Noninflammatory Intestinal Disorders

Question 1

Symptoms of IBS

Answer 1

May see cramping, abdominal pain, and bloating.

Women are 2-3X more likely than me to have(hormones play a role).
Symptoms are worse or more frequent during stressful events.
The most common digestive issue(usually diagnosed by testing stool)

Question 2

Non pharmacological treatment of IBS

Answer 2

Diet and symptom diary
Modify the diet
Adequate fiber(30-40g)
Adequate fluids 
Stress management
Exercise counseling

Question 3

Drug therapy for IBS-C

Answer 3

Bulk forming laxatives(Metamucil)

Luboproatone(amitiza)

Question 4

Drug therapy for IBS-D

Answer 4

Antidiarrheals(Imodium)

Alosetron(lotronex) CAUTION
- monitor extremely closely, it can totally stop peristalsis

Question 5

More meds for IBS

Answer 5

Tricyclic antidepressants(Elavil)
-good for abdominal pain

Peppermint oil, probiotics
-restore and maintain health bacteria

Question 6

Herniations

Answer 6

Weakness in a muscle wall through which something is allow to protrude

Question 7

Inguinal hernia

Answer 7

(occur mostly in men) often occur in baby boys

Question 8

Acquired hernias

Answer 8

Just happen, may be doing a lot of lifting, straining, stress, obesity

Question 9

Ventral hernia

Answer 9

Incisional

Question 10

Hernia term: reducible

Answer 10

Can be manipulated back through internally back through the muscle. NOT done by standard RN

Question 11

Hernia term:

Incarcerated(irreducible)

Answer 11

To large or the split in the wall is not big enough to get it back through

Question 12

Hernia term:strangulated

Answer 12

Not getting enough blood supply

Question 13

Herniorrhaphy/Plasty

Answer 13

Surgical repair of hernia by MIS(Plasty if they put in mesh)

Elderly are not good candidates to have hernia reduced.

Question 14

Post hernia surgery care

Answer 14

May use abdominal binder(put on while laying down)

Do not cough your patient.
Often give stool softeners.

Truss: support held against hernia(put on while laying down)(usually given to someone who cannot have hernia surgery)

Question 15

Colorectal cancer

3rd most contracted cancer

Answer 15

Lower survival rate in African Americans.
Hot spot is the sigmoid.

Usually starts with a pallop(cells go through changes)

Rich blood supply in that area( metastasizes very easily)

Question 16

Etiology of colorectal cancer(CRC)

Answer 16

HX of ulcerative colitis/cronh's.
Family HX of colon cancer.
High fat low fiber diet
Smoking/alcohol 
Increased body fat

Question 17

Assessment finding with CRC

Answer 17

Change in stool consistency and shape.
Rectally bleeding 
Anemia
Distention 
Incomplete evacuation of stool.
Fatigue 
Weight loss

Question 18

Screening/Disgnosis of CRC

Answer 18

Fecal occult blood test
Serum test CEA level(carcinoembryonic antigen)
Barium enema or CT scan
Colonoscopy and biopsy

Question 19

Radiation of CRC

Answer 19

Does not work well to improve survival, but helps local control(may use before surgery)

Can be palliative

Question 20

Chemotherapy of CRC

Answer 20

FOLFOX4, 5-FU,leucivin,eloxatin(can’t tell normal cells from cancer cells, just kills active growing cells)

Avastin: advanced CRC(more targeted to cancer cells and helps reduce blood flow to cancerous tumor.

Question 21

Colon resection with anastomosis

Answer 21

Cut out the Tumor and out the stomach back together

No colostomy

Remain a patent bowel

Question 22

Collecting with colostomy or ileostomy

Answer 22

Completely or partially removed colon

Ileostomy: entire colon removed
Colostomy: part of colon removed

Question 23

Abdominoperineal(AP) resection

Answer 23

For cancer in lower 1/3 of the colon.

Go into abdominal area and remove the rectum

Will have JP drains coming out of rectal area.

Question 24

Certified wound, ostomy, continence nurse

Answer 24

Ostomy:surgically made opening.

Opening is called the stoma

Question 25

Loop colostomy

Answer 25

Frequently are temporarily used to divert feces through and area

Question 26

Colostomy management: teaching tips

Answer 26

``` Normal appearance of stoma. S/S of complications Measurement of stoma The choice,use,care and application of appropriate alliance to cover stoma Nutrition changes to control odor Resumption of normal activities ```

Question 27

Normal appearance of stoma

Answer 27

Pink,rosy,moist(not black) Most ostomys protrude out 3-4" When colostomy is formed usually takes 2-3 days to start working

Question 28

Recognition of potential complication of ostomy

Answer 28

should not bleed, should not have cramping or pain in stoma, is stoma still cuffed?

Question 29

Mechanics of the bag

Answer 29

``` Needs to remain covered Measure once a week for six weeks. 1/8"-1/16" cut right around stoma. Wafer can be on up to 7 days. Clean around stoma with soap and water. ``` Empty bag when 1/2-3/4 full

Question 30

Skin perfection with ostomy

Answer 30

Often develop fungal infection around stoma. Don't let drainage continue over skin. Ostomy irrigation: garunteed the individual won't have feces come out for a few hours.

Question 31

Dietary concerns with ostomy

Answer 31

There are no dietary restrictions Cranberry juice helps demise the smell of feces

Question 32

Resuming activities

Answer 32

Should be treated like patient with abdominal surgery. Restricted weight activities Driving restrictions

Question 33

Mechanical obstructions

Answer 33

Adhesions(scar tissue very common,look like bands of tissue) Hernias Structures Tumors Fecal impactions

Question 34

Non mechanical obstructions | AKA:paralytic ileus

Answer 34

Temporarily stops working Abdominal surgery or trauma Peritonitis Hypokalemia(peristalsis slows down)

Question 35

Clues to bowel obstruction

Answer 35

Abdominal pain may be sporadic or constant Abdominal distention, perhaps perstaltic waves -may see lateral movement in abdomen Bowels sound active in early obstruction, absent in later Hypovolemia/dehydration Vomiting(may contain fecal matter) Lack of stools or diarrhea

Question 36

Management of bowel obstruction

Answer 36

NG tube placement to suction NPO IV fluid replacement(especially K) Surgery(exploratory laparotomy)

Question 37

Lactose intolerance

Answer 37

A malabsorptive disorder Lactase deficiency. S/S: diarrhea,bloating, abd. Discomfort after meals Enzyme products available(lactaid)

Question 38

Irritable bowel syndrome | AKA:spastic colon

Answer 38

``` Bowel motility problem IBS-D(diarrhea) IBS-C(constipation) IBS-A(alternating) IBS-M(mixed) ```