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CH 38 MIV-1
Ch 38 digestive: Disorders affecting digestion 2
| Question | Answer |
|---|---|
| Dumping syndrome: when are you at risk | operations of stomach/gastrectomy/bypass/rapid feeding |
| Dumping syndrome: stage 1 | abdominal distention/fullness/nausea w/in 10-20 mins. Feels faint & flushed, heart rate races, sweats |
| Dumping syndrome: Stage 2 | 20-60 mins = bloating, flatulence/gas,cramps, diarrhea |
| Dumping syndrome: Stage 3 think hypoglcemia | 1-3 hours = sweat, weakness, anxious, shaky, hungry |
| Dumping syndrome: what type of diets should be? | Low carbohydrates, low sugar, moderate fat, moderate to high proteins |
| early signs and symptoms of stomach cancer | none |
| later signs and symptoms of stomach cancer: | liver enlargment, ascites, vomiting, abdominal mass |
| cause of stomach cancer | unknown |
| stomach cancer risk factors: | H. pylori infection, pernicious anemia, chronic atrophic gastritis,lack of HCl, family Hx |
| diagnosis of stomach cancer | gastroscopy, UGI,CAT scan, MRI,PET Scan, endoscopic ultrasound |
| diet considerations for stomach cancer | eat well = high fiber, vitamins, minerals whole-grain, 5 to 9 servings of fruits and vegetables; maintain weight and activity |
| how many servings of fruits and vegetables is suggested | 5 to 9 |
| exercise should be how many minutes, how many times days | 30 minutes for five or more days each week |
| normal weight is how many kg/m2 | 18.5 to 24.9 |
| overweight | 25 to 29.9 |
| obese | 30 to 39.9 |
| severely obese | 40 or more |
| formula for calculating obesity | weight in kilograms/height in meters squared |
| the basic cause of obesity is caloric intake exceeds | metabolic demands |
| Obesity story | energy converted to fat cells, fats expand, divide to form new fat cells. Do not decrease in number when a person loses weight. Only decrease in size |
| primary treatment for obesity | weight reduction and exercise |
| calorie allowance may be as low as | 800 calories a day |
| two types of bariatric surgery | restrictive, malabsorptive |
| a surgery that reduces the size of the stomach | restrictive |
| surgery that bypasses the stomach | malabsorptive |
| RNYGBP decreases stomach size by creating a ____ connected to ____ | pouch, jejunum |
| VBG ____ stomach leave a small pouch into what part of the stomach | staples; lower part |
| what is a risk for RNYGBP | dumping syndrome cuz food passes to fast in jejunum |
| Bypass surgery complication | metabolic and nutritional complications |
| VBG complication | vomiting if solids are consumed fast, distention of pouch, rupture of staples |
| position a patient that is obese to auscultate heart sounds | left side lying |
| name three interventions to prevent cardiopulmonary complications | leg exercises, TC&DB, position changes |
| reason for early ambulation for obese patients after surgery | risk for DVT and pulmonary embolism |
| What other treatment is given to obese pts. after surgery to prevent DVT/emboli/thrombi | LMWH |
| what powder should you avoid | cornstarch, talcum powder |
| obese pt who underwent surgery can be fed only after what is done? | image studies to see no leaks |
| how many liquids can the pouch hold initially | 15-30 ml |
| What is a common problem of bariatric surgery | dumping syndrome |
| type of malabsorption w/ severe changes in intestinal mucosa and inability to absorb most nutrients | ciliac |
| malabsorption caused by ___ agent and unable to absorb what 3 things? | tropical sprue: infections; vitamin B 12, folic acid, fats |
| common and sign of malabsorption | steotorrhea |
| steotorrhea | excessive fat in stool |
| Rx for Celiac sprue | avoid gluten: rye, oat, barley, wheat; corticosteriods |
| Rx for tropical sprue | B12 injections, oral folate, antibiotics |
| people who frequently ignore the urge to defecate may become: | chronically constipated |
| frequent use of laxatives and enemas are good treatments for constipation: T or F | False, it causes chronic constipation |
| chronic constipation contributes to the development of what other conditions? | Hemorrhoids, fecal impaction |
| an enema or suppository takes many hours to work? Laxatives? | w/in an hour; 8-10 hrs |
| a condition in which the large intestines loses the ability to contract and propel fecal mass | Megacolon treated by enemas |
| the retention of large stool in the rectum | fecal impaction |
| what symptom is seen in fecal impaction? What misunderstanding is made? | leaking stool; dx as diarrhea |
| suspect impaction if patient has not had a bowel movement for several days and has repeated episodes of | mild diarrhea |
| to remove fecal impaction what may be administered to soften stool: name 2 | mineral oil followed by soapsuds enema |
| S/Sx of intestinal structure | projectile vomit is possible; abdominal pain, constipation |
| Intestinal obstruction: give the order of what if vomited | gastric contents first, bile is next, fecal matters last |
| untreated obstruction of intestines can result in: | death, shock, gangrene, perforation |
| Dx of intestinal obstruction: | confirmed by radiograph |
| initial treatment of intestinal obstuction | GI decomp |
| if nasoenteral suction is ordered; what is the main nursing intervention? | monitor output to ensure free drainage at all times |
| initial symptom of appendicitis is usually pain in the___region or the___. Then shifts to the___lower quadrant | epigastrium; umbilicus; right |
| the classic symptom of appendicitis is pain at? | McBurneys point = midway between umbilicus and iliac |
| appendicitis: because of pain the patient may assume what kind of position | flexion |
| S/Sx of peritonitis | absent bowel sounds, severe distention, increased pulse, rebound tenderness |
| Dx of appendicitis is classic sign of WBC being what counts | 10,000 to 15,000 |
| laxatives and heat applications are good nursing interventions for undaignosed abdominal pain: T or F | false |
| Heat and laxatives can cause appendix to___ if inflamed: | rupture |
| Dx for non ruptured appendicitis is suspected | cold packs, NPO |
| Dx for ruptured appendicitis | delay surgery 6-8 hrs, IV, antibiotics |
| Surgery of appendix is done ___ when it is confirmed | immediately |
| appendicitis pre-op: what position is best | semi fowler, sideliying w/ hips flexxed |
| appendicitis pre-op: are analgesics given right away | not until physician determines dx |
| why do you w/d pain meds when diagnosing appendicitis? | pain pattern is need to dx; explain this to pt. |
| appendicitis pre-op: If rupture occurs | Elevate HOB to localize infection |
| appendicitis post-op: what is given? | IV fluids, antibiotics, GI decomp |
| appendicitis post: Ambulation? | early ambulation is ordered |
| appendicitis post: normal activities can be done when? when are you discharged? | 2-3wks; few days |
| peritonitis: what is done to obtain specimen for culture | paracentisis |
| Rx of peritonitis: | antibiotics, IV, NG decomp, analgesics |
| buldging in portion of intestines | hernia |
| Herniorrhaphy | repair of hernia by suturing |
| Hernioplasty | enforces sutures |
| If surgery of hernia is contraindicated, what is given? | truss |
| abdominal hernia: what S/sx suggest stragulation | nausea,pain, distention, fever, tachycardia |
| what are two common side effects after hernia surgery | urinary retention and scrotal swelling |
| inflammatory bowel disease refers to what two types of conditions | colitis and Crohns |
| ulcerative colitis inflammation begins where to where? and Crohns begins where? | rectum to cecum; anywhere but usual site is terminal ileum |
| Ulcerative colitis S/Sx: if in the rectum | constipation |
| Ulcerative colitis S/Sx: overall | diarrhea, BLOODY STOOL; severe case is fever and weight loss |
| Crohn's S/Sx: stomach and duodenum | epigastric pain, nausea, vomiting |
| Crohn's S/Sx: small intestines | pain, abd tenderness, cramping |
| Crohn's S/Sx: colon | abd pain, cramping, RECTAL BLEEDING, diarrhea |
| Crohn's S/Sx: systemic signs | fever, malaise, night sweats, joint pain |
| Dx confirmation of IBD | barium enema/colonoscopy w/ biospy, video capsule |
| antidiarrheals are not given for? | severe ulcerative colitis |
| which condition is unaffected by antibiotics: Crohn's or colitis | colitis |
| Ulcerative colitis is maintained by what med | aminosalicylats |
| Crohn's is treated w/ | azathioprine or 6-MP |
| surgery for Ulcerative? | colectomy w/ an ileostomy |
| surgery for Crohn's | recurrence is often so surgery is not always done. But they can remove affected area |
| Postop wise, Crohn's reappears where? | site of anastomosis |
| IBD foods not allowed | caffiene, alcohol, pepper, raw fruits and vegs |
| what antibiotic is often prescribed w/ colitis (i know it's a contradiction) | sulfasalazine: treat acute attacks and prevent future attacks: dosage reduced after acute |
| cause of IBD | unknown |
| why should pts on sulfasalazine need adequate fluids | causes crystals that damage kidneys |
| normal urine output | 1500 mL/day |
| pts. on steroids are monitored for? why? | s/sx of infection. Brings inflammation down but suppresses immune system too |
| small sac like pouches in the intestinal wall | diverticulitis |
| diverticulitis is usually found where? | Week areas, mostly sigmoid colon |
| S/Sx of diverticulitis | none to changes in bowels, periodic constipation and diarrhea, rectal bleeding, Pain in lower left abdomen |
| Main complications of diverticulitis | severe bleeding, abnormal opening/fistula between colon and bladder or vagina |
| Dx of diverticulitis | occult blood, barium enema |
| if thre is an acute inflammation of diverticulitis? | delay Dx testing because they are invasive |
| diverticulitis: what type of diet | high residue no spicy |
| diverticulitis:why can't you give morphine | causes constipation |
| diverticulitis: decrease spasms in colon | anticholinergics |
| diverticulitis:constipation | stool softners and bulk-forming laxatives |
| diverticulitis:during period of acute inflammation | bed rest/NPO, IV fluids, GI decompress |
| diverticulitis: if surgery is needed | affected colon is removed, temp colostomy to rest colon while incision heals |
| diverticulitis: post op...be alert for? | perforation |
| cancer of the large intestines | colorectal cancer |
| colorectal cancer: 3rd most common cancer in | women |
| colorectal cancer: early sign right side | cramping, unexplained anemia, weakness |
| colorectal cancer: left side S/Sx | blood in stool, narrow pencil like stool |
| colorectal cancer: why is there pencil like stool on the left side | pressure on bowel from growing tumor in rectum |
| colorectal cancer surgery: above rectum | remove diseased portion and then anastomosed |
| colorectal cancer surgery: rectal involves two incisions | perineum and abdominal |
| colorectal cancer surgery: rectal | removal of rectum and put colostomy (perm) |
| colorectal cancer: early stage is treated w/ | radiation and surgery |
| colorectal cancer surgery: how many incisions of rectal surgery? describe what is used for Perineum close, partly close, open | 3; closed = jackson pratt, partial = penrose, open = packed |
| colorectal cancer surgery: what is best postion right after surgery | side lying |
| complications of polyps | obstruction, hemorrhage |
| dilated veins in the rectum | hemorrhoids |
| hemorrhoids above the sphincter muscles of the anus | internal hemorrhoids |
| hemorrhoids below sphincter anus muscle | external hemorrhoids |
| hemorrhoids containing clotted blood are said to be | thrombosed |
| key risk factor of hemorrhoids | increased pressure in the rectal blood vessels |
| pressures increased by | constipation, pregnancy, prolonged sitting and standing |
| hemorrhoids: what soothes anus after BM | witch hazel compress |
| Treatment for thrombosed hemorrhoids | ice packs follow by warm packs |
| Out pt procedure for hemorrhoids | litigation, sclerotherapy, thermocoagulation and electrocoagulation, laser surgery |
| tying offered rubber bands | litigation |
| injection if an agent into the tissue around the hemorrhoids | sclerotherapy |
| use of different types of devices to remove hemorrhoids | thermo and electro |
| effective but more expensive and risky hemorrhoid surgery | laser surgery |
| hemorrhoid surgery that may have temporary results | sclerotherapy |
| hemorrhoidectomy | removal of hemorrhoids (excision) |
| hemorrhoidectomy: wounds are kept open or closed? | both |
| hemorrhoidectomy: is important to assess and record what? what can be ordered | stools; stool softner; pain meds before BM |
| hemorrhoids: if you have fever or bleeding | notify physician |
Created by:
Jgar2007
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