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Nursing Theory IV > GI > Flashcards

Flashcards in GI Deck (81)
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1

Gastroenteritis: Assessment

Medical History
Med review (most meds can be constipating)
Diet history
Travel history (H2O)
Physical and abdominal assessment (distention, BP, skin, dehydration, cardiac

2

Gastroenteritis: Management

Hand washing
Isolation (contact isolation)
Identify cause
F&E replacement (Na+, K+, Cl-, glucose)
Food safety measures (turkey)
Dietary management
*Don't give anti-diarrheals

3

Gastroenteritis: Medications

Antidiarrheals
Narcotic
Anticholinergic
Probiotics

4

Diarrhea

Risk for deficient fluid volume (Monitor I&O, BP; watch trends, hydration assessment, might have to do IV infusion; Ringer's lactate)
Risk for impaired skin integrity (lots of nutrients, barrier creams, might have to sit in sits bath; avoid overuse of soaps)

5

Diarrhea: Evaluation

Stool frequency
Nutritional status
Weight
Fluid volume status
Skin integrity
Monitor electrolytes

6

Diarrhea: Teaching

Teach causes and preventative measure
Infection control (isolate STAT if C.Diff)
Purification of water for travel
Fluid replacement
Chronic diarrhea (may be sign of chronic constipation)

7

Intestinal Obstruction: Assessment/ Management

Assess for bowel sounds (hypoactive; potential for blockage), distention
Assess for complications

Diagnostic tests
Gastric decompression
Surgery (take out the area where the obstruction is)

8

Intestinal Obstruction: Nursing Implementation

Monitor dehydration and electrolyte status closely
Strict intake and output (if nothing is going through- NPO)
NG tube care (always ensure proper placement)
IV fluids
Comfort measures and a quiet environment (High/semi fowlers)
Postop care same as for laparotomy

9

Intestinal Obstruction: Deficient Fluid Volume/ Ineffective Breathing Pattern

Monitor VS and CVP (Central venous pressure)
I&O, urine output, gastric output
Measure abdominal girth

Resp. rate, lung sounds
Resp. support

10

Intestinal Obstruction: Evaluation

Abdominal girth
Bowel sounds
Pain
Tolerance
Fluid volume status
Potential complications

11

Colorectal Cancer

Colon cancer screening guidelines; for the individual at average risk, colonoscopy every 10 years (If polyps are seen during colonoscopy, screening becomes yearly)
Important hereditary condition; familial adenomatous polyposis (FAP) (if family member is diagnosed, you get screened 10 years before they were diagnosed)

12

Colorectal Cancer: Prognosis

Early detection, better prognosis
Depends on extent of timor invasion, cell type, degree of dysplasia, tumour genetics, presence or absence of metastasis
TNM classification used for metastasis

13

Colorectal Cancaer: Treatment

Surgical removal
Colostomy
Chemotherapy, radiation, or both

14

Colorectal Cancer: Assessment

Effects of the disease (not just pt. but whole family)
Treatment (depends on person. May be palliative surgery)
Clients ability to function and maintain ADLs

15

Colorectal Cancer: Nursing Implementation

Health Promotions: Screening, use of NSAIDs
Acute Interventions: Preop; Similar to care of a client undergoing laparotomy. Postop; After abdominal resection, 2 wounds and a stoma
Ambulatory and home care: Psychological support for client and family

16

Colorectal Cancer: Complications/ Management

Bowel obstruction
Perforation into neighbouring organs

Annual screening beginning at age 50
Diagnostic tests
Surgery
Adjunctive therapy (chemo)

17

Colorectal Cancer: Nursing care

Provide emotional support
Teaching
Surgical needs (RT hemicolectomy; LT hemicolectomy; Abd. - perineal resection; laproscopic colectomy; laproscopic)

18

Colorectal Cancer: Teaching

Prevention
American Cancer Society recommendations
Regular health examinations
Tests and procedures
Ostomy care
Pain and symptom management

19

Colorectal Cancer: Nursing Diagnosis

Diarrhea or constipation
Acute pain
Fear
Ineffective coping

20

Colorectal Cancer: Planning

Goals include appropriate treatment, normal bowel pattern, good quality of life, relief of pain and promotion of comfort

21

Inflammatory Bowel Diease: Goals of Treatment

Rest the bowel
Control inflammation
Combat infection
Correct malnutrition
Alleviate stress
Symptomatic relief
Improve quality of life

22

Inflammatory Bowel Disease: Planning

Experience a decrease in number and severity of acute exacerbations
Maintain normal fluid/electrolyte balance
Remain free from pain or discomfort
Comply with medical regimen
Improve QOL

23

Inflammatory Bowel Disease: Surgical Therapy

Procedures for chronic ulcerative colitis:
Total colectomy with rectal mucosal stripping and ileoanal reservoir
Total protocolectomy with continent ileostomy (Kock pouch)
Total protocolectomy with permanent ileostomy
Total colectomy with rectal mucosal stripping and ileoanal reservoir
Total protocolectomy with continent ileostomy (Kock pouch) or permanent ileostomy

24

Ulcerative Colitis and Crohn's Disease: Managemetn

Manage symptoms
Control disease process
Supportive care
Diagnostic tests
Medications
Dietary management
Surgery

25

Ulcerative Colitis: Treatment

Corticosteroids
Broad spectrum antibiotic
Salicylate analogs
Immunomodulating agents (Azathioprine; Mercaptopurine)
IV followed by oral cyclosporine for refractory
Infliximab (Remicade) for refractory

26

Crohn's Disease: Treatment

Prednisone and sulfasalazine
Antibiotics: metronidazole
Azathioprine, 6-mercaptopurine, methotrexate, and biologic therapies (refractory)
Anti-tumor necrosis factor agents infliximab, adalimulab, and certolizumab (refractory)

27

Crohn's Diease: Surgical therapy

75% will require surgery
Surgery produces remission, but high recurrence rate
Ileostomy

28

Colostomy or Ilostomy: Diagnosis

Change in body image
Nutritional imbalance
Loss of sexuality
Possible dehydration
Diarrhea
Impaired skin integrity
Anxiety
Ineffective coping
Ineffective therapeutic regimen management

29

Ulcerative Colitis and Crohn's Disease: Teaching

Disease process, effects, stress
Treatment options
Medications
Complications, management
Diet
Nutritional supplements
Fluids
Exercise
Teaching for surgery

30

Malabsorption: Nursing Care

Effects on nutrition and bowel patterns
Nutritional status
Weight, fat fold measurements, lab data, dietary intake
Enteral feeding supplements as prescribed
I&O, daily weights, skin turgor, mucous membranes
Frequency stools
Medications
Skin care