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210 Ch. 38

Intestinal/Rectal Disorders

QuestionAnswer
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