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chapter 38

digestive disorders for exam 4

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
Created by: nursingTSJC2013