Flashcards in Test #3 Chapter 59: Care of Patients with Non-inflammatory Intestinal Disorders Deck (58):
Irritable Bowel Syndrome info
Do not get this confused with irritable bowel disease. That is a whole different group.
This is sometimes referred to as the nervous colon or spastic colon.
People that have this are typically nervous type of people.
They believe that stress can act upon the colon and cause the symptoms.
This does not mean that is the only cause but it may not help the issue. People can be genetically predisposed to this.
What is Irritable Bowel Syndrome
Mucosal inflammation and abnormal intestinal motility which alter gut function and generate symptoms. Also called spastic colon or nervous colon.
What are the S&S of Irritable Bowel Syndrome
S&S: Abdominal pain, bloating and cramping. Changes in bowel movements such as diarrhea and or constipation.
What is the etiology of Irritable Bowel Syndrome
Etiology: Unclear, but may be a result of environmental, immunologic, hormonal and stress.
Typically begin in young adulthood and continues through-out the patient’s life. Environmental can be like what they consume such as being allergic to dairy products or people that consume caffeine ect.
True or False
IBS is not the same as IBD (Inflammatory Bowel Disease), which includes Crohn’s and Ulcerative Colitis
***What are the nursing interventions for Irritable Bowel Syndrome?
Health teaching- there is not a cure. There is not any medications that can make it go away.
So the main intervention for this group involves teaching them about what needs to be removed from their diet.
Their diet should be clean and simple, and do that for a while and start adding things back one at a time such as lets add cheese and see how you do.
They need to be advised to avoid caffeine, alcohol, eggs, wheat...stuff like that.
They need to be advised to increase their fiber and increase their water intake. This is to help fix the diarrhea and constipation, and the diet change helps start fresh and add things back one at a time to see what exactly it is in their diet that aggravates their colon.
Drug therapy includes antibiotics, immodium, probiotics. These treat the symptoms.
Stress reduction. and Complementary things can be used as well. We need to mainly teach about lifestyle changes.
What is a Hernia
Hernia is a weakness in the abdominal muscle wall through which a segment of the bowel or other abdominal structure protrudes.
What are the risk factors for a hernia
Risk Factor: Obesity, Heavy lifting, Constipation, Pregnancy, Age, Males, Genetics
What are the S&S of a hernia
S&S: Lump or Protrusion
What are the 5 Types of Abdominal Hernias?
1. Indirect Inguinal Hernias
2. Direct Inguinal Hernias
*3. Umbilical Hernias (most common in obese and pregnant women)
*4. Incisional or Vertical Hernias ( This is more common after surgeries, can be at risk for up to a year after surgery as well)
5. Femoral Hernias
What do you chart about a hernia? (3 main things)
1. What type
2. Where at
3. Classification (must palpate)
Hernia's are classified into categories. What are the 3 main categories?
Which one of these categories of hernia's is considered emergent?
Which one of these categories of hernia's is considered urgent?
What is a Reducible hernia?
you can push this one back.
When the person stands, it will protrude, and when they sit, it disappears.
**This is not something that you call the doctor about right away.
You must chart it, and then make sure that the doctor knows about it next time he comes in.
Doesn’t usually have pain.
What is a irreducible hernia?
cannot be pushed back. This is one that is in the middle.
They might need surgery and they might not.
**This is something that you would let the doctor know as soon as you could. Do not go more than 12 -24 hours without letting the doctor know. If it is 3 am and the doctor comes in at 5, there is no need to call and wake him up.
**This is more urgent.
Doesn’t usually have pain.
What is a Strangulated hernia?
Strangulated- or twisted, the blood supply is getting cut off to that part of the bowel.
Remember once ischemia sets in, it is irreversible.
**This is emergent. Call the doctor ASAP.
S/S of this include hypoactive bowel sounds, severe abdominal pain in that area.
Nausea and vomiting from the pain and back up.
Always go to surgery. No choice.
What is the Non-Surgical Management for hernia's
Truss- kind of like support underwear that hold the hernia in.
Education- Teach them that they need to wear all of the time except for when they are asleep or in the shower. But as soon as they get up or get out of the shower, they need to put it on. Holds it in place and makes it more comfortable.
What is the Surgical Management for hernias
(MIIHR) Minimally Invasive Inguinal Hernia Repair.
Usually done laprascopically.
They might have a small 1 inch incision.
They might have to have an open surgery if they are not a candidate or if it turns out to be more serious like a strangulated hernia ect. This is just up to the doctor.
Usually, they apply a mesh to the area to give the abdominal wall some support and it holds it in like the truss and keeps everything where it should be.
*** What is the post-op care for someone that had hernia surgery?
non-invasive is less post op care than invasive.
**Monitor respiratory, no coughing, dressing changes daily,
**General Postoperative care, exception Avoid Coughing- do not want any aggressive post-op movement down below that can mess up the mesh or the incision.
They still do all of the other respiratory precautions but just not the coughing.
**Daily dressing changes until the staples are removed. Those usually stay in about 10 days. They may even go home with the staples in place and then come back to the doctor to have them removed when ready.
*****Colorectal refers to colon and rectum. What are the risk factors?
Age > 50,
genetic predisposition (if your parent had this, you are going to have a colonoscopy earlier) , family history, travels extensively (eating foods with a lot of bacteria that hangs out in the bowel), smoking, obesity, sedentary lifestyle, heavy alcohol consumption, diet (link between how you eat, such as fast food all of the time ect)
What are the S&S of Colorectal Cancer?
S&S: Rectal Bleeding, Anemia, Change in stool consistency( usually what they complain of first) and shape
What are the Nursing Interventions for preventing Colorectal Cancer?
Diet: Decrease fat and refined carbohydrates and increase fiber
Smoking Cessation (main things)
Increase Exercise ( main things)
What are the Nursing Interventions once they have Colorectal Cancer.
(once they have it, you are no longer going to beat them over the head with ways to prevent it.
Interventions include ways to diagnose it.
Lab Values: H&H often decreased (anemic because loosing a lot of blood, do they need a transfusion or are they ok?), Fecal Occult Blood Test positive (if it turns blue then they have blood in their stool. this is the easiest and quickest way to determine if there is blood in the stool. rule 48 hours prior avoid aspirin, red meat, NSAIDs) Negative test does not rule out colon cancer.
Assess medications patient is taking. Coumadin or other things that put them at risk for bleeding
Colonoscopy: Definitive test for diagnosis of colorectal cancer
True or False
Once a person has colorectal cancer, their survival rate is low. It does not always get detected early.
What is the Non-Surgical Management for Colorectal Cancer
Non-Surgical Management for colorectal cancer is radiation and chemotherapy. Education for these topics include do not go into the sun without protecting the radiated area for up to a year ect.
What is the Surgical Management for Colorectal Cancer
Surgical Management- they are going to remove that part of the colon, so it is a colon resection, they may or may not get a colostomy, it just depends on where the tumor is located. They will remove the part where the tumor is located and then check the femoral lymph nodes to see if there is any cancer present. Then they will stage it accordingly.
***What is the first thing that you need to know about a colostomy?
the first thing that you have to know is that it can be placed at different locations. You must know the different locations in order to provide great nursing care. To find out where it is located, you can either look at the abdomen, ask the patient, or check the chart. Just figure it out.
**Why is it important to know where a colostomy is located on a patient?
Because the stool looks different in different parts of the colon. You must know what is normal so that you know what to look for that may be abnormal.
**What does stool in the ascending colon look like?
Stool in the ascending colon would look like water. It is more liquid.
**What does stool in the Transverse colon look like?
Transverse colon would look more pasty.
***What does stool in the descending colon look like?
The descending colon will be solid in nature.
*** After a colostomy is placed, what should the stoma look like?
The Stoma- the color should be beefy red and moist.
If not, call the doctor.
***What is the Post-op after a colostomy is placed?
after a colostomy is placed, the patients stool will be loose for 2-4 days. It will then change depending on where it is located.
Priority nursing interventions include monitoring the stoma for color, make sure it is getting circulation, and monitor the skin around the stoma. It may be monitored by wound care, however it is the nurses job to check it daily and chart it. If it is not looking well, it needs to be reported to the doctor.
Intestinal Obstructions are fairly common. They Can be Partial or Complete obstruction.
What are the two classifications of intestinal obstructions?
Classified as Mechanical or Non-Mechanical (Paralytic Ileus)
What is the etiology of Intestinal Obstructions?
Etiology: Can start out as just constipation and then lead to a Fecal Impaction, or could be a Tumor, Adhesions, Hernias, Strictures, Volvulus. Anything that might restrict flow within the bowel.
What are the S&S of Intestinal Obstructions?
S&S: Severe Abdominal pain or cramping, nausea and vomiting (can’t keep anything down). Obstipation (means severe constipation) , Diarrhea
What are the Nursing Interventions for Intestinal Obstructions when they come into the ER?
If someone comes in complaining of Severe Abdominal pain or cramping, nausea and vomiting (can’t keep anything down). Obstipation (means severe constipation) , Diarrhea, we get labs and then Abdominal CT to diagnose. It tells where it is obstructed exactly,
The main goal is to rest the bowel. They do not want anything going through it. To do this, they are NPO, they get NG Tube, IV Fluids, Opioids Analgesics *****(once diagnosed), Anti-Nausea Medication.
What are the Nursing Interventions for Intestinal Obstructions when they come to the Med-surgre floor?
Once a person is up on the med-surge floor, they have already had labs drawn, CT, Meds Given, NPO, NG Tube and IV. It is now your job to make sure to recognize if they are getting worse because not everyone gets surgery right away. They try to rest the bowel first and then do surgery later.
**Monitor s/s to see if resting the bowel is working or not. Look for if the pain is getting worse, monitor bowel sounds to make sure they are not absent (must listen 5 min in each quadrant) then chart, and rebound tenderness. Abdomen might get hard or rigid. These are things that you would need to call the doctor for.
What is the Surgical Management of an intestinal obstruction?
Surgical Management: Exploratory Laparotomy- overall goal is to fix the obstruction problem.
Postoperative Care- normal post op care.
Most of these people will go to the ICU. It just depends on the extent of the trauma.
injury to the structures located between the diaphragm and the pelvis.
What is the etiology of abdominal trauma?
Etiology: Blunt or penetrating forces. MVC, Falls, Aggravated Assaults, Contact Sports, etc.
Who is at risk for abdominal trauma?
Risk: <40 years of age
****What are the nursing interventions for abdominal trauma?
ABCs. Once they have had trauma to the abdomen it makes it hard for them to breathe.
IVs, IV fluids, T&C, NPO, Labs, ABG, Detailed Assessment (must do all of the systems. Not just a focused assessment because you may not be able to see what else may be going on (neuro, heart, lungs, especially GI, extremities)),
(Be careful with NGT and Foley Catheter, if they are bleeding, we do not put these in or if the patient has brain trauma, we don’t put an NG Tube)
One of the major things to look for with abdominal trauma is bruising. Ecchymosis across the abdomen may indicate organ injury.
Cullen’s Sign is bruising around the umbilicus area. Can be from pancreatitis, trauma.
Grey Turners Sign is bruising along the flanks.
These people are generally pretty sick. Neuro, they might be confused, Urine output will be low due to their blood loss. This is why they typically go to ICU.
What is the typical surgery for abdominal trauma?
Surgery: Exploratory Laparotomy- they may not know where the bleeding is coming from so they will go in an look around until they find it.
What are Polyps
Small growths covered with mucosa and attached to the surface of the intestine.
Start benign but have potential to become malignant. This is why we want to go in there and get them removed before they change. They typically start developing when people turn 50. If they find polyps, the patient will need to have a colonoscopy more frequently to keep an eye one them.
Usually asymptomatic and are discovered during colonoscopy
What are the Nursing interventions for polyps
Nursing interventions for polyps pertains to education. Teach the patients that they need to get a routine colonoscopy at 50 so that they can fix something while it is still easy to fix. They will simply remove the polyps and you can go on with your life.
What are Hemorrhoids
Swollen or distended veins in the anorectal region
What is the etiology of Hemorrhoids
Etiology: Intra-abdominal pressure causes elevated systemic and portal venous pressure which is transmitted to the anorectal veins.
What is the risk factors for developing Hemorrhoids
Risk Factors: Pregnancy, Constipation (straining a lot) , Obesity, Prolonged sitting, standing, decreased fluid intake, strenuous exercise
What is the S&S of Hemorrhoids
S&S: Bleeding, Swelling, Pain when using the restroom, Prolapse, Itching, Mucous discharge
****Hemorrhoids can be internal or external.
True or False
This is important for charting. You first must chart if it is internal, external, or both.
How are Hemorrhoids diagnosed?
Diagnosed by inspection and digital examination done by the doctor.
***What are the Nursing Interventions for Hemorrhoids
Prevent Constipation, so they need to be educated about their Diet. Constipation is a risk factor for hemorrhoids.
Once they have them, Cold packs, sitz bath (Sitting in a bucket of warm water), lidocaine, Dibucaine, teach them to keep the area clean, so best to use wet wipes instead of toilet paper
Surgical Therapies- remove them. give them a doughnut to sit on.
What is Malabsorption Syndrome
Nutrients are not absorbed correctly related to the flattening of the mucosal lining of the intestines.
Inability to absorb nutrients as a result of generalized flattening of the mucosa of the small intestine.
What are the S&S of Malabsorption Syndrome
****Chronic Diarrhea, Steatorrhea,
*****unintentional weight loss, bloating,
WHat is the etiology of Malabsorption Syndrome
Etiology: bacterial infection (treat with antibiotics or steroids) , can be an enzyme deficiency such as lactose intolerance (teach to avoid that type of food) , bile salt deficiencies (liver produces bile that breaks down fat, if this is not working it can build up to toxic levels which can flatten the intestinal wall, preventing absorption) , cancers as well.