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Intestinal Dysfunct.

NU122 Intestinal Dysfunction

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