cough deep breathe sneeze- if no pain not appendicitis - rebound tenderness - BP. HR, RR- peritonitis with rupture

Lower GI Flashcards by Abby Yaske

Bowel obstruction: patho

Passage of intestinal material is impaired

can be complete or partial
strangulated = no blood supply

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Bowel obstruction: non-mechanical cause

paralytic
inflammatory
electrolyte
interrupted blood supply

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bowel obstruction: priority labs/diagnostics

Abdominal x-rays CT scan
Scope
CBC- metabolic profile

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bowel obstruction: priority interventions

NPO
NG
IV fluids (LR)
I&O
Oral care
Pre-post surgery care (possibility of stoma)

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bowel obstruction: complications

Perforation
Strangulated necrotic bowel 
Septic shock 
Ostomy 
Fatality

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bowel obstruction: meds

pain- GI (H2 blockers, PPIs)- vasopressors

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bowel obstruction: education

Bowel movements- go when you get the urge – schedule
Know symptoms of obstruction
Ostomy care –
Weeks for recovery

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Small bowel obstruction: cause

Adhesions
Intussusception (more in infants, bowel folds back on self)
Volvulus
Paralytic ileus

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Small bowel obstruction: assess

distention
bowel sounds
vomiting
dehydration
pain
last BM

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Small bowel obstruction: management

Decompression (NG)
Fluid replacement
Surgery

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What might you expect will start happening in a client with BO?

eventually start vomiting fecal contents

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Constipation: what?

less than 3 stools / week

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Constipation: assess

abdominal distention
pain
cramp
don’t feel like they have emptied

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Constipation: complications

Hemorrhoids (d/t pressure)
Anal fissures (d/t pressure)
Increase arterial blood pressure
Vagal stimulation (drop HR and BP, syncope)
Megacolon (colon stretches to compensate)

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Constipation: treatment

Increase fluid intake
 Increase dietary fiber 
Exercise 
Laxatives- non stimulant first (softeners like colace) 
Enema last resort

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What is considered diarhhea?

more than 3 stools per day or abnormally liquid stool

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Diarrhea: cause

meds, metabolic disorders, infectious process, intestinal obstruction

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Diarrhea: manifestations

Borborygmus, abdominal cramps, thirst, anorexia, tenesmus (ineffective straining)

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Diarrhea: complications

Metabolic acidosis
Hypokalemia
Dehydrations

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Diarrhea: elderly

Become dehydrated quick

Digoxin (watch for problems w digoxin because hypokalemia and dig toxicity and really common)

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Appendicitis: assess

cough deep breathe sneeze- if no pain not appendicitis

rebound tenderness
BP. HR, RR- peritonitis with rupture

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Appendicitis: complications

peritonitis

abcess

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appendicitis: interventions

Prep for surgery
NPO may need NG 
Bowel Sounds 
Post op care 
BP HR RR

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Why are we not going to give someone who is constipated a laxative if they already have appendicitis?

may cause appendix to rupture

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appendicitis: s/s

``` Sudden pain RLQ NV Loss of appetite Fever Constipation or diarrhea Abdominal bloating ```

Appendicitis: meds

analgesics antiemetics antibiotics

appendicitis: teaching

Discharge in 24 hours if no complications Med teaching if on antibiotics Signs of wound infection

Diverticular disease: patho

Sac-like herniation of the lining of the bowel extending through a defect in the muscle layer

What is diverticulitis vs diverticulosis?

Diverticulosis: outpouching Diverticulitis: inflammation/infection of the outpouching

Diverticular disease: cause

``` Low fiber Constipation Obesity ETOH smoking ```

Diverticular disease: assessment

``` NV Pain LLQ (worsens w strain, lifting or cough) Flatulence Blood in stool signs of perforation ```

Acute diverticular disease: s/s

fever, chills, increase in pain

Diverticular disease: tests for acute phase

CT scan

Diverticular disease: tests for chronic

scope

Diverticular disease: tests

CBC | blood cultures

Diverticular disease: complications

``` perforation peritonitis sepsis fatality ostomy ```

Diverticular disease: interventions

``` NPO IV fluids I&O Post op care Advance diet ```

Diverticular disease: meds

Antibiotics (primarily metronidiazole), stool softeners, laxatives (bulk over stimulant)

Diverticular disease: education

prevention (don’t get constipated) avoid fat and meats increase fluids avoid activity that increase intrabdominal pressure

Crohn's and Ulcerative colitis: location

Crohn's: mouth to anus | Ulcerative colitis: Rectum to cecum

Crohn's and Ulcerative colitis: inflammation

Crohn's: skilled pattern (cobblestone) | Ulcerative colitis: continuous

Crohn's and Ulcerative colitis: complications

Crohn's: abscess peritonitis, narrowed lumen scarring, ulcerative fistulas, small intestine cancer Ulcerative colitis: Inflamed mucosa prevents absorption of electrolytes and water, Toxic megacolon, colorectal cancer

Crohn's and ulcerative colitis: Diet

Crohn's: high fruit, fiber | Ulcerative colitis: high intake vegetables

Crohn's and ulcerative colitis: tests

``` C reactive protein WBC CBC stool metabolic profile CT MRI barium enema scopes ```

Crohn's and ulcerative colitis: interventions

``` prep for testing weight assess fluid loss I & O NPO- acute phase IV fluids/electrolytes Nutritional needs Monitor Stools for consistency bowel sounds Hygiene ```

Crohn's and ulcerative colitis: surgery

may eventually have all of colon removed Ileostomy care --> initial output can be up to 1800 ml / 24 hours Significant for maintaining hydration for client

Crohn's and ulcerative colitis: education

``` hygiene high protein, calories, vitamins Stress reduction emotional needs Medication administration ```

Ileostomy

Creation of opening into ileum

Ileostomy: kock pouch

Continent ileal reservoir

Ileostomy: ileoanal anastomosis

Voluntary defecation is maintained

Ileostomy: nursing care

``` Stoma should be pink or red and moist Stoma will change sizes post op Drainage should begin in 72 hours Kock pouch will have a catheter for continuous drainage 1-3 weeks post op Fluid loss Skin care ```

Colorectal cancer: begins as what?

benign polyp

colorectal cancer: risk factors

age and family

colorectal cancer: monitor

monitor minor bowel changes | -- blood in bowel / stools

What is a late indicator of colorectal cancer?

abdominal pain

What is an early indicator of colorectal cancer?

blood in stool

Colorectal cancer: CEA levels (cancer antigen levels)

indicate prognosis and should return to normal post tumor resection – if elevated, you have cancer

Colorectal cancer: complications

obstruction by the tumor

Hemorrhoids

Dilated veins in the anal canal | Related to shearing of the mucosa

Hemorrhoids: s/s

itching pain bright red bleeding with defication

hemorrhoids: treatment

increase fiber good hygiene light exercise all of these will help improve peristalsis and avoid constipation

Lower GI Flashcards

(61 cards)