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NURB 3141 > Lower GI > Flashcards

Lower GI Flashcards

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1
Q

constipation

A

-decrease frequency or changes in quality of BMs (less than what’s normal for the individual)

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2
Q

causes of constipation

A
  • decreased fiber, fluid, activity
  • ignoring urge to defecate
  • medications
  • diseases that slow motility
  • depression
  • stress
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3
Q

complications of constipation

A
  • decreased HR, BP, CO output, perfusion
  • valsava maneuver
  • hemorrhoids/anal fissures
  • fecal impaction
  • megacolon/chronic perforation
  • diverticulitis
  • faint/pass out
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4
Q

treatment of constipation

A
  • increase activity, fluids, fiber
  • gastrocolic reflux utilization
  • laxatives, enemas- short term
  • stool softeners
  • methylnaltexrone (Relistor) for opioid use
  • educate
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5
Q

diarrhea

A
  • at least 3 loose or liquid stools per day

- can be acute (1-2 days), persistent (2-4 weeks), or chronic (at least 4 weeks)

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6
Q

causes of diarrhea

A
  • acute & persistent: infectious organisms

- medications

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7
Q

manifestations of diarrhea

A
  • cramping
  • thirst
  • distention
  • gas
  • tenesmus
  • boyborgymus
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8
Q

complications of diarrhea

A
  • fatal electrolyte imbalance, mainly K & Na
  • dehydration
  • metabolic acidosis (from loss of lots of bicarbonate if not treated)
  • peri-anal skin breakdown
  • can be life threatening quickly in elderly, very young, malnourished, and immunocompromised
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9
Q

management of diarrhea

A
  • prevent f/e imbalance
  • control sx
  • treat underlying cause
  • infection control
  • stool studies
  • diet: clear liquids, low bulk fiber, bland foods or BRAT diet
  • prevent skin breakdown
  • teach: food maintenance, prevent spread, infectious for two weeks
  • antidiarrheal when appropriate
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10
Q

fecal incontinence

A

-involuntary passage of stool due to damage of the anal sphincters, musculature tissue, or nerves that innervate the anorectum

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11
Q

causes of fecal incontinence

A
  • anorectal surgery trauma
  • chronic constipation
  • diarrhea
  • neurologic conditions (ms, sci, parkinsons)
  • diabetic neuropathy
  • obstetric trauma
  • holding stool
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12
Q

management of fecal incontinence

A
  • rectal tube (short term use only)
  • bowel training program
  • skin care to prevent skin breakdown
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13
Q

peritonitis

A

-localized or generalized inflammation of the peritoneum

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14
Q

secondary causes of peritonitis

A
  • ruptured appendix
  • perforated peptic ulcer
  • perforated bowel
  • PID
  • trauma
  • bowel obstruction
  • peritoneal dialysis
  • surgical complication
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15
Q

pathophysiology of peritonitis

A

-inflammatory response-> massive intra-abdominal fluid shifts-> loss of circulatory volume r/t to amount of fluid shifted-> hypovolemia and electrolyte imbalances -> shock

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16
Q

complications of peritonitis

A
  • hypovolemic shock
  • sepsis
  • paralytic ileus
  • ARDS
  • death
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17
Q

manifestations of abdominal peritonitis

A
  • severe pain
  • extreme tenderness over involved area as it progresses
  • distention due to third spacing
  • decreases peristalsis
  • ascites
  • ileus
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18
Q

manifestations of systemic peritonitis

A
  • fever, tachycardia
  • increased WBC
  • n/v, anorexia
  • sx of shock (worsening tachycardia, restlessness, hypotension, tachypnea, pallor, diaphoresis)
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19
Q

peritonitis diagnostics

A
  • CBC
  • electrolytes
  • abdominal x-ray (free air= perforation, dilated loops of bowel = ileus)
  • c&s of aspiration to find cause
  • U/S, MRI, CT
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20
Q

assessment of peritonitis

A
  • abdomen (may need to measure girth)
  • s/s of hypovolemic shock
  • vs: decreased BP
  • pain: admin. meds and monitor effectiveness
  • increased WBC
  • slower bowel sounds
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21
Q

nursing dx for peritonitis

A
  • pain
  • risk for FVD
  • nutrition deficit
  • anxiety
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22
Q

implementation of peritonitis

A
  • replace fluids
  • monitor electrolytes
  • NPO, possible NGT to decompress
  • iv antibiotics
  • pain medication
  • sedatives prn
  • antiemetics if vomiting
  • oxygen prn
  • positioning
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23
Q

appendicitis

A

-acute inflammation of the appendix

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24
Q

manifestations of appendicitis

A
  • abdominal pain, mcburney’s point
  • rebound tenderness
  • rigidity
  • guarding
  • n/v, anorexia, low grade temp, mild/moderate elevation of WBC
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25
diet with appendicitis
NPO with IV fluids
26
diagnostics of appendicitis
- labs - pain, N/V - if atypical symptoms CT scanning or U/S
27
medications for appendicitis
- abx | - pain meds
28
surgery
appendectomy ASAP
29
interventions for appendicitis
- NPO with IV fluids - bedrest - no laxatives or heat - ice pack - position for comfort
30
diverticula
out-pouching micro-herniations of the mucosa through the muscular wall of GI tract, from esophagus to colon (most common)
31
etiology of diverticula
-increased intraluminal pressure and decrease in muscle strength in colon wall
32
types of diverticula
- diverticulosis | - diverticulitis
33
diverticulosis
- presence of diverticula in wall of intestine | - asymptomatic
34
diverticulitis
inflammation of one or more diverticula
35
manifestations of diverticulitis
- acute, persistent, crampy, LLQ pain - constipation - fever, leukocytosis, N/V - can progress to abscess, severe bleeding and peritonitis - chronic episodes can lead to fistulas and strictures from scar tissue formation depending on inflammation
36
complications of diverticulitis
- GI bleeding (bright red because of lower GI) | - severe pain
37
diagnostics of diverticulitis
- colonoscopy for "losis" | - CT with contrast for "litis"
38
treatment for diverticulitis
- rest bowel, NPO or clear liquids - IVF, antibiotics, analgesics - usually clears after 48-72 hours - prevention education - antispasmodics: control cramping
39
education for diverticulitis
- prevent constipation with high fiber diet and/or bulk forming laxatives - dont consume high fiber when experiencing sx of inflammation - keep fluids around 2,000 mL/day to soften stools - avoid activities that increase intrabdominal pressure - ID any food triggers to avoid
40
typed of intestinal obstruction
- mechanical: a detectable occlusion, usually in small intestine - function/paralytic ( most common form is a paralytic ileus) - can be partial or complete - can be in the small or large intestine
41
etiology of intestinal obstruction
adhesions
42
pathophysiology of intestinal obstruction
- fluid, gas, and intestinal contents accumulate above area of obstruction - distention - plasma leaks into peritoneal cavity - decreased circulating blood volume (IVVD), dehydation - hypotension and hypovolemic shock - bowel tissue becomes ischemic - massive infection - septic shock - death
43
small intestinal obstruction
- crammy wave like pain - vomiting (may be orange, brown, fecal smelling) - BM for short time - abdominal distention - high obstructions lose HCL -> metabolic acidosis
44
large intestinal obstruction
- slower, more gradual onset - rare vomiting - pain is lower grade, cramping abdominal pain - no BM, constipation more quickly - dehydration and F/E imbalance more slowly
45
assessment of intestinal obstruction
- high pitched, tinkly bowel sounds above area of obstruction early, may hear none later - abdominal distention; may see peristaltic waves in abdomen - ongoing assessment for acute abdomen, indicates strangulation
46
labs of intestinal obstruction
- infection, electrolytes | - dehydration labs... concentrated H/H; high BUN
47
radiology testing of intestinal obstruction
flat and upright xray of abdomen, CT
48
treatment of intestinal obstruction
- parenteral nutrition - NPO - IVF to correct/prevent IVVD - electrolyte replacement and IV antibiotics - pain management, avoid opioids - semi-fowlers position - surgical measures - NGT to LIWS to decompress - measure abd girth, monitor output, irrigate q 4hrs w/ 30 mL to maintain patency - possible rectal tube for large intestine obstuctions to decompress - monitor for improvement in bowel function
49
complications of intestinal obstructions
- IV or hypovolemic shock due to fluid shift - electrolyte imbalance - renal insufficiency - peritonitis with or without actual perforation - septic shock - death
50
inflammatory bowel disease
- chronic inflammation and or ulceration of the GI tract - periods of remission with periods of exacerbations - autoimmune
51
common s/s of IBD
- diarrhea - bloody stools - weight loss - abdominal pain - fever and fatigue
52
cause of IBD
-unknown, possibly genetics
53
types of IBD
- ulcerative colitis | - crohn's disease
54
treatment of IBD
- NPO/TPN when acute - low residue, high protein, high calorie with vitamin/mineral supplement - reduce lactose - caution with GI stimulants (pepper, caffeinated drinks)
55
medications for IBD
- aminosalicylates (sulfasalazine): decreases inflammation by direct contact with GI mucosa - antimicrobials: prevent or treat secondary infection from abscesses, often metronidazole - corticosteroids: decrease inflammation - immunomodulators: suppress immune response... imuran, methotrexate - biologics- inhibit tumor necrosis (TNF)... remicade, humira
56
pathophysiology ulcerative colitis
- inflammation of colon/rectum - ulcerations develop in mucosal layer only - pseudopolyps form in areas of inflamed mucosa
57
manifestations of ulcerative colititis
- LLQ pain/cramping - urgency - bloody or mucousy diarrhea - tenesmus - anorexia - fatigue - fever when acute
58
complications of ulcerative colitis
- toxic megacolon & possible performation - bleeding - dehydration
59
pathophysiology of crohn's disease
deep ulcerations in any portion of the GI tract form and penetrate through the entire wall -lots of mucosal edema, "cobblestone" appearance
60
manifestations of crohn's disease
- right side colicky abdominal pain - diarrhea/semi solid large stools - pus in stool - weight loss/malnut/anemia if malabsorption - steatorrhea
61
complications of crohn's disease
- perforation of ulcerations - fistulas - malabsorption - strictures - f/e imbalance
62
complications of UC and chron's disease
- mild to sever excacerbations - hemorrhage - strictures - perforation - metabolic acidosis - fistulas
63
surgical treatment for uc & chron's
- only if not responding to medical therapy - uc: protolectomy with ileostomy - chron's: stricture plasty (widen narrowed bowel), resection and anastomosis, intestinal transplant
64
irritable bowel syndrome
-intermittent, recurrent abdominal pain, stool pattern irregularities (diarrhea, constipation, both)
65
manifestations of IBS
- abdominal distention - excessive flatulence - bloating - urgency
66
polyps
- growth on mucosa of colon that can call rectal bleeding - mostly benign - easy removal to decrease incidence of colorectal cancer - can grow and become an obstruction
67
hemorrhoids
- dilated hemorrhoidal veins | - can be internal or external
68
manifestations of hemorrhoids
- rectal bleeding - pruritis - pain - can become thrombosed
69
treatment of hemorrhoids
- high fiber with fluids | - surgery as last result
70
anal fissure
skin ulcer or crack in lining of anal wall caused by trauma, local infection, or inflammation
71
sx of anal fissure
- anal pain | - bleeding
72
treatment of anal fissures
- topical angalesics, stool softeners | - surgery as last resort

NURB 3141 (5 decks)

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