NU122 Intestinal Dysfunction
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| What are the function of the intestines | - Absorption of food for nutrition
- Elimination of Waste
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| Where does absorption take place in the small intestines | - through the villi
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| With what action is the absorption done in the small intestine | - Active transport
- Diffusion
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| What is secreted in the duodenum of the small intestine | - Digestive enzymes
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| Where do the digestive enzymes come from for the small intestines | - Pancreas
- Bile
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| What is absorbed in the Jejunum of the small intestine | - Fats
- Proteins
- Carbohydrates
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| What is absorbed in the Ileum of the small intestine | - B12
- Bile
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| What is the main function of the Large intestine | - Reabsorbs water
- Reabsorbs electrolytes
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| What is secreted to protect the lining from feces in the large intestine | - Mucous
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| How does feces move in the large intestine | - Slowly by peristalsis
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| How long does it take for the feces to reach the rectum | - 12 hours
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| What interferes with the function of the small intestines and the large intestines | - Constipation
- Malabsorption
- Obstructions
- Inflammations
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| What is Constipation | - Abnormal infrequent defecation
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| What causes Constipation | - Old age are increased risk for
- Perceived Constipation
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| How many bowel movements per week is considered constipation | - less than 3
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| What are the symptoms of constipation | - Straining at stool
- Indigestion
- Nausea
- Abdominal distention
- Small volume hard stools
- loss of appetite
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| What may constipation lead to | - Megacolon
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| What should you teach patients about constipation | - Increase activity
- Eat high fiber foods
- lots of fluids
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| What types of medications are used for treatment of constipation | - Laxatives
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| What are the different types of laxatives | - Bulk-forming
- Lubricant
- Stimulant
- Fecal softener
- Osmotic agent
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| What are some of the names of Bulk-forming laxatives | - Psyillium hydrophyilic mucilloid
- Metamucil
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| What are some of the names of Lubricant Laxatives | - Mineral Oil
- Glycerin suppository
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| What are some of the names of Stimulant Laxatives | - Biscodyl(Dulcolax)
- Senna(Senokot)
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| What are some of the names of Fecal Softener Laxatives | - Docusate
- Colace
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| What are some of the names of Osmotic agent Laxatives | - Polyethylene glycol and electrolytes
- Colyte
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| What is another name for Malabsorption | - Diarrhea
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| What are some of the chief characteristics of Diarrhea | - Frequent, watery stools
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| What are the causes of Malabsorption or Diarrhea | - Infection
- Inability of digestive system to absorb certain nutrients
- Irritable Bowel Syndrome
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| What bacterium may cause diarrhea | - Infection with C.difficile bacterium
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| How dose C.difficile proliferate in the bowels | - this happens when the normal foral is disrupted by the use of antibiotics
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| What is a moderate C.difficile infection treated with | - Metronidazole or Flagyl
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| What is a severe C.difficile infection treated with | - Vancomycin orally
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| What is a severe infection of C.difficile called | - Pseudomembranous colitis
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| What are some of the causes of the inability of the digestive system to absorb nutrients | - Celiac Disease or Gluten intolerance
- Radiation enteritis
- Pancreatic enzyme insufficiency
- Crohn's disease
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| What are the stool characteristics of Celiac disease, radiation enteritis, pancreatic enzyme insufficiency and crohn's disease | - Loose, bulky, foul-odored, with increased fat content and may be grey in color
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| What may the inability of the digestive system to absorb nutrients lead to | - Malnutrition
- Vitamin and mineral deficiency
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| What may an older adult signs and symptoms be with malabsorption due to the digestive systems inability to absorb nutrients | - fatigue and confusion
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| What is Irritable Bowel Syndrome | - spasms of the intestine causing diarrhea and constipation
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| What causes Irritable Bowel Syndrome | - Intestinal motility dysfunction
- Serotonin signaling dysfunction
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| What are the signs and symptoms of IBS | - Pain
- Bloating
- Distention
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| What usually relieves the signs and symptoms of IBS | - Defecation
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| What are usually leads to IBS | - Heredity
- Psychological Stress
- Irritating foods
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| What is the usual treatment for IBS | - High fiber diet
- antidepressants
- probiotics
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| What medications are used in treating IBS | - Alosetron
- Lubiprostone
- Tricylic Antidepressants
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| How does alosetron treat IBS | - It is used to treat the diarrhea associated with IBS
- Antagonizes the spasms caused by seratonin
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| How does Lubiprostone treat IBS | - It is used to treat the Constipation associated with IBS
- Draws water into the bowels
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| How does Tricylic Antidepressants Treat IBS | - Slows Parastalsis
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| What are some of the complications of diarrhea | - Fluid and Electrolyte imbalances
- Dehydration
- Cardiac dysrhythmias
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| What Electrolytes are loosed through diarrhea | - Potassium
- Magnesium
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| What should a patient do if diarrhea is prolonged | - Seek medical attention
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| What type of diet should a person be on with Diarrhea | - replace Fluid and Electrolytes
- Avoid Caffeine, Very Hot or Cold Foods
- May havev to Avoid Milk, Fats, Fresh Fruits, Whole Grain, Vegetables
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| What Medications are used to treat Diarrhea | - Kaopectate
- Imodium
- Anticholinergics such as dicyclomine as an antispasmotic
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| What are the two types of intestinal obstructions | - Mechanical
- Functional
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| What is a Mechanical Obstruction | - Strictures
- Tumors
- Hernias
- Stenosis
- Adhesions
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| What are functional obstructions | - Intestinal musculature cannot propel due to paralytic ileus
- Diabetes melitus
- Parkinson's
- Muscular dystrophy
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| What is given to a diabetic with intestinal obstructions | - Reglan
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| Where can intestinal obstructions occur | - in both the small intestines and large intestines
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| Where does the fluid and gas accumulate in a small bowel obstruction | - above the obstruction
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| What does this fluid a gas accumulation lead to | - Abdominal distention
- that leads to inability to absorb fluids
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| What happens within the intestinal lumen | - Increased pressure
- decreases venous and capillary pressure
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| What does the increased pressure in the intestinal lumen and decreased venous and capillary pressure lead to | - Results in swelling and congestion of intestinal wall causing necrosis and eventual perforation of wall
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| What are some of the symptoms of Small bowel obstruction | - crampy wave like pain
- Passes blood and mucous but no fecal matter
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| Is there vomiting associate with a small bowel obstruction | - Yes
- First stomach contents
- then bile
- possible fecal matter if ileum is obstructed
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| Is there thirst associated with a small bowel obstruction | - Yes
- Extreme thirst
- Parched tounge
- Becomes dehydrated
- which leads to hypovolemic shock
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| How can a small bowel obstruction be diagnosed | - Abdominal Xray
- CT will show large quantities of gas and fluid in intestine
- CBC
- Electrolytes
- Infection
- dehydration
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| What is the treatment of a small bowel obstruction | - NG suction to decompress bowel this may be all that is needed
- Surgery if needed to remove hernia, adhesions
- Resection and reanastomosis
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| What is the nursing care for a patient with a small bowel obstruction | - Maintain NG suction
- monitor electrolytes and fluid status
- Monitor for return of normal bowel function
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| Where does the accumulation occur in a large bowel obstruction | - Proximal to the obstruction
- usually fluid and gas
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| What does this accumulation of fluid and gas lead to in a large bowel obstruction | - Severe distention and perforation ensue unless some gas and fluid can back flow through ileal valve
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| What about dehydration in a large bowel obstruction | - Happens more slowly than in a small bowel obstruction
- Because colon can absorb its fluid contents and can expand its size
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| What accounts for a large majority of large bowel obstructions | - Adenocarcinoid tumors
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| What are the symptoms of a large bowel obstruction | - Constipation
- change is shape of stool
- blood in stool
- weakness
- weight loss
- distended abdomen
- fecal vomiting
- shock
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| How do these symptoms of a large bowel obstruction develop | - Slowly
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| What is used to diagnose a large bowel obstruction | - Abdominal Xray, CT, MRI all pinpoint obstruction
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| What should you not give when doing a diagnostic test for a large bowel obstruction | - Barium for contrast it will cause constipation
- Use gastrograffin instead
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| What are the non surgical treatments for a large bowel obstruction | - Restore fluids and electrolytes
- NG suction for decompression
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| What are the surgical treatments for a large bowel obstruction | - Colonoscopy to untwist bowel
- Surgical resection with possible colostomy
- Ileo-anal anastomosis it total colectomy done
- Cecostomy if poor surgical risk to relieve gas
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| What can be given in a cecostomy to induce bowel movements | - an enema
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| What is the nursing care for a patient with a large bowel obstruction | - Observe for worsening obstruction
- IVs
- Pre and post op care
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| What is the 3rd most common cause of death from cancer | - Colorectal Cancer
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| What is the most important thing to do for prevention of colorectal cancer | - Screenings
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| What are the symptoms of Colorectal Cancer | - Change in bowel habits
- Blood in stool(tarry, or bright, occult)
- Tenesmus
- Pain
- Anemia
- Anorexia
- Weight loss
- Fatigue
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| What are some of the risk factors for Colorectal cancer | - Increased age
- High alcohol consumption
- family history
- Smooking
- Chronic inflammatory diseases of bowel
- High fat, high protein, low fiber diets
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| What is a colostomy | - a surgical creation of an opening into the colon to drain through skin into a pouch
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| What is the consistency of the fecal matter in a colostomy in the ascending colon | - Liquid stool
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| What is the consistency of the fecal matter in a colostomy in the transverse colon | - unformed stool
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| What is the consistency of the fecal matter in a colostomy in the descending colon | - semi formed stool
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| What is the consistency of the fecal matter in a colostomy in the sigmoid colon | - formed stool
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| What does function return with colostomy | - 3 - 6 days after surgery
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| How should the wafer be hung with a colostomy | - It should hug the stoma
- Change weekly
- Check the skin
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| What does the wound care nurse do with a patient getting a colostomy | - Marks the stoma site pre-op
- teaches patient the care of stoma
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| What should a patient do when given a colostomy | - drink 2 liters of water per day
- avoid gas producing foods
- avoid pop corn, nuts, large seeds
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| What are the inflammatory diseases of the intestines | - Diverticulitis
- Appendicitis
- Peritonitis
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| What is a Diverticulum | - a sac like herniation of the lining of the bowel that extends through a defect in the muscle layer
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| What are diverticulum most common | - In the sigmoid colon
- but may occur anywhere
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| What is diverticulosis | - Multiple diverticula without inflammation
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| What is diverticulitis | - Infection and inflammation of the diverticula
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| What is diverticula disease associated with | - Age and low fiber diets
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| What may a person have preceding diverticulosis | - Constipation
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| What are the the symptoms of Diverticulitis | - Mild or severe pain in left lower quadrant
- Nausea
- Vomiting
- Fever
- Chills
- Elevated WBCs
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| What are some of the complications associated with Diverticulitis | - Perforation
- Peritonitis
- Abscess formation
- Bleeding
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| What are some of the signs and symptoms of a Perforation | - Abdominal pain
- loss of bowel sounds
- Shock
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| What type of diet should a person be on with diverticulitis | - Clear liquids to low residue initially
- High Fiber
- Low fat diet after the inflammation is gone
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| What type of medication is given to a person with diverticulitis | - Antibiotics for 7 - 10 days
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| What should a person do if they have severe symptoms | - Hospitalization
- with IV fluids and NG suction to rest bowel
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| What type of surgical interventions would a patient get with diverticulitis | - Percutaneous drainage of abscess
- resection of colon with temporary colostomy
- Later re-anastomosis
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| What is the appendix | - 4" long narrow lumen that attaches to cecum just below ileo-cecal valve
- Fills with food and empties into cecum
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| What is an appendix prone to | - Obstruction and infection
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| What happens when the appendix gets inflamed | - intraluminal pressure increases with constricts the circulation
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| Where is the pain when the appendix gets inflamed | - It get progressively worse in right lower quadrant within a few hours
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| At what age would a person experience appendicitis | - usually between 10 - 30 years of age
- Uncommon in elderly
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| What type of pain is associated with appendicitis | - Mild abdominal pain that increases and localized to RLQ
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| What are some of the signs and symptoms of Appendicitis | - Low Grade Fever
- Elevated WBCs
- Elevated Neutrophils
- Nausea
- Loss of appetite
- maybe vomiting
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| What types of diagnostic tests are given for appendicitis | - CT
- U/S of abdomen
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| What is McBurney's Point | - Half way between umbilicus and Right anterior iliac spine
- There will be tenderness there
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| What is Rovsing's Sign | - Pain in RLQ after LLQ is palpated
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| Why should you not give laxatives in a patient with appendicitis | - may cause a perforation
- Eventhough they may have constipation with adbominal pain and fever
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| When is surgery usually done with appendicitis | - Immediately
- either laparoscopic or laparotomy
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| What medications are given to a person with appendicitis | - Antibiotics
- Iv Fluids to prevent sepsis and fluid and electrolyte imbalances
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| When is a surgical drain used in a patient with appendicitis | - if there is an abscess
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| What should be done Post-Op for a patient with appendicitis | - placed in high fowlers position
- Opiods for pain
- IVs Oral fluids
- Possible solid foods and same day discharge if uncomplicated
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| When should a patient follow up with the surgeon | - 5-7 Days
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| What are the signs and symptoms of a Ruptured appendix | - Pain more diffuse, spread out
- Abdominal distention
- paralytic ileus
- peritonitis
- abscess formation
- Temp > 100
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| What is peritonitis caused by | - Leakage of contents of abdominal organs into the abdominal cavity
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| What can peritonitis result from | - Inflammation
- infection
- trauma
- ischemia
- tumor perforation
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| What happens when bacteria spread in a patient with peritonitis | - causes edema of the tissues
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| What does the exudate contain | - Fluid with blood, WBCs and protein
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| What happens to the intestines in peritonitis | - Intestines become hypermotile at first and then develop paralytic ileus
- air and fluid accumulates in the bowel
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| What is the pain like with peritonitis | - pain is diffuse and then localized over the diseased site
- worsens with movement
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| What are some of the signs and symptoms of peritonitis | - Rebound tenderness
- Paralytic ileus
- temp 100- 101
- Eleveated WBCs
- tacchycardia
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| What electrolytes are altered with peritonitis | - Potassium
- Sodium
- Chloride
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| What happens as the peritonitis progresses | - Patient may become hypotensive
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| What are used to diagnose peritonitis | - Abdominal Xrays
- CT shows distended bowel loop, free air and fluid in peritoneum and bowels
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| What are some of the complications of peritonitis | - Widespread infection in abdominal cavity
- Sepsis leading to shock
- Death
- Bowel adhesion and then blockage
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| Why does hypovolemia occur with peritonitis | - Because massive amounts of fluids and electrolytes move from intestinal lumen into peritoneal cavity and depletes fluid in intra-vascular space
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| What is used to treat hypovolemia in peritonitis | - Fluid, electrolyte and colloid replacement
- requires several liters of isotonic IV fluids
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| What medications are given to patients with peritonitis | - Antibiotics
- analgesics for pain
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| Why is a NG Tube or LIWS used for in a patient with peritonitis | - To relieve abdominal distention and promotes intestinal function
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| Why would you have to administer oxygen to a patient with peritonitis | - Because of the fluid in the abdomen lead to abdominal distention which leads to pressure on the diaphragm which leads to respiratory distress
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| What happens if the peritonitis leads to shock | - Patient goes to ICU
- Placed on ventilator
- close monitoring
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| What are some of the chronic inflammatory diseases of the intestine | - Crohn's Disease
- Ulcerative Colitis
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| When does Crohns disease first occur | - in adolescents and young adults
- smokers
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| What is Crohns disease | - Chronic inflammation of GI tract wall extending through all layers(Transmural lesion)
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| Where do the lesions of crohns disease occur | - Distal lumen
- ocassionally in ascending colon
- there are periods of exacerbation and remission
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| How does crohns disease start off as | - Edema and thickening of mucosa
- then ulcers from and are separated by normal tissue
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| What is the cobblestone appearance of crohns disease | - Ulcers are not continuous and do not touch each other so they appear as a cobblestones
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| What forms and the inflammation of crohns disease extends to the peritoneum | - Fistulas, fissures and abscesses
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| What happens as crohns disease progresses | - bowel walls thicken
- Fibrosis
- Intestinal lumen narrows
- Adhesions form
- diseased bowel loops adhere to other loops
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| Where is the pain in a patient with crohns disease | - Right lower quadrant
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| What is not relieved by defecation in crohns disease | - Diarrhea
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| What are the complications of the constricted lumen in crohns disease | - Does not allow digestive contents of upper Gi to pass through easily
- so crampy abdominal pain, tenderness and intestinal spasm occur especially after eating
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| What may the patient do with crohns disease because of the crampy pain | - Limit food intake
- which will lead to malnutrition, anemia and weight loss
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| What does the edematous intestine empty into the colon | - irritating discharge
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| What can the abscesses, fever and high WBC of crohns disease affect | - Joints by arthritis, eyes and skin inflammations, oral ulcers
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| What are the Diagnostic tests used in crohns disease | - Barrium Xray
- Barrium Enema
- Endoscopy
- CBC
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| What does a barrium Xray show with crohns disease | - classic String signs of terminal ileum
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| What does a barrium enema show in crohns disease | - Cobblestone lesions
- fissures
- fistulas
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| What does an endoscopy show in crohns disease | - Intestinal biopsies confirm diagnosis
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| What does a CBC show in crohns disease | - Anemia
- Elevated WBC and ESR(sed rate)
- If malnourished protein and albumin levels are decreased
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| What are some of the complications of crohns disease | - Intestinal obstruction
- Peri-anal disease
- Fluid and electorlyte imbalances
- Malnutrition
- Entero-cutaneous fistulas
- increased risk of colon cancer
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| What are the intestinal obstruction in crohns disease due to | - Stricture formation
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| What is the malnutrition in crohns disease due to | - Malabsorption
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| What is an entero-cutaneous fistula | - Abnormal opening between small bowel and skin
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| What are patients at risk for with crohns disease | - Colon Cancer
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| What is Ulcerative colitis | - Recurrent ulcerative and inflammatory disease of mucosal and submucosal of colon and rectum
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| What does ulcerative colitis affect | - Superficial mucosa of colon
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| What are some of the manifestations of Ulcerative colitis | - Multiple ulcerations
- Diffuse Inflammation
- Shedding of colons epithelium
- Bleeding due to ulcers
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| What is the mucosa like in ulcerative colitis | - Edematous
- inflammed
- abscesses form
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| How are the lesions in ulcerative colitis | - They are contiguous meaning they touch one another
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| How does ulcerative colitis develop | - Starts in the rectum and spreads up to involve entire colon
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| What eventually happens to the colon in ulcerative colitis | - The colon narrows, shortens and thickens
- Fistuals
- Obstructions
- Fissures uncommon
- Disease not transmural
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| What are some of the signs and symptoms of Ulcerative colitis | - anorexia
- Weight loss
- Fever
- Vomiting
- Dehydration
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| What may a person develop with ulcerative colitis | - Anemia
- fatigue
- Hypocalcemia
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| Where is the pain with ulcerative colitis | - LLQ
- Cramping
- Rebound tenderness in RLQ
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| What are the stools like with ulcerative colitis | - Diarrhea with mucous, pus
- rectal bleeding
- 10 - 20 per day
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| What can ulcerative colitis also affect | - Skin
- Eyes
- Liver
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| What may a patient present with ulcerative colitis | - Tachycardia
- Fever
- hypotension
- pallor
- abdominal distention
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| What are some of the lab test results in a patient with ulcerative colitis | - decreased hemoglobin and hematocrit
- Decreased albumin
- Elevated WBC
- Electrolyte abnormalities
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| What can a barrium enema or sigmoid or colonoscopies detect in a patient with ulcerative colitis | - Ulcerations
- mucosal abnormalities
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| What can a CT,MRI,U/S detect in a patient with ulcerative colitits | - abscesses
- perirectal problems
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| What are some of the complications of ulcerative colitis | - Perforation
- bleeding
- Toxic Megacolon
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| What will a perforation lead to in a patient with ulcerative colitis | - peritonitis
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| What is toxic Megacolon | - Inflammatory process extends into muscle layer of colon
- inhibits its ability to contract
- resulting in distention of colon
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| What are some of the signs and symptoms of toxic megacolon | - Fever
- abdominal pain
- distention
- vomiting
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| What are some of the treatments for toxic megacolon | - NG suction
- IV fluids with electrolytes
- Steroids
- antibiotics
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| What happens if patient does on improve in 24 - 72 hrs | - surgery required
- Total colectomy
- ileostomy
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| What type of diet should a patient be on with ulcerative colitis and crohns disease | - Oral fluids
- low residue
- high protein
- high calorie
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| What type of foods should a patient avoid with ulcerative colitis and crohns disease | - one that exacerbate diarrhea
- avoid smoking
- cold foods these increase intestinal motility
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| What type of supplements should a person with ulcerative colitis and crohns disease take | - Vitamin
- mineral supplements
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| What Fluids are a person with ulcerative colitis or crohns disease be given | - IV fluids to correct fluid and electrolyte imbalances
- TPN if needed
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| Why are sedatives, anti-diarrheals and anti-peristaltic meds given to a patient with ulcerative colitis or crohns disease | - to slow peristals and rest bowel until stools are normal
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| What are given for long-term maintainence for mild or moderate inflammations | - Mesalamine
- sulfasalazine
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| What medications are given for severe disease of crohns disease or ulcerative colitis | - Corticosteriods
- Given rectally if rictal involvement
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| What percentage of Crohns disease patients have surgery | - 75% within 10 years
- non cuarative
- achieve remission
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| What is lap-guided strictureplasty | - Widening of narrowed intestine
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| How much of the bowel can be removed in a small bowel resection | - up to 50% can be tolerated
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| What percentage of ulcerative colitits patients have total colectomies | - 25%
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| Why are colectomies and ileostomies given | - Due to continued bleeding, perforation, stricture formation
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| When is a cure acheved in a patient with ulcerative colitis | - when colon is removed
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| What are is Pre op procedure with ileostomy | - WOC nurse marks stoma 2" below the waist
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| How long does it take for the ileostomy to function | - 1 - 2 days post op
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| How much extra fluid does a person lose with an ileostomy | - 1 - 2 liters per day
- use NG suction
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| Why would a person need emotional support with and ileostomy | - Change in body image
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| Who takes care of the skin and stoma post op in an ileostomy | - WOC
- It will be pink and shiny
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| What is the pouch called that is attached to the ileostomy | - Kocks pouch
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| What type of diet should a patient be on with an ileostomy | - Low residue for 8 weeks
- increase fluids
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|
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