Intestinal/Rectal Disorders
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| Define constipation | abnormal frequency, abnormal hardening of stool so passage is hard, painful, retention of stool
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| What is perceived constipation | person's bowel elimination pattern is not consistent with what they consider normal.
Chronic laxative use contributes
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| What is processes in urge to defecate? | 1.stimulation rectoanal reflex
2. relax int/ext sphincter muscle
3.incr abd pressure
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| 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
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| 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
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| Treating cause and preventing recurrence of constipation would be? | education, bowel habit training, incr fiber(25-30g/day)/fluids, careful use of laxatives
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| Enemas and rectal supp are best used to treat constipation or impaction? | impaction
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| 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)
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| 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
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| Action for lubricant laxative? contraindications? | act: lubricate mucosa
cont:not take w/ meals, impair absorption of fat-soluble vit and delay gastric emptying
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| Action for bulk form lax? contraindications? | act: draw fluids to int/peristalsis
cont: take with h2o, short use, MOM not for renal insuff.
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| 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
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| Acute vs chronic diarrhea | acute: 7-14 days/infection
chronic: 2-3 wks
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| Types of diarrhea: secretive | secretive: high volume/bacteria/neoplasms/incr secretion of h2o and electrolytes into intestine
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| osmotic diarrhea | osm: water pulled into int by unabsorbed particles, slows reabsorption of h2o
cause: lactase def, pancreatic dysfx, int hemorrhage
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| Malabsorption diarrhea | Mal: inhibit absorption of nutrients, hypoalbuminemia, greasy, grayish, oil drops = pancreatic dysfx
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| Infectious diarrhea | inf: C Diff
blood, mucus, pus in stool can mean enteritis/colitis
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| exudative diarrhea | caused by radiation or chemo
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| what is borborygmus? what is tenesmus? | intestinal rumbling
ineffective anal straining
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| Difference in small bowel and large bowel disorders are seen in what kind of stool? | small bowel: watery stool
lg bowel: loose, semisolid
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| what cardiologic complication can come from diarrhea? | loss of K = dysrhythmias
s/s: muscle weak/paresthesia/hypotension/drowsy
Can lead to dig toxicity
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| What is med of choice for diarrhea? | loperamide(Imodium)fewer SE than diphenoxylate(Lomotil)
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| Define fecal incontinence? | involuntary passage of stool and often symptom of impaction
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| 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
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| Define zollinger-ellison syndrome | hyperacidity in duodenum inactivates pancreatic enzymes...so steatorrhea
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| what nsg intv would be necessary for both peritonitis and ileus | nasogastric suction/assess F&E
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| 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
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| RLQ pain, low grade fever, nausea/vomiting, pain at MrBurney's point usually indicates? | appendicitis
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| If ileus forms or peritonitis what nsg intv would be for both | nasogastric suction correct F&E
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| 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
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| 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
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| what are two common complications of peritonitis post surgery | wound evisceration: assess location of abd tenderness/pain/blood from wound
abscess formation
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| what position helps pt wtih abd pain from peritonitis | side lying with knees flexed
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| what s/s reveal subsiding peritonitis | decr temp/pulse, abd softening, bowel snds return, flatus passes, bowel mvmts
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| IBD-inflammatory bowel disease refers to two GI dirsorders? | Crohns disease
ulcerative colitis
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| Crohn's disease defined and found where? | inflammation of GI tract wall, all layers and usually in ileum or maybe ascending colon
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| s/s of crohn's disease | RLQ pain with diarrhea unrelieved by defecation, cramps after meals, emaciated, malabsorption, steatorrhea
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| Small bowel fistulas, the enterocutaneous fistula(b/n sm bowel and skin) are indication of | Crohn's disease, incr risk for colon Ca
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| Ulcerative colitis is usually found where? | rectum/colon
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| pharmocological tx for crohn's and ulcerative colitis | reduce inflammation: corticosteroids
suppress immune response: Methotrexate
rest for bowel
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| Tx for crohn's diesase can lead to total colectomy(remove entire colon) which usually results in | ileostomy
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| what is proctocolectomy? IPAA | remove colon,rectum,anus
IPAA: pouch for rectum
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| Nutritional mgmt for inflammatory bowel disease | low residue, high protein/vitamin diet. Keep food diary of foods that irritate
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| what is purpose of nasogastric suctioning after ileostomy? | part of post op care to prevent build up of gastric contents while int not fx
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| 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
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| If effluent is dry in ileostomy, should water be incr? | no, water excreted in urine, incr salt intake
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| what is leading complication for ileostomy>? | skin integrity
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| 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
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| 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
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| 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
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| Risk factors for colorectal cancer | age/fam hx/alcohol/smoking/obesity/hx IBD/low fiber,high fat diet/genital, breast Ca
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| 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
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| How can pt regulate emptying of stoma with colostomy | irrigation of stoma at reg times helps reduce gas and stool retention
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| Anal fistula? anal fissure? hemorrhoids? | fistula: opening from skin to anal canal
fissure: tear in anal canal
hemm: dilated vv in anal canal
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| Pilonidal Sinus/cyst? | found on post surface of lower sacrum with hair protruding from opening.
Mgmt: sitz bath/stool softeners/fluids
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