GI Disorders

Question 1

What stops diarrhea

Answer 1

Immodium

Question 2

Who’s at risk for c-diff

Answer 2

Those on chemo or abx

Question 2

Goals for care and nursing interventions:

Answer 2

Replace fluid and electrolytes

. Pharmacological management – meds? Table 45-3
3. Limit/prevent peri-anal skin breakdown
4. Manage nutritional intake
5. Prevent transmission

Question 3

What does not kill C-diff

Answer 3

Hand santitizer

Question 4

Inflammatory Bowel Disease

Answer 4

Autoimmune disease
Tissue damage caused by overactive, inappropriate, & sustained inflammatory response
More prevalent in industrialized regions of world

Question 5

Two types of IBD

Answer 5

Crohns

Ulcerative Colitis

Question 6

Crohns disease occurs where

Answer 6

Any part of the GI tract may be affected (mostly small intestine)
Inflammation involves all layers of the bowel wall (transmural)
Inflammation is discontinuous – skip lesions

Question 7

SS of Crohns

Answer 7

*diarrhea, *abdominal pain, malabsorption and nutritional deficiencies, weight loss (severe), fever (during acute episodes),

Question 8

Prognosis of Crohn’s

Answer 8

No curative sx

Question 9

Ulcerative Colitis occurs where

Answer 9

Only the colon is involved
Inflammation of inner lining
Continuous inflammation from rectum upward
May appear as a fulminating crisis (severe)or as a chronic disorder.

Question 10

SS of Ulcerative colitis

Answer 10

Bloody diarreha*abdominal pain, tenesmus (Still need to go after you’ve gone), rectal bleeding

Question 11

Prognosis for colitis

Answer 11

Removal of large bowel is generally curative

Question 12

STUDY IBD complications

Question 13

Crohn’s disease complications

Answer 13

Intestninal
- Scar tissue, strictures, obstructure
Fistulas
Perforation, abscesses, peritonitis
Fat malabsorption - low Vit K

Extra intestinal, ;iver dx, anemia

Question 14

Intestinal complications of colitis

Answer 14

Intestinal
*Bleeding, perforation (most often associated with toxic megacolon), *toxic megacolon, colonic dilation, *fulminant colitis, pseudopolyps
Increased risk of colorectal cancer

Question 15

Extraintestinal colitis complications

Answer 15

Directly related to colitis, or nonspecific mediated by disturbance in immune system – anemia
Arthritis, osteoporosis, erythema nodusum, Pyoderma gangrenosum, mouth ulcers.

Question 16

Toxic Megacolon

Answer 16

inflammation and infection cause the colon to dilate(enlarge). Walls thin as colon enlarges - loses functionality
- Cannot remove gas or feces from the body
- Can cause rupture
- Life threatening if it ruptures

Question 17

Labs for IBD diagnositics

Answer 17

Anemia
Increased CRP (Increases with inflammation), increased WBC
Electrolytes
Stool samples

Question 17

Studies (scopes) of IBD

Answer 17

Varium enema, colonscopy, sigmoidoscopy endoscopy

Question 18

When should scopes NOT Be done in IBD

Answer 18

In ulcerative colitis when recturm and colon are severely inflamed
Biopsy

Question 19

Malabsorption in IBD

Answer 19

Varies bw crohns and UC - depends on area affected

• Low albumin levels (protein in blood that is not being absorbed with IBD)

Question 20

Drug therapy for IBD

Answer 20

Sulphasalazine (Salofalk, Dipentum etc)- locally acting anti-inflammatory
Corticosteroids
Immunosuppressive drugs (cyclosporin)

Question 21

Nutrition for IBD

Answer 21

NPO in acute state

High-calorie, high-protein, low-residue diet with vitamin & iron supplements

Special dietary restricitons usually not necessary

Enteral supplements and TPN

Avoid fiber, brown rice, whole wheat bread

• White rice, white bread etc.

Question 22

Why sx for IBD

Answer 22

Blockages, ruptures, tissue changes indicating cancer, exacerbations that can not be controlled

Question 23

Crohn's Drug therapy

Answer 23

Sulphasalazine Corticosteroids Flagyl Biological drug therapies

Question 24

Sx therapy for crohns

Answer 24

Not curative Intestinal resection with anastomosis of healthy bowelN

Question 25

Nutritional therapy

Answer 25

Elemental diet & parenteral nutrition Low in residue, roughage & fat High in calories & protein May need to exclude milk & milk products Vitamin B12 injections (malabsorption)

Question 26

Colorectal cancer

Answer 26

A malignant disease of colon, rectum, or both 2nd most common cause of cancer death in Canada Highest % of colorectal cancers in Canada are located in rectum, ascending colon & sigmoid colon

Question 27

Risk factors for coloretal cancer

Answer 27

Being over 50 years Genetic predispostioin COlorectal polyps Chronic IBD Family hx Obesity Hx of cancer Red meat intake Smoking/alcohol

Question 28

Prevention of colorectal cancer

Answer 28

Mixed evidence but diet seems to play an important role Obesity 2x risk Dietary recommendations: Avoid? Removal of polyps

Question 29

Secondary prevention and dx

Answer 29

Early detection is essentional GOBT every 1-2 yrs after 50

Question 30

Clinical SS of colorectal cancer

Answer 30

Usually asymptomatic till advanced Rectal bleeding Alternating constipation & diarrhea Gas or bloating Change in stool caliber (narrow, ribbon-like) Sensation of incomplete evacuation Loss of appetite/early satiety Crampy, colicky abdominal pain Weight loss/lethargy Iron deficiency/ Occult bleeding `

Question 31

Diagnostics for Colorectal cancer

Answer 31

Digital ExamFecal Occult Blood Test (FOBT) q2yrsFecal Immunochemical Test (FIT) Colonoscopy /Sigmoidoscopy /Barium enemaLabs – which ones CEA (carcinoembryonic antigen)

Question 32

Labs for Colorectal cancer

Answer 32

CBC and electorlytes Clotting factors

Question 33

Dukes staging for colon cancer

Answer 33

Duke A: Invasion into bot not thorugh bowel wall Dukes B: invasion through bowel wall but not into lympth Dukes C: Invovlemend of lymph nodes Dukes D: Wedspread metastases

Question 34

Tx of colorectal cancer

Answer 34

Surgery is only curative treatment Colostomy Resection Chemotherapy Radiation

Question 35

Which type og colostomies are often temporary

Answer 35

DOuble barrel and loop

Question 36

What should a stoma look like

Answer 36

Pink/red NOT pale - indicates bad blood flow

Question 37

Assessment of colonostomies

Answer 37

Stoma site (see Table 45-34) Color Edema Bowel function Bleeding Perineum Assess perineal wound if end colostomy performed

Question 38

When are ostomy bags chaged

Answer 38

1-2/3

Question 39

Post op care for ostomies

Answer 39

NG suction Maintain gastric decompression by NG suction Do not remove suction until peristalsis returns Reduce colic pain Promote ambulation Progress diet as peristalsis returns Monitor abdominal and rectal wound Prevent infection Assess for bleeding from rectal wound Monitor drainage from catheter and abdominal drain site 100-150 mls in 24 hours Prevent complications – high risk for DVT!

Question 40

Risk for injury increased r/t nursing diagnoses

Answer 40

Infection, stoma problems (necrosis, retraction, stenosis, obstruction), general post-op complications.

Question 41

Know difference bw Crohns and Colitis, know complications, Know LABS amd diagnostics