Flashcards in Test #3 Chapter 60: Care of Patients with Inflammatory Intestinal Disorders Deck (65):
What is Appendicitis?
Acute inflammation of the appendix.
****What are the S&S of Appendicitis?
S&S: Classic symptoms Fever, High WBC, RLQ pain and is diagnosed by x-ray or CT. Sometimes by surgery after it is visualized. These people go to surgery within hours.
What is the etiology of Appendicitis?
Etiology: Fecaliths, Infection- starts to expand when inflammation builds up and eventually it will rupture.
What is the patho behind Appendicitis?
Patho: Inflammation causes obstruction of lumen of appendix, leading to infection as bacteria invades appendix. Blood flow restricted causing pain.
What is the treatment for Appendicitis?
Surgery: Appendectomy - incision is made on the abdomen, they will remove it, sew them back up and most people recover without any issues. Usually occurs more in younger people rather than older. This is not 100% of the time but mostly.
What is the post-op care after an Appendectomy?
Post-op care- fairly minimal, they need early ambulation with normal post op care. Check for infection ect.
What is Peritonitis?
Acute inflammation of the peritoneum and endothelial lining of the abdominal cavity
if an appendix ruptures the patient is at risk for peritonitis.
What is the etiology of Peritonitis?
Etiology: Appendicitis, Diverticulitis, Peptic Ulcer Disease, Gunshot/Stab wound, Bowel Obstruction can lead to peritonitis.
****What are the S&S of Peritonitis?
S&S: most important- nausea and vomiting, fever, swelling, ****RIGID ABDOMEN. Distended, B/P issues, (body tries to wall off infection, ends up 3rd spacing, if that does not fix the problem, body sends more blood to help fight, which increases the 3rd spaced fluid and pulls more out of the vascular system thus decreasing B/P and increasing heart rate.)
this needs to be on your assessment and charted.
not everyone goes to surgery but some do. They will get IV fluids, antibiotics, they will be NPO, and get NGT to decompress the stomach because they don’t want anything else flowing through there and leaking out into the peritoneal cavity.
Exploratory Laparotomy- they will go in and fix whatever the issue is, such as a ruptured appendix, diverticulitis, ect.
Postoperative Care for Peritonitis-
Normal post op care.
What is Gastroenteritis?
Inflammation of the mucous membranes of stomach and intestinal tract. This is mainly located in the small bowel. They will lose their absorption of their nutrients because of where it is located.
What is the etiology of Gastroenteritis?
Etiology: Viral or Bacteria Infections
What are the S&S of Gastroenteritis?
S&S: (GI bug) Abdominal pain, nausea, vomiting, diarrhea
Gastroenteritis Nursing Interventions:
Most people that come to the ER with this will go home. Some may get admitted if they are extremely dehydrated or Elderly.
**The main thing is Fluid Replacement,
Labs, Make sure that they do not have an obstruction by getting a CT or and X-ray of the abdomen.
**Medications for nausea and pain , Keep their Skin Intact from all of the diarrhea (make patient do this themselves unless elderly and can’t, educate them the importance of keeping the area clean) Things we can do to keep the skin intact is: barrier cream, sitz bath, ointments, wet wipes, medications to stop that from progressing. Also need to monitor Potassium because this gets off when a person has a lot of diarrhea. Monitor their heart. Lamodial can cause dizziness so caution with the elderly or with anyone. Do not let them drive home. Safety is a big deal with this medication.
What is Ulcerative Colitis?
Widespread inflammation of rectum and rect-sigmoid colon. It can extend to the entire colon when disease extensive. It can be localized or throughout the colon, it just depends on the severity. Every time they eat, their belly hurts so they eventually stop eating which causes weight loss. This is chronic, it never goes away. The patient will go through periods where they are ok and then have symptoms.
What is the etiology of Ulcerative Colitis?
Etiology: Genetic (born with it) and Immunologic Factors
What are the S&S of Ulcerative Colitis?
S&S: tenesmus, stool with blood and mucus, abdominal pain, malaise, anorexia, anemia, dehydration, fever, weight loss.
How do you diagnose Ulcerative Colitis?
Colonoscopy for definitive diagnosing
Nursing Interventions Ulcerative Colitis?
Medications: Aminosalicylates, Glucocorticoids, Antidiarrheal more to treat the signs and symptoms that they have and to decrease their inflammation. Educate about Nutrition and Resting the bowel. Don’t eat spicy foods ect.
Surgical Management for Ulcerative Colitis-
they may go to surgery if they think that there is something else that is going on that is making it worse. Typically it is just managed with diet and medications. There is not a cure.
What is Crohn’s Disease?
Inflammatory disease of small intestines, the colon or both. Is worse than Ulcerative Colitis.
What is the etiology of Crohn’s Disease?
Etiology: Environment, Genetics, Immune, Tobacco use, Jewish ethnicity puts them at greater risk.
What are the S&S of Crohn’s Disease?
S&S: More severe Diarrhea, Abdominal pain, low grade fever, steatorrhea, malabsorption of nutrients, anemia (this group is more prone to anemia than the Ulcerative Colitis group) This disease has periods of remission and exacerbation just like Ulcerative Colitis.
What are some Crohn’s Disease Complications-
This group is at risk for fistulas, strictures, abscesses. They are at risk for greater complications than the Ulcerative Colitis patient. Sometimes the whelps or abscessed areas can get infected or they can also get obstructed as well.
What are Crohn’s Disease Nursing Interventions?
Medications- Humira (given SQ, no regards to taking with food or not. It decreases their immune system so need to be educated not to be around sick people or large crowds. Also teach that the second that they think they have a cold they need to inform the doctor.)
Nutrition- stay hydrated.
Monitor potassium and heart because of severe diarrhea. Assess their heart rate and how they are acting if there is not a heart monitor in front of you. They might feel weak if their potassium is off.
Diverticular Disease in the intestines
What is a major difference between Diverticulosis and Diverticulitis?
Diverticulosis = no inflammation
Diverticulitis = inflammation
What is Diverticulosis?
Pouch like herniation of the mucosa through the muscular wall of any portion of the gut but most common in the colon.
What is the etiology of Diverticulosis?
Etiology: Muscle weakness over time related to aging or diet
What are the S&S of Diverticular Disease-
S&S: None for some. Others pain or bleeding develops, constipation, nausea, vomiting. If a patient has Diverticulitis- it can perforate can lead to peritonitis which would present with the rigid abdomen, rebound tenderness and decreased BP, with increased HR. If the patient keeps eating wrong, that can lead to scarring of the intestinal wall which can lead to narrowing of the intestine causing obstruction.
Diverticular Disease- Nursing Interventions-
Medications- to treat symptoms, antibiotics for bacteria.
****Teach about Nutrition and Rest- diet is low in fat, no seeds or anything that can get caught in the pockets. Once they have a flare up, it takes a couple of weeks for that to go down.
Surgical Management- if it is bad enough they can have surgery. Not usually.
What is an Anorectal Abscess?
Localized area of induration and pus caused by inflammation of the soft tissue near the rectum or anus.
What is the etiology of an Anorectal Abscess?
Etiology: Obstruction of ducts of glands in the anorectal region. Feces, foreign bodies or trauma can be the cause of the obstruction.
What are the S&S of an Anorectal Abscess?
S&S: Rectal Pain, local swelling, redness and tenderness, bleeding, pruritus
What are the Anorectal Abscess Nursing Interventions-
I&D- the doctor will make an incision to drain all of that puss out, then pack it with iodoform. Then it will heal by secondary intention (inside to out). Send them home with antibiotics, then they usually follow up with primary doctor in 10 days.
****Perineal Hygiene- after the I&D is done, we have to teach them to keep the area clean. We do not want stool to get in the area that was just drained.
What is an Anal Fissure
Tear in the anal lining. Not a fistula.
What is the etiology of an Anal Fissure?
Etiology: Fissures occur with straining to have a stool and larger fissures occur with trauma, disorders.
What are the S&S of an Anal Fissure?
S&S: Pain with defecation, bright red blood in stool, pruritus
How is an anal fissure diagnoses?
Anal Fissure- Diagnosed by inspection perianal skin and digital exam
Nursing Interventions for Anal Fissure-
Pain medications, stool softeners (the last thing we want is for this to tear even more if they are constipated, sitz bath, anti-inflammatory agents.
Diet - increase their fluids and fibers to avoid constipation.
H&H if there is a lot of rectal bleeding. But not typically.
What is an Anal Fistula-
Abnormal tract leading form the anal canal to the perianal skin. This is worse than a fissure. Fistulas can be anywhere.
What is the etiology of an Anal Fistula?
Etiology: Anorectal abscesses that grows and grows until it comes out somewhere else.
What are the S&S of an Anal Fistula?
S&S: pain, pruritus, purulent discharge that fissures do not have because there are two places that it can exit from.
Anal Fistula Nursing Interventions-
These are a little out of our hands. They usually go to Surgery: Fistulotomy- which is very dramatic. They find it first and then they cut it open and let it heal inside out. Secondary intention. This is very painful for the patient once they wake up. They will need pain medication around the clock.
What is a Parasitic Infection
Parasites enter and invade the GI tract and cause infections.
What is the etiology of a Parasitic Infection
Etiology: Commonly enter mouth from contaminated food or water, oral-anal sexual practices or contact with feces from a contaminated person.
What are the S&S of a Parasitic Infection
S&S: Abdominal PainDiarrhea, frothy, malodorous with mucus, weight loss, weakness, fever
What are the Nursing Interventions for Parasitic infection-
Medications- Whatever will treat the specific parasite. There is not a magic pill that will treat all of them.
Fluids- Teach if they go out of the country not to drink the water.
Hand-washing is the best way to prevent the spread of parasitic infections
What is Salmonellosis?
Bacterial Infection caused by Salmonella organism
What is the etiology of Salmonellosis?
Etiology: Lives in intestinal tracts of humans and animals. Transmitted by Flies, Fingers, Food, Feces and Fomites (clothing, bedding) but more by contamonated food and water.
What are the S&S of Salmonellosis?
S&S: Diarrhea, Nausea, Vomiting, abdominal pain, fever
***** What is the incubation time for Salmonellosis?
Incubation 8-48 hours after ingestion of contaminated food/liquid. Common source eggs, beef, poultry green leafy vegetables
What are the Salmonellosis Nursing Interventions-
Diagnosis made by stool culture, not from the toilet
Antibiotics: Cipro is typically what they are on usually BID for 10 days.
Educate the patient to take all of the medication regardless of if they feel better.
Patients can carry bacteria for up to 1 year.
*****Hand Hygiene important
Staphylococcal Infections are Responsible for 25% of reported food poisoning outbreaks.
What is its etiology?
Etiology: Found in meats and dairy products. Transmitted by carriers of organism. Usually from food that sat out to long at a picnic or gathering.
***** What is the incubation time for a Staphylococcal Infection?
Symptoms begin 2-4 hours after ingesting of contaminated food
What is the treatment for a Staphylococcal Infection?
Treatment: Hydration is the main focus because they have a lot of diarrhea.
What are S&S of an Escherichia Coli Infection?
S&S: Abdominal Pain and Cramping, Vomiting, Diarrhea
What is the treatment for an Escherichia Coli Infection?
Treatments: IV fluids, antidiarrheal agents, prevention
How can you prevent an Escherichia Coli Infection?
Prevention- wash hands throughly after you use the restroom and before you eat, after touching meat. Make sure you cook your foods all of the way. Avoid raw and unpasturized tpe foods that have bacteria. (honey). Avoid swallowing water while swimming, avoid cross contamination of food.
What is Botulism-
Paralytic disease resulting form ingestion of a toxin in food contaminated with Clostridium botulinum.. This one is a little more serious because it causes respiratory problems.
What is the etiology of Botulism-
Occurs in home-canned foods, and meat and fish. Once consumed, it releases a toxin within the body that acts upon the respiratory system.
What are the S&S of Botulism-
S&S: Diplopia (blurry vision), dysphagia (trouble swallowing), dysarthria (slurred speech), nausea, vomiting, (neuro issues that the other groups do not have)
*****What is the Incubation time of Botulism?
Incubation 18-36 hours