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chapter 38
digestive disorders for exam 4
| Question | Answer |
|---|---|
| pharynx | resp and digestive |
| esophagus | from pharynx to stomach |
| chyme | semiliquid mass |
| sm intestine | chemical digestion and absorption; 20 ft long; liver and pancreatic secretions enter the duodenum; 3 layers - 1. mucous membrane layer secretes digestive enzymes sucrase, lactase, maltase, carboxypeptidase, aminopeptidase, dipeptidase, nucleosidase, lipase and enterokinase; 2. inner layer of villi where food molecules are absorbed into the bloodstream; 3. muscle layer |
| lg intestine | chyme enters ileocecal valve; lg intestine goes up the right side of abd=ascending, across just below the waist=transverse, down the left side=descending |
| lg intestine | has no villi, secretes no digestive enzymes; just absorbes water |
| ileocecal valve | chyme enters lg intestine, first section of lg intestine is the cecum, appendix is located here; |
| age related changes | does not significantly impair ingestion, digestion, absorption or elimination; illess put the older person at risk for problems with digestion and elimination; teeth wear down, appear darker and transparent; gingiva recede; jaw may have osteoarthritis; loss of taste buds; xerostomia caused more by poor hydration and drugs; wall of the esophagus and stomach become thinner and secretions lessen; motor activity slows; vit A absorption increases and causes vit D, calcium and zinc to decrease; |
| age related changes continued | muscle layer and mucosa atrophy; blood flow decreases; CT increases; |
| constipation | not a normal age related change; causes by low fluid intake, lack of fiber, inactivity, drugs, depression, hypothyroidism |
| edentulous | missing teeth |
| assessment of GI tract | hx of alternative methods of feeding or fecal diversion - iliostomy, colostomy; food allergies or intolerance with description of reaction; is pt able to obtain and prepare food; |
| gastric ulcers | increased pain after eating |
| duodenal ulcers | decreased pain after eating |
| goal of therapy for diarrhea | replace lost fluids |
| treatment of constipation | increase fluids and fiber intake |
| order of examination | inspection, auscultation, percussion, palpation |
| post-procedure nursing care for Upper GI, sm bowel series and barium enema | monitor stools for 2 days for passage of white stools that show barium is being eliminated; provide food, fluid and rest |
| post-procedure nursing care for endoscopic tests | NPO until gag reflex returns; monitor for bleeding, fever, abd distention, cramping pain and vague discomfort= perforation |
| capsule endoscopy | 10 hr fast if small bowel study; 2 hr fast if esophagus study; simethicone given to reduce bubbles and improve visualization; capsule may require surgical removal if there is an obstruction; pt returns to the office in 6-10 hrs to turn in recording device |
| serum electrolytes | medications that affect results may be held until blood is drawn; resume meds after |
| serum protein electrophoresis | medications that alter test results held till after blood id drawn; includes aspirin, isoniazid, neomycin, bicarbonate, sulfonamide |
| gastric analysis | NPO for 12 hours; NG tube is inserted into stomach and contents aspirated and discarded; at 15 minute intervals for 1 hour contents are aspirated and collected separately; |
| esophageal function tests | NPO for 8 hours; takes 30 minutes; swallow small tubes that measure the pressure in esophagus; pt may have mild sore throat after |
| fecal fat test | observe a 60 g fat diet for 3-6 days then collect stool sample, do not use laxatives, enemas or suppositories for 3 days prior to test; |
| tube feedings placement | gravity flow or infusion pump; pt in fowlers position during and for 30 minutes after; confirm placement of tube - radiographic is most reliable for sm bore, aspirate contents for pH or 5 or less is most reliable for lg bore; if continuous feedings - check placement once per shift; method that lacks scientific support is listening while air is injected |
| tube feedings residual | monitored to prevent overfilling the stomach; check before each feeding; action taken for the amount of residual is agency determined; return residual to prevent loss of electrolytes |
| tube feeding rights | right formula right amount right dilution right schedule right patient |
| NC for tube feedings | stop feeding and notify provider if pt complains of nausea or pain; rinse tube by flushing with 30 mL of water after each feeding; contact the provider if diarrhea occurs; dumping syndrome may occur with rapid feedings |
| S&S of dumping syndrome | cold sweat, abd distention, dizziness, weakness, rapid pulse, nausea, diarrhea |
| tube feeding procedure syringe | remove plunger from barrel of syringe, attach to feeding tube, pinch or kink tube while formula is added to syringe, hold barrel about 12 inches above stomach, flush tube |
| tube feeding procedure infusion pump | fill tubing with formula before connecting to feeding tube, continuous feedings are delivered at a rate of 80-150 mL/hr, hang no more than 6 hours worth or formula to prevent contamination; bolus feedings are usually 200-300 mL over 30-45 minutes; tubing and bag must be changed q24h |
| GI decompression | NG tube; removes fluid and gases that accumulate when motility is impaired; may be ordered until motility returns, usually in 3-5 days; |
| GI decompression procedure | attach tube to suction, low intermittent suction with single lumen tubes; low continuous suction with double lumen tubes; monitor patency of tube; if tube is not draining, reposition pt or gently rotate tube; notify provider if drainage does not resume; irrigation is not done routinely by may be ordered, usually done with 20-30 mL of normal saline; |
| GI decompression NC | monitor suction output, record amount, color, and characteristics qshift; blood= bright/dark red, brown or black; dark brown or green suggest obstuction is below point where bile enters digestive tract; monitor for successful decompression; assess for return of peristalsis by presence of bowel sounds; provide comfort measures; do not tape tube to the forehead, this puts excess pressure on nasal tissues |
| TPN important points | always use sterile tech; inspect site each time dressings are changed; monitor temp; monitor flow rate-if given too rapidly then circulatory overload, changes in BG or diuresis may result; monitor BG; label TPN lines and do not use them to deliver drugs; death will occur is TPN line is confused with enteral feeding line; be alert for depression |
| preop NC for GI surgery | GI tract is usually cleaned prior to GI surgery, extent depends of exact site of surgery; cartharic=laxative; enemas till returning fluid is clear; changes in vs or mental status should be reported to provider; liquid diet 24 hrs prior to surgery; IV fluids; oral antibiotics; |
| postop NC for GI surgery | relieve pain, detect complications, prevent adverse effects of immobility, anesthesia and drug therapy; inspect, describe and measure drainage; do not irrigate or reposition tube b/c trauma to healing tissues; IV fluids till GI suction is d/c; catheter or interventions to promote voiding |
| antacids | teach pt that they still have SE even though they are OTC; follow with water or milk, interfere with absorption of drugs given within 1-2 hours of each other; chew tablets before swallowing |
| H2 receptor antagonists | give with or after meals; do not give ranitidine at the same time as antacid; risk of confusion in older adults with use of cimetidine |
| SE of antacids | Ca and aluminum salts cause constipation, mag salts cause diarrhea, combos neutrilize the SE of each other |
| SE of H2 receptor antagonists | diarrhea, muscle pain, rash, confusion, cimetidine- impotence and gynecomastia and impairs metabolism of many drugs; |
| proton pump inhibitor agents | swallow capsules whole, if unable to swallow then use prevacid or liquid preparations |
| SE of proton pump inhibitor agents | nausea, diarrhea, HA |
| mucosal barrier agents | carafate; give on empty stomach one hour before meals and antacids, interferes with absorption of other medications |
| SE of mucosal bariier agent | constipation, dry mouth, drowsiness, rash, itching |
| synthetic prostaglandin agents | cytotec; give with meals or HS; avoid pregnancy |
| SE of synthetic prostaglandin agents | diarrhea, abd pain, miscarriage, HA, gas, N/V |
| anticholinergic agents | atropine, pirenzepine; contraindicated with narrow angle glaucoma, renal disease, prostatic hypertrophy or intestinal obstruction, give .5-1 hr before meals and HS, report changes in behavior, monitor stools and urine output; provide oral hygiene |
| SE anticholinergic agents | dry mouth, constipation, visual disturbances, urine retention, less side effects with pirenzepine |
| 5-hr receptor antagonist agents | ondansetron, granisetron, palonosetron; dilute medication; give IV 30 minutes before chemo; drowsiness may occur; encourage fluids, fiber and activity to help with constipation |
| SE 5-hr receptor antagonist agents | constipation, diarrhea, abd pain, musculoskeletal pain, shivering, fever, hypoxia, urinary retention |
| laxative and stimulant agents | bisacodyl, senna, cascara, castor oil; monitor stools, fiber and fluids encouraged, CI: undiagnosed abd pain, inflammatory conditions of GI tract; |
| SE laxative and stimulant agents | irritate anus, cascara and senna make urine pink or brown, castor oil rapidly produces watery stool, not recommended for older adults b/c of risk for aspiration |
| bulk forming laxatives | must take with adequate fluids, may take 3 days to work |
| SE bulk forming laxatives | obstruction may occur; safest for long term use |
| saline osmotic laxative | CI with kidney disease, HF, hypertention or edema |
| SE saline osmotic laxative | dehydration with frequent or prolonged use |
| lubricant agents | mineral oil impairs absorption of sat soluble drugs and nutrients, give on empty stomach |
| SE lubricant agents | lipid pneumonia if aspirated |
| fecal wetting agents | given in milk or juice to mask taste; no SE |
| lactulose | mix with water, milk or juice; more effective on empty stomach; adjust dose if pt has diarrhea; if retention enema give with rectal balloon catheter |
| SE lactulose | cramps, gas, diarrhea, hyperglycemia in diabetics |
| polyethylene glycol glycerine supp or enema | can be used with renal and cardiac disease b/c it does not disturb electrolyte balance; pt must drink 300-350 mL every 10 minutes for 2-3 hours; glycerine works within 1 hour; make sure pt has immediate access to a toilet! no SE listed |
| opiate agents | antidiarrheal agent; given after each stool for acute diarrhea but do not exceed max dose; encourage good oral hygiene |
| SE opiate agents | CNS depression, drowsiness, constipation, nausea, dry mouth |
| absorbent agents | shake before pouring; interferes with absorption of other drugs |
| lactobacillus | may require refrigeration |
| ipecac syrup | give only if recommended by poison control center; follow with water according to age: ↓ 1 yo give 1 glass of water, 1-2 glasses of water for older children, 3-4 glasses of water for adults; action is impeded by charcoal or milk |
| SE ipecac syrup | CNS depression |
| antihistamine agents | promethazine, dimenhydrinate HCl; use cautiously with asthma, glaucoma and BPH |
| SE antihistamine agents | drowsiness and confusion |
| sedatives | hydroxyzine; prevents nausea and vomiting; monitor LOC, BP, urine output, assist with ambulation, bed in low position, oral care |
| SE sedatives | drowsiness, confusion, hypotension, dry mouth, nausea, diarrhea, urinary retention |
| anticholinergic agents | scopolamine; suppress the vomiting center; transderm scop is adhesive disk placed behind ear; CI with narrow angle glaucoma, and urinaty tract obstruction |
| prokinetic agents | metoclopramide; CI with GI perforation, obstruction, hemorrhage and epilepsy |
| SE prokinetic agents | CNS depression, GI upset, parkinson-like symptoms |
| cipro, erythromcin, flagyl; | complete entire therapy; report worsening symptoms |
| SE cipro, erythromcin, flagyl; | vary |
| olsalazine | used for ulcerative colitis; antiinfective agent; d/c if hives, rash or wheezing, encourage fluids |
| SE olsalazine | abd pain, diarrhea, HA, nausea |
| amoxicillin | used for H. pylori; take all this medication |
| SE amoxicillin | rash, diarrhea, anaphylaxis, superinfections (colitis) |
| nystatin | antifungal used to treat candida albicans; dissolve lozewnges in mouth, shake suspensions, swish and swallow |
| SE nystatin | nausea, vomiting, diarrhea |
| clotrimazole | treat candida albicans; vag preparation are available |
| SE clotrimazole | nausea, vomiting, itching |
| feeding problems | due to temporary or long-term problems; paralysis, arthritis, neuromusclular disorders, confusion, weakness, visual impairment |
| TX of feeding problems | identify the problem; PT and OT |
| stomatitis | inflammation of the oral mucosa; mechanical trauma, tobacco or alcohol use, poor oral hygeine, inadequate nutrition, patholgenic organisms, radiation therapy or drug therapy, emotional tension or fatigue; identify and eliminate cause; soft, bland diet |
| vincent infection | trench mouth; metallic taste and bleeding ulcers in mouth, foul breath, increased saliva; may have signs of general infection, topical antibiotics, mouthwashes, rest nutritious diet, good oral hygiene |
| herpes type 1 | ulcers and vesicles on/in the mouth; URI and sun exposure; acyclovir, valacyclovir, famiciclovir |
| aphthous stomatitis | canker sore; viral; ulcers on lips; topical and systemic steroids |
| candida albicans | yeast like fungus; bluish white lesions; topical antifungal agents vaginal nystatin tablets can be used like lozenges |
| oral cancer | squamous cell occur on the lips, buccal mucosa, gums, floor or mouth, tonsils and tongue; basal cell is on the lips |
| risk factors of oral cancer | irritants, sun, wind, pipe smoking, tobacco, alcohol, poor nutrition, chronic irritation |
| diagnosis and tx of oral cancer | biopsy, surgery, radiation, chemotherapy, sm lesions may just be excised and sutured; grafts are needed to close large defects caused by surgical procedures, donor site is usually pts thigh |
| NC for oral cancer | s&s difficulty swallowing or chewing, decreased appetite, weight loss, change in fit of dentures, hemoptysis; radiation causes edema; dry mouth, consult dr before doing any oral care if pt has had surgery or radiation; soothing solution H2O2 and NS or baking soda and water; monitor resp; |
| main concern with grafted tissue | maintain adequate blood supply to the graft; report coolness or darkness of the graft immediately |
| parotitis | inflammation of the parotid glands below the ear next to lower jaw; pay develop in pts unable to take oral fluids for a long time; tx is with antibiotics, mouthwashes, warm compresses; surgical drainage if chronic; prevention= chewing gum or citus candies; assess temp and level of comfort; |
| achalasia | progressively worsening dysphagia; caused by failure of lower esophageal muscles and sphincter to relax during swallowing; tx is drug therapy, dilation and surgical measures; isosorbide and nifedipine may provide short term improvement, botulinum toxin; complications of dilation are perforation of the esophagus; |
| s&s of perforated esophagus | chest and shoulder pain, fever, subcutaneous emphysema |
| NC for dilation and esophagomyotomy | monitor for bleeding, and perforation, NPO for 1 hour and only liquids for for 24 hours; have pt expectorate instead of swallow so bleeding can be detected; reflux is common after esophagomyotomy |
| esophageal cancer | not common but has a very poor prognosis; risks: smoking, alcohol, chronic trauma, poor oral hygiene, eating spicy foods; |
| S&S of esophageal cancer | progressive dysphagia, pain with swallowing may be substernal, epigastric or located in the back and radiating to the neck, jaw, ear or shoulder, sore throat, choking, weight loss |
| tx and dx of esophageal cancer | radiological studies, barium swallow, CT, esophagoscopy, ultrasound; removal of all or part of the esophagus, esophagogastrostomy-resection with the stomach; esophagoentersotomy=resection with colon; palliative tx= dlation, stent, laser tx, radiation therapy, chemo, photodynamic therapy=pt given light sensitive drug and 2 days later a fiber optic probe activates drug and kills only cancer cells |
| N/V | may or may not be accompanied by abd pain, pallor, perspiration, and cold clammy skin; |
| hiatal hernia | esophageal hiatus is the opening in the diaphragm; protrusion of the lower esophagus and stomach upward through the diaphragm; sliding hernias are associated with GERD; rolling hernia the stomach herniates up through a secondary opening; causes are weakness in the diaphragm, intraabdominal pressure, truama, long term bed rest, obesity, pregnancy, abd tumors, ascites heavy lifting |
| S&S of hiatal hernia | no symptoms; fellings of fullness, dysphagia, eructation, regurgitation, heartburn |
| DX and TX of hiatal hernia | barium swallow, CT, esophagoscopy, esophageal manometry; drug therapy, diet and measures to avoid intraabdominal pressure; surgery if severe bleeding or narrowing of the esophagus |
| fundoplication and angelchik prosthesis | surgeries to treat hiatal hernia; angelchik is the ring is tied around distal esophagus. |
| chronic pain from hiatal hernia | is caused by reflux |
| bethanechol chloride (Urecholine) | drug used to increase LES pressure in hiatal hernia |
| NC for hiatal hernia | dont eat for 2-3 hours before bedtime, sleep with head elevated 6-12 inches, eat small frequent meals, prevention of intraabdominal pressure includes do not bend forward. lift or strain and avoid tight clothing |
| GERD | the backward flow of stomach contents from the stomach into the esophagus; factors: abnormalities around the LES, gastric or duodenal ulcer, prolonged vomiting, prolonged gastric intubation; complications: sudden or gradual, esophageal stricture, adenocarcinoma; |
| S&S of GERD | painful burning sensation that moves up and down after meals, is relieved by antacids, may radiate to the back, neck or jaw, belching, symptoms occur after activities |
| DX and TX of GERD | dx is by symptoms and a trial of proton pump inhibitor if the symptoms go away while on the med and come back when d/c then reflux is assumed rather than cardiac disease; other drugs include H2 receptor blocker, prokinetics; if medical care is unsuccessful then fundoplication may be done |
| Gastritis | inflammation of the lining of the stomach; classified as acute, chronic type A or chronic type B; causes: h pylori, NSAIDs, stress, alcohol, peppers, reflux of bile salts, vomiting, CNS lesions; can affect production of intrinsic factor and decreased acid production, pernicious anemia |
| S&S of gastritis | N/V, anorexia, feeling of fullness, pain in the stomach, may only be mild indigestion, |
| TX and DX of gastritis | gastroscopy, occult blood, h pylori dx by breath test, urine, stool or serum tests; tx of symptoms and fluid replacement; H2 receptor blockers, proton pump inhibitors and antinausea drugs; focus is on the elimination of the cause; amox or clarithromycin or both, corticosteroids, bland diet |
| NC for gastritis | pt ed: adjust diet, stress reduction, notify dr if bloody vomit or dark tarry stools, avoid tobacco, no NSAIDs; assess effectiveness of drugs, sm meals, record I&O |
| peptic ulcer | a loss of tissue from the lining of the digestive tract; acute- affect superficial layers of GI lining or chronic- extend into the muscle layer; gastric or duodenal; most common in men and older adults; type A get gastric ulcers, type O get duodenal ulcers |
| causes, S&S of peptic ulcer | drugs, infection and stress; aspirin and NSAIDs, h pylori, stressful events such as shock, burns and trauma; s&s: gastric- burning pain in epigastric area 1-2 hours after meals, nausea, anorexia, duodenal- burning or cramping 2-4 hrs after meals, pain beneath xiphoid process, relieved by antacids or food, pain comes and goes; complications: intractability of symptoms, hemorrhage, perforation, peritonitis, pyloric obstruction due to edema or scarring, persistent vomiting |
| DX and TX of PUD | barium swallow, gastroscopy, esophagogastroduodenoscopy, gastric analysis, give pentagastrin to stimulate gastric secretions before collection of specimens; lab tests for h pylori; Goal: relieve symptoms, heal the ulcer, cure h pylori, prevent recurrance; H2 receptor blockers, proton pump inhibitors, prostaglandins, pirenzepine=anticholinergic without serious SE; carafate, cytotec; diet; |
| TX of complications of PUD | hemorrhage - NG tube to remove and measure blood and then saline lavage to control bleeding- place pt on left side and instill 50-200 mL of iced saline to cause vasoconstriction, then suction out saline, repeat till the returning fluid of free of clots, vasopressin IV, arterial embolization to seal bleeding arteries; perforation: gastric decompression, surgical repain when needed; obstruction: gastric decompression, IV fluids, surgical repair if needed; total gastrectomy |
| NC of hemorrhage | assist with procedure, monitor for water intoxication, HA, coma, tremor, sweating, anxiety, maintain patent NG tube, IV fluids |
| NC of Perforation | monitor vs, I&O, NPO, fluid and blood as ordered, keep NG tube patent |
| NC or obstruction | monitor vs, I&O, keep NG tube patent |
| NC of truncal vagotomy, selective or superselective vagotomy | vagus nerve is severed; monitor for delayed gastric emptying, may have a feeling of fulness, dumping syndrome, diarrhea |
| NC of pyloroplasty | widens pylorus; dumping syndrome |
| NC of simple gastroenterostomy | creates a passage b/t stomach and jejunum; increased gastric secretion |
| NC of antrectomy | removal of the antrum of the stomach; diarrhea, feeling of fullness, dumping syndrome, malabsorption and anemia |
| gastroduodenoscopy Billroth I | part of the distal stomach including antrum is removed and remaining stomach is anastomosed to the dodenum; dumping syndrome, anemia, malabsorption, weight loss, bile reflux |
| gastrojejunostomy | distal part of stomach and antrum is removed and anastomosed to the jejunum; dumping syndrome, malabsorption, duodenal infection, pernicious anemia, afferent loop syndrome=obstruction of duodenal loop |
| total gastrectomy | removal of entire stomach, esophagus is anastomosed to duodenum; consume sm frequents meals of semisolid foods, pernicious anemia and dumping syndrome; low carb diet, drink fluids b/t meals not with meals, lie down for 30 minutes after meals |
| early signs of shock | weakness, tachycardia, pallor, hypotension is a late sign of shock |
| risk of stomach cancer | begins in mucous membranes, invades gastric wall and spreads to lymphatics; h pylori, infection, pernicious anemia, chronic atrophic gastritis, type A blood, smoking, high starch diet, salt, pickled foods, salted meats, nitrates, obesity, |
| DX and TX for stomach cancer | gastroscopy and biopsy, carcinoembryonic antigen (CEA); surgery, chemo and radiationgene therapy and immune based therapy are used in early stage |
| NC for stomach cancer | focus is on teaching, 6 sm meals, low carbs, fat, refined sugar, high protein, lie down for 30 minutes after meals, monitor weight daily, |
| obesity | BMI is 30 kg/m2, divide weight in kg by height in meters2. complications: cardiovascular and resp problems, diabetes, dyslipidemia, cholelithiasis, infertility, endometrial cancer and fatty liver infiltration, joint disease |
| TX for obesity | exercise program, diet, behavioral therapist, drug therapy, sibutramine - decreases appetite, wellbutrin, prozac, tompamax, bariatric surgery, |
| realistic weight loss goal | 1-2 lb per week |
| malabsorption | one or more nutrients are not digested or absorbed; causes: bacteria, deficiencies of bile salts, digestive enzymes, alterations in the intestinal mucosa, absence of all or part of the stomach or intestines |
| sprue | celiac- severe changes in the intestinal mucosa and imparied absoroption of most nutrients, tropical- infectious agent and results in malabsorption of fats, folic acid and vit B |
| lactase deficiency | do not have adequate lactase to metabolize lactose; inherited; acquired- inflammaroty bowel disease, gastroenteritis and sprue; s&s bloating, cramping and diarrhea within several hours of consuming milk products |
| s&s of malabsorption | steatorrhea, large, bulky, foamy and foul smelling stools, weight loss, fatigue, decreased libido, edema, anemia, bone pain, |
| tx of sprue | drug therapy, avoiding gluten, tropical is tx with antibiotics, oral folate and B12 injections, |
| NC of malabsorption | effect of therapy is evaluated by the return of normal stool consistency, educate on dietary restrictions |
| diarrhea | causes: spoiled foods, allergies, infections, diverticulosis, malabsorption, cancer, stress, fecal impaction, tube feedings; complications: dehydration, electrolyte imbalance, metabolic acidosis; TX: clear liquids OP, IV and NPO IP, TPN if severe; NC: determine possible cause, measure liquid stools, watch for fluid imbalance, daily fluid intake of 2000-3000 mL, |
| constipation | normal=2-3 times per day or once a week; stool must be hard, dry and passed with difficulty to be considered constipated; causes: laxative dependence, cheese, lean meat, pasta, anesthesia, pain meds and OTC cold meds; complications: valsalva maneuver=slow blood flow to the chest cuasing a brief drop in pulse and BP, blood rushes back in when relaxing and can be fatal, |
| goal for constipation | immediate relief of problem and prevention of further episodes; softeners are not used for acute cause they take too long to work; |
| megacolon | large intesting loses the ability to contract enough to propel the fecal mass towards the rectum; neurological conditions; consider possible impaction when pt hasnet had a bowel movement for several days and has repeated episodes of mild diarrhea; mineral oil enema followed by soap suds enema |
| intestinal obstruction | causes: strangulated hernia, tumor, paralytic ileus, stricture, volvulus, intessusception and post op adhesions; S&S most acute when located in proximal part of sm intestine, abd pain, vomiting, constipation, complications: EI, metabolic alkalosis, gangrene and perforation; TX: GI decompression, surgical intervention |
| EI | electrolyte imbalance, I'm tired of typing those words |
| NC of intestinal obstruction | auscultate for rapid, high pitched tinkling bowel sounds, visible peristatsis, rigidity could indicate rupture -notify dr immediately; elevate HOB to relieve pressure on diaphragm |
| appendicitis | blind pouch off cecum; ruptured can lead to peritonitis, S&S: pain in epigastric region or around umbilicus, McBurneys point is located midway b/t umbilicus and iliac crest, N/V, elevated WBCs, |
| tx of appendicitis | NPO, cold pack if ordered; !!!NEVER!!!! use heat or laxatives; if ruptured elevate HOB to localize infection, surgery may be delayed 6-8 hrs to give IV antibiotics; semi fowlers or side lying position, |
| peritonitis | absence of bowel sounds, severe abd distention, increased HR and temp, N/V; chemical or bacterial, peristalsis slows or stops; TX: NG tube for decompression, surgery, NC: elevate HOB, imm report increasing pulse, restlessness, pallor and decreasing BP, |
| abd hernia | large intestine pushes through abd wall, weak locations include umbilicus and lower inguinal areas; painful when strangulated or incarcerated |
| NC of hernia repair | pt may have temp problem with urination, palpate for bladder distention; no coughing or sneezing, scrotal swelling is common, give him an ice pack; activities are restricted for 2-6 weeks; |
| IBD Inflammatory bowel disease | colitis and chrohn's disease; complications: hemorrhage, obstruction, perforation, abscess in the anus or rectum, fistulas and megacolon |
| colitis | inflammation begins in the rectum and gradually extends up to cecum; s&s: constipation, diarrhea with bloody stools, abd cramps, fever, weight loss; complications: increased risk of cancer of lg intestine, inflammatory conditions of joints, eyes, skin, urinary stones, liver disease |
| chrohn's disease | can affect any portion of the GI tract, terminal ileum is most affected; s&s: N/V, epigastric pain, abd cramping and tenderness, rectal bleeding and diarrhea, |
| current thinking about stress | IBD is the result of stress rather than IBD being caused by stress |
| DX and TX of IBD | history and phys exam, radiography; TX: corticosteroids, immunosuppressants, antidiarrheals, anticholeringics, antibiotics, aminosalicylates, iron supplements, infliximab, antidepressants |
| colitis | maintained b/t episodes with aminosalicylate or 6-MP; removal of the colon is curative |
| crohns disease | less responsive to aminosalicylates so pt is maintained on azathioprine or 6-MP; disease reappears within on year if resection and anastommosis; |
| NC for IBD | low residue diet with no caffeine, pepper, alcohol, grains, nuts, raw fruits and veggies, stress management may be helpful, report sadness or discouragement to dr.; sulfasalazine can cause crystals to form in the urine and damage the kidneys, take in enough fluid to maintain 1500 ml/day output; |
| diverticulosis | small saclike pouches in intestinal wall, most are found in sigmoid colon; cause: lack of dietary fiber, old age, constipations, obesity and emotional tension; s&s: diarrhea and/or constipation, rectal bleeding, pain in LLQ, N/V, urinary problems |
| DX and TX of diverticulosis | complications: inflammation and infection, fistula formation b/t colon and bladder or vagina; CT or barium enema, TX: high residue diet without spicy foods, pain control, anticholinergics to decrease spasms in colon; temp colostomy; |
| colorectal cancer | 3rd most common cancer; 3/4 are located in the rectum or lower sigmoid colon; S&S: mild symptoms of vague cramping in right side of abd; anemia, weakness, fatigue are related to blood loss; left sided or rectal cancer is more obvious with changes in bowel habits, stools become very narrow, pencil like, fullness or pressure in abd or rectum |
| TX of colorectal cancer | surgical, removal of rectum a permanent colostomy or attach rectal stump to anus, chemo and radiation if in lymph nodes |
| NC for colorectal cancer | very demanding care, pt has 3 incisions-abd, perineum and colostomy; perineal wound drains a large amount of serosanguineous fluid, may be open or closed, may have drain, reinforce dressings when saturated, t-binder to hold perineal dressings in place; use sterile procedures, gentle irrigations to promote healing |
| polyps | small growths in intestine, inherited= familial or Gardners almost always leads to cancer, complications: bleeding and obstruction; |
| hemorrhoids | dilated veins in rectum, thrombosed hemorrhoid has a blood clot; s&s: pain and itching; |
| ligation | tying off hemorrhoid with rubber bands |
| sclerotherapy | injection of an agent into tissue around hemorrhoid causes them to shrink |
| anorectal abscess | antibiotics and I&D, ice packs, sitz baths, topical agents |
| anal fissure | laceration b/t anal canal and perianal skin; usually heal spontaneously, |
| anal fistula | abnormal opening b/t anal canal and perianal skin; related to IBD, TB, abscess; TX: excision of fistula and surrounding tissue, temp colostomy |
| pilonidal cyst | sacrococcygeal area, an infolding of skin causing a sinus that can become infected; |
| pt ed to promote normal bowel function | identify foods that create distress, good hand washing and proper food handling, periodic sigmoidoscopy and occult blood tests for pts over 50 |
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nursingTSJC2013
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