GI Tract Flashcards
(115 cards)
1
Q
Diarrhea: What went wrong?
A
3 or more lose or liquid stools per day. Often organisms. Contaminated- undercooked food
2
Q
Diarrhea: Patients signs and symptoms
A
Large volume stools cramping, dehydration, metabolic acidosis. C-diff in hospital
3
Q
Diarrhea: Diagnostic tests
A
Stool cultures. Stool WBC, blood, mucus. Ova and parasites for more than 2 weeks
4
Q
Diarrhea: Collaberative care and meds
A
Tx underlying cause. May need IVs. Anti diarrheals contraindicated in infectious diarrhea. C-diff-use antibiotics
5
Q
Diarrhea: nursing management
A
Replace fluids, protect skin, prevent transmission. C-diff isolation lives 70 days. Private room
6
Q
Fecal Incontinence: what went wrong?
A
Involuntary passage of stool. Nuero/motor/sensory impaction.
7
Q
Fecal Incontinence: Patient signs and symtpoms
A
Patient unable to control bowel movements
8
Q
Fecal Incontinence: Diagnostic Tests
A
H&P. Recal exam. CT scan or abd x-ray. Colonoscopy or sigmoidoscopy.
9
Q
Fecal Incontinence: collaborative care and meds
A
Tx underlying cause. Removal of impaction. Bowel regimen. Surgery for damaged sphincters.
10
Q
Fecal Incontinence: nursing management
A
Teach fiber and bulk-forming laxatives. Avoid foods that contribute. Imodium. Bowl training. Skin barrier. Fecal management systmes
11
Q
Constipation: what went wrong?
A
Absent or infrequent stools due to diet, decreased fluid intake, meds (opiods). Nuero. and stress
12
Q
Constipation: Patient signs and symptoms
A
Discomfort, hard, dry stools, bloating, distention, flatulence. Rectal pressure. Coloic perf.
13
Q
Constipation: Diagnostic tests
A
H&P, rectal exam, meds. X-rays, barium enema, colonoscopy, sigmoidoscopy
14
Q
Constipation: collaborative care and meds
A
Treat underlying cause. Stool softeners, bulk laxatives, enemas, bowl regimen. Physical activity
15
Q
Constipation: nursing management
A
Increase fiber and fluids. Teach to avoid valsalva-bradycardia, decreased CO. Teach fiber and bulk-forming laxatives. Knees higher than hips
16
Q
Acute abdominal pain: what went wrong?
A
Recent onset. May be life-threatening cause. Poss. perforation
17
Q
Acute abdominal pain: patient signs and symptoms
A
pain, may have nausea, vomiting, fever, bloating, constipation or diarrhea, flatulance
18
Q
Acute abdominal pain: diagnostic tests
A
H&P, position. Pain assessment. CBC, x-ray, CT scan, EKG. Urinalysis, pregnancy test
19
Q
Acute abdominal pain: collaborative care and meds
A
Identify cause and treat. Possible surgery
20
Q
Acute abdominal pain: nursing management
A
Vital signs AAP, determine baseline. I&O, bowl sounds. Full assessment. Poss NG, NPO. Table 43-10
21
Q
Irritable bowel syndrome: what went wrong?
A
Common, chronic functional disorder. No organic cause.. FODMAPS. Diet. Stress/PTSD
22
Q
Irritable bowel syndrome: patient signs and symptoms
A
Abd pain, constipation or diarrhea. Distention, flatulence, bloating, urgency, incomplete evacuation.
23
Q
Irritable bowel syndrome: diagnostic tests
A
H&P. Diagnosis of exclusion. ROME 3 criteria
24
Q
Irritable bowel syndrome: collaborative care and meds
A
Psych. intervention. Increase fiber. Imodium for diarrhea. Alosetron for pain and diarrhea. Amitzia and Linzess for constipation. Tricyclic antidepressants
25
Irritable bowel syndrome: nursing management
Have pt keep diary. Suggest CAM, acupincture, stress management. Teach avoid gas producing foods
26
Appendicitis: what went wrong?
Inflammation of appendix. Most common cause abd pain. Fecalith. Can have gangrene, perforation, peritonitis
27
Appendicitis: patient signs and symptoms
Periumbilical pain. Anorexia, N&V. Pain to RLQ- McBurneys point. Rebound tenderness. Increased coughing
28
Appendicitis: diagnostic tests
Check temp and CBC with diff. Full abd assessment. Urinanalysis. Preg test. CT scan, ultrasound
29
Appendicitis: collaberative care and meds
Antibiotics and fluids followed by surgical removal. If ruptures, peritonitis serious complication
30
Appendicitis: nursing management
All patients with abd pain need to see HCP. Keep NPO, no laxatives, enemas, or warm packs. Medicate for pain. Post-op care.
31
Peritonitis: what went wrong?
Inflammatory process of peritoneum. Infection, perf, peritoneal dialysis, injury, chemical irritation with massive fluid shifts and shock. Can be fatal!
32
Peritonitis: patient signs and symptoms
Severe abdominal pain. Rebound tenderness. Shallow breaths due to pain. Distention, fever, tachucardia, N&V, shock, ileus, abscess
33
Peritonitis: diagnostic tests
CBC with diff., aspiration of peritoneal fluids, x-ray, CT scan, ultrasound
34
Peritonitis: collaberative care and meds
Surgery. May be treated with antibiotics, fluids, NG, analgesics
35
Peritonitis: nursing management
Very careful assessment. Report changes immediately. IV, pain meds, postion. Oxygen if indicated. I&O. Drains post-op
36
Gastroenteritis: what went wrong?
Inflammation of mucosa of stomach and small intestine. Norovirus common
37
Gastroenteritis: patient signs and symptoms
Risk for dehydration in elderly. Diarrhea, N&V, abd pain
38
Gastroenteritis: diagnostic tests
Determine source. R/O other conditions
39
Gastroenteritis: collaborative care and meds
IV or oral fluids
40
Gastroenteritis: nursing management
Electrolytes, pedialyte, cola, antiemetics, may help. Avoid antidiarrheals.
41
Crohns Disease: what went wrong?
IBD. Genetic link. Autoimmune. Chronic inflammation of GI tract from mouth to anus. Often ileum. Skip lesions
42
Crohns Disease: patient signs and symptoms
All layers of bowel. Deep ulcerations, cobblestone. Strictures, with obstruction and perf poss. Fistulas. Diarrhea, weight loss. Crampy and pain. Fatigue
43
Crohns Disease: diagnostic tests
R/O other diseases. CBC, electrolytes, elevated ESR, CRP, stool cultures. Barium enema, contrast small bowell series, ultrasound, CT or MRI scan, colonoscopy, biopsy.
44
Crohns Disease: collaborative care and meds
Replace bile salts and cobalamin. Screen for small bowel and colon cancer (increased risk). May be hospitalized. Aminosalicylates, antimicrobials, corticosteroids, immunosuppressants, biologic and targeted therapies. Surgery. May need life-time parenteral nutrition. Psychotherapy
45
Crohns Disease: nursing management
Assess for systematic complications. Risk for post-op obstruction. Assess for anemia. Think nutrition with vitamin and mineral loss. Skin care, rest
46
Ulcerative Colitis: what went wrong?
IBD. Autoimmune. Starts at rectum and moves up. Perf poss. Fistulas
47
Ulcerative Colitis: patient signs and symptoms
Bloody diarrhea with abd pain. Dehydration. Up to 20 stools a day. Toxic megacolon. Anemia
48
Ulcerative Colitis: diagnostic tests
R/O other diseases. CBC, electrolytes, elevated ESR, CRP, stool cultures. Barium enema, contrast small bowell series, ultrasound, CT or MRI scan, colonoscopy, biopsy
49
Ulcerative Colitis: collaborative care and meds
Screen for increased risk of colon cancer. May be hospitalized. Aminosalicylates, antimicrobials, corticosteroids, immunosuppresesants, biologic and targeted therapies. Proctocolectomy. Permanent ileostomy. Psychotherapy
50
Ulcerative Colitis: nursing management
Assess for systemic complications. Stoma care post-op. Very high ileostomy output initially. Assess for anemia. Think nutrition with vitamin and mineral loss. Skin care, rest
51
Intestinal Obstruction: what went wrong?
Fluid, gas and intestinal contents accumulate proximal to the obstruction and distal bowel collapses. Strangulation or perforation, shock and death. partial or complete. mechanical. paralytic ileus
52
Intestinal Obstruction: patient signs and symptoms
Distention, fluids and electrolytes move into peritoneal cavity. Dehydration, fluid and electrolyte imbalances, pain, N&V. Constipation later. High pitched sounds above, usually absent or below. Borborygmi.
53
Intestinal Obstruction: diagnostic tests
H&P, full labs, CT scan, colonoscopy or sigmoidoscopy
54
Intestinal Obstruction: collaborative care and meds
Emergency surgery for strangulation or unresolved with conservative care. may require colostomy. Otherwise, NPO, NG, IVs, stent placement
55
Intestinal Obstruction: nursing management
Monitor potassium levels (renal failure), pain meds. Very careful assessment and call surgeon if changes. Catheter with I&O. assess kidney function. Oral care!
56
Colonic Polys: What went wrong?
Growths from mucosal surface. Sessile- flat and broad. Pedunculated- small stalk. Hyperplastic- noncancerous. Ademonatous- increased risk of colon cancer
57
Colonic Polyps: patient signs and symptoms
Rectal bleeding, occult blood in stool
58
Colonic Polyps: Diagnostic Tests
Genetic Testing for FAP, Cancer is inevitable-colon removal. Colonoscopy, barium enema, CT/MRI
59
Colonic Polyps: collaborative care and meds
Remove all polyps and have tested. Observe for bleeding or perforation.
60
Colonic Polyps: nursing management
Teach about importance of follow up with testing. Suggest increased fruits and vegetables, with exercise
61
Colorectal cancer: what went wrong?
3rd most common form of cancer. Risk: red meat, obesity, inactivity, alcohol, smoking, low fruits and vegetables, IBO, familial link
62
Colorectal cancer: patient signs and symptoms
Often no symptoms until advanced. Anemina, rectal bleeding, abdominal pain, change in bowel habits, obstruction
63
Colorectal cancer: diagnostic testing
Genetic testing for FAP and HPNCC (lynch syndrome). Colonoscopy, simdoidoscopy to begin at 50. 45 for AA. CBC. Barium enema, FOBT, FIT, CT or MRI, LFTs, CEA- follow up care
64
Colorectal cancer: collaborative care an management
TNM staging. Bowel cleansing pre-op. Surgery to resect, remove lymph nodes. Reanastomosis or colostomy, may be temporary. Rectal cancer usually requires permanent colostomy. Chemotherapy with high risk stage 2, all 3 and 4 stages. 5FU and oral drug Capecitabine. Targeted therapy, "nibs" and "mabs"- Avastin most often. RT may be used
65
Colorectal cancer: nursing management
Educate re: screening and reporting, post-op APR, pain, wounds, drains, stoma, psych issues. Freq dressing changes. Watch for infection. Sexual dysfunction. Diet to control ostomy or none
66
Ostomy: what went wrong?
Rectal cancer, advanced colon cancer, trauma, inflammatory bowel disorders
67
Ostomy: collaborative care and management
End stoma- remove distal bowel or Hartmans pouch for takedown. Loop and double-barrel have distal bowel and usually temporary. Higher ostomy more liquid and difficuly to manage
68
Ostomy: nursing management
concern about leakage and odor. Watch for dark red, very swollen or bloody stoma. Assess every 4 hours! WOCN, teach patient. May irrigate.
69
Ileostomy Surgery: collaborative care and treatment
May need psychiatric support for loss and body image changes. United Ostomy Associatin, support groups, partnering. Radiation, partnering. Radiation and chemo can cause severe diarrhea. Sexual dysfunction if nerves damaged
70
Ileostomy Surgery: nursing management
Frequent drainage. open-ended pouch worn 4-7 days. Think fluid and electrolyte imbalances. Diet. Need 2-3 L/day. Skin care
71
Diverticulitis: what went wrong?
Decreased dietary fiber.
72
Diverticulitis: patient signs and symptoms
Abdominal pain, bloating, flatulence. Or no symptoms
73
Diverticulitis: diagnostic studies
Routine sigmoidoscopy or colonoscopy symptoms
74
Diverticulitis: collaborative care and management
High fiber diet. Decreased fat and red meat intake. Increased physical activity
75
Diverticulitis: nursing management
Teach diet, exercise, weight reduction. No straining
76
Hernias: what went wrong?
Protrusion of internal organ, such as intestine thru weakened area in wall
77
Hernias: patient signs and symptoms
May be visible. Discomfort. Severe pain if strangulated. Distention, vomiting, cramping
78
Hernias: diagnostic studies
Reducible or incarcerated by exam
79
Hernias: collaborative and management
Emergency surgery if strangulated. Lapoorascopic surgery with mesh hernioplasty
80
Hernias: nursing management
Watch for distended bladder post-op. Scrotal support and ice bag for inguinal hernia. No coughing, no lifting
81
Celiac Disease: what went wrong?
Autoimmune disorder. Damage to small intestine by wheat, barley, rye. Genetic link
82
Celiac Disease: patient signs and symptoms
Diarrhea, steatorrhea, abdominal distention, malnutrition, rash. Weight loss, osteoporosis
83
Celiac Disease: diagnostic tests
Biopsy, serologic testing, genotyping
84
Celiac Disease: collaborative care and management
Gluten-free diet. Corticosteroids initially
85
Celiac Disease: nursing management
Avoid wheat, oats, barley, rye. Read labels closely
86
Short bowel syndrome: what went wrong?
Small intestine doesnt absorb nutrients. Surgery
87
Short bowel syndrome: patient signs and symptoms
Diarrhea and steatorrhea (fat). Weight loss, kidney stones, vitamin deficiencies
88
Short bowel syndrome: diagnostic tests
History and physical exam
89
Short bowel syndrome: collaborative care and management
May need supplements or TPN. H2 blocker or PPI. 6 small meals per day. Opioid antidiarrheals. Transplant
90
Short bowel syndrome: nursing management
Comfort measures. Teach meds and small meals.
91
Lactase Deficiency: what went wrong?
Lactase enzyme absent or deficient. Genetic. Intestinal mucosal damage.
92
Lactase Deficiency: patient signs and symptoms
bloating, flatulence, cramping, diarrhea. Within 30 minutes to hours after ingesting milk
93
Lactase deficiency: diagnostic tests
Lactose tolerance test
94
Lactase deficiency: collaborative care and management
Lactose products (Lactaid) or eliminate milk products
95
Lactase deficiency: nursing management
Teach diet adherence, calcium supplements may be needed
96
Hemorrhoids: what went wrong?
Internal or external dilated veins from increased pressure
97
Hemorrhoids: patient signs and symptoms
Rectal bleeding, pruritis, prolapse and pain
98
Hemorrhoids: diagnostic studies
Digital exam, anoscopy
99
Hemorrhoids: collaborative care and management
Fiber, fluids, witch hazel, topical steroids, band ligation, surgery
100
Hemorrhoids: nursing management
Prevent constipation, sitz baths, opioids. Assess for bleeding. Stool softener, enema
101
Anal Fissure: what went wrong?
crack in lining of anal wall. tissue ischemia
102
Anal Fissure: patient signs and symptoms
Pain and bright red bleeding. Constipatin
103
Anal Fissure: diagnostic tests
physical exam
104
Anal Fissure: collaborative care and management
Fiber, fluids, sitz baths. Topical therapies. surgery
105
Anal Fissure: nursing diagnosis
Comfort, pain meds, stool softeners
106
Anal Cancer: what went wrong?
HPV associated many sexual partners, HIV
107
Anal Cancer: patient signs and symptoms
rectal bleeding, pain, pressure
108
Anal Cancer: diagnostic tests
anal scope, biopsy or swab. anal ultrasound
109
Anal Cancer: collaborative care and treatment
Gardasil, or Cervarix. Surgery, radiation, chemotherpay
110
Anal Cancer: nursing management
Medicate for pain. side-effect management. Teach prevention with condoms and vaccines
111
Pilonidal Sinus: what went wrong?
Tract under skin filled with hair and epithelial cells
112
Pilonidal Sinus: patient signs and symptoms
No symptoms unless infected. Pain and swelling
113
Pilonidal Sinus: diagnostic tests
Physical exam. Culture if infected
114
Pilondial Sinus: collaborative care and management
Surgery, open or closed. Packing, sitz baths
115
Pilondial Sinus: nursing management
Medicate for pain, infection. Warm, moist heat, lie on side
