Lower GI Problems Flashcards
(80 cards)
1
Q
Appendicitis is commonly caused by?
A
Obstruction of the lumen by feces, foreign bodies, tumor of the cecum or appendix, thickening of lymphoid tissue
2
Q
Appendicitis can lead to?
A
Abscess
Gangrene
Perforation
Peritonitis
3
Q
Appendicitis S/S
A
- Difficult to diagnose
- Pre-umbilical pain
- anorexia
- N/V
- Pain is continuous and shifts to right lower quad and localizes at McBurney’s point
- Localized tenderness
- rebound tenderness
- muscle guarding
- pain worsens with coughing, sneezing, and deep breathing
- Wants to lay still-right leg flexed
- May have fever
4
Q
Older Adults S/S of Appendicitis?
A
- Discomfort –R iliac fossa
- Pain is less severe
- Slight fever
- Diagnosis often delayed
- Higher incidence of ruptured appendix and peritonitis
- Higher fatality due to co-morbidities
5
Q
Appendicitis Diagnostics
A
- WBC-mildly to moderately elevated
- Urinalysis-r/o GU problems
- US
- CT preferred
6
Q
Treatment of Appendicitis?
A
- Immediate-Urgent Appendectomy
- NPO
- Treat pain
- ice pack & medications
- Antibiotics & IVF before surgery and after
- 6-8 hours before OR if possible – prevent sepsis and dehydration
7
Q
Preferred diagnostic procedure for appendicitis?
A
CT
8
Q
Patient Teaching for Appendicitis?
A
- Patients with suspected appendicitis should NOT use laxatives or enemas
, or apply heat to the painful area - Can result in perforation or rupture of appendix
9
Q
Post Op Nursing Interventions
A
- Watch for peritonitis (can occur with or without perforation)
- Ambulate day of surgery
- Assess incision
- Advance diet as tolerated
10
Q
Localized or generalized inflammatory process of the peritoneum
A
Peritonitis
11
Q
Causes for Primary Peritonitis?
A
- blood-borne organisms
- genital tract organisms
- cirrhosis with ascites
12
Q
Causes for Secondary Peritonitis?
A
- Peritoneal dialysis-HIGH risk;
- ruptured appendix
- diverticulitis rupture
- ischemic bowel
- pancreatitis
- perforated peptic ulcer
- gun shot or knife wounds
13
Q
Pathophysiology – organ ruptures, spills contents; chemical peritonitis initially followed by bacterial peritonitis in?
A
6 -8 hours
14
Q
S/S of Peritonitis
A
- Abdominal pain
- rebound tenderness
- Pt lies still with shallow respirations
- spasm
- Abdominal distension or ascites
- fever
- tachycardia
- tachypnea
- N/V
- altered bowels habits
15
Q
Complications of Peritonitis?
A
- Hypovolemic shock
- sepsis
- intra-abdominal abscess
- paralytic ileus
- respiratory distress
- Can be fatal if not treated
16
Q
Peritonitis Diagnostics
A
- CBC-elevated WBC count
- Abdominal Xray
- Ultrasound
- CT scan
- Paracentesis (peritoneal aspiration)
- Peritoneoscopy
- Cell count of peritoneal dialysis drainage
17
Q
What does it indicate if a patient with suspected Peritonitis has an ABD x-ray showing free air?
A
perforation
18
Q
What does it indicate if a patient with suspected Peritonitis has an ABD x-ray showing dilated loops?
A
parylytic ileus
19
Q
What does it indicate if a patient with suspected Peritonitis has an ABD x-ray showing air and fluid?
A
obstruction
20
Q
Treatment of Peritonitis?
A
- Treat the cause
- Surgery to correct inflammation and drain purulent fluid
- Medical
- if mild or pt poor candidate for OR, start an NG & antibiotics – hope tear repairs self
- Antibiotics-almost all patients
- NPO/NG suction
- Analgesics, antiemetics, sedatives
- Position - knees flexed
- IV fluids
- Monitor I&O
- Drain care-if present after OR
21
Q
Nursing Assessments for Peritonitis?
A
focused on Pain, abdominal, VS, urine output, hypovolemic shock
22
Q
Nursing Interventions for a patient with Peritonitis?
A
- IV (fluid replacement and antibiotics)
- NG monitoring and care
- I&O
- N/V
- drain monitoring
- incision and drain site care
23
Q
Types of Inflammatory Bowel Disease (IBD)
A
Crohn’s disease and ulcerative colitis
24
Q
What part of the GI is affected in a patient with Crohn’s disease?
A
can occur anywhere in the GI tract (mouth to anus)
25
Crohn's disease most often affects the?
terminal ileum and colon
26
Crohn's affects which layers of the bowel wall?
all of them
27
Inflammation and ulceration of the colon and rectum
Ulcerative colitis
28
Pathology of Ulcerative colitis?
starts in the rectum and moves towards the cecum
29
Ulcerative colitis affects which layers of the bowel wall?
- the mucosal layer or inner most layer, which is why uclers are rare
30
Signs and Symptoms IBD (Crohn's and UC)
```
Diarrhea
Bloody stool
Fatigue
Abdominal pain
Weight loss
Fever
```
31
Main symptoms of Crohn's?
- Diarrhea
- Colicky abdominal pain (comes and goes)
- Fever
32
symptoms of crohns if the small intestine is affected?
- weight loss due to malnutrition
| - nutritional problems
33
Main symptoms of UC?
- Bloody diarrhea if severe
- Abdominal pain
- Rectal bleeding
- Severity can range from 1-20 stools per day
34
IBD: Diagnostic Studies
- Rule out other diseases
- H & P
- Blood studies
- CBC-iron deficiency or blood loss
- WBC-toxic megacolon or perforation
- Serum electrolyte levels
- Serum protein levels
- Serum albumin levels
- Stool cultures
- Blood
- Pus
- Mucus
35
IBD: Diagnostic Procedures
- Sigmoidoscopy w/ biopsy
- colonoscopy w/ biopsy (preferred)
- Double-contrast barium enema
- Identifies areas of ulceration
- Capsule endoscopy
- CT, MRI, transabdominal US, small bowl series
36
Which diagnostic procedure has the greatest sensitivity for diagnosing Crohn’s Disease?
Capsule Endoscopy
37
IBD: Complications
- Nutritional deficits
- Hemorrhage
- Strictures
- Perforation (with possible peritonitis)
- Fistula with Crohn’s
- Perineal abscess with Crohn’s
- Toxic megacolon with Ulcerative Colitis
38
What are S/S of Toxic Megacolon?
- Dilation and paralysis of the colon, associated with perforation.
- Abdominal pain, distension and tenderness
- Tachycardia
- Loss of bowel sounds
39
In Crohn’s fistulas can develop where?
between the bowel and bladder, and the bowel and vagina
40
IBD Systemic Complications
- Inflammation of joints, eye, mouth, kidneys, bone, vascular, and skin due to an increase in circulation of cytokines
- Increase risk of liver failure – sclerosing cholangitis develops
41
IBD Treatment
- Hemodynamically stable
- Monitor H/H, Vital signs
- res to the bowels
- Hydrate-IVF
- Monitor electrolytes
- Pain control
- Nutritional support (TPN in severe cases)
- May need surgery
42
Diet for IBD when they can tolerate it?
high calorie, high vitamin, high protein, low residue, lactose free diet when eating
43
Drug Therapy for IBD?
- Aminosalicylates
- Antimicrobials
- Corticosteroids
- Immunosuppressants
- Biologic and targeted therapy
44
Complications related to an exacerbation of IBD?
- Massive bleeding
- Perforation
- Strictures and/or obstruction
- Toxic megacolon
- Tissues changes indicating dysplasia or carcinoma
45
Post Op Care for IBD?
- I&O
- Initial ileostomy output 1500-1800/2000mL per 24hr
- Normal 500mL/day
- Assess Stoma –shrinkage, output
- Assess for:
- Fluid & electrolyte imbalance
- Hemorrhage
- Abdominal abscess
- SBO (no bowel sounds, vomiting, no BM’s)
- Dehydration
46
Teaching for IBD?
- Rest
- Dietary modification`
- Smoking cessation
- Stress reduction
- Medication adherence
- Supplements as needed
- Ca, Iron, Zinc
- Stoma care-if stoma present
- Perianal skin care
47
2nd peak of IBD after what age?
60 y/o
48
Causes of Intestinal Obstruction?
- Mechanical- detectable occlusion commonly in the small intestine
- Non-mechanical
49
Causes of Mechanical Intestinal Obstruction?
- Surgical adhesions
- hernia
- strictures from Crohn’s
- diverticulitis
- tumor
50
Causes of Non-Mechanical Intestinal Obstruction?
- Paralytic ileus
- lack of peristalsis
- absence of bowel sounds
51
```
Clinical Manifestations of poximal SBO?
A) Onset
B) Vomitting
C) Pain
D) Bowel movement
E) Abd distention
```
```
A) rapid
B) frequent & copious
C) colicky, cramping occurs at frequent intervals
D) feces for a short time
E) minimal
```
52
```
Clinical Manifestations of LBO?
A) Onset
B) Vomitting
C) Pain
D) Bowel movement
E) Abd distention
```
```
A) gradual
B) late or absent
C) low-grade, persistent cramping abd pain
D) absolute constipation
E) Increased
```
53
Early common S/S of Intestinal Obstruction?
- N/V, abdominal pain & distension
54
Late common S/S of Intestinal Obstruction?
inability to pass flatus, constipation, may show s/s of hypovolemia
55
Diagnostics for Intestinal Obstruction?
- Absent or high pitched BS above obstruction
- CT Scan and abd Xray
- Sigmoidoscopy or colonoscopy to visualize obstruction
56
What does it indicate if a patient with suspected Intestinal Obstruction has an ABD x-ray showing the following:
A) Presence of air on scan
B) Dilated loops
C) Air and fluid
A) perforation
B) paralytic ileus
C) obstruction
57
```
Clinical Manifestations of Distal SBO?
A) Onset
B) Vomitting
C) Pain
D) Bowel movement
E) Abd distention
```
```
A) rapid
B) less frequent
C) colicky, cramping occurs intermittently
D) gradual constipation
E) increased
```
58
diagnostic labs for an Intestinal Obstruction?
- CBC
- Electrolytes
- BUN
- Creatinine
- ABG
- Stool-occult blood
59
An elevated WBC in a patient suspected of having an Intestinal Obstructions indicates?
strangulation or perforation
60
A decrease H/H in a patient suspected of having an Intestinal Obstructions indicates?
hemorrhage or strangulation
61
Intestinal Obstruction Treatment?
- NPO
- Hydrate IVF- watch for fluid over load
- NG tube
- Oral care
- Patency
- Skin breakdown
- Total Parenteral Nutrition
- May need to prep pt for surgery
- Resection
- Resection with ostomy if obstruction is extensive or necrosis is present
62
Nursing Assessments for Intestinal Obstruction?
- Monitor for dehydration and electrolyte imbalances
- Assess pain
- Assess emesis (if present) - Bowel sounds
- is pt passing gas
- when was last BM
- Abd distension-look for abdominal scars & masses
- Measure abdominal girth
- Strict I&O
63
If waiting for intestinal obstruction to resolve on own assess for _______ and report an urine output of _______?
- changes in urine output, VS, BS, rising BUN/Cr, increase in pain or distention
- urine output < 0.5mL/kg/hr
64
Intestinal Obstruction Complications?
- Severe reduction in circulating blood volume and electrolyte deficiencies
- Hypotension
- Hypovolemic Shock
- Cardiac dysrhythmias
- Intestinal strangulation or intestinal infarction
65
Intestinal strangulation or intestinal infarction can cause?
- Inadequate blood flow
- Edema
- Cyanosis
- Gangrene
- Can lead to peritonitis
66
created when the intestine is brought through the abdominal wall and sutured to the skin
stoma
67
Major types of Ostomies?
- End stoma
- Loop stoma
- Double barreled stoma
68
- Assess stoma q______ and color should be?
| -
- q4 hrs & PRN
| - pink
69
Stoma colors:
A) Dusky blue = ___?
B) Brown-black = ___?
A) ischemia
| B) necrosis
70
How often should a stoma pouch be change and should be empty when it is _______?
- q 4-7 days
| - 1/3 full
71
Output amount from a:
A) colostomy
B) Ileostomy
A) mimic normal output
| B) 1000-1800mL initially, then an average daily amount 500mL
72
How long surgery can a patient with an ostomy resume ADL?
6-8 weeks but should avoid heavy lifting
73
When should colostomy irrigation be used and why?
- only when the stoma is from the distal colon or rectum
| - to promote regular evacuation of stool
74
how to perform a colostomy irrigation?
- hold Irrigation bag 18 – 24 inches above stoma
- use 500 – 1000mL warm water flow in over 5-10 minutes – 750mL is norm
- If cramping occurs, slow down rate, may stop water but do not stop the process
- Wait ½ to 1 hour and empty reservoir bag
- Initial evacuation occurs after 15 minutes
75
Ostomy Complications?
- Skin breakdown
- Infection
- Electrolyte imbalances
76
Electrolyte imbalances are seen more often in which type of ostomy?
- ileostomy
- K
- NA
- Fluid volume deficits
77
divides the bowel. Proximal end to skin. Distal end removed or left in place (Hartman’s pouch)
end stoma
78
loop of bowel up to surface – anterior portion = feces, distal portion = mucus drainage
loop stoma
79
2 separate stomas – works like loop stoma-usually temporary
double barreled stoma
80
In a loop stoma, the anterior portion = _____, distal portion = _________
1) feces
| 2) mucus drainage
