Week 10 - GI and GU Health Flashcards

Question

Metoclopramide (Maxeran)

Answer 1

Therapeutic Class: Antiemetic Pharmacy Class: Dopamine Receptor Antagonist Action: → increases the motility of the upper GI tract, helping food move through the stomach more quickly & reducing nausea Common doses: Adults usually take 10-20 mg orally or IV before chemotherapy or surgery Routes: Oral (tablets, liquid), & injectable (IM, IV). Side effects: → Drowsiness, fatigue, restlessness, & potential movement disorders Nursing considerations: → Monitor for signs of movement disorders → advise patients to avoid alcohol → assess for drowsiness & dizziness

Answer 2

Therapeutic Class: Antiemetic Pharmacy Class: Serotonin Receptor Antagonist Action: → blocks serotonin receptors in the brain & gut, which helps prevent nausea & vomiting Common doses: Adults typically take 8 mg orally or IV before chemotherapy or surgery, & then every 8 hours as needed Routes: Oral (tablets, disintegrating tablets, liquid), & injectable (IV, IM) Side effects: → Headache, constipation, dizziness, & potential QT interval prolongation Nursing considerations: → Monitor for signs of QT prolongation → assess for headache & constipation → ensure proper hydration

Answer 3

Goals → Minimize nausea & vomiting → Maintain normal electrolyte levels & hydration → Restore normal fluid balance & nutrient intake Nursing Management: Non-pharmacological methods → Monitor for dehydration, electrolyte imbalances → Provide physical & emotional support Nutritional Therapy: → IV fluids with electrolytes & glucose for severe vomiting → NG tube & suction to decompress the stomach → Gradual reintroduction of oral nourishment

Answer 4

Expected Outcomes of Treatment The patient will: → be comfortable with minimal or no nausea and vomiting → maintain body weight → electrolytes will be within normal range → maintain adequate intake of fluids and nutrients → maintain normal urone volume

Answer 5

- Frequent passage of loose, watery stools - Symptom, not a disease Etiology: → Decreased fluid absorption → Increased fluid secretion → Motility disturbances → Combination of factors Infectious Causes: → Viruses (e.g., rotavirus, norovirus) → Bacteria (e.g., Salmonella, Clostridioides (aka clostridium difficile) → Parasites (e.g., Giardiasis lamblia)

Answer 6

Clinical Manifestations: → Acute vs. chronic diarrhea (> 2 weeks, returns more than 2-4 weeks after initial episode) → Symptoms: Explosive watery diarrhea, tenesmus, cramping, perianal irritation → Systemic symptoms: Fever, nausea, vomiting, malaise → Severe cases: Dehydration, electrolyte imbalances, malabsorption, malnutrition Diagnostic Studies: → Thorough history & physical examination → Stool tests: Blood, mucus, WBCs, ova, parasites → Stool cultures (to identify infectious organisms) → Endoscopy & radiographic studies

Answer 7

Treatment Goals → Replace fluids & electrolytes → Decrease stool frequency & volume Mild Diarrhea → Oral solutions with glucose & electrolytes (e.g., Pedialyte) Severe Diarrhea → Parenteral fluids, electrolytes, vitamins, & nutrition Pharmacological Agents Protect mucous membranes → Absorb irritants → Inhibit GI motility → Decrease intestinal secretions → *** Avoid antidiarrheals in infectious diarrhea ***

Answer 8

1) Loperamide (Imodium) Therapeutic Class: Antidiarrheal Action: → acts directly on the intestinal muscles to decrease GI peristalsis; reduced volume & increased bulk of stool & prevents loss of electrolytes Common doses: Adults take 4 mg orally after the first loose stool, then 2 mg after each subsequent loose stool Routes: Oral (tablets, tablets, liquid), Side effects: → Constipation, dizziness, drowsiness, nausea, & stomach cramps Nursing considerations: → Monitor for signs of constipation & abdominal distension → assess bowel function & fluid balance

Answer 9

Clostridium difficile: → Causes diarrhea & colitis → Present in normal flora & hospital environments → Risk factors: Prolonged antibiotic therapy, chemotherapy, advanced age Symptoms: → Watery diarrhea, fever, loss of appetite, nausea, abdominal pain Diagnosis & Treatment: → Laboratory confirmation from stool sample → First-line therapy: Metronidazole (Flagyl) → Alternatives: Vancomycin, Fidaxomicin

Answer 10

Nursing Assessment → Thorough history & physical examination → Assess stool pattern, duration, frequency, character, consistency → Medication, travel, dietary history Goals → Prevent transmission of infection → Cease diarrhea, resume normal bowel patterns → Maintain fluid, electrolyte, & acid-base balance → Prevent perianal skin breakdown Infection Control for C.Diff → Contact isolation precautions → Environmental cleaning with hospital-grade disinfectant → Wash hands with soap & water*

Answer 11

- Decrease in bowel movement frequency - Hard, difficult-to-pass stools - Decrease in stool volume - Retention of feces in the rectum - May be accompanied by nausea, abdominal distention, bloating - May be acute or chronic

Answer 12

- insufficient dietary fiber - inadequate fluid intake - medications - lack of exercise - sociocultural and environmental factors

Answer 13

- Diverticulosis - Fecal impaction & colonic perforation - Anal fissures & rectal mucosal ulcers - Hemorrhoids (straining) - Complications of Valsalva manoeuvre

Answer 14

Diagnostic Studies: → History & physical examination → Abdominal radiographs, barium enema, colonoscopy, sigmoidoscopy Management: → Diet therapy: Increase fiber & fluids (min 30 g fiber, 1.5-2L/day) → Exercise → Cautious use of laxatives → Step wise approach from bulk-forming fibre to stimulants → Enemas for immediate relief

Answer 15

Bulk-forming medications (ex. Metamucil) → Absorb water which increases bulk, stimulating peristalsis Stool softeners & lubricants (ex. Docusate sodium [Colace]) → Lubricate intestinal tract & soften feces, making it easier to pass Saline & Osmotic Solutions (ex. Fleet enema, lactulose, PegLyte) → Cause retention of fluid in intestinal lumen Stimulants (ex. Senna [Senokot], Bisacodyl [Dulcolax]) → Increase peristalsis by irritating colon wall & stimulating enteric nerves

Answer 16

Planning Goals: → Increase dietary fiber & fluid intake → Achieve passage of soft, formed stools → Prevent complications (e.g., bleeding hemorrhoids) Nursing Assessment: → Obtain subjective & objective data Nursing Implementation: → Teach importance of dietary measures → Maintain high-fiber diet, increased fluid intake (3000 mL/day), regular exercise → Establish regular meal & defecation patterns → Proper positioning during defecation

Answer 17

Fecal Incontinence → Involuntary passage of stool Pathophysiology → Motor or sensory disorders (dementia, stroke, spinal cord injury, radiation) → Secondary to fecal impaction → Functional incontinence (physical or mobility impairment affecting toileting) Diagnostic Studies: → Health history & physical examination → Rectal examination, flexible sigmoidoscopy

Answer 18

- Address underlying cause - Antidiarrheal agents – if incontinence is related to noninfectious diarrhea - Manual disimpaction, lubricants, cleansing enemas – if incontinence is from fecal impaction - High-fiber diet, increased fluid intake – to prevent recurrence - Assess bowel habits & symptoms - Implement bowel training programs - Administer medications as needed - Maintain skin integrity - Use fecal containment devices, incontinence briefs - Educate patient on proper perianal care

Answer 19

Kidneys: Filter blood to remove waste products & excess fluids, forming urine Ureters: Transport urine from the kidneys to the bladder Bladder: Stores urine until it is excreted Urethra: Transports urine from the bladder out of the body Reproductive Organs: Include the testes & penis in males, & the ovaries, fallopian tubes, uterus, & vagina in females

Answer 20

- Urinary Tract Infections (UTIs) - Urinary Incontinence - Urinary Retention - Benign Prostatic Hyperplasia (BPH) - Kidney Stones - Sexually Transmitted Infections (STIs) - Acute Kidney Injury - Chronic Kidney Disease

Answer 21

- Most common bacterial infection in women - High prevalence in older adults Causes: → Bacterial infection most common → E. coli is the primary pathogen Classification: → Upper UTI: Involves renal parenchyma, renal pelvis, ureters – systemic manifestations → Lower UTI: Involves bladder & urethra → Location of the UTI/inflammation → Initial vs. recurrent infections

Answer 22

Sterility of Urinary Tract: → Normally sterile above the urethra → Defence mechanisms against UTIs: Complete bladder emptying, antibacterial properties of bladder mucosa & urine Pathogens → Introduced via ascending route from urethra → Common pathogens: Gram-negative bacilli (e.g., E. coli), Grampositive organisms (e.g., streptococci, enterococci) Predisposing Factors → Urological instrumentation (e.g., catheterization) → Sexual intercourse → Health care– associated infections (e.g., indwelling urinary catheters) Routes of Infection: → Ascending route most common → Hematogenous route (rare): Bloodborne bacteria invade urinary tract

Answer 23

Lower Urinary Tract Symptoms (LUTS): → Dysuria, frequency, urgency, pain on urination → Suprapubic discomfort or pressure → Hematuria or cloudy urine Upper Urinary Tract Symptoms: → LUTS listed above & flank pain, chills, fever → Indicates pyelonephritis Older Adults: → Nonlocalized abdominal discomfort → Cognitive impairment or delirium → Less likely to have fever

Answer 24

Dipstick Urinalysis: → Initial test → Identifies nitrites (indicating bacteriuria), WBCs, leukocyte esterase Urine Culture: → Indicated for complicated or recurrent UTIs or when UTI unresponsive to ABX → Preferred method: Voided midstream clean-catch sample → Alternative methods: Catheterization, suprapubic needle aspiration → Sensitivity Testing Imaging Studies: → IVP or abdominal CT scan for suspected obstruction

Answer 25

Planning Goals: → Relief from symptoms → Prevention of upper urinary tract involvement → Prevention of recurrence Nursing Assessment: → Obtain subjective & objective data → Identify symptoms & risk factors

Answer 26

Health Promotion → Recognize individuals at risk → Educate on preventive measures: regular bladder & bowel emptying, proper perineal hygiene, adequate fluid intake (33ml/kg/day) → Avoid unnecessary catheterization & advocate for early removal of indwelling catheters → Perform hand hygiene & use aseptic technique Acute Intervention: → Collect urine samples → Ensure adequate fluid intake → Avoid bladder irritants: alcohol, caffeine, citrus juices, chocolate → Apply heat to relieve discomfort → Educate on medication adherence & full course of antibiotics (usually 1-3- or 3-5-day course) → Monitor for changes in urine & symptoms

Answer 27

- Uncontrolled loss of urine - More common in women & older adults - *UI is NOT a natural consequence of aging* - Transient (acute) UI - Caused by confusion, depression, infection, medications, restricted mobility, stool impaction Established (chronic) UI 1) Stress incontinence: sudden increase in intrabdominal pressure → pelvic muscle concerns 2) Urge incontinence: sudden involuntary urination with little warning → overactive bladder secondary to CNS and bladder disorders 3) Overflow incontinence: pressure from overfull bladder causes leakage → outlet obstruction 4) Functional incontinence: due to mobility/environmental factors

Answer 28

- Inability to empty the bladder - May be associated with dribbling (overflow UI) - Acute: Total inability to pass urine (medical emergency) - Chronic: Incomplete bladder emptying despite urination → Post-void residuals may be 150-200 mL or more Causes: → Bladder outlet obstruction (eg. enlarged prostate) → Deficient detrusor contraction strength (eg. neurological disorders, DM, overdistension)

Answer 29

Evaluation of Incontinence & Retention → Focused history, physical assessment, bladder log or voiding record → Assess onset of UI, provoking factors, associated conditions Physical Examination → General health, mobility, dexterity, cognitive function → Pelvic examination: Inspect perineal skin, evaluate pelvic muscle strength Diagnostic Tests → Urinalysis: Identify contributing factors (e.g., infection, diabetes) for transient UI or retention → Postvoid residual volume: Measure after urination using a bladder scan or intermittent catheterization

Answer 30

- 80% of incontinence can be cured or significantly improved - Pelvic Muscle Training → Kegel exercises for stress, urge, or mixed UI - Bladder Training & Prompted Toileting - Anti-incontinence devices → Intravaginal support devices (pessaries) - Containment devices → Condom catheters, absorbent products - Antimuscarinic (antispasmodic) medications for urge UI - Surgical therapy if needed

Answer 31

Conservative Management of UI symptoms → Hydration, reduce caffeine & alcohol, smoking cessation → Manage constipation: Fluid intake, dietary fiber, exercise, stool softeners → Improving continence can help prevent falls & skin breakdown Habit Training & Prompted Toileting: → Habit training: Use voiding diary to establish voiding frequency & create voiding schedule → Prompted toileting: Regular reminders for patients with cognitive impairment Product Information: → Use products designed to contain urine → Incontinence pads, briefs, pad–pant systems

Answer 32

Scheduled Toileting & Double Voiding → Effective for urinary retention with moderate postvoid residual volumes → Crede manoeuvre: Manual pressure on lower abdomen to facilitate bladder emptying Intermittent Catheterization → Reduces risk of UTI & urethral irritation compared to in-dwelling catheters In-Dwelling Catheter → Used when urethral obstruction makes intermittent catheterization unfeasible Medication Therapy → Tamsulosin (Flomax): Relax smooth muscle of bladder neck & urethra → Finasteride (Proscar): Reduces prostate size, useful for BPH-related hematuria Surgical Therapy → Treatment of prostatic enlargement

Answer 33

Indications for Catheterization → Accurate measurement of urinary output in critically ill patient → Facilitation of surgical repair → Measurement of residual urine if bladder scanner not available → Relief of urinary retention → Urine contamination of stage 3 or 4 pressure injury → Sterile urine specimens in complicated infections → Instillation of medications into bladder Indications that are NOT Valid → Routine urine specimen collection → Convenience of staff or family Risks → High risk of health care–associated infections & major cause of UTIs

Answer 34

Catheter Types: → Vary in materials, tip shape, & lumen size → Sized according to the French scale (12-14F for women, 14- 16F for men) – larger # = larger diameter Urethral Catheterization: → Most common route: through external meatus into the bladder → Use sterile, closed drainage system → Maintain unobstructed downhill flow → Regular perineal care with soap & water → Avoid routine catheter irrigation. If irrigation is needed, use a triple-lumen catheter with an irrigation port → Common complication CAUTI

Answer 35

1) Ureteral Catheters → Inserted through ureters into renal pelvis → Used post-surgery to splint the ureters & prevent obstruction by edema 2) Suprapubic Catheters → Catheter placed through a small incision in the abdominal wall → Care similar to urethral catheter → Temporary: Bladder, prostate, urethral surgery → Long-term: Select patients (e.g., tetraplegia)

Answer 36

Purpose: → Gold standard for urinary retention → Used for neurogenic bladder, bladder outlet obstruction, post-surgery → Reduced complications compared to indwelling catheter Technique: → Insert urethral catheter every 3 to 5 hours → Remove catheter after bladder is emptied

Answer 37

Goal: Prevent infection, maintain skin integrity Interventions: → Manage fluid intake & track fluid balance → Use sterile technique to insert catheter & advocate for catheter removal when it is no longer indicated → Check the catheter & drainage system regularly for signs of blockage, leakage, or infection → Perform routine perineal care & clean the catheter insertion site → Educate patients & their families on proper catheter care → Maintain a closed drainage system to minimize the risk of infection (bag always lower than bladder to prevent backflow)

Week 10 - GI and GU Health Flashcards

(61 cards)