Chapter 51 Word Scramble
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Question | Answer |
what are the symtoms of irritable bowel syndrome? | abdominal pain, constipation, diarrhea abdominal distention and bloating -belching, nausea w/ meals or passing stool, cramping |
risk factors of IBS | diet (fatty foods, caffeine, alcohol), stress, more common in women |
diet for IBS | avoid dairy eggs and wheat products, drink 2-4L of fluid, increase fiber to 30-40g/day |
laboratory tests | CBC, serum albumin, erythrocyte sedimentation rate (ESR), occult stools |
Hydrogen breath test (Pg. 571) -special diet before? | exhale into hydrogen analyzer before and after ingesting test sugar. positive=excess hydrogen in blood from bacterial overgrowth ror malabsorption *NPO 12 hrs before test |
erythrocyte sedimentation rate (ESR) | if elevated- tells you that there is an inflammatory response going on but it doesnt tell you what one |
barium enema | dye injected into large intestine to see intestine, colon, and rectum |
constipation causes? | meds (opioids!!), lack of exercise, diet, holding in your poop |
constipation complications | internal and external hemorrhoids, fistula in rectum can cause reccurent UTIs bc the bacteria (ecoli) from the colon keeps going into the bladder, can also have a rectal-vaginal fistula and have the same problem |
treatment: non pharmacologic | diet high in fiber and fluids, establish normal routine, respond to urge, exercise/activity |
treatment: pharmacological | stool softeners, laxatives |
docusate sodium | colace- pulls water into the stool, not gonna work if the stool is extremely compacted. More of a preventative measure |
saline laxative | milk of magnesium- can cause diarrhea |
hyperosmotic | magnesium citrate |
stimulant lax | magnesium citrate |
bulk forming | metamucil |
diarrhea causes | medications, metabolic disorder/endocrine disorders, infections (cdiff) |
why do antibiotics cause diarrhea | they destroy all bacteria- including the good bacteria in your intestines |
problems from diarrhea | fluid and electrolyte imbalance, dehydration, dysrhythmmias |
diarrhea treatment: nonpharmacological | rest, avoid irritants in diet like caffeine, dairy, milk, fats, perianal skin care |
diarrhea treatment: pharmacological | probiotics and antidiarrheals |
alosetron | 5-HT4 (serotonin) blocker- blocks serotonin receptors in gut |
diphenoxylate HCl with atropine sulfate | lomotil- reduces motility of stomach |
narcotics? | purposely give them for their constipating effects |
fecal transplant | from donor to get good bacteria back into gut |
intestinal obstruction | surgical emergency!! (mechanical or non mechanical) |
mechanical causes (90%) -pain is like? | adhesions, tumors, fibrosis, strictures -usually requires surgery -mild, colicky, intermittent |
volvulus | twisting of intestines |
intususception | bowel folds in on itself, *telescoping* |
hernia | bowel becomes trapped in weakened area of abdominal wall |
non mechanical causes (decreased peristalsis) | paralytics ileus, mesenteric emboli, hypokalemia, inflammatory response to peritonitis or sepsis |
small bowel obstruction S/S | F/E imbalance, vomiting leading to metabolic alkalosis, abdominal pain, obstipation, distention, changes in BS -profuse sudden projectile vomiting w/ fecal odor.. relieves pain |
obstipation | inability to pass stool even though you feel like you need to |
colonic obstruction (LBO) S/S | minor F/E imbalance, infrequent voiding, possible metabolic acidosis, extreme abdominal pain, obstipation, distention, |
lab tests | -increased hgb creatinine and hematocrit- may indicate dehydration -amylase might show pancreatic involvement -decreased sodium, chloride, potassium |
diagnostic test for obstructions | xray, CT scan (cause & exact location), endoscopy (determines the cause) |
treatment (all IV all the time) | NPO, KCL replacement, analgesics, antibiotics, NG tube |
cause of obstruction: colorectal cancer | most common cause of LBO |
risk factors | colon polys, >50 years old, african american, CRC more common in women, rectal cancer more common in men, high fat low fiber diet |
gold standard for finding colorectal cancer | colonoscopy |
Carcinoembryonic antigen (CEA) | as the body goes thru fetal development there are cells that are undifferentiated and then they become differentiated, in cancer cells they don’t differentiate and those undifferentiated cells become a protein (not very sensitive to stage 1 cancer) |
colonoscopy | every 10 years after you turn 50, more often if there are polyps |
how do you prep a pt for a colonoscopy? | bowel prep, clear liquid diet day before, NPO after midnight unless doctor orders them to take their normal meds (beta blockers) |
bowel prep | laxatives such as bisacodyl and polyethylene glycol |
what should you educate the pt about before a colonoscopy? | they're awake during procedure (versed), they will be gassy after |
post procedure care | monitor VS, monitor for complications like hemorrhage and perforation, they need someone to drive them home, bowel sounds |
What are the group of disorders in noninflammatory bowel disorders? | Hemorrhoids, cancer, hernia, irritable bowel syndrome, intestinal obstruction |
What is a hernia? (Pg. 569) | The displacement of the bowel through the abdominal muscle into other areas of the abdominal cavity |
Where are hernia's commonly found? | Groin area, umbilicus, healed incision |
Non surgical hernia client actions? -Wear a ___ w/ hernia belt during ____ hrs | truss pad during walking hours |
Post operative hernia actions? -Avoid increased intra-abdominal pressure for _____, such as? | 2-3 weeks -coughing, straining, heavy lifting |
Medications for IBS: alosetron (Lotronex) | IBS specific med -blocks 5-HT4 receptors which innervate the viscera *indicated for diarrhea lasting longer than 6 months |
Expected result of Alosetron? | Formed stool, and decreased urgency and frequency of defecation |
Medications for IBS: Lubiprostone (Amitiza) | IBS specific med -increases fluid secretion in the intestine to promote intestinal motility (IBS w/ constipation) not for men |
What kind of pain is a non-mechanical bowel obstruction like? | Vague, diffuse, constant pain w significant abdominal distention |
BOTH small & large intestine obstructions give these main S/S: | obstipation (can't for >8hrs even though you feel you need to), abdominal distention & high pitched BS above obstruction (borborygmi) w/ hypoactive BS below or over the area |
NG tube for intestinal obstructions (Pg. 574) Why? | to decompress the bowel |
What med would you give for a non mechanical intestinal obstruction? | Prokinetics; promote gastric motility (Octreotide (sandostatin)) |
Complications to bowel obstructions: Dehydration from..? Lyte imbalance from..? Metabolic alkalosis Metabolic acidosis | -Vomiting (SBO) -vomiting, potassium especially (SBO) -SBO-- vomiting -acidosis; lower obstruction d/t non reabsorption of alkaline fluids |
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