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Test #3 GI PART 2

NUR 201

Functional or anatomical loss of small intestines is defined as what.. Short Bowel Syndrome
What is the average length of the adult human small intestines? 600 cm
What is the range (cm) for the length of the small intestines? 260-800 cm
What is the most common SBS in adults? Crohn's disease
What is the most common SBS in pediatric patients? Necrotizing Enterocolitis
What do you call it when absorption capacity is severely compromised? Malabsorption
What are some characteristics of malabsorption? diarrhea, steatorrhea, F&E disturbances, malnutrition.
What are some cofactors for development of Malabsorption? Segment lost/remaining, age, and presence/absence of ileocecal valve
Most common GI emergency occuring in neonates. Necrotizing Enterocolitis
T/F Necrotizing Enterocolitis initial symptoms occur rapidly. False. Necrotizing Enterocolitis initial symptoms may be subtle.
Define Hematochezia. passing of stools with blood.
What are the initial symptoms of Necrotizing Enterocolitis? Feeding intolerance, delayed gastric emptying, adb. distention, abd. tenderness, ileus with decreased bowel sounds, abd. wall erythema (adv stage), Hematochezia
T/F Necrotizing enterocolitis can occur in full term infants. True.
Nectrotizing Enterocolitis affects ___% of infants who weigh less than ___kg (or ____ lbs). 10%, 1.5 kg = 3.31 lbs
What is the mortality rate for an infant who develops Necrotizing Enterocolitis? (%) greater than 50% mortality rate!
In severe cases the infant can have _________ failure! (NE) multisystem
Why is Necrotizing Enterocolitis so serious? Because it occurs in infants, who cannot describe their pain level -- so it can be missed or overlooked.
What is a possible cause for NE and does it get better on its own? NE could potentially be caused by gram-neg bacteria (normal flora which spreads across the barrier). It has a domino affect.. cannot get better on it's own!!
What are s/s of late stages of NE? apnea, lethargy, decreased peripheral defusion, CV collapse.
An acute inflammation of the veriform appendix is called what.. Appendicitis
Where is the appendix connected to (in sm. int)? cecum
What is the avg. length of the appendix in adults? (and normal range in cm) 10 cm; ranges 2-20 cm
Inflammation in the appendix occurs when ____________________ and can lead to ____________. the lumen of the appendix is obstructed; leading to an infection (bacteria invade the wall).
In appendicitis, the mucosa secretes fluid and increases the internal pressure and restricting blood flow which causes _______! PAIN!
If the process of appendicitis occurs slowly what can form?? abcess
If the process of appendicitis occurs fast, what can form? peritonitis!!!
Gangrene can occur within __ to ___ hrs after appendicitis/obstruction. This is life-threatening EMERGENCY SURGERY. _____ May develop w/in 24hrs. (Risk increases after 48hr) 24-36hrs; perforation
What is the initial obstruction of appendicitis usually caused by? fecaliths
Appendicitis FIRST clinical manifestation (&loc) pain around navel
Appendicitis second manifestation (&loc) McBurney;s point
Describe McBurney's Point 1/2 way between umbilicus and anterior iliac crest in RLQ
Clinical Manifestations of Appendicitis n/v, anorexia, fever >101F, ^pulse, psoas and obtrator sign,^WBC --- remember PAIN then N/V!!!
bending at the R hip or knees to relieve pain in RLQ suggests what..? perforation and peritonitis!
How do you test for appendicitis? Pain on passive right leg extension!
T/F Appendicitis is harder to dx in the elderly True
WBC count 10000 - 18000 and ^ immature WBC is called a ___ __ ____. shift to left
T/F WBC count >20,000 is a sign of perforation from Appendicitis TRUE
Diagnosis of Appendicitis is made by performing what test and checking for what upon palpation... checking for rebound tenderness and doing a CT scan of abdomen. (remember: abdm pain ^ w/ cough/movement)
What are 3 nonsurgical treatments for Appendicitis? NPO (prep for surg. and prevent more inflamm.), IV fluids, semi-fowlers
Two contraindications when pt has an Appendicitis... NO heat packs! NO laxatives or enemas!! This could perfortate pocket of infection!!!
Surgery for Appendicitis.. and recovery time.. Laparascopy / Laparotomy ; 2-3 weeks recovery (5-6weeks if complications arise)... Most uncomp. appedectomy procedures done via laparoscopy.
Three things used during surgery (meds/etc) opioid analgesics, ABOX, Cold packs
What is Peritonitis (danger level, what is it, cause) Danger: Life-threatening WHAT: inflammation of the peritoneum CAUSE: chemical or bacterial contamination of the peritoneal cavity.
How does the body try to fight off peritonitis? Causes an inflammatory respone, and walls off the area to contain and fight infection. Requires vascular dilation and ^permeability. fluid shift excracellular --> peritoneal cavity, connec. tissue and GI tract (third spacing). PERISTALSIS may SLOW or STOP
Complications of peritonitis? abcesses, adheasions, septicemia, hypovolemia (bc of 3rd spacing), shock, paralytic ileus(bc slowed peristalsis), organ failure. ALL PRESS ON DIAPHRAGM--> respiratory FAILURE or compromise, b/c of PAIN.
Clinical manifestations of Peritonitis include: RIGID, BOARDLIKE ABDOMEN!!! (CLASSIC). Pain, N/V, tachycardia, tachypnea, fever (low-grade or spike), decrease urine output, hiccups. EMERGENCY SURGERY. gangrene/perforation w/in 24hrs.
Diagnostic of Peritonitis from WBC count: WBC ^ to 20,000 and high Neutrophils.
Other dx tests for Peritonitis (besides WBC count) CBC with diff, abd. x-rays, ultrasound, peritoneal lavage..
Peritoneal lavage, describe. 1 L of fluid instilled into peritoneal dialysis catheter. POSITIVE: if 500 WBC/mL &AND& 50,000 RBC/mL. OR POSITIVE: Bacteria on gram stain. Green/bile stain: may indicate: rupt. gallbladder or perforated intestine.
T/F NPO, NGT for gastric decompression, and rest all are treatments for Peritonitis.. True.
Broad ABOX and IV fluids used prior to dx. After dx is made, ___ and ____ are prescribed. analgesics, stool softeners to prevent pressure
When is surgery contraindicated for Peritonitis? When the pt is too sick or too ill to have the surgery.
What type of surgery is used for Peritonitis? Abdominal surgery and controlling the infection by irrigating cavity with antibiotic solution
Why do you use semi-fowler's position for Peritonitis? use gravity to drain the cavity. Monitor VS q1hr immediately following surgery.
T?F Strictly measure I&O and no strict IV flow rate post-surgery for Peritonitis. True.
No lifting for ___ weeks post-op with Peritonitis. 6
What s/s of worsening would be immediately reported tothe physician post-surg for Peritonitis? unusual or fowl smelling drainage, swelling, redness, warth or bleeding from incision, Temp >101F, abd. pain, signs of wound dehiscence or ileus.
Nursing Dx for Peritonitis include: Acute Pain, FVD (measure i&o and daily wts), imbalanced nutrition, decreased CO (r/t fluid status vs q4h), anxiety (prescibe Anxioytic)
What is the most common digestive d/o? IBS .. 1/5, more common in WOMEN
Functional GI disorder that causes chronic or recurrent diarrhea, constipation, and/or pain and bloating. IBS aka nervous colon, spastic colon, mucous colon
IBS is an impairment in the ____/____ function of the GI tract. motor/sensory
T/F Structural and infectious etiology is identified as an IBS cause. False. No structural or infectious etiology is identified, cause is unknown!
When the pt is exposed to Causitive agents, IBS _______. exacerbates "flares up."
What are some causitive agents for IBS? diverticular dz, gastric stimulants, smoking, NSAIDS, fat intake, sulfer intake, coffee... BUT the mucosal lining remains unchanged.
What is the Manning Criteria? Characteristic Symptoms of IBS. 1. abd pain relieved by defacation/falling asleep (HA). 2. abd. pain assoc. w/ stool changes (freq/consis) 3. abd. distention 4. sensation of incomplete evac of stool 5. presence of mucous w/ stool passage.
What is the most common symptom of IBS?? (&loc) PAIN in the LLQ. nausea may be assoc. with meal time and defacation.
What to include with teaching IBS patient? AVOID problem stimulants!!! Keep a symptom/food diary!! Increase FIBER to: 30-40 g + 8-10 cups liquid
T/F Drug therapy for IBS is specific to symptoms!!! True. Specific to constipation, diarrhea, and pain
IBS tx for when the prodominent symptom is constipation.. Bulk-forming laxative (Metamucil)
IBS tx for when the prodominent symptom is diarrhea.. Anti-diarrheals (Imodium)
IBS tx for when the prodominent symptom is pain.. Paxil (Tricyclic antidepressant) -- stress mgmt also.
Complimentary/Alternative therapies Peppermint oil (relax intestines and expel gas), Ginger (gas, discomfort), Yoga (relax), Acupuncture, Artichoke leaf extract, regular exercise
What age group is most affected by IBS? young adults and continues t/o life.
What are just two ingredients can worsen IBS (ie sugar types..)? fructose and sucralose
This disease is also known as "tied to the toilet" UC Ulcerative Colitis
This is a widespread inflammation mainly in rectum and rectosigmoid. UC
UC gradually extends from rectum up thru the ______ colon towards _____. descending; cecum
With UC, what eventually becomes edematous and THICK with SCAR TISSUE. COLON. loses elasticity and absorption and then Fluid Loss!!
T/F UC has periods of remission and infection. False. UC has periods of remission and inflammation
UC stool usually contains ... (2) blood & musous
What are the possible causes of UC? infectous agent, autoimmune rxns, food allergies, heredity, sever emotion distress, tobacco use, 20-40 y/o(females) && 55-65 y/o (males.
Who is at higher risk for UC and why? smoker or non-smokers non-smokers bc nicotine causes smooth muscle contractions
UC clinical manifestations: colicky abd pain, diarrhea w/ bloody stools (20-30 x a day), and tenesmus
Tenesmus, define unpleasant, urgent sensation to defacate!
> 10years w/ UC, you have a higher risk for what developing? Development of large intestines cancer.
What are complications of UC? liver dz, arthritis, anemia, anorexia, electrolyte imbalance, inflammation of joints, eye, skin dz, malnourished
What is the MOST definitive test for UC?? colonoscopy
How do you diagnose UC? H&P, Barium enema, sigmoidoscopy (perforation ^ risks), colonoscopy (usually give versed), stool cultures, hemat. stools
Order of giving meds for UC? PO meds THEN suppositories THEN enemas.
Inflammation leads to BREAKDOWN in lining of COLON. UC (opposite of Crohn's Disease)
This reduces symptoms or maintains remission for UC tx Aminosalicylates : Mesalamine (5-ASA) it is effective in 2-4 wks. usually used for mainanence btw acute episodes
High dose short period of time, used during exacerbations for UC tx. Glucocorticoids: Predisone, Budesonide, and hydrocortisone
Alter person's immune respone and used w/ combo of steriods but helps reduce the amt of days steriods is needed. (helps quicken response). UC tx Immunomodilators
Give cautiously! Can cause toxic MEGACOLON! UC tx. Anti-diarrheals: Lomotril or Imodium
Used for severe complications such as MEGACOLON. Suppository or enema Remicade...or Humira.
Massive dilation of colon that can lead to peritonitis.. mega colon
Treats acute attacks and helps prevent future attacks. Can cause CRYSTAL URIA... SO, output is monitored to be at least 1500mL/day!!!! Sulfasalazine (can have low dose year round).. if crystaluria occurs --> can cause damage to kidneys.
When a pt is taking Sulfasalazine.. what do you encourage a pt to do (dietary advice). Increase PO fluids to 2500mL/day
Nutritional plan for UC pts... In acute phase..NPO to allow bowel to rest.... Then, when food is permitted --small freq meals, increase fluid, low residue, low fate, high protein... LOW FIBER!!
Last resort treatment for UC pt is.. Colectomy (Surgery). It is curative and is the standard. (15-20^% require it when.... failure to respond to medical tx, freq&debilitating exacerbations, massive bleeding/obstr/perforations, tissue changes to suggest dyspasia, CANCER
What is the priority nursing care for UC pt post-surgery? Skin care!!!
If surgery is needed for UC, ileostomy is placed in RLQ...If it is pale, blue or dark--- what is your nursing intervention? REPORT it immediately
What is the normal stoma color, expected. Cherry Red!!
What is the initial output described as with a permanent ileostomy? Loose, dark green liquid -- may contain blood.
When do you empty an ostomy bag? 1/3 to 1/2 full
When do you change the pouch system for ostomy? every 3-7 days
Use Humira with what execptions for megacolon.. if the pt has no allergy to proteins and no infections.. it can be used!
Inflammatory dz of small intestines Regional Enteritis aka Crohn's Disease
Crohn's dz (CD) mainly affects what part of the small intestines terminal ileum
Describe onset pattern for CD.. slowly progressive, unpredictable, and recurrent
T/F Severe malabsorbtion by the small intestines during CD causes malnourishment True
What is a common formation with CD patients including bowel? fistula
T/F Crohn's dz has an unknown cause True
Emotional stress is NOT a factor for this dz... CD
Poor ____ worsens CD.. nutrition
CD affects what population of race the most.. Jewish
If the stomach and duodenum is involved with CD... what are the clinical manifestations.. n/v, epigastric pain
Common manifestions of CD are.. malaise, wt. loss, fatigue, anorexia.. and mainly MILD DIARRHEA (w/mucous,fat,pus)3-4 qd after meals. Ileum - 5-6 qd
With CD, when ___ ____ is diseased, the pain common in both lower quadrants. lower colon
Systemic s/s of CD colicky, RLQ pain, relieved with bowel movement, pain replaced with achey soreness, night sweats, lowgrade fever, growth failure, arthritis, joint pain, steatorrhea!!
Complications of CD are: mainly: fissures, ulcerations, fistulas. also, sm bowel obst, high-pitched or rushing dounds present over narrowed bowel obstr.
T/F No disease-specific test to confirm Crohn's dz. (what is available for dx?) True, but can use classic biopsy via colonoscopy.
Pharm. tx for CD is similar to UC except what addt'l med.... CD uses ABOX (can be useful) and CD is less responsive to aminosalicylates! Maintained on 6-MP (Azathioprine).
high local glucocorticoid concentration to terminal ileum and R colon. High doses-short periods... Name it. Taper or dont taper off this med?? Budesinide. tapered off, yes. Use with caution!!!
Immunosuppresant for refractory dz or fistula. Name it and tell the dosage.. What do you use for long term tx??? Imuran 50mg qd for 12 months.. if longer tx needed use Methotrexate!
For megacolon relief...use every ___ weeks. Name it and tell dosage. What is another option (and precaustions for the drug). Remicade..use every 8wks. 5mg/kg. Alt: Humira only if NO allergy to proteins or infection is presented!!
Antibiotics for CD.. name it and dose Flagyl 250-500 mg PO 3 times daily (fistulas)
T/F NPO during acute phase (rest and heal) for CD. True
What is used for rapid absoption for CD IV fluids and TPN. ^cals,^protein,^fluid.. low residue, low fat.. avoid irritants
this therapy relax and soothes GI tract.. ginger root
this therapy is combonation of diet, herbs, yoga, and breathing exercise Ayuveda
This therapy helps promote remission for CD.. vivonex
Surgery is curative/non-curative for Crohn's dz. non-curative. Recurrance (70-90%) in 1 yr at spot of resection(anastomosis site) (MIS laparascopy).
How many calories a day for CD patient for Fistula Healing... 3,000 calories per day
Define Enterovesical fistula btw bowel and bladder.
Define Enteroenteral fistula btw bowel to bowel
Define Enterocutaneous. fistula btw bowel to skin
Define Enterovaginal fistula btw bowel to vagina
what is a fistula?? abnormal tract btw two or more body areas.
Never allow what to come in contact with skin?? wound drainage!!!
Which dz is thickening of BOWEL WALL CD
With Immusuppressive drugs.. what is your nursing teaching to the pt receiving this drug.. report signs of infections early (cold or sore throat) and avoid... LARGE CROWDS
Created by: Sarahmarie001