NUR 201
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| Functional or anatomical loss of small intestines is defined as what.. | Short Bowel Syndrome
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| What is the average length of the adult human small intestines? | 600 cm
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| What is the range (cm) for the length of the small intestines? | 260-800 cm
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| What is the most common SBS in adults? | Crohn's disease
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| What is the most common SBS in pediatric patients? | Necrotizing Enterocolitis
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| What do you call it when absorption capacity is severely compromised? | Malabsorption
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| What are some characteristics of malabsorption? | diarrhea, steatorrhea, F&E disturbances, malnutrition.
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| What are some cofactors for development of Malabsorption? | Segment lost/remaining, age, and presence/absence of ileocecal valve
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| Most common GI emergency occuring in neonates. | Necrotizing Enterocolitis
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| T/F Necrotizing Enterocolitis initial symptoms occur rapidly. | False. Necrotizing Enterocolitis initial symptoms may be subtle.
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| Define Hematochezia. | passing of stools with blood.
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| 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
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| T/F Necrotizing enterocolitis can occur in full term infants. | True.
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| Nectrotizing Enterocolitis affects ___% of infants who weigh less than ___kg (or ____ lbs). | 10%, 1.5 kg = 3.31 lbs
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| What is the mortality rate for an infant who develops Necrotizing Enterocolitis? (%) | greater than 50% mortality rate!
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| In severe cases the infant can have _________ failure! (NE) | multisystem
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| Why is Necrotizing Enterocolitis so serious? | Because it occurs in infants, who cannot describe their pain level -- so it can be missed or overlooked.
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| 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!!
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| What are s/s of late stages of NE? | apnea, lethargy, decreased peripheral defusion, CV collapse.
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| An acute inflammation of the veriform appendix is called what.. | Appendicitis
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| Where is the appendix connected to (in sm. int)? | cecum
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| What is the avg. length of the appendix in adults? (and normal range in cm) | 10 cm; ranges 2-20 cm
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| 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).
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| In appendicitis, the mucosa secretes fluid and increases the internal pressure and restricting blood flow which causes _______! | PAIN!
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| If the process of appendicitis occurs slowly what can form?? | abcess
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| If the process of appendicitis occurs fast, what can form? | peritonitis!!!
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| 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
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| What is the initial obstruction of appendicitis usually caused by? | fecaliths
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| Appendicitis FIRST clinical manifestation (&loc) | pain around navel
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| Appendicitis second manifestation (&loc) | McBurney;s point
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| Describe McBurney's Point | 1/2 way between umbilicus and anterior iliac crest in RLQ
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| Clinical Manifestations of Appendicitis | n/v, anorexia, fever >101F, ^pulse, psoas and obtrator sign,^WBC --- remember PAIN then N/V!!!
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| bending at the R hip or knees to relieve pain in RLQ suggests what..? | perforation and peritonitis!
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| How do you test for appendicitis? | Pain on passive right leg extension!
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| T/F Appendicitis is harder to dx in the elderly | True
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| WBC count 10000 - 18000 and ^ immature WBC is called a ___ __ ____. | shift to left
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| T/F WBC count >20,000 is a sign of perforation from Appendicitis | TRUE
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| 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)
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| What are 3 nonsurgical treatments for Appendicitis? | NPO (prep for surg. and prevent more inflamm.), IV fluids, semi-fowlers
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| Two contraindications when pt has an Appendicitis... | NO heat packs! NO laxatives or enemas!! This could perfortate pocket of infection!!!
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| Surgery for Appendicitis.. and recovery time.. | Laparascopy / Laparotomy ; 2-3 weeks recovery (5-6weeks if complications arise)... Most uncomp. appedectomy procedures done via laparoscopy.
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| Three things used during surgery (meds/etc) | opioid analgesics, ABOX, Cold packs
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| 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.
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| 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
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| 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.
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| 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.
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| Diagnostic of Peritonitis from WBC count: | WBC ^ to 20,000 and high Neutrophils.
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| Other dx tests for Peritonitis (besides WBC count) | CBC with diff, abd. x-rays, ultrasound, peritoneal lavage..
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| 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.
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| T/F NPO, NGT for gastric decompression, and rest all are treatments for Peritonitis.. | True.
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| Broad ABOX and IV fluids used prior to dx. After dx is made, ___ and ____ are prescribed. | analgesics, stool softeners to prevent pressure
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| When is surgery contraindicated for Peritonitis? | When the pt is too sick or too ill to have the surgery.
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| What type of surgery is used for Peritonitis? | Abdominal surgery and controlling the infection by irrigating cavity with antibiotic solution
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| Why do you use semi-fowler's position for Peritonitis? | use gravity to drain the cavity. Monitor VS q1hr immediately following surgery.
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| T?F Strictly measure I&O and no strict IV flow rate post-surgery for Peritonitis. | True.
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| No lifting for ___ weeks post-op with Peritonitis. | 6
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| 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.
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| 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)
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| What is the most common digestive d/o? | IBS .. 1/5, more common in WOMEN
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| Functional GI disorder that causes chronic or recurrent diarrhea, constipation, and/or pain and bloating. | IBS aka nervous colon, spastic colon, mucous colon
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| IBS is an impairment in the ____/____ function of the GI tract. | motor/sensory
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| T/F Structural and infectious etiology is identified as an IBS cause. | False. No structural or infectious etiology is identified, cause is unknown!
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| When the pt is exposed to Causitive agents, IBS _______. | exacerbates "flares up."
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| What are some causitive agents for IBS? | diverticular dz, gastric stimulants, smoking, NSAIDS, fat intake, sulfer intake, coffee... BUT the mucosal lining remains unchanged.
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| 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.
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| What is the most common symptom of IBS?? (&loc) | PAIN in the LLQ. nausea may be assoc. with meal time and defacation.
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| 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
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| T/F Drug therapy for IBS is specific to symptoms!!! | True. Specific to constipation, diarrhea, and pain
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| IBS tx for when the prodominent symptom is constipation.. | Bulk-forming laxative (Metamucil)
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| IBS tx for when the prodominent symptom is diarrhea.. | Anti-diarrheals (Imodium)
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| IBS tx for when the prodominent symptom is pain.. | Paxil (Tricyclic antidepressant) -- stress mgmt also.
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| Complimentary/Alternative therapies | Peppermint oil (relax intestines and expel gas), Ginger (gas, discomfort), Yoga (relax), Acupuncture, Artichoke leaf extract, regular exercise
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| What age group is most affected by IBS? | young adults and continues t/o life.
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| What are just two ingredients can worsen IBS (ie sugar types..)? | fructose and sucralose
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| This disease is also known as "tied to the toilet" | UC Ulcerative Colitis
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| This is a widespread inflammation mainly in rectum and rectosigmoid. | UC
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| UC gradually extends from rectum up thru the ______ colon towards _____. | descending; cecum
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| With UC, what eventually becomes edematous and THICK with SCAR TISSUE. | COLON. loses elasticity and absorption and then Fluid Loss!!
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| T/F UC has periods of remission and infection. | False. UC has periods of remission and inflammation
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| UC stool usually contains ... (2) | blood & musous
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| 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.
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| Who is at higher risk for UC and why? smoker or non-smokers | non-smokers bc nicotine causes smooth muscle contractions
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| UC clinical manifestations: | colicky abd pain, diarrhea w/ bloody stools (20-30 x a day), and tenesmus
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| Tenesmus, define | unpleasant, urgent sensation to defacate!
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| > 10years w/ UC, you have a higher risk for what developing? | Development of large intestines cancer.
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| What are complications of UC? | liver dz, arthritis, anemia, anorexia, electrolyte imbalance, inflammation of joints, eye, skin dz, malnourished
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| What is the MOST definitive test for UC?? | colonoscopy
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| How do you diagnose UC? | H&P, Barium enema, sigmoidoscopy (perforation ^ risks), colonoscopy (usually give versed), stool cultures, hemat. stools
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| Order of giving meds for UC? | PO meds THEN suppositories THEN enemas.
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| Inflammation leads to BREAKDOWN in lining of COLON. | UC (opposite of Crohn's Disease)
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| 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
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| High dose short period of time, used during exacerbations for UC tx. | Glucocorticoids: Predisone, Budesonide, and hydrocortisone
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| 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
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| Give cautiously! Can cause toxic MEGACOLON! UC tx. | Anti-diarrheals: Lomotril or Imodium
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| Used for severe complications such as MEGACOLON. Suppository or enema | Remicade...or Humira.
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| Massive dilation of colon that can lead to peritonitis.. | mega colon
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| 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.
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| When a pt is taking Sulfasalazine.. what do you encourage a pt to do (dietary advice). | Increase PO fluids to 2500mL/day
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| 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!!
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| 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
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| What is the priority nursing care for UC pt post-surgery? | Skin care!!!
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| 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
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| What is the normal stoma color, expected. | Cherry Red!!
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| What is the initial output described as with a permanent ileostomy? | Loose, dark green liquid -- may contain blood.
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| When do you empty an ostomy bag? | 1/3 to 1/2 full
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| When do you change the pouch system for ostomy? | every 3-7 days
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| Use Humira with what execptions for megacolon.. | if the pt has no allergy to proteins and no infections.. it can be used!
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| Inflammatory dz of small intestines | Regional Enteritis aka Crohn's Disease
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| Crohn's dz (CD) mainly affects what part of the small intestines | terminal ileum
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| Describe onset pattern for CD.. | slowly progressive, unpredictable, and recurrent
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| T/F Severe malabsorbtion by the small intestines during CD causes malnourishment | True
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| What is a common formation with CD patients including bowel? | fistula
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| T/F Crohn's dz has an unknown cause | True
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| Emotional stress is NOT a factor for this dz... | CD
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| Poor ____ worsens CD.. | nutrition
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| CD affects what population of race the most.. | Jewish
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| If the stomach and duodenum is involved with CD... what are the clinical manifestations.. | n/v, epigastric pain
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| 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
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| With CD, when ___ ____ is diseased, the pain common in both lower quadrants. | lower colon
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| 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!!
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| Complications of CD are: | mainly: fissures, ulcerations, fistulas. also, sm bowel obst, high-pitched or rushing dounds present over narrowed bowel obstr.
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| T/F No disease-specific test to confirm Crohn's dz. (what is available for dx?) | True, but can use classic biopsy via colonoscopy.
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| 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).
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| 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!!!
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| 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!
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| 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!!
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| Antibiotics for CD.. name it and dose | Flagyl 250-500 mg PO 3 times daily (fistulas)
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| T/F NPO during acute phase (rest and heal) for CD. | True
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| What is used for rapid absoption for CD | IV fluids and TPN. ^cals,^protein,^fluid.. low residue, low fat.. avoid irritants
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| this therapy relax and soothes GI tract.. | ginger root
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| this therapy is combonation of diet, herbs, yoga, and breathing exercise | Ayuveda
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| This therapy helps promote remission for CD.. | vivonex
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| 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).
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| How many calories a day for CD patient for Fistula Healing... | 3,000 calories per day
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| Define Enterovesical | fistula btw bowel and bladder.
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| Define Enteroenteral | fistula btw bowel to bowel
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| Define Enterocutaneous. | fistula btw bowel to skin
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| Define Enterovaginal | fistula btw bowel to vagina
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| what is a fistula?? | abnormal tract btw two or more body areas.
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| Never allow what to come in contact with skin?? | wound drainage!!!
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| Which dz is thickening of BOWEL WALL | CD
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| 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
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