INTESTINAL AND RECTAL DISORDERS Flashcards
(31 cards)
Risk factors for IBS
PSYCHOLOGICAL STRESS:
(Anxiety, Stress, Depression)
IRRITATING FOODS
(milk, yeast products, eggs, wheat, red meat)
hereditary
high-fat diet
alcohol and smoking use
women
CLINICAL MANIFESTATIONS FOR IBS
Assessment: recognize cues
-Changed Alteration in bowel patterns
(IBS-D, IBS-C or IBS-M)
D-diarrhea C-constipation M-mixed U-unsubtyped
-Pain, Bloating, Abdominal distention accompanies change in bowel motility
IBS
Patient Teaching/learning needs ?
Interventions: take action
(5/8 Important ones)
*Diet: *Increase Fiber –> reduce diarrhea
Metamucil (psyllium) - bulk-forming fiber laxative
-Probiotics –>restores gut flora
-Adequate fluid intake
*Encourage relaxation techniques –> reduce stress
AVOID ALCOHOL AND SMOKING
-Medication management
Medication tx for IBS-D
-Loperamide (Imodium)
antidiarrheal (fecal urgency control)→ slows intestinal motility and affects water and electrolyte movement through the bowel
-Bile Acid Sequestrants (Cholestyramine)
-Alosetron (lotronex)[5HT antagonist] –>
ONLY for women with severe IBS-D that don’t respond adequately to conventional therapy
ATB for IBS-D (Rifaxamin)
Medication tx for IBS-C
-Alosetron (Lotronex) → selective 5HT antagonist (selective serotonin antagonist) [slows colonic motility];
monitor for ischemic colitis, tx for severe constipation
Ischemic colitis → reduced blood flow to the colon resulting in pain and damage → SEVERE CONSTIPATION → If adverse reactions occur you need to stop right away
-Osmotic laxatives (PEG)
-Cl-channel activator (lubiprostone)
-Guanylate cyclase agonist (linaclotide)
Diagnostic testing to r/o IBS
CBC or C-reactive protein
Sac-like herniation of the lining of the bowel?
Diverticulum
Difference between
Diverticulosis and Diverticulitis?
Diverticulosis → is the diverticula w/o inflammation → benign condition usually ASYMPTOMATIC
Diverticulitis → sac becomes inflamed and infected d/t food or feces getting stuck in sac and creating irritation/infection
Clinical Manifestation for Diverticular Disease
-Pain is the most common symptom – helps to identify location of inflammation/infection; Reports of pain to LLQ → r/o diverticulosis/diverticulitis in sigmoid colon
-Chronic Constipation preceding diverticulosis (w/o inflammation → ASYMPTOMATIC but may include
bowel irregularities, nausea, anorexia,
bloating, and abdominal distention.
Nursing Intervention for constipation
↑ fluids,
↑ soft fiber
-bulk-forming laxative: Psyllium
-exercise
-high fiber/low fat diet
No stimulants laxatives: (bisacodyl, senna) or mineral oil
routinely
No nuts, corn, popcorn/seeds (tomatoes, cucumber, squash, berries) [will get stuck and form diverculosis]
S/S ACUTE DIVERCULITIS
mild or severe pain in LLQ
nausea, vomiting, fever, chills, and leukocytosis (elevated WBC)
ACUTE DIVERCULITIS DIET AND TX (OUTPATIENT)
clear liquids until inflammation subsides
→ high-fiber, low-fat diet
(Prepared cereals or soft-cooked vegetables =
↑ Bulk of stool and facilitates peristalsis= defecating)
PO Antibiotics 7-10 days
If PO is not tolerated and excessive vomiting and nausea then hospitalization may be needed
ACUTE DIVERCULITIS TX in HOSPITAL
- NPO, Rest, IV fluids, NG tube suctioning (same tx for acute gastritis; but no ATB-> Antacids, H2B, PPIs instead)
- IV antibiotics (UNASYN or TIMENTIN)
COMPLICATIONS OF ACUTE DIVERCULITIS
Complications:
*Perforation,
hemorrhage,
*peritonitis,
obstruction,
*fistula (colovesical)
abscess
What is Inflammatory Bowel Disease (IBD) ?
Group of chronic disorders that involve chronic inflammation of your digestive tract.
*Onset peaks between ages 15 and 25 years
*Autoimmune disease: *mild-severe acute exacerbations that occur at unpredictable lifetime intervals with *periods of remission [Dx in childhood]
Types of IBD include: *Ulcerative colitis and *Crohn’s disease → long-lasting inflammation and sores (ulcers) in the innermost lining of your large intestine (colon) and rectum
CLINICAL MANIFESTATIONS FOR IBD
(CROHN’S)
CROHN’s Disease/Regional enteritis (or usually ascending colon)
-Inflammation of any segment of the GI tract →
mouth to anus (will jump sections); unable to surgically cure
*most common in ileum;
-diarrhea less severe;
*steatorrhea (increase fat in feces)
*severe weight loss (d/t decreased absorption),
-abdominal pain,
-fatigue
CLINICAL MANIFESTATIONS FOR IBD
(ULCERATIVE COLITIS)
-Inflammation and ulceration of the
*colon (descending colon) and *rectum(100%),
bleeding & diarrhea with mucus
*pus are severe (10- 20 stools/day);
*dehydration;
-“cured” by colectomy
COMPLICATIONS OF IBD (4)
(NEED TO KNOW)
hemorrhage,
bowel perforation,
peritonitis,
fistula (between bowel & bladder)
NURSING INTERVENTIONS FOR IBD (6)
-Assess & treat pain or discomfort,
*anticholinergic medications b4 meals,
[Anticholinergic medication → ↓ parasympathetic stimulation → ↓GI]
-analgesics (ASA), positioning, diversional activities, and
prevention of fatigue
*Encourage bed rest to reduce peristalsis during exacerbation
-Fluid deficit,
*I&O, *daily weight →monitor for dehydration/fluid loss→ IV FLUIDS
-encourage oral intake,
-measures to decrease diarrhea
-Reduce anxiety (talk calmly, listen, pt. education)
*CONTACT PRECAUTION- C.dif via Antibiotics
NUTRITIONAL DIET FOR IBD (
OPTIMAL Nutrition:
*↑ Protein
*↑ calorie and nutrients
*↓ residue (fruits)
*AVOID HIGH fiber diet
*Parental Nutrition (PN) may be needed
*AVOID HIGH fiber diet
*AVOID gas forming, and milk products
AVOID alcohol & smoking
THINGS TO AVOID IN IBD (6)
*AVOID HIGH fiber diet
*AVOID gas forming
*AVOID dairy
*AVOID alcohol
AVOID smoking and caffeine(↑ motility & secretion)
What is a Total colectomy with ileostomy?
removes all your large intestine (colon) and an ileostomy (a type of stoma in the ileum) is then formed using the end of your small intestine → the stoma is an opening in your abdomen, which is surgically created.
It diverts feces into a bag attached to the opening → *RLQ 2 cm below waist
Post-op care for Ileostomy
Accurate record of I&O d/t loss of large volume (continuous liquid drainage), →NG suction, rectal packing removal in 1 wk → monitor stoma
*Skin and stoma care:
*1” pink to bright red, shiny (beef fresh looking)→
-fecal drainage (continuous liquids form) begin in 24-48 hrs→ empty q 4-6hrs, change bags 5-10
days -disposable, odor-proof pouch→ don’t irrigate
-Empty when ½ - 1/3 full to prevent pulling and leaks
*Diet and fluid intake: low-residue diet x 6-8 wks,
*Avoid hard-to-digest food- (i.e: corn, nuts, fruit seeds)
*obstruction risk (diverticulum)
What is a Continent ileostomy (Kock pouch)
Surgeon removes your colon and rectum and creates an internal reservoir from your small intestine (Use distal ileum (30 cm)) to create a reservoir with a nipple valve
→ no need for external bag use → nipple valve is used to remove feces by catheter
Also used as treatment for bladder cancer when bladder is removed and ueter is connected to small intestine to make a reservoir
Irrigation helps train your body Irrigate with 10 -20 mL of warm NS → instill water gently → allow to drain via gravity using catheter
