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210 Ch. 38
Intestinal/Rectal Disorders
| Question | Answer |
|---|---|
| Define constipation | abnormal frequency, abnormal hardening of stool so passage is hard, painful, retention of stool |
| What is perceived constipation | person's bowel elimination pattern is not consistent with what they consider normal. Chronic laxative use contributes |
| What is processes in urge to defecate? | 1.stimulation rectoanal reflex 2. relax int/ext sphincter muscle 3.incr abd pressure |
| What clinicaly defines constipation | Rome criteria: <3 bowel mvmts/wk, abd distention/pain, decr appetite, HA, fatigue, lumpy/hard/dry stools all for 12 wks in last 12 months |
| What cardiologic complication can appear wtih constipation | Valsava manuever which lowers bp during straining, then rebounding to high bp and can rupture major aa in brain or elsewhere |
| Treating cause and preventing recurrence of constipation would be? | education, bowel habit training, incr fiber(25-30g/day)/fluids, careful use of laxatives |
| Enemas and rectal supp are best used to treat constipation or impaction? | impaction |
| Laxative medications Bulk forming meds? lubricant meds? stimulant meds? stool softeners? osmotic agents? | bulk form: metamucil/citrucel/MOM lub: mineral oil/glycerin supp stim: dulcolax/senokot soft: Colace(pt avoid strain) osm: Colyte(cleanse/diarrhea) |
| stimulant laxative have what action? contraindications? | action: irritate epithelium/stimulate mucosal secretions contra: avoid milk/antacids, not long term use, may cause F&E imbalance |
| Action for lubricant laxative? contraindications? | act: lubricate mucosa cont:not take w/ meals, impair absorption of fat-soluble vit and delay gastric emptying |
| Action for bulk form lax? contraindications? | act: draw fluids to int/peristalsis cont: take with h2o, short use, MOM not for renal insuff. |
| Define diarrhea? typical causes? | >3x/day, >200g/day amt, liquidity Caused by: irritable bowel syn, inflammatory bowel dis, lactose intolerance, malabsorptive disorders, ZES, ileus, obstruction, AIDS |
| Acute vs chronic diarrhea | acute: 7-14 days/infection chronic: 2-3 wks |
| Types of diarrhea: secretive | secretive: high volume/bacteria/neoplasms/incr secretion of h2o and electrolytes into intestine |
| osmotic diarrhea | osm: water pulled into int by unabsorbed particles, slows reabsorption of h2o cause: lactase def, pancreatic dysfx, int hemorrhage |
| Malabsorption diarrhea | Mal: inhibit absorption of nutrients, hypoalbuminemia, greasy, grayish, oil drops = pancreatic dysfx |
| Infectious diarrhea | inf: C Diff blood, mucus, pus in stool can mean enteritis/colitis |
| exudative diarrhea | caused by radiation or chemo |
| what is borborygmus? what is tenesmus? | intestinal rumbling ineffective anal straining |
| Difference in small bowel and large bowel disorders are seen in what kind of stool? | small bowel: watery stool lg bowel: loose, semisolid |
| what cardiologic complication can come from diarrhea? | loss of K = dysrhythmias s/s: muscle weak/paresthesia/hypotension/drowsy Can lead to dig toxicity |
| What is med of choice for diarrhea? | loperamide(Imodium)fewer SE than diphenoxylate(Lomotil) |
| Define fecal incontinence? | involuntary passage of stool and often symptom of impaction |
| IBS(Irritable bowel syndrome)is spastic contractions in bowel... primary s/s are? | alternating of constipation/diarrhea/or both, pain/bloating/abd distention at least 3 days a month and improves with defacation |
| Define zollinger-ellison syndrome | hyperacidity in duodenum inactivates pancreatic enzymes...so steatorrhea |
| what nsg intv would be necessary for both peritonitis and ileus | nasogastric suction/assess F&E |
| appendicitis and diverticulitis can lead to | peritonitis which is leakage of contents from abd organs into abd cavity. s/s: abd pain/muscle rigidity, fever, vomiting/incr WBC Med mgmt: fluid/colloid/elec replace loss in vascular space |
| RLQ pain, low grade fever, nausea/vomiting, pain at MrBurney's point usually indicates? | appendicitis |
| If ileus forms or peritonitis what nsg intv would be for both | nasogastric suction correct F&E |
| define diverticulum | saclike herniation of lining of bowel thru muscle layer, LLQ pain, fever, chills, leukocytosis CT scan best diagnostic tool and incr wtih age |
| More medical mgmt of peritonitis | analgesics for pain, antiemetics for nausea, NG suction to relieve abd distention, O2 via mask/cannula from excess fluid in cavity..intubate/ventilate if septic |
| what are two common complications of peritonitis post surgery | wound evisceration: assess location of abd tenderness/pain/blood from wound abscess formation |
| what position helps pt wtih abd pain from peritonitis | side lying with knees flexed |
| what s/s reveal subsiding peritonitis | decr temp/pulse, abd softening, bowel snds return, flatus passes, bowel mvmts |
| IBD-inflammatory bowel disease refers to two GI dirsorders? | Crohns disease ulcerative colitis |
| Crohn's disease defined and found where? | inflammation of GI tract wall, all layers and usually in ileum or maybe ascending colon |
| s/s of crohn's disease | RLQ pain with diarrhea unrelieved by defecation, cramps after meals, emaciated, malabsorption, steatorrhea |
| Small bowel fistulas, the enterocutaneous fistula(b/n sm bowel and skin) are indication of | Crohn's disease, incr risk for colon Ca |
| Ulcerative colitis is usually found where? | rectum/colon |
| pharmocological tx for crohn's and ulcerative colitis | reduce inflammation: corticosteroids suppress immune response: Methotrexate rest for bowel |
| Tx for crohn's diesase can lead to total colectomy(remove entire colon) which usually results in | ileostomy |
| what is proctocolectomy? IPAA | remove colon,rectum,anus IPAA: pouch for rectum |
| Nutritional mgmt for inflammatory bowel disease | low residue, high protein/vitamin diet. Keep food diary of foods that irritate |
| what is purpose of nasogastric suctioning after ileostomy? | part of post op care to prevent build up of gastric contents while int not fx |
| what foods are odor reducers? odor inhancers? Meds to reduce odor? | red: spinach/parsley inhance: apsaragus/cabbage/onion/fish meds to reduce: bismuth subcarbonate tablets, Lomotil thicken stool(rice/mashed pot/applesauce |
| If effluent is dry in ileostomy, should water be incr? | no, water excreted in urine, incr salt intake |
| what is leading complication for ileostomy>? | skin integrity |
| Pt says they can eat prunes/grapes/bananas/seeds with ileostomy. Does this pt have good understanding of good nutrition | no, seeds are undigestible, constipate, provide bulk. fruits incr quantity of stool/diarrhea |
| Mechanical causes of intestinal obstruction: Adhesion, intussesception, volvulus, hernia, tumor | adhesion: after surgery, adhesions intuss: part of int slips into other, more in infants volvulus: bowel twists on self hernia: int through abd muscle/wall tumor: most lg bowel obstructions |
| Sm bowel obstruction can lead to metabolic alkalosis why? acidosis, why? | vomiting loses H ions and K from stomach, leads to decr Chloride/K acidosis: dehydration and Na loss |
| Risk factors for colorectal cancer | age/fam hx/alcohol/smoking/obesity/hx IBD/low fiber,high fat diet/genital, breast Ca |
| rt sided lesions s/s? left sided lesions s/s? rectal lesions? | rt: dull,abd pain/melena lft: abd cramps,pain/narrowing stools/constipation/distention/bright red blood in stool rect:tenesmus/pain/incomplete empyting/bloody/diarrhea alternate wtih constipation |
| How can pt regulate emptying of stoma with colostomy | irrigation of stoma at reg times helps reduce gas and stool retention |
| Anal fistula? anal fissure? hemorrhoids? | fistula: opening from skin to anal canal fissure: tear in anal canal hemm: dilated vv in anal canal |
| Pilonidal Sinus/cyst? | found on post surface of lower sacrum with hair protruding from opening. Mgmt: sitz bath/stool softeners/fluids |
Created by:
palmerag
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