Lower GI: Diverticulitis, Colon Cancer, PCA

Question 1

What is diverticulitis?

Answer 1

• Inflammation of diverticula (small pouches in the intestine)
• Usually occurs in descending colon

Question 2

What is the path of diverticulitis?

Answer 2

• High intraluminal pressure causes diverticula to form in weak spots in the GI wall.
• Undigested food and bacteria accumulate in the diverticula, leading to inflammation
• If untreated, rupture can occur

Question 3

What are the risk factors that can lead to diverticulitis?

Answer 3

• Low fiber diet
• Genetics
• Obestity
• Smoking/alcohol
• NSAIDs
• Corticosteroids

Question 4

What are the s/s of diverticulitis?

Answer 4

• LLQ abdominal pain (descending, sigmoid colon)
• Bloating
• Fever
• N/V

Question 5

What lab results would indicate diverticulitis?

Answer 5

• ↑ WBCs, ESR

* ↓ Hgb/Hct with bleeding

Question 6

What dx tests would be ordered for diverticulitis?

Answer 6

• Barium enema
• Colonoscopy
• CT
• Lower GI series

Question 7

What is the medication treatment for diverticulitis?

Answer 7

• Abx

* Analgesics

Question 8

What complications need to be monitored for with diverticulitis?

Answer 8

• Perforation
• Peritonitis
• Bleeding
• Fistula

Question 9

What is the pt teaching for diverticulitis?

Answer 9

• NP or clear liquid diet during exacerbations, then progress to low-fiber diet
• After immediate resolution, move to high-fiber diet

Question 10

What surgical tx is available for diverticulitis if medication doesn’t work?

Answer 10

• Colectomy

Question 11

True or False

The pt w/ diverticulitis is at increased risk for cancer.

Answer 11

• True

Question 12

What lifestyle change can a patient do to help keep the bowel active?

Answer 12

• Exercise

Question 13

What is used to help clean out the bowel with diverticulitis?

Answer 13

• GoLytely, a common laxative

* Mixed in 3L water and pt needs to drink whole thing

Question 14

In general, good bacteria like what kind of food?

Answer 14

• Vegetables

Question 15

In general, bad bacteria like what kind of food?

Answer 15

• Sugars and fats

Question 16

What screening needs to be done for colon cancer?

Answer 16

• Guaiac test, annually
• Colonoscopy, every 10 yrs
• Sigmoidoscopy, every 5yrs

Question 17

What are the risk factors for colon cancer?

Answer 17

• Older age
• High-fat diet (especially red meat)
• Genetics
• Smoking/alcohol
• Obesity
• Sedentary lifestyle

Question 18

What labs and dx tests are done for colon cancer?

Answer 18

• Colonoscopy w/ biopsy (definitive)
• Positive Guaiac
• CT/MRI

Question 19

What is the tx for colon cancer?

Answer 19

• Chemotherapy/Radiation
• Colon resection
• Colectomy w/ colostomy/ileostomy

Question 20

Describe stage 1 of colon cancer.

Answer 20

• Cancer has grown through the mucosa layer of the colon/rectum but hasn’t spread beyond the colon/rectum wall

Question 21

Describe stage 2 of colon cancer.

Answer 21

• Cancer has grown into or through the wall of the colon/rectum, but hasn’t spread to nearby lyph nodes

Question 22

Describe stage 3 of colon cancer.

Answer 22

• Cancer has invaded nearby lymph nodes, but isn’t affective other parts of the body yet

Question 23

Describe stage 4 of colon cancer.

Answer 23

• Cancer has metastasized to distant parts of the body

Question 24

What occurs with a partial colectomy?

Answer 24

• The disease section of the colon is removed

* The cut ends are then re-attached to repair colon

Question 25

What is a total colectomy?

Answer 25

• The entire colon is removed

Question 26

What is the Abdominal Perineal Resection procedure?

Answer 26

* Done for distal colon cancer w/ large tumor * Colon is cut and non-cancerous portion is diverted to abdominal wall colostomy * Rest of colon and rectum is completely removed and anus is sealed * A perineal drain is inserted to drain exudate * No rectal temp may be taken again, as there is no rectum

Question 27

What is a PCA and what is it used for?

Answer 27

* Patient Controlled Analgesia | * To control severe pain post-surgery

Question 28

The physician’s order reads… ``` PCA infusion to administer: 5% Dextrose 100ml w/ 100mg morphine sulfate to infuse as follows: Loading dose: 2mg Maintenance dose: 1mg/hr PCA dosage: 0.5mg Lockout interval: 15 min ``` This client pushed PCA button every 30mins for your shift after given the loading dose at 9am. Client pushed the first button at 9:30am. How much did the client receive morphine for your 8am – 3pm shift?

Answer 28

Ans: 14

Question 29

What must be done at setup of the PCA pump?

Answer 29

• Double check with another nurse

Question 30

What must be assessed hourly for those on a PCA pump?

Answer 30

* Resp status * Pain * Mental status * Adverse effects of morphine (itching, n/v)