By blocking specific proteins that play a role in inflammation.
35
List the four main classes of biologics used in IBD treatment.
* Anti-TNF agents
* Alpha 4-integrin inhibitors
* Interleukin (IL)-12/23 antagonists
* Janus kinase (JAK) inhibitors
36
What is the route of administration for infliximab (Remicade)?
Intravenous (IV).
37
What conditions is infliximab used to treat?
* Ulcerative colitis (UC)
* Crohn's disease
* Draining fistulas
38
How are the other anti-TNF agents administered?
Subcutaneously.
39
40
What are the most common side effects of the discussed therapies?
Upper respiratory infections, urinary tract infections, headaches, nausea, joint pain, abdominal pain
## Footnote
More serious effects include reactivation of hepatitis and tuberculosis, opportunistic infections, and cancers, especially lymphoma.
41
What must patients be tested for before beginning treatment?
Tuberculosis (TB) and hepatitis
## Footnote
Therapy must be delayed if an active infection is present.
42
What are alpha 4-integrin inhibitors used for?
To inhibit leukocyte adhesion by blocking da-integrin
## Footnote
Examples include natalizumab (Tysabri) and vedolizumab (Entyvio).
43
What is a significant risk associated with natalizumab?
Progressive multifocal leukoencephalopathy
## Footnote
Natalizumab is available only through a restricted program due to this risk.
44
How are IL-12/23 antagonists administered?
The first dose is given IV followed by injections every 8 weeks
## Footnote
Examples include ustekinumab and risankizumab.
45
What do JAK inhibitors do?
Suppress the immune system by blocking the TAK enzyme
## Footnote
They prevent the activation of specific immune system cells that cause inflammation.
46
What must patients be tested for before starting tofacitinib?
Tuberculosis (TB)
## Footnote
Tofacitinib should not be given with other biologics or immunomodulators.
47
What does immunogenicity in biologic therapy lead to?
Acute infusion reactions and delayed hypersensitivity-type reactions
## Footnote
Patients may develop antibodies against the biologic agents.
48
What is the purpose of corticosteroids in treating intestinal inflammation?
To prevent or decrease inflammation of the intestinal mucosa
## Footnote
They are given for the shortest possible time due to long-term side effects.
49
How are corticosteroids delivered to the inflamed tissue in patients with left colon, sigmoid, and rectal disease?
Suppositories, enemas, and foams
## Footnote
This method minimizes systemic effects.
50
What is the oral medication given to patients with mild to moderate disease who did not respond to 5-ASA?
Oral prednisone
## Footnote
It is part of the treatment for those who did not respond to other therapies.
51
52
What is included in the diagnostic assessment 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
## Footnote
None
53
What dietary recommendations are made for managing Inflammatory Bowel Disease?
* High-calorie
* High-vitamin
* High-protein diet
## Footnote
None
54
What is the role of enteral nutrition (EN) in the management of Inflammatory Bowel Disease?
EN is used during exacerbations.
## Footnote
None
55
List the types of drug therapy used in the management of Inflammatory Bowel Disease.
* Aminosalicylates
* Antimicrobials
* Biologic therapies
* Corticosteroids
* Immunomodulators
## Footnote
None
56
What non-pharmacological management strategies are recommended for Inflammatory Bowel Disease?
* Physical and emotional rest
* Referral for counseling or support group
## Footnote
None
57
True or False: Surgical therapy is not an option in the management of Inflammatory Bowel Disease.
False
## Footnote
Surgical therapy is considered when necessary.
58
59
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
60
What is the role of antimicrobials in treating Inflammatory Bowel Disease?
Prevent or treat secondary infection
61
What do Anti-TNF agents inhibit in the treatment of Inflammatory Bowel Disease?
The cytokine tumor necrosis factor (TNF)
62
What is the function of integrin receptor antagonists in Inflammatory Bowel Disease therapy?
Prevent migration of leukocytes from bloodstream to inflamed tissue
63
What do IL-12/23 antagonists bind to prevent activation of immune cells?
Bind IL-12 and IL-23
64
What is the mechanism of action of JAK inhibitors in Inflammatory Bowel Disease?
Block the JAK enzyme, preventing it from activating immune cells that cause inflammation
65
What is the primary action of immunomodulators in the treatment of Inflammatory Bowel Disease?
Suppress immune response
66
Give an example of a systemic 5-Aminosalicylate used in Inflammatory Bowel Disease.
balsalazide (Colazal), mesalamine (Asacol, Apriso, Delzicol, Liada, Pentasa), olsalazine (Dipentum), sulfasalazine (Azulfidine)
67
What are some topical forms of 5-Aminosalicylates?
5-ASA enema, foam, suppositories
68
Name an example of an antimicrobial used in treating Inflammatory Bowel Disease.
ciprofloxacin (Cipro), clarithromycin (Biaxin), metronidazole (Flagyl)
69
List some examples of Anti-TNF agents.
adalimumab (Humira), certolizumab pegol (Cimzia), golimumab (Simponi), infliximab (Remicade)
70
What are some examples of integrin receptor antagonists used in Inflammatory Bowel Disease?
natalizumab (Tysabri), vedolizumab (Entyvio)
71
Name two IL-12/23 antagonists used in the treatment of Inflammatory Bowel Disease.
Risankizumab (Skyrizi), ustekinumab (Stelara)
72
What is a JAK inhibitor used in treating Inflammatory Bowel Disease?
tofacitinib (Xeljanz)
73
What are systemic corticosteroids commonly used for in Inflammatory Bowel Disease?
prednisone, budesonide; hydrocortisone, methyl-prednisolone (IV for severe IBD)
74
What are some topical corticosteroids used in Inflammatory Bowel Disease?
hydrocortisone suppository, foam (Cortifoam), enema (Cortenema)
75
Name some examples of immunomodulators used in Inflammatory Bowel Disease.
azathioprine, cyclosporine, methotrexate, 6-mercaptopurine
76
77
What are topical corticosteroids used for?
They are used to treat severe inflammation.
78
What is required when planning surgery for patients on corticosteroids?
Corticosteroids must be tapered to very low levels.
79
What complications can arise from not tapering corticosteroids before surgery?
Infection, delayed wound healing, fistula formation.
80
What is the role of immunomodulators in treating IBD?
They maintain remission after corticosteroid therapy.
81
Who may benefit from immunomodulators?
Patients who do not respond to 5-ASA, corticosteroids, or antibiotics, have side effects from corticosteroids, or have fistulas.
82
Do immunomodulators have a rapid onset of action?
No, they have a delayed onset of action.
83
What monitoring is required for patients on immunomodulators?
Regular CBC monitoring.
84
What side effects can immunomodulators cause?
Suppression of bone marrow, infections, bleeding, liver and pancreas problems, flu-like symptoms.
85
Why must women of childbearing age avoid pregnancy while taking methotrexate?
It can cause birth defects and fetal death.
86
What are the indications for surgery in Ulcerative Colitis?
* Bowel obstruction
* Drain abdominal abscess
* Fistulas
* Inability to decrease corticosteroids
* Lack of response to conservative therapy
* Massive hemorrhage
* Perforation, impending or actual
* Severe anorectal disease
* Strictures
* Suspicion of cancer
87
What are the common surgical procedures for Ulcerative Colitis?
* Proctocolectomy with ileal pouch/anal anastomosis (IPAA)
* Proctocolectomy with permanent ileostomy
88
Is total proctocolectomy curative for Ulcerative Colitis?
Yes, since UC affects only the colon.
89
What is the most common reason for surgery in Crohn's disease?
Complications such as obstructions or lack of response to therapy.
90
What is Short Bowel Syndrome (SBS)?
Occurs when there is too little small intestine surface area to maintain normal nutrition and hydration.
91
What may be needed for patients with Short Bowel Syndrome?
Lifetime fluid boluses and parenteral nutrition (PN).
92
What is strictureplasty?
A surgery that opens narrowed areas obstructing the bowel.
93
What is the advantage of strictureplasty over resection?
It reduces the risk of developing Short Bowel Syndrome.
94
What are the goals of diet management for IBD patients?
* Provide adequate nutrition without worsening symptoms
* Correct and prevent malnutrition
* Replace fluid and electrolyte losses
* Prevent weight loss
95
What nutritional deficiencies are common in IBD patients?
* Iron deficiency anemia
* Zinc deficiency
* Cobalamin deficiency
96
What supplements may be needed for IBD patients?
* Oral iron supplements
* Zinc supplements
* Cobalamin injections
* Calcium supplements
* Potassium supplements
97
What is the preferred nutritional support during an acute exacerbation of IBD?
Liquid enteral feedings.
98
What is the role of cholestyramine in IBD treatment?
It helps control diarrhea by binding unabsorbed bile salts.
99
What should patients with IBD do to identify food triggers?
Keep a food diary.
100
What are common clinical problems for patients with IBD?
* Impaired bowel elimination
* Nutritionally compromised
* Difficulty coping
* Pain
101
102
What health history is important for assessing IBD?
Infection, autoimmune disorders
## Footnote
Important to note for the patient's background and risk factors.
103
What medications are commonly associated with IBD?
Antidiarrheal drugs
## Footnote
These medications help manage symptoms of diarrhea.
104
What family history is significant in IBD assessment?
Family history of ulcerative colitis, Crohn's disease
## Footnote
Genetic predisposition can influence the likelihood of developing IBD.
105
What are common symptoms of IBD related to nutritional status?
Nausea, vomiting, anorexia, weight loss
## Footnote
These symptoms may indicate malnutrition and require further evaluation.
106
What elimination symptoms are characteristic of IBD?
Diarrhea, blood, mucus, pus in stools
## Footnote
These symptoms are crucial for diagnosis and management of IBD.
107
What cognitive-perceptual symptoms may indicate IBD?
Lower abdominal pain, cramping, tenesmus
## Footnote
Tenesmus refers to the feeling of incomplete evacuation after a bowel movement.
108
What general objective data might indicate IBD?
Intermittent fever, emaciated appearance, fatigue
## Footnote
These signs suggest a chronic inflammatory process.
109
What cardiovascular signs may be observed in IBD?
THR, 1 BP
## Footnote
These abbreviations refer to tachycardia and low blood pressure, indicating possible dehydration or anemia.
110
What GI symptoms are observed in IBD?
Abdominal distention, hyperactive bowel sounds, abdominal cramps
## Footnote
These symptoms are indicative of gastrointestinal distress.
111
What skin symptoms might be present in patients with IBD?
Pale skin, poor turgor, dry mucous membranes, skin lesions, anorectal irritation, skin tags, cutaneous fistulas
## Footnote
Skin manifestations can occur due to systemic effects of IBD.
112
What possible diagnostic findings are associated with IBD?
Anemia, WBC elevation, electrolyte imbalance, hypoalbuminemia, vitamin deficiencies, guaiac-positive stool, abnormal sigmoidoscopy, colonoscopy, and/or barium enema findings
## Footnote
These findings help confirm the diagnosis and assess disease severity.
113
114
What should be calculated to assess nutritional adequacy post-surgery for IBD?
Daily calorie intake
## Footnote
This includes obtaining a daily weight and assessing the abdomen.
115
What is a key aspect of postoperative care for IBD?
Similar to bowel resection and ostomy surgery care
## Footnote
Refer to general nursing care of the postoperative patient.
116
What chronic illness management aspect should be emphasized to IBD patients?
Acceptance of chronicity and coping strategies
## Footnote
Teaching includes rest, diet management, and stress reduction.
117
List three important teaching topics for patients with IBD.
* Importance of rest and diet management
* Drug action and side effects
* Symptoms of recurrence of disease
118
True or False: Establishing rapport with IBD patients is unimportant.
False
## Footnote
Building trust is crucial for promoting self-care.
119
What should patients with Crohn's disease be encouraged to do regarding smoking?
Quit smoking
## Footnote
Smoking can lead to more severe disease.
120
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 nutrition balance
* Have an improved quality of life
121
What is a common psychological struggle for patients with IBD?
Depression and anxiety
## Footnote
Many patients deal with feelings related to the chronic nature of the disease.
122
During the acute phase of IBD, what should be the focus of care?
Hemodynamic stability, pain control, fluid and electrolyte balance, nutrition support
## Footnote
Monitoring intake and output is also crucial.
123
What should be monitored to assess a patient’s condition during the acute phase?
* Number and appearance of stools
* Presence of blood in stools and emesis
* Serum electrolytes
* CBC
* Vital signs
124
What is crucial for maintaining patient hygiene during acute diarrhea?
Keeping the patient clean, dry, and free of odor
## Footnote
Using a deodorizer can help manage odor.
125
What preventive measure can reduce perianal irritation and pain?
Meticulous perianal skincare
## Footnote
Use plain water and moisturizing skin barrier cream.
126
What is a second peak in the occurrence of IBD associated with?
The 6th decade of life
## Footnote
Proctitis and left-sided UC are more common in older patients.
127
Fill in the blank: The expected outcome is that the patient with IBD will have a decrease in the number of _______.
diarrhea stools
128
What should be taught to a patient experiencing orthostatic hypotension?
Change position slowly and use safety precautions
## Footnote
This is important to prevent falls.
129
130
What is a bowel obstruction?
A bowel obstruction occurs when intestinal contents cannot pass through the GI tract.
131
What are the two types of bowel obstruction?
* Mechanical
* Nonmechanical
132
What is the difference between partial and complete bowel obstruction?
Partial obstruction does not completely occlude the intestinal lumen, while complete obstruction totally occludes the lumen.
133
What characterizes a simple obstruction?
A simple obstruction has an intact blood supply.
134
What characterizes a strangulated obstruction?
A strangulated obstruction does not have an intact blood supply.
135
What is the most common cause of small bowel obstruction (SBO)?
Surgical adhesions.
136
What are other causes of small bowel obstruction (SBO)?
* Hernia
* Cancer
* Strictures from Crohn's disease
* Intussusception after bariatric surgery
137
What is the most common cause of large bowel obstruction (LBO)?
Colorectal cancer (CRC).
138
What are other causes of large bowel obstruction (LBO)?
* Diverticular disease
* Adhesions
* Ischemia
* Volvulus
* Crohn's disease
139
What is a nonmechanical bowel obstruction?
A nonmechanical obstruction occurs with reduced or absent peristalsis due to altered neuromuscular transmission.
140
What is the most common form of nonmechanical obstruction?
Paralytic ileus.
141
What can cause paralytic ileus?
* Abdominal surgery
* Peritonitis
* Inflammatory responses
* Electrolyte imbalances
* Thoracic or lumbar spinal fractures
142
What is pseudo-obstruction?
A GI motility disorder that mimics a mechanical obstruction without a detectable cause on imaging.
143
What are some conditions associated with pseudo-obstruction?
* Neurologic conditions
* Drugs
* Endocrine and metabolic problems
* Lung disease
* Trauma
* Burns
144
What are vascular obstructions, and what are their common causes?
Vascular obstructions result from interference with blood supply to the intestines, commonly caused by emboli and atherosclerosis.
145
What is the daily fluid intake to the small intestine?
About 6 to 8 liters.
146
What happens to fluid, gas, and intestinal contents during a bowel obstruction?
They accumulate proximal to the obstruction, reducing fluid absorption and stimulating intestinal secretions.
147
What happens to the bowel distal to the obstruction?
The bowel empties and then collapses.
148
True or False: Anemia and malnutrition are less common in older adults with bowel obstruction.
False.
149
Fill in the blank: A _______ obstruction does not allow any intestinal contents to pass through.
complete
150
151
What happens to capillary permeability during increased pressure?
It increases, leading to extravasation of fluids and electrolytes into the peritoneal cavity.
## Footnote
This process contributes to fluid retention and a decrease in circulating blood volume.
152
What is the result of intestinal muscle fatigue?
Peristalsis stops.
## Footnote
This leads to retention of fluids and a decrease in blood volume.
153
What can inadequate blood flow to bowel tissue lead to?
Ischemia, necrosis, and possible bowel perforation.
## Footnote
This can result in serious complications including infection and septic shock.
154
What is intestinal strangulation?
A condition where the bowel becomes distended, causing blood flow to stop and leading to edema, cyanosis, and gangrene.
## Footnote
If untreated, it can lead to bowel necrosis and rupture.
155
List the 4 hallmark manifestations of an obstruction.
* Abdominal pain
* Nausea and vomiting
* Distention
* Constipation
## Footnote
The order and degree of these symptoms vary based on the cause and type of obstruction.
156
What type of abdominal pain is usually the first symptom of obstruction?
Colicky abdominal pain.
## Footnote
This pain is often of sudden onset in small bowel obstructions.
157
Describe the vomiting in proximal obstruction.
It is frequent, copious, and may be projectile and contain bile.
## Footnote
Vomiting usually provides temporary relief from abdominal pain.
158
What are the bowel sounds like in paralytic ileus?
Usually absent.
## Footnote
This differs from bowel sounds being high-pitched above the area of obstruction.
159
What is a sign of large bowel obstruction (LBO)?
Abdominal distention and lack of flatus.
## Footnote
Patients may experience persistent cramping abdominal pain.
160
What occurs with strangulation in bowel obstructions?
Severe, constant pain that is rapid in onset.
## Footnote
This can indicate a serious complication requiring immediate attention.
161
What are the signs of dehydration and sepsis in a patient with obstruction?
* Tachycardia
* Dry mucous membranes
* Hypotension
* Elevated temperature
## Footnote
These signs indicate a deteriorating condition.
162
What type of metabolic imbalance may occur with a high obstruction?
Metabolic alkalosis.
## Footnote
This results from loss of gastric hydrochloric acid through vomiting.
163
What occurs rapidly with a small intestine obstruction?
Dehydration.
## Footnote
This can happen due to fluid retention and electrolyte imbalances.
164
165
What is a key early concern in patients with large bowel obstruction?
Preventing fluid and electrolyte imbalances
## Footnote
Early intervention is crucial to avoid complications such as hypovolemic shock and sepsis.
166
What imaging studies can identify an obstruction in the gastrointestinal tract?
* Abdominal x-rays
* CT scan
* Contrast enema
* Sigmoidoscopy
* Colonoscopy
## Footnote
These imaging techniques help visualize obstructions and guide surgical decisions.
167
What blood test results might indicate strangulation or perforation in bowel obstruction?
A high WBC count
## Footnote
Elevated white blood cell count is a common indicator of infection or severe complications.
168
How can metabolic alkalosis develop in patients with bowel obstruction?
From vomiting
## Footnote
Vomiting leads to loss of gastric acid, resulting in metabolic alkalosis.
169
What is the treatment goal for a patient with a bowel obstruction?
Regain intestinal patency and resolve the obstruction
## Footnote
Successful treatment aims to restore normal bowel function and alleviate symptoms.
170
What clinical problems may arise for a patient with an obstruction?
* Pain
* Impaired GI function
* Fluid imbalance
## Footnote
These issues can complicate treatment and recovery.
171
What are the potential surgical interventions for bowel obstruction?
* Resection of the obstructed bowel segment
* Partial or total colectomy
* Colostomy
* Ileostomy
## Footnote
The type of surgery depends on the extent and cause of the obstruction.
172
What should be monitored in a patient with a bowel obstruction?
* Laboratory values
* Arterial blood gas values
* Intake and output records
* Signs of dehydration
## Footnote
Regular monitoring helps detect complications early.
173
Fill in the blank: A patient with a high obstruction is more likely to have _______.
[metabolic alkalosis]
174
What is the purpose of placing stents in patients with bowel obstruction?
Palliative purposes or as a bridge to surgery
## Footnote
Stents can help relieve symptoms and provide time for stabilization before surgery.
175
What nursing management strategies should be implemented for a patient with bowel obstruction?
* Give IV fluids and electrolytes
* Monitor for dehydration
* Maintain NPO status
* Implement pain management
* Insert indwelling urinary catheter
## Footnote
These strategies are essential for patient comfort and safety.
176
What is a common symptom that indicates an obstruction in the gastrointestinal tract?
Abdominal pain
## Footnote
Patients often exhibit restlessness and frequent position changes to relieve pain.
177
True or False: A patient with a bowel obstruction should be allowed to eat and drink normally.
False
## Footnote
Patients are typically placed on NPO status to prevent further complications.
178
What are colonic polyps?
Arise from the mucosal surface of the colon and project into the lumen
## Footnote
Polyps can be sessile (flat, broad-based) or pedunculated (with a stalk).
179
180
What are the two types of polyps based on their attachment?
Sessile and pedunculated
## Footnote
Sessile polyps are attached directly to the intestinal wall, while pedunculated polyps are attached by a thin stalk.
181
What is the most common symptom in patients with polyps?
Asymptomatic, rectal bleeding, and occult blood in the stool
## Footnote
Most patients with polyps do not exhibit symptoms.
182
What are the most common types of polyps?
Hyperplastic and adenomatous
## Footnote
Hyperplastic polyps are noncancerous and rarely cause symptoms.
183
What is the risk associated with adenomatous polyps?
Closely linked to colorectal adenocarcinoma
## Footnote
There are three types of adenomatous polyps: tubular, tubulovillous, and villous.
184
What is the second leading cause of cancer-related deaths?
Colorectal cancer (CRC)
## Footnote
Annually about 148,000 people are diagnosed with CRC in the United States.
185
At what age is the risk of CRC significantly higher?
Older than 50
## Footnote
About 85% of new CRC cases are detected in this age group.
186
What factors are thought to contribute to the rising CRC cases in people aged 20 to 49?
Diet, physical inactivity, and increasing rates of obesity
## Footnote
The rate of CRC in younger populations is expected to continue rising.
187
What is familial adenomatous polyposis (FAP)?
A genetic disorder characterized by hundreds or thousands of polyps in the colon
## Footnote
FAP usually leads to cancer by age 40, necessitating removal of the colon and rectum by age 25.
188
What cancers are patients with classic FAP at risk for?
Thyroid, stomach, small intestine, liver, and brain cancers
## Footnote
Lifetime cancer surveillance is essential for these patients.
189
What diagnostic studies are used to discover polyps?
Colonoscopy, sigmoidoscopy, barium enema, and virtual colonoscopy
## Footnote
Colonoscopy is preferred for evaluating the total colon.
190
What should be done with all discovered polyps?
They should be removed (polypectomy)
## Footnote
Polyps can be removed during colonoscopy or sigmoidoscopy but not during barium enema or virtual colonoscopy.
191
What are patients monitored for after polypectomy?
Rectal bleeding, fever, severe abdominal pain
## Footnote
These are potential complications following the procedure.
192
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194
What are the two types of polyps based on their attachment?
Sessile and pedunculated
## Footnote
Sessile polyps are attached directly to the intestinal wall, while pedunculated polyps are attached by a thin stalk.
195
What is the most common symptom in patients with polyps?
Asymptomatic, rectal bleeding, and occult blood in the stool
## Footnote
Most patients with polyps do not exhibit symptoms.
196
What are the most common types of polyps?
Hyperplastic and adenomatous
## Footnote
Hyperplastic polyps are noncancerous and rarely cause symptoms.
197
What is the risk associated with adenomatous polyps?
Closely linked to colorectal adenocarcinoma
## Footnote
There are three types of adenomatous polyps: tubular, tubulovillous, and villous.
198
What is the second leading cause of cancer-related deaths?
Colorectal cancer (CRC)
## Footnote
Annually about 148,000 people are diagnosed with CRC in the United States.
199
At what age is the risk of CRC significantly higher?
Older than 50
## Footnote
About 85% of new CRC cases are detected in this age group.
200
What factors are thought to contribute to the rising CRC cases in people aged 20 to 49?
Diet, physical inactivity, and increasing rates of obesity
## Footnote
The rate of CRC in younger populations is expected to continue rising.
201
What is familial adenomatous polyposis (FAP)?
A genetic disorder characterized by hundreds or thousands of polyps in the colon
## Footnote
FAP usually leads to cancer by age 40, necessitating removal of the colon and rectum by age 25.
202
What cancers are patients with classic FAP at risk for?
Thyroid, stomach, small intestine, liver, and brain cancers
## Footnote
Lifetime cancer surveillance is essential for these patients.
203
What diagnostic studies are used to discover polyps?
Colonoscopy, sigmoidoscopy, barium enema, and virtual colonoscopy
## Footnote
Colonoscopy is preferred for evaluating the total colon.
204
What should be done with all discovered polyps?
They should be removed (polypectomy)
## Footnote
Polyps can be removed during colonoscopy or sigmoidoscopy but not during barium enema or virtual colonoscopy.
205
What are patients monitored for after polypectomy?
Rectal bleeding, fever, severe abdominal pain
## Footnote
These are potential complications following the procedure.
206
207
What percentage of colorectal cancer (CRC) cases occur in patients with a family history of CRC?
About 20% of cases
208
What are the hereditary forms of CRC that account for another percentage of cases?
FAP and hereditary nonpolyposis colorectal cancer (HNPCC) syndrome
## Footnote
These hereditary forms account for about 5% of CRC cases.
209
What percentage of people with CRC have an abnormal KRAS gene?
About 30% to 50%
210
What is the primary function of the KRAS gene?
Regulating cell division
211
What lifestyle factors may decrease the risk for CRC?
* Maintaining a healthy weight
* Being physically active
* Limiting alcohol use
* Not smoking
* Eating a diet high in fruits, vegetables, and grains
212
How long does it typically take for CRC to develop from a polyp?
10 to 20 years
213
What type of polyp is most commonly associated with CRC?
Adenomas
214
What are the five stages of CRC?
* Stage 0: Cancer has not grown beyond the mucosal layer
* Stage I: Cancer has grown into the submucosa, no lymph nodes involved
* Stage II: Cancer has grown into the muscle, no lymph node involvement or metastasis
* Stage III: Tumor with lymph node involvement, no metastasis
* Stage IV: Tumor with lymph node involvement and metastasis
215
What is a common site of metastasis for CRC?
Liver
216
What symptoms may indicate advanced CRC?
* Fatigue
* Weight loss
* Abdominal pain
* Change in bowel habits
217
What is a common early manifestation of right-sided CRC?
Anemia
218
What is hematochezia?
Fresh blood in the stool
219
Which side of CRC is more likely to cause diarrhea?
Right-sided cancers
220
What complications can arise from CRC?
* Obstruction
* Bleeding
* Perforation
* Peritonitis
* Fistula formation
221
At what age should screening for CRC begin for those at average risk?
Age 45
222
What screening tests are recommended for CRC detection?
* Flexible sigmoidoscopy (every 5 years)
* Colonoscopy (every 10 years)
223
224
What are the key components of diagnostic assessment 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
## Footnote
DRE stands for Digital Rectal Examination.
225
List the management options for colorectal cancer.
• Surgery
• Right hemicolectomy
• Left hemicolectomy
• Abdominal-perineal resection
• Laparoscopic colectomy
• Low anterior resection
• Chemotherapy
• Targeted therapy
• Radiation therapy
## Footnote
Surgical options vary based on the location and extent of the cancer.
226
What is the gold standard for colorectal cancer screening?
Colonoscopy.
## Footnote
Colonoscopy allows for the examination of the entire colon, biopsies, and polyp removal.
227
At what age should individuals at average risk for colorectal cancer begin screening with colonoscopy?
Age 45.
## Footnote
Screening should occur every 10 years.
228
What tests primarily find colorectal cancer?
• High-sensitivity fecal occult blood test (FOBT) (every year)
• Fecal immunochemical test (FIT) (every year)
• Stool DNA test (every 3 years)
## Footnote
FOBT and FIT look for blood in the stool, which may indicate cancer.
229
What is the recommended colonoscopy schedule for individuals with a first-degree relative who developed colorectal cancer before age 60?
Every 5 years beginning at age 40 or 10 years earlier than when the youngest relative developed cancer.
## Footnote
This is to ensure early detection due to increased risk.
230
True or False: Carcinoembryonic antigen (CEA) is the best screening tool for colorectal cancer.
False.
## Footnote
CEA has a large number of false-positive findings and may be elevated in non-colon cancers and some noncancerous conditions.
231
What does the tumor, node, metastasis (TNM) staging system correlate with?
Prognosis and treatment of colorectal cancer.
## Footnote
Prognosis worsens with greater size and depth of tumor, lymph node involvement, and metastasis.
232
Fill in the blank: Once tissue biopsies confirm the diagnosis of CRC, the patient needs a _______ to check for anemia.
CBC.
## Footnote
CBC stands for Complete Blood Count.
233
What imaging techniques may be used to detect metastases and determine the depth of penetration of the tumor into the bowel wall?
• CT scan
• PET scan
• MRI
## Footnote
These imaging techniques help assess the extent of cancer spread.
234
235
What are the primary goals of surgical therapy for cancer?
Complete resection of the tumor, thorough exploration of the abdomen, removing all lymph nodes, restoring bowel continuity.
236
What is polypectomy during colonoscopy used for?
Resect CRC in situ.
237
What indicates a successful polypectomy?
Resected margin free of cancer, well-differentiated cancer, no lymphatic or blood vessel involvement.
238
What factors influence the decision for surgical treatment in cancer?
Staging and location of the cancer, ability to restore normal bowel function and continence.
239
What surgical treatments are indicated for stage I and stage II colon cancers?
Removing the tumor, surrounding tissues, and nearby lymph nodes, followed by anastomosis when possible.
240
When is laparoscopic surgery particularly used?
For tumors in the left colon.
241
What is the role of chemotherapy after surgery for high-risk stage II tumors?
It is used to reduce the risk of cancer recurrence.
242
How are stage III tumors typically treated?
With surgery and chemotherapy.
243
What is the purpose of radiation and chemotherapy before surgery?
To reduce tumor size.
244
What determines the course of treatment in rectal cancer?
The location and size of the tumor.
245
What is an abdominal-perineal resection (APR)?
Removal of the entire rectum with the tumor, resulting in a permanent colostomy.
246
What is a low anterior resection (LAR)?
Removal of the rectum while preserving sphincters, anastomosing the colon to the anal canal.
247
What may be done to allow time for the anastomosis to heal after a LAR?
A temporary ostomy may be created.
248
What is the purpose of palliative surgery in cancer treatment?
To control hemorrhage or relieve bowel obstruction.
249
What is the role of chemotherapy and radiation in the context of metastatic cancer?
To control the spread and provide pain relief.
250
What are some examples of targeted therapies for metastatic CRC?
* Aflibercept (Zaltrap) * Bevacizumab (Avastin) * Ramucirumab (Cyramza) * Cetuximab (Erbitux) * Panitumumab (Vectibix)
251
What is the function of angiogenesis inhibitors in cancer treatment?
They inhibit the blood supply to tumors.
252
What is Regorafenib (Stivarga)?
A multikinase inhibitor that blocks several enzymes promoting cancer growth.
253
What is the role of trifluridine and tipiracil in cancer treatment?
Trifluridine impairs DNA function and angiogenesis; tipiracil increases trifluridine's bioavailability.
254
What is the purpose of adjuvant chemotherapy in cancer treatment?
To reduce the risk of cancer recurrence after surgery.
255
True or False: Chemotherapy is only used after surgery.
False.
256
257
What is the primary goal of palliative care for patients with metastatic cancer?
To reduce tumor size and provide symptomatic relief.
258
What are the clinical problems associated with colorectal cancer (CRC)?
* Altered bowel elimination
* Anxiety
* Difficulty coping
* Planning
259
What are the overall goals for patients with colorectal cancer?
* Normal bowel elimination patterns
* Quality of life appropriate to disease progression
* Relief of pain
* Feelings of comfort and well-being
260
At what age should individuals start having regular CRC screenings?
Over 45 years
261
What is a barrier to CRC screening mentioned in the text?
* Lack of accurate information
* Fear of diagnosis
262
What are the key components of postoperative care for patients after bowel resection?
* Sterile dressing changes
* Care of drains
* Patient and caregiver teaching about the ostomy
263
What emotional support needs do patients with CRC have?
Discussion about prognosis and future screening; emotional support.
264
What dietary advice may be necessary for patients who have undergone sphincter-sparing surgery?
* Antidiarrheal drugs
* Bulking agents
265
What are the expected outcomes for patients with CRC?
* Minimal changes in bowel elimination patterns
* Optimal nutrition intake
* Quality of life appropriate to disease progression
* Feelings of comfort and well-being
266
What are the reasons for surgical resection of the bowel?
* Remove cancer
* Repair a perforation, fistula, or traumatic injury
* Relieve an obstruction or stricture
* Treat an abscess, inflammatory disease, or hemorrhage
267
Fill in the blank: The expected outcomes for a patient with CRC include achieving _______.
[optimal nutrition intake]
268
True or False: Patients with CRC should be taught about bowel cleansing for outpatient diagnostic procedures.
True
269
What is the importance of ostomy rehabilitation for patients?
Teaching and ongoing support for all ostomy patients.
270
271
What important health history factors are associated with colorectal cancer?
Previous breast or ovarian cancer, familial polyposis, villous adenoma, adenomatous polyps, IBD
## Footnote
IBD stands for Inflammatory Bowel Disease.
272
Which medications should be considered when assessing for colorectal cancer?
Medications affecting bowel function (e.g., laxatives, antidiarrheal drugs)
## Footnote
These medications can alter bowel habits and affect symptoms.
273
What family history factors are significant in colorectal cancer assessment?
Family history of colorectal, breast, or ovarian cancer
## Footnote
A strong family history may increase risk.
274
What nutritional patterns are associated with colorectal cancer?
High-calorie, high-fat, low-fiber diet; anorexia, nausea and vomiting, weight loss
## Footnote
These dietary factors can contribute to cancer risk.
275
What changes in bowel habits may indicate colorectal cancer?
Alternating diarrhea and constipation, defecation urgency, rectal bleeding, mucoid stools, black tarry stools, flatulence, decrease in stool caliber, feelings of incomplete evacuation
## Footnote
These symptoms are critical for early detection.
276
What cognitive-perceptual symptoms are associated with colorectal cancer?
Abdominal and low back pain, tenesmus
## Footnote
Tenesmus refers to the feeling of incomplete evacuation after a bowel movement.
277
What are some objective signs of colorectal cancer?
Pallor, cachexia, lymphadenopathy, palpable abdominal mass, distention, ascites, hepatomegaly
## Footnote
Cachexia is a wasting syndrome often seen in cancer patients.
278
What possible diagnostic findings indicate colorectal cancer?
Anemia, guaiac-positive stools, palpable mass on DRE, positive sigmoidoscopy, colonoscopy, barium enema, or CT scan, positive biopsy
## Footnote
A positive biopsy confirms the presence of cancer.
279
280
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.
## Footnote
The outermost visible part is called a stoma.
281
What is the stoma?
The stoma is the result of the large or small bowel being brought to the outside of the abdomen and sutured in place.
## Footnote
It allows for fecal diversion when normal elimination is not possible.
282
What are the two main types of ostomies?
* Ileostomy
* Colostomy
## Footnote
Ostomies are named according to their location and type.
283
What is an ileostomy?
An ostomy in the ileum.
## Footnote
It results in liquid to thin paste output since it does not enter the colon.
284
What is a colostomy?
An ostomy in the colon.
## Footnote
Output resembles normal formed stool.
285
How does the output differ between ileostomies and colostomies?
* Ileostomy: liquid to thin paste
* Colostomy: resembles normal formed stool
## Footnote
Patients with ileostomies have no control over drainage.
286
What characterizes the more distal the ostomy?
The more functioning bowel remains, and the more likely that the intestinal contents will resemble the feces that would have been eliminated from an intact colon and rectum.
## Footnote
This is important for understanding ostomy output.
287
What are the two categories of ostomies based on permanence?
* Temporary
* Permanent
## Footnote
Some ostomies are created to prevent stool from reaching a diseased area.
288
What is a permanent ostomy?
An ostomy that is created when bowel distal to the ostomy is removed, such as in cancer involving the rectum.
## Footnote
It may be continent or traditional.
289
What is a continent ileostomy?
Uses 40 to 45 cm of the terminal ileum to fashion an internal pouch, nipple valve, and abdominal stoma.
## Footnote
The pouch replaces the rectum as a reservoir for stool.
290
How does a continent ileostomy function?
Patients must drain the pouch manually by inserting a catheter through the nipple valve.
## Footnote
Initially done every 1 to 2 hours, decreasing to 4 times daily as the pouch enlarges.
291
What must patients with a continent ileostomy follow for diet?
A low-residue diet to keep stool consistency relatively fluid.
## Footnote
This is crucial for pouch function.
292
What are the major types of traditional ostomies?
* End ostomy
* Double-barreled ostomy
* Loop ostomy
## Footnote
These types vary based on surgical technique and purpose.
293
294
What is an abdominal-perineal resection (APR)?
Removal of the entire rectum with creation of a permanent colostomy
## Footnote
This procedure is often used in cases of rectal cancer.
295
What is involved in an anterior rectosigmoid resection?
Removal of part of descending colon, the sigmoid colon, and upper rectum with the descending colon anastomosed to remaining rectum
## Footnote
This procedure preserves some function of the rectum.
296
Define colectomy.
Removal of the entire colon with the ileum anastomosed to the rectum
## Footnote
This procedure is typically performed for colon cancer or severe colitis.
297
What is a left hemicolectomy?
Removal of splenic flexure, descending colon, and sigmoid colon with the transverse colon anastomosed to rectum
## Footnote
This procedure is used to treat conditions affecting the left side of the colon.
298
Describe a low anterior resection (LAR).
Removal of the rectum with anastomosis of the colon to the anal canal, may include temporary ileostomy or colostomy
## Footnote
This procedure allows for preservation of anal function.
299
What does a proctocolectomy with ileostomy entail?
Removal of the colon, rectum, and anus with closure of the anal opening and formation of a permanent ileostomy
## Footnote
This is often done in severe cases of inflammatory bowel disease.
300
What is a proctocolectomy with ileal pouch/anal anastomosis (IPAA)?
Two surgeries, first includes colectomy, rectal mucosectomy, ileal pouch construction, ileoanal anastomosis; second surgery closes ileostomy to direct stool toward new pouch
## Footnote
This procedure allows for preservation of anal function with a new reservoir for stool.
301
What is involved in a right hemicolectomy?
Removal of ascending colon and hepatic flexure with the ileum anastomosed to transverse colon
## Footnote
This procedure treats conditions in the right colon.
302
303
What is an end stoma?
An end stoma is made by dividing the bowel and bringing out the proximal end as a single stoma
## Footnote
It results in either a colostomy or ileostomy, with the distal part of the GI tract being surgically removed or oversewn.
304
What is the procedure called when the distal bowel is oversewn and left in the abdominal cavity?
Hartmann pouch
## Footnote
This allows for the potential of reanastomosing the bowel and closing the stoma.
305
What characterizes a loop stoma?
A loop stoma is made by bringing a loop of bowel to the abdominal surface and opening the anterior wall
## Footnote
It results in one stoma with a proximal opening for feces and a distal opening for mucus drainage.
306
How long is a plastic rod typically used to hold a loop stoma in place after surgery?
7 to 10 days
## Footnote
This prevents the loop of bowel from slipping back into the abdominal cavity.
307
What is a double-barreled stoma?
A double-barreled stoma is created by dividing the bowel and bringing both proximal and distal ends through the abdominal wall as 2 separate stomas
## Footnote
The proximal stoma functions, while the distal stoma acts as a mucus fistula.
308
What are the three unique care aspects for ostomy surgery?
1. Psychologic preparation for the ostomy
2. Educational preparation
3. Selecting the best site for the stoma
## Footnote
These aspects aid in the patient's adjustment and management post-surgery.
309
What is the role of a WOCN in ostomy surgery preparation?
A WOCN should choose the site for the ostomy and mark the abdomen before surgery
## Footnote
The site should be within the rectus muscle and on a flat surface for better management.
310
Why is psychologic preparation important for patients undergoing ostomy surgery?
It helps the patient cope with changes in body image and elimination
## Footnote
Emotional support can enhance feelings of control and ability to cope.
311
Fill in the blank: The distal stoma in a double-barreled stoma is a _______.
mucus fistula
312
True or False: A loop stoma is usually a permanent solution.
False
## Footnote
A loop stoma is usually temporary.
313
What should the site for the ostomy ideally be like?
Flat, within the rectus muscle, and visible to the patient
## Footnote
This facilitates better care and management of the ostomy.
314
315
What is the stool consistency for an ileostomy?
Liquid to semiliquid
316
Is bowel regulation required for an ileostomy?
Yes
317
What are the indications for surgery for an ileostomy?
* UC
* Crohn's disease
* Diseased or injured colon
* Familial polyposis
* Trauma
* Cancer
318
What is the stool consistency for a colostomy?
* Semiliquid (Ascending)
* Semiliquid to semiformed (Transverse)
* Formed (Sigmoid)
319
Is bowel regulation required for a colostomy?
No
320
What are the indications for surgery for a colostomy?
* Perforating diverticulum in lower colon
* Trauma
* Rectovaginal fistula
* Inoperable tumors of colon, rectum, or pelvis
* Cancer of the rectum or rectosigmoid area
321
Fill in the blank: The stool consistency for a sigmoid colostomy is _______.
Formed
322
True or False: A colostomy requires a change in fluid requirements.
False
323
What is the fluid requirement for an ileostomy?
No
324
What is the fluid requirement for a colostomy?
Possibly T
325
Fill in the blank: The stool consistency for a transverse colostomy is _______.
Semiliquid to semiformed
326
327
What should be assessed if the patient's wound is closed or partially closed?
The integrity of the incision
## Footnote
Monitor for complications such as delayed wound healing, hemorrhage, fistulas, and infections.
328
What complications should be monitored in postoperative care?
* Delayed wound healing
* Hemorrhage
* Fistulas
* Infections
## Footnote
Regular assessment and documentation are crucial.
329
What should be recorded when assessing the wound?
* Bleeding
* Excess drainage
* Unusual odor
* Edema
* Redness
* Drainage
* Fever
* High WBC count
## Footnote
Observing the skin and the area around drains for signs of inflammation is also important.
330
When caring for a patient with an open wound and packing, what is crucial?
Meticulous care
## Footnote
Reinforce dressings and change them often during the first several hours postoperatively.
331
What type of drainage is typically expected postoperatively?
Serosanguineous
## Footnote
Assess all drainage for amount, color, and consistency.
332
What should be assessed in a patient with an ostomy?
The stoma
## Footnote
The stoma should be rosy pink to red and mildly swollen.
333
How often should stoma color be assessed and documented?
Every 4 hours
## Footnote
Report any sustained color changes or bleeding to the HCP.
334
When does the colostomy start functioning?
When peristalsis returns
## Footnote
Record the volume, color, and consistency of the drainage.
335
What is common during the first 2 weeks after a colostomy?
Excessive amounts of gas
## Footnote
Assure patients that this is common and may be distressing.
336
What may the ileostomy output be when peristalsis returns?
As high as 1500 to 1800 mL/24 hr
## Footnote
If the small bowel is shortened by surgery, drainage may be greater.
337
What should be observed in patients post-surgery for ileostomy?
Fluid deficits and electrolyte imbalances, particularly potassium and sodium
## Footnote
Over time, the proximal small bowel adapts and increases fluid absorption.
338
What is the expected consistency of feces after adaptation post-surgery?
Paste-like consistency
## Footnote
The volume decreases to around 500 mL/day.
339
How many stools may a patient have after an IPAA initially?
4 to 6 stools or more daily
## Footnote
Adaptation over the next 3 to 6 months results in fewer bowel movements.
340
What may occur after intraoperative manipulation of the anal canal?
Transient incontinence of mucus
## Footnote
Kegel exercises are recommended about 4 weeks after surgery.
341
What is the purpose of Kegel exercises post-surgery?
To strengthen the pelvic floor and sphincter muscles
## Footnote
This is especially important after anal canal manipulation.
342
Fill in the blank: The area around any drains should be kept _______.
Clean and dry
## Footnote
This is vital for preventing infection and promoting healing.
343
344
What color characterizes a healthy stoma?
Rose to brick-red
## Footnote
A healthy stoma should exhibit a rose to brick-red color, indicating good blood supply and viability.
345
What color indicates a pale stoma?
Pale
## Footnote
A pale stoma may suggest anemia or inadequate blood supply.
346
What does blanching, dark red to dusky blue or purple indicate in stoma health?
Inadequate blood supply
## Footnote
These colors can indicate potential necrosis or serious issues with blood flow to the stoma.
347
What color suggests necrosis in a stoma?
Brown-black
## Footnote
Brown-black coloration indicates necrosis and should be addressed immediately.
348
What is the typical edema characteristic of a viable stoma?
Mild to moderate edema
## Footnote
Mild to moderate edema is expected in a healthy stoma postoperatively.
349
What edema characteristic can indicate a problem with the stoma?
Moderate to severe edema
## Footnote
Moderate to severe edema may indicate complications such as obstruction or infection.
350
What is the typical amount of bleeding in a healthy stoma?
Small amount
## Footnote
A small amount of bleeding may occur, especially when the stoma is touched.
351
What amount of bleeding is concerning for stoma health?
Moderate to large amount
## Footnote
Moderate to large amounts of bleeding can indicate serious complications and should be evaluated.
352
What describes viable stoma mucosa?
Normal appearance with adequate blood supply
## Footnote
Viable stoma mucosa appears healthy and well-perfused.
353
What causes necrosis in a stoma?
Inadequate blood supply or trauma
## Footnote
Necrosis can occur due to lack of blood flow or injury to the stoma.
354
What can cause obstruction of the stoma?
Allergic reaction to food, gastroenteritis
## Footnote
These conditions can lead to swelling and blockage of the stoma.
355
What is the significance of oozing from the stoma mucosa when touched?
Normal due to high vascularity
## Footnote
Oozing is expected and indicates good blood supply to the stoma.
356
What conditions can lead to lower GI bleeding?
Coagulation factor deficiency, stomal varices
## Footnote
These conditions can result in bleeding from the stoma.
357
358
What is important to protect the epidermis from?
Mucous drainage and maceration
359
What should the patient use to clean the skin?
A mild cleanser
360
What may be used alongside a moisture barrier ointment?
A perineal pad
361
What is a common sensation some patients experience post-surgery?
Phantom rectal pain
362
True or False: Phantom sensations can be mistaken for perineal abscess pain.
True
363
What can pelvic surgery disrupt that affects sexual function?
Nerve and vascular supplies to the genitalia
364
What nerve plexus is at risk during surgeries that remove the rectum?
Parasympathetic nerve plexus
365
For men, what are the main concerns regarding sexual function?
Erection and ejaculation
366
What factors affect the ability to have an erection?
* Intact parasympathetic nerves
* Nonadrenergic noncholinergic nerves
* Adequate blood supply
367
What surgical procedure can disrupt ejaculation due to sympathetic nerve damage?
APR procedure
368
How long may sexual problems be temporary after surgery?
3 to 12 months
369
What can nerve-sparing surgical techniques help preserve?
Sexual function
370
What issues can nerve damage cause for women post-surgery?
Vaginal dryness and decreased sensation
371
What may help women experiencing vaginal dryness post-surgery?
Experimenting with positions and using lubrication
372
What concerns do patients with an ostomy often have regarding sexuality?
* Fear of rejection
* Concerns about desirability
373
What should patients do before engaging in sexual activities?
Empty the pouch
374
What is crucial for patients with new ostomies?
Frequent assessment, planning, intervention, and evaluation
375
What are the two major aspects of nursing care for ostomy patients?
* Patient and caregiver teaching about ostomy care
* Emotional support for body image changes
376
What should patient teaching focus on for ostomy care?
* Basic skills about managing the ostomy
* Diet
* How to get help for problems
377
What is vital to protect the skin around the ostomy?
An appropriate pouching system
378
What components do most pouching systems include?
* Adhesive skin barrier
* Pouch to collect feces
379
What is a key nursing management task for ostomy care?
Assess and document stoma and peristomal skin appearance
380
What should be included in patient and caregiver teaching about ostomy self-care?
* Explain what an ostomy is
* Describe the underlying condition
* Demonstrate skin barrier removal and application
* Explain diet and fluid management
381
Fill in the blank: The ostomy pouch should be emptied before it is ______ full.
one-third
382
What is a recommended fluid intake for ostomy patients to prevent dehydration?
At least 3000 mL/day
383
What should patients do to reduce the chance of blockage?
Chew food very well
384
What are some symptoms of fluid and electrolyte imbalance?
Fever, diarrhea, skin irritation, stomal problems
385
What can help with emotional and psychologic adjustment to the ostomy?
Community resources
386
Why is follow-up care important for ostomy patients?
To monitor health and manage potential complications
387
What factors can the ostomy potentially affect?
* Sexual activity
* Social life
* Work
* Recreation
388
389
What type of pouch should be used in the initial postoperative period for stoma assessment?
A transparent pouch
## Footnote
This allows for easy assessment of stoma viability and pouch application.
390
How often should the peristomal skin be assessed?
Each time the pouch is changed
## Footnote
This is important to check for irritation.
391
What should be done if the peristomal skin is irritated and raw?
More products may have to be applied.
392
What is the stool consistency for a colostomy in the ascending and transverse colon?
Semi-liquid stools.
393
What type of pouch is recommended for a colostomy in the ascending and transverse colon?
A drainable pouch.
394
How long may a drainable pouch last?
Up to 4 to 7 days.
395
What stool consistency is associated with a colostomy in the sigmoid or descending colon?
Semiformed or formed stools.
396
What type of pouch can a patient with a sigmoid or descending colostomy use?
* Drainable pouch
* Disposable, closed-end pouch changed every day.
397
What is a feature of charcoal filters for ostomy pouches?
They can deodorize and automatically release flatus.
398
What is colostomy irrigation used for?
To stimulate emptying of the colon.
399
What are the requirements for a patient to perform colostomy irrigation?
Manual dexterity and adequate vision.
400
What should patients who irrigate have on hand?
Ostomy bags in case they develop diarrhea.
401
What is important for patients with a colostomy regarding diet?
The effect of food on stoma output is individual.
402
What can most patients with colostomies do regarding their diet?
Eat anything they want.
403
What activities can a patient resume within 6 to 8 weeks post-surgery?
Activities of daily living.
404
What should patients avoid lifting post-surgery?
Heavy lifting.
405
Is swimming with an ostomy pouch intact a problem?
No.
406
What type of obstruction is an ileostomy susceptible to?
Obstruction due to a lumen less than 1 inch in diameter.
407
What foods should be chewed very well before swallowing with an ileostomy?
* Nuts
* Raisins
* Popcorn
* Coconut
* Mushrooms
* Olives
* Stringy vegetables
* Foods with skins
* Dried fruits
* Meats with casings.
408
What is diverticulosis?
Saccular dilations or outpouchings of the mucosa that develop in the colon.
409
What occurs when diverticula become inflamed?
Diverticulitis.
410
What is a common concern for patients adjusting to an ostomy?
Stool leaking, odor, sounds of flatus, pouch reliability, and changes in lifestyle.
411
What should be provided to patients to help them cope with an ostomy?
Information, emotional support, and mastering basic skills.
412
What is vital for supporting patients with an ostomy?
Support from caregivers, family, and friends.
413
What type of pouching system is important for patients with an ileostomy?
A secure pouching system.
414
How much fluid intake is recommended for patients with an ileostomy?
At least 2 to 3 L/day.
415
What are the signs and symptoms patients must learn regarding fluid and electrolyte imbalance?
Signs and symptoms of fluid and electrolyte imbalance.
416
What types of foods can cause odor in stoma output?
* Alcohol
* Asparagus
* Broccoli
* Cabbage
* Eggs
* Fish
* Garlic
* Onions.
417
What foods can cause gas formation in stoma output?
* Beans
* Beer
* Cabbage family
* Carbonated beverages
* Strong cheeses
* Onions
* Sprouts.
418
What foods can cause diarrhea in stoma output?
* Alcohol
* Beer
* Cabbage family
* Coffee
* Raw fruits
* Green beans
* Spicy foods
* Spinach.
419
420
What is diverticulitis?
Inflammation of 1 or more diverticula, resulting in perforation into the peritoneum.
421
What does diverticular disease encompass?
A spectrum from asymptomatic, uncomplicated diverticulosis to diverticulitis with complications such as perforation, abscess, fistula, and bleeding.
422
Where are diverticula most commonly found in the GI tract?
In the left (descending, sigmoid) colon.
423
What are the main contributing factors to the development of diverticula?
* Genetic factors
* Environmental factors
* Diet
* Lifestyle
424
What dietary habits are associated with a higher prevalence of diverticulitis?
Low fiber intake and high consumption of red meat and refined carbohydrates.
425
What are common risk factors for diverticulitis?
* Obesity
* Inactivity
* Smoking
* Excess alcohol use
* NSAID use
426
What symptoms are typically associated with diverticulosis?
Most patients are asymptomatic; those with symptoms may experience abdominal pain, bloating, flatulence, and changes in bowel habits.
427
What are the most common signs of diverticulitis?
* Acute pain in the left lower quadrant
* Distention
* Decreased or absent bowel sounds
* Nausea
* Vomiting
* Systemic symptoms of infection
428
What complications can arise from diverticulitis?
* Erosion of the bowel wall
* Perforation into the peritoneum
* Localized abscess
* Peritonitis
* Extensive bleeding
429
What is the preferred diagnostic test for diverticulitis?
CT scan with oral contrast.
430
What clinical assessments are involved in diagnosing diverticular disease?
* History and physical assessment
* Testing of stool for occult blood
* CBC
* Urinalysis
* Imaging studies (CT scan, X-ray, MRI, ultrasound)
431
What is the primary goal of treatment in acute diverticulitis?
To let the colon rest and the inflammation subside.
432
What conservative therapies are recommended for diverticulosis?
* High-fiber diet
* Fiber supplements
* Weight loss (if overweight)
* Smoking cessation
433
What are some management strategies for acute diverticulitis?
* Antibiotic therapy
* NPO status
* IV fluids
* Analgesics
* NG suction
* Surgery (possibly resection or temporary colostomy)
434
True or False: Most patients with diverticulosis have symptoms.
False.
435
What nursing management steps should be taken for a patient with acute diverticulitis?
* Give IV fluids and electrolyte replacement
* Place the patient on NPO status
* Administer IV fluids and antibiotics
* Observe for signs of abscess, bleeding, and peritonitis
* Monitor the WBC count
* Implement pain management measures
* Maintain a strict intake and output record
* Provide frequent oral care and lubricant for the lips
* Institute NG suctioning and check for patency
436
Fill in the blank: Diverticula are uncommon in _______.
[vegetarians]
437
438
What is a fistula?
An abnormal tract between two hollow organs or a hollow organ and the skin
## Footnote
Fistulas are named based on the tract they form, such as enterocutaneous or enterovaginal.
439
What are the types of GI fistulas?
They are classified as simple or complex and by the amount of output:
* Simple fistula: one short, direct tract
* Complex fistula: associated with abscess and multiple organs
440
What characterizes a high-output fistula?
Drains more than 500 mL/day
## Footnote
Other classifications include moderate-output (200-500 mL/day) and low-output (less than 200 mL/day).
441
What are early signs of a fistula?
Fever and abdominal pain
## Footnote
Other signs depend on the type of fistula present.
442
What are common complications associated with GI fistulas?
Increased morbidity and mortality, extended hospital stays, and increased costs
## Footnote
Most fistulas occur after surgery or trauma.
443
What is the importance of maintaining fluid and electrolyte balance in fistula management?
To prevent dehydration and manage output effectively
## Footnote
Accurate intake and output records are essential for fluid replacement.
444
What dietary considerations should be taken for patients with fistulas?
High-calorie, high-protein parenteral or enteral nutrition is needed
## Footnote
Consult a dietitian for tailored nutritional support.
445
What is a hernia?
A protrusion of tissue through an abnormal opening or weakened area in a cavity wall
## Footnote
Hernias commonly occur in the abdominal cavity.
446
What is the difference between reducible and irreducible hernias?
Reducible hernias can return to the abdominal cavity, while irreducible hernias cannot
## Footnote
Irreducible hernias may lead to strangulation and acute bowel obstruction.
447
What complications can arise from strangulated hernias?
Gangrene and necrosis of the hernia contents
## Footnote
Strangulation compromises blood supply to the trapped contents.
448
What is the recommended fluid intake for patients with diverticular disease?
At least 2 L/day
## Footnote
This helps manage symptoms and prevent exacerbations.
449
What lifestyle modifications should be encouraged for patients with diverticular disease?
High-fiber diet, weight loss, smoking cessation, and avoiding increased intraabdominal pressure
## Footnote
Activities that increase pressure include straining, vomiting, and heavy lifting.
450
What is an enterocutaneous fistula?
An opening between the small intestine and the skin
## Footnote
It allows intestinal contents to drain through the skin.
451
What are some manifestations of a colovesical fistula?
Fecaluria, recurrent urinary tract infections, dysuria, and hematuria
## Footnote
This type of fistula connects the colon to the urinary tract.
452
What is the typical surgical procedure for recurrent diverticulitis?
Resection of the involved colon with a primary anastomosis
## Footnote
A temporary diverting colostomy may be necessary if anastomosis is not possible.
453
What is the impact of patient education on diverticular disease management?
Patients who understand the disease process and adhere to the regimen are less likely to have exacerbations
## Footnote
Education includes explaining dietary needs and symptom management.
454
455
What is a femoral hernia?
A protrusion through the femoral ring into the femoral canal, appearing as a bulge below the inguinal ligament.
456
What is herniorrhaphy?
A surgical procedure to repair a hernia, usually performed on an outpatient basis.
457
What is the most common type of hernia?
Inguinal hernia.
458
What are the common causes of ventral or incisional hernias?
* Weakness of the abdominal wall at a previous incision site
* Obesity
* Multiple surgeries in the same area
* Inadequate wound healing due to poor nutrition or infection.
459
What is the classic symptom of a hernia?
Pain, which may worsen with activities that increase intraabdominal pressure.
460
What complications can arise after an inguinal hernia repair?
Scrotal edema, which is painful.
461
What is the lifetime risk for men developing an inguinal hernia?
25% lifetime risk.
462
What is the lifetime risk for women developing an inguinal hernia?
Less than a 5% lifetime risk.
463
What is malabsorption syndrome?
Impaired absorption of fats, carbohydrates, proteins, minerals, and vitamins.
464
What is the most common malabsorption disorder?
Lactose intolerance.
465
What are the most common signs of malabsorption?
* Weight loss
* Diarrhea
* Fatigue
* Abdominal pain
* Steatorrhea.
466
What laboratory studies are needed to diagnose malabsorption?
* CBC
* Prothrombin time
* Liver function tests
* Serum levels of vitamin A, carotene, electrolytes, iron, and calcium.
467
What imaging studies can help diagnose malabsorption?
* CT scan
* Endoscopy
* Barium studies.
468
Fill in the blank: A hernia may be readily visible, especially when the person tenses the _______.
abdominal muscles.
469
True or False: Women are more likely to have inguinal hernias than men.
False.
470
What are the symptoms of a strangulated hernia?
* Severe pain
* Symptoms of bowel obstruction (vomiting, cramping, abdominal pain, distention).
471
What is the treatment of choice for a hernia?
Laparoscopic surgery.
472
What is steatorrhea?
Bulky, foul-smelling, yellow-gray, greasy stools with putty-like consistency.
