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Intestinal Dysfunct.
NU122 Intestinal Dysfunction
| Question | Answer |
|---|---|
| What are the function of the intestines | - Absorption of food for nutrition - Elimination of Waste |
| Where does absorption take place in the small intestines | - through the villi |
| With what action is the absorption done in the small intestine | - Active transport - Diffusion |
| What is secreted in the duodenum of the small intestine | - Digestive enzymes |
| Where do the digestive enzymes come from for the small intestines | - Pancreas - Bile |
| What is absorbed in the Jejunum of the small intestine | - Fats - Proteins - Carbohydrates |
| What is absorbed in the Ileum of the small intestine | - B12 - Bile |
| What is the main function of the Large intestine | - Reabsorbs water - Reabsorbs electrolytes |
| What is secreted to protect the lining from feces in the large intestine | - Mucous |
| How does feces move in the large intestine | - Slowly by peristalsis |
| How long does it take for the feces to reach the rectum | - 12 hours |
| What interferes with the function of the small intestines and the large intestines | - Constipation - Malabsorption - Obstructions - Inflammations |
| What is Constipation | - Abnormal infrequent defecation |
| What causes Constipation | - Old age are increased risk for - Perceived Constipation |
| How many bowel movements per week is considered constipation | - less than 3 |
| What are the symptoms of constipation | - Straining at stool - Indigestion - Nausea - Abdominal distention - Small volume hard stools - loss of appetite |
| What may constipation lead to | - Megacolon |
| What should you teach patients about constipation | - Increase activity - Eat high fiber foods - lots of fluids |
| What types of medications are used for treatment of constipation | - Laxatives |
| What are the different types of laxatives | - Bulk-forming - Lubricant - Stimulant - Fecal softener - Osmotic agent |
| What are some of the names of Bulk-forming laxatives | - Psyillium hydrophyilic mucilloid - Metamucil |
| What are some of the names of Lubricant Laxatives | - Mineral Oil - Glycerin suppository |
| What are some of the names of Stimulant Laxatives | - Biscodyl(Dulcolax) - Senna(Senokot) |
| What are some of the names of Fecal Softener Laxatives | - Docusate - Colace |
| What are some of the names of Osmotic agent Laxatives | - Polyethylene glycol and electrolytes - Colyte |
| What is another name for Malabsorption | - Diarrhea |
| What are some of the chief characteristics of Diarrhea | - Frequent, watery stools |
| What are the causes of Malabsorption or Diarrhea | - Infection - Inability of digestive system to absorb certain nutrients - Irritable Bowel Syndrome |
| What bacterium may cause diarrhea | - Infection with C.difficile bacterium |
| How dose C.difficile proliferate in the bowels | - this happens when the normal foral is disrupted by the use of antibiotics |
| What is a moderate C.difficile infection treated with | - Metronidazole or Flagyl |
| What is a severe C.difficile infection treated with | - Vancomycin orally |
| What is a severe infection of C.difficile called | - Pseudomembranous colitis |
| What are some of the causes of the inability of the digestive system to absorb nutrients | - Celiac Disease or Gluten intolerance - Radiation enteritis - Pancreatic enzyme insufficiency - Crohn's disease |
| What are the stool characteristics of Celiac disease, radiation enteritis, pancreatic enzyme insufficiency and crohn's disease | - Loose, bulky, foul-odored, with increased fat content and may be grey in color |
| What may the inability of the digestive system to absorb nutrients lead to | - Malnutrition - Vitamin and mineral deficiency |
| What may an older adult signs and symptoms be with malabsorption due to the digestive systems inability to absorb nutrients | - fatigue and confusion |
| What is Irritable Bowel Syndrome | - spasms of the intestine causing diarrhea and constipation |
| What causes Irritable Bowel Syndrome | - Intestinal motility dysfunction - Serotonin signaling dysfunction |
| What are the signs and symptoms of IBS | - Pain - Bloating - Distention |
| What usually relieves the signs and symptoms of IBS | - Defecation |
| What are usually leads to IBS | - Heredity - Psychological Stress - Irritating foods |
| What is the usual treatment for IBS | - High fiber diet - antidepressants - probiotics |
| What medications are used in treating IBS | - Alosetron - Lubiprostone - Tricylic Antidepressants |
| How does alosetron treat IBS | - It is used to treat the diarrhea associated with IBS - Antagonizes the spasms caused by seratonin |
| How does Lubiprostone treat IBS | - It is used to treat the Constipation associated with IBS - Draws water into the bowels |
| How does Tricylic Antidepressants Treat IBS | - Slows Parastalsis |
| What are some of the complications of diarrhea | - Fluid and Electrolyte imbalances - Dehydration - Cardiac dysrhythmias |
| What Electrolytes are loosed through diarrhea | - Potassium - Magnesium |
| What should a patient do if diarrhea is prolonged | - Seek medical attention |
| What type of diet should a person be on with Diarrhea | - replace Fluid and Electrolytes - Avoid Caffeine, Very Hot or Cold Foods - May havev to Avoid Milk, Fats, Fresh Fruits, Whole Grain, Vegetables |
| What Medications are used to treat Diarrhea | - Kaopectate - Imodium - Anticholinergics such as dicyclomine as an antispasmotic |
| What are the two types of intestinal obstructions | - Mechanical - Functional |
| What is a Mechanical Obstruction | - Strictures - Tumors - Hernias - Stenosis - Adhesions |
| What are functional obstructions | - Intestinal musculature cannot propel due to paralytic ileus - Diabetes melitus - Parkinson's - Muscular dystrophy |
| What is given to a diabetic with intestinal obstructions | - Reglan |
| Where can intestinal obstructions occur | - in both the small intestines and large intestines |
| Where does the fluid and gas accumulate in a small bowel obstruction | - above the obstruction |
| What does this fluid a gas accumulation lead to | - Abdominal distention - that leads to inability to absorb fluids |
| What happens within the intestinal lumen | - Increased pressure - decreases venous and capillary pressure |
| What does the increased pressure in the intestinal lumen and decreased venous and capillary pressure lead to | - Results in swelling and congestion of intestinal wall causing necrosis and eventual perforation of wall |
| What are some of the symptoms of Small bowel obstruction | - crampy wave like pain - Passes blood and mucous but no fecal matter |
| Is there vomiting associate with a small bowel obstruction | - Yes - First stomach contents - then bile - possible fecal matter if ileum is obstructed |
| Is there thirst associated with a small bowel obstruction | - Yes - Extreme thirst - Parched tounge - Becomes dehydrated - which leads to hypovolemic shock |
| How can a small bowel obstruction be diagnosed | - Abdominal Xray - CT will show large quantities of gas and fluid in intestine - CBC - Electrolytes - Infection - dehydration |
| What is the treatment of a small bowel obstruction | - NG suction to decompress bowel this may be all that is needed - Surgery if needed to remove hernia, adhesions - Resection and reanastomosis |
| What is the nursing care for a patient with a small bowel obstruction | - Maintain NG suction - monitor electrolytes and fluid status - Monitor for return of normal bowel function |
| Where does the accumulation occur in a large bowel obstruction | - Proximal to the obstruction - usually fluid and gas |
| What does this accumulation of fluid and gas lead to in a large bowel obstruction | - Severe distention and perforation ensue unless some gas and fluid can back flow through ileal valve |
| What about dehydration in a large bowel obstruction | - Happens more slowly than in a small bowel obstruction - Because colon can absorb its fluid contents and can expand its size |
| What accounts for a large majority of large bowel obstructions | - Adenocarcinoid tumors |
| What are the symptoms of a large bowel obstruction | - Constipation - change is shape of stool - blood in stool - weakness - weight loss - distended abdomen - fecal vomiting - shock |
| How do these symptoms of a large bowel obstruction develop | - Slowly |
| What is used to diagnose a large bowel obstruction | - Abdominal Xray, CT, MRI all pinpoint obstruction |
| What should you not give when doing a diagnostic test for a large bowel obstruction | - Barium for contrast it will cause constipation - Use gastrograffin instead |
| What are the non surgical treatments for a large bowel obstruction | - Restore fluids and electrolytes - NG suction for decompression |
| What are the surgical treatments for a large bowel obstruction | - Colonoscopy to untwist bowel - Surgical resection with possible colostomy - Ileo-anal anastomosis it total colectomy done - Cecostomy if poor surgical risk to relieve gas |
| What can be given in a cecostomy to induce bowel movements | - an enema |
| What is the nursing care for a patient with a large bowel obstruction | - Observe for worsening obstruction - IVs - Pre and post op care |
| What is the 3rd most common cause of death from cancer | - Colorectal Cancer |
| What is the most important thing to do for prevention of colorectal cancer | - Screenings |
| What are the symptoms of Colorectal Cancer | - Change in bowel habits - Blood in stool(tarry, or bright, occult) - Tenesmus - Pain - Anemia - Anorexia - Weight loss - Fatigue |
| What are some of the risk factors for Colorectal cancer | - Increased age - High alcohol consumption - family history - Smooking - Chronic inflammatory diseases of bowel - High fat, high protein, low fiber diets |
| What is a colostomy | - a surgical creation of an opening into the colon to drain through skin into a pouch |
| What is the consistency of the fecal matter in a colostomy in the ascending colon | - Liquid stool |
| What is the consistency of the fecal matter in a colostomy in the transverse colon | - unformed stool |
| What is the consistency of the fecal matter in a colostomy in the descending colon | - semi formed stool |
| What is the consistency of the fecal matter in a colostomy in the sigmoid colon | - formed stool |
| What does function return with colostomy | - 3 - 6 days after surgery |
| How should the wafer be hung with a colostomy | - It should hug the stoma - Change weekly - Check the skin |
| What does the wound care nurse do with a patient getting a colostomy | - Marks the stoma site pre-op - teaches patient the care of stoma |
| What should a patient do when given a colostomy | - drink 2 liters of water per day - avoid gas producing foods - avoid pop corn, nuts, large seeds |
| What are the inflammatory diseases of the intestines | - Diverticulitis - Appendicitis - Peritonitis |
| What is a Diverticulum | - a sac like herniation of the lining of the bowel that extends through a defect in the muscle layer |
| What are diverticulum most common | - In the sigmoid colon - but may occur anywhere |
| What is diverticulosis | - Multiple diverticula without inflammation |
| What is diverticulitis | - Infection and inflammation of the diverticula |
| What is diverticula disease associated with | - Age and low fiber diets |
| What may a person have preceding diverticulosis | - Constipation |
| What are the the symptoms of Diverticulitis | - Mild or severe pain in left lower quadrant - Nausea - Vomiting - Fever - Chills - Elevated WBCs |
| What are some of the complications associated with Diverticulitis | - Perforation - Peritonitis - Abscess formation - Bleeding |
| What are some of the signs and symptoms of a Perforation | - Abdominal pain - loss of bowel sounds - Shock |
| What type of diet should a person be on with diverticulitis | - Clear liquids to low residue initially - High Fiber - Low fat diet after the inflammation is gone |
| What type of medication is given to a person with diverticulitis | - Antibiotics for 7 - 10 days |
| What should a person do if they have severe symptoms | - Hospitalization - with IV fluids and NG suction to rest bowel |
| What type of surgical interventions would a patient get with diverticulitis | - Percutaneous drainage of abscess - resection of colon with temporary colostomy - Later re-anastomosis |
| What is the appendix | - 4" long narrow lumen that attaches to cecum just below ileo-cecal valve - Fills with food and empties into cecum |
| What is an appendix prone to | - Obstruction and infection |
| What happens when the appendix gets inflamed | - intraluminal pressure increases with constricts the circulation |
| Where is the pain when the appendix gets inflamed | - It get progressively worse in right lower quadrant within a few hours |
| At what age would a person experience appendicitis | - usually between 10 - 30 years of age - Uncommon in elderly |
| What type of pain is associated with appendicitis | - Mild abdominal pain that increases and localized to RLQ |
| What are some of the signs and symptoms of Appendicitis | - Low Grade Fever - Elevated WBCs - Elevated Neutrophils - Nausea - Loss of appetite - maybe vomiting |
| What types of diagnostic tests are given for appendicitis | - CT - U/S of abdomen |
| What is McBurney's Point | - Half way between umbilicus and Right anterior iliac spine - There will be tenderness there |
| What is Rovsing's Sign | - Pain in RLQ after LLQ is palpated |
| Why should you not give laxatives in a patient with appendicitis | - may cause a perforation - Eventhough they may have constipation with adbominal pain and fever |
| When is surgery usually done with appendicitis | - Immediately - either laparoscopic or laparotomy |
| What medications are given to a person with appendicitis | - Antibiotics - Iv Fluids to prevent sepsis and fluid and electrolyte imbalances |
| When is a surgical drain used in a patient with appendicitis | - if there is an abscess |
| What should be done Post-Op for a patient with appendicitis | - placed in high fowlers position - Opiods for pain - IVs Oral fluids - Possible solid foods and same day discharge if uncomplicated |
| When should a patient follow up with the surgeon | - 5-7 Days |
| What are the signs and symptoms of a Ruptured appendix | - Pain more diffuse, spread out - Abdominal distention - paralytic ileus - peritonitis - abscess formation - Temp > 100 |
| What is peritonitis caused by | - Leakage of contents of abdominal organs into the abdominal cavity |
| What can peritonitis result from | - Inflammation - infection - trauma - ischemia - tumor perforation |
| What happens when bacteria spread in a patient with peritonitis | - causes edema of the tissues |
| What does the exudate contain | - Fluid with blood, WBCs and protein |
| What happens to the intestines in peritonitis | - Intestines become hypermotile at first and then develop paralytic ileus - air and fluid accumulates in the bowel |
| What is the pain like with peritonitis | - pain is diffuse and then localized over the diseased site - worsens with movement |
| What are some of the signs and symptoms of peritonitis | - Rebound tenderness - Paralytic ileus - temp 100- 101 - Eleveated WBCs - tacchycardia |
| What electrolytes are altered with peritonitis | - Potassium - Sodium - Chloride |
| What happens as the peritonitis progresses | - Patient may become hypotensive |
| What are used to diagnose peritonitis | - Abdominal Xrays - CT shows distended bowel loop, free air and fluid in peritoneum and bowels |
| What are some of the complications of peritonitis | - Widespread infection in abdominal cavity - Sepsis leading to shock - Death - Bowel adhesion and then blockage |
| Why does hypovolemia occur with peritonitis | - Because massive amounts of fluids and electrolytes move from intestinal lumen into peritoneal cavity and depletes fluid in intra-vascular space |
| What is used to treat hypovolemia in peritonitis | - Fluid, electrolyte and colloid replacement - requires several liters of isotonic IV fluids |
| What medications are given to patients with peritonitis | - Antibiotics - analgesics for pain |
| Why is a NG Tube or LIWS used for in a patient with peritonitis | - To relieve abdominal distention and promotes intestinal function |
| Why would you have to administer oxygen to a patient with peritonitis | - Because of the fluid in the abdomen lead to abdominal distention which leads to pressure on the diaphragm which leads to respiratory distress |
| What happens if the peritonitis leads to shock | - Patient goes to ICU - Placed on ventilator - close monitoring |
| What are some of the chronic inflammatory diseases of the intestine | - Crohn's Disease - Ulcerative Colitis |
| When does Crohns disease first occur | - in adolescents and young adults - smokers |
| What is Crohns disease | - Chronic inflammation of GI tract wall extending through all layers(Transmural lesion) |
| Where do the lesions of crohns disease occur | - Distal lumen - ocassionally in ascending colon - there are periods of exacerbation and remission |
| How does crohns disease start off as | - Edema and thickening of mucosa - then ulcers from and are separated by normal tissue |
| What is the cobblestone appearance of crohns disease | - Ulcers are not continuous and do not touch each other so they appear as a cobblestones |
| What forms and the inflammation of crohns disease extends to the peritoneum | - Fistulas, fissures and abscesses |
| What happens as crohns disease progresses | - bowel walls thicken - Fibrosis - Intestinal lumen narrows - Adhesions form - diseased bowel loops adhere to other loops |
| Where is the pain in a patient with crohns disease | - Right lower quadrant |
| What is not relieved by defecation in crohns disease | - Diarrhea |
| What are the complications of the constricted lumen in crohns disease | - Does not allow digestive contents of upper Gi to pass through easily - so crampy abdominal pain, tenderness and intestinal spasm occur especially after eating |
| What may the patient do with crohns disease because of the crampy pain | - Limit food intake - which will lead to malnutrition, anemia and weight loss |
| What does the edematous intestine empty into the colon | - irritating discharge |
| What can the abscesses, fever and high WBC of crohns disease affect | - Joints by arthritis, eyes and skin inflammations, oral ulcers |
| What are the Diagnostic tests used in crohns disease | - Barrium Xray - Barrium Enema - Endoscopy - CBC |
| What does a barrium Xray show with crohns disease | - classic String signs of terminal ileum |
| What does a barrium enema show in crohns disease | - Cobblestone lesions - fissures - fistulas |
| What does an endoscopy show in crohns disease | - Intestinal biopsies confirm diagnosis |
| What does a CBC show in crohns disease | - Anemia - Elevated WBC and ESR(sed rate) - If malnourished protein and albumin levels are decreased |
| What are some of the complications of crohns disease | - Intestinal obstruction - Peri-anal disease - Fluid and electorlyte imbalances - Malnutrition - Entero-cutaneous fistulas - increased risk of colon cancer |
| What are the intestinal obstruction in crohns disease due to | - Stricture formation |
| What is the malnutrition in crohns disease due to | - Malabsorption |
| What is an entero-cutaneous fistula | - Abnormal opening between small bowel and skin |
| What are patients at risk for with crohns disease | - Colon Cancer |
| What is Ulcerative colitis | - Recurrent ulcerative and inflammatory disease of mucosal and submucosal of colon and rectum |
| What does ulcerative colitis affect | - Superficial mucosa of colon |
| What are some of the manifestations of Ulcerative colitis | - Multiple ulcerations - Diffuse Inflammation - Shedding of colons epithelium - Bleeding due to ulcers |
| What is the mucosa like in ulcerative colitis | - Edematous - inflammed - abscesses form |
| How are the lesions in ulcerative colitis | - They are contiguous meaning they touch one another |
| How does ulcerative colitis develop | - Starts in the rectum and spreads up to involve entire colon |
| What eventually happens to the colon in ulcerative colitis | - The colon narrows, shortens and thickens - Fistuals - Obstructions - Fissures uncommon - Disease not transmural |
| What are some of the signs and symptoms of Ulcerative colitis | - anorexia - Weight loss - Fever - Vomiting - Dehydration |
| What may a person develop with ulcerative colitis | - Anemia - fatigue - Hypocalcemia |
| Where is the pain with ulcerative colitis | - LLQ - Cramping - Rebound tenderness in RLQ |
| What are the stools like with ulcerative colitis | - Diarrhea with mucous, pus - rectal bleeding - 10 - 20 per day |
| What can ulcerative colitis also affect | - Skin - Eyes - Liver |
| What may a patient present with ulcerative colitis | - Tachycardia - Fever - hypotension - pallor - abdominal distention |
| What are some of the lab test results in a patient with ulcerative colitis | - decreased hemoglobin and hematocrit - Decreased albumin - Elevated WBC - Electrolyte abnormalities |
| What can a barrium enema or sigmoid or colonoscopies detect in a patient with ulcerative colitis | - Ulcerations - mucosal abnormalities |
| What can a CT,MRI,U/S detect in a patient with ulcerative colitits | - abscesses - perirectal problems |
| What are some of the complications of ulcerative colitis | - Perforation - bleeding - Toxic Megacolon |
| What will a perforation lead to in a patient with ulcerative colitis | - peritonitis |
| What is toxic Megacolon | - Inflammatory process extends into muscle layer of colon - inhibits its ability to contract - resulting in distention of colon |
| What are some of the signs and symptoms of toxic megacolon | - Fever - abdominal pain - distention - vomiting |
| What are some of the treatments for toxic megacolon | - NG suction - IV fluids with electrolytes - Steroids - antibiotics |
| What happens if patient does on improve in 24 - 72 hrs | - surgery required - Total colectomy - ileostomy |
| What type of diet should a patient be on with ulcerative colitis and crohns disease | - Oral fluids - low residue - high protein - high calorie |
| What type of foods should a patient avoid with ulcerative colitis and crohns disease | - one that exacerbate diarrhea - avoid smoking - cold foods these increase intestinal motility |
| What type of supplements should a person with ulcerative colitis and crohns disease take | - Vitamin - mineral supplements |
| What Fluids are a person with ulcerative colitis or crohns disease be given | - IV fluids to correct fluid and electrolyte imbalances - TPN if needed |
| Why are sedatives, anti-diarrheals and anti-peristaltic meds given to a patient with ulcerative colitis or crohns disease | - to slow peristals and rest bowel until stools are normal |
| What are given for long-term maintainence for mild or moderate inflammations | - Mesalamine - sulfasalazine |
| What medications are given for severe disease of crohns disease or ulcerative colitis | - Corticosteriods - Given rectally if rictal involvement |
| What percentage of Crohns disease patients have surgery | - 75% within 10 years - non cuarative - achieve remission |
| What is lap-guided strictureplasty | - Widening of narrowed intestine |
| How much of the bowel can be removed in a small bowel resection | - up to 50% can be tolerated |
| What percentage of ulcerative colitits patients have total colectomies | - 25% |
| Why are colectomies and ileostomies given | - Due to continued bleeding, perforation, stricture formation |
| When is a cure acheved in a patient with ulcerative colitis | - when colon is removed |
| What are is Pre op procedure with ileostomy | - WOC nurse marks stoma 2" below the waist |
| How long does it take for the ileostomy to function | - 1 - 2 days post op |
| How much extra fluid does a person lose with an ileostomy | - 1 - 2 liters per day - use NG suction |
| Why would a person need emotional support with and ileostomy | - Change in body image |
| Who takes care of the skin and stoma post op in an ileostomy | - WOC - It will be pink and shiny |
| What is the pouch called that is attached to the ileostomy | - Kocks pouch |
| What type of diet should a patient be on with an ileostomy | - Low residue for 8 weeks - increase fluids |
Created by:
saraken2007
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