1010- Test 5 Large Bowel Disorders

Front 1

If blood is ON the stool it is related to

Back 1

bleeding from the sigmoid colon, anus, rectum.

Front 2

If blood is IN the stool, it is related to

Back 2

bleeding from the colon due to ulcerative colitis, diverticulosis, or tumors.

Front 3

Melena or black and tarry stools are seen with

Back 3

Upper GI bleeds (stomach, SI, and esophagus)

Front 4

Gray stools indicate a

Back 4

bile obstruction.

Front 5

Steatorrhea stools are

Back 5

greasy, frothy, and yellow. They are fatty.

Front 6

Steatorrhea stools are fatty and indicate ______.

Back 6

fat malabsorption.

Front 7

When observing stool, not the ____, ____ and _____.

Back 7

color, odor, and consistency.

Front 8

Mucousy, slimy stool could indicate _____.

Back 8

ulcerative colitis or IBS

Front 9

Watery, diarrheal stool could indicate

Back 9

bacterial infections (C. diff.), IBS, lactose intolerance, malabsorption issues, stress

Front 10

Hard, flat stools could indicate

Back 10

constipation and/or possible tumor

Front 11

____ is an increase in the frequency, volume, and fluid content.

Back 11

Diarrhea

Front 12

____ diarrhea is related to an event such as food poisoning or stress.

Back 12

Acute

Front 13

____ diarrhea is related to a disease process (IBS, Crohns, ulcerative colitis).

Back 13

Chronic

Front 14

Dehydration results in a loss of ___ and ___.

Back 14

K and Mg

Front 15

Diagnostic tests for diarrhea include:

Back 15

stool specimen
stool culture
serum electrolytes
sigmoidoscopy
colonoscopy
biopsy

Front 16

Jejunum and ileum related problems are diagnosed with

Back 16

virtual endoscopy (a swallowed camera)

Front 17

Management of diarrhea includes

Back 17

-fld and electrolyte replacement
-NPO (bowel rest x24 hours)
-Add milk products last
-No raw fruits, vegetables, spicy foods, caffeine

Front 18

When giving medications for diarrhea you should

Back 18

wait until a diagnosis has been made.

Front 19

Kaolin and pectin along with Polycarbophil are ___ and ____.

Back 19

absorbents and protectants

Front 20

Kaopectate and Polycarbophil can cause _____.

Back 20

constipation

Front 21

Kaopectate and Polycarbophil are contraindicated for pt with

Back 21

chronic inflammatory bowel disease including ulcerative colitis

Front 22

Paregoric and Imodium are ______ used to treat diarrhea.

Back 22

Opium and Opium derivatives

Front 23

____ and ____ are opium and opium derivatives that can decrease peristalsis, promoting more water absorption, and therefore lead to constipation.

Back 23

Paregoric and Imodium

Front 24

If opium drugs are given to a patient with ulcerative colitis, ____ could occur.

Back 24

toxic megacolon

Front 25

Nursing care of pt with diarrhea includes

Back 25

-assess stool characteristics
-monitor frequency
-monitor electrolytes; I and O
-assess ABD
-limit food when appropriate
-skin care to perineal area

Front 26

____ is infrequent, 2 or less stools per week, or difficulty passing stool.

Back 26

Constipation

Front 27

Constipation medications that can be taken daily are

Back 27

Fibercon, Citrucel, Metamucil and Miralax

Front 28

____ can be taken daily.

Back 28

Bulk forming agents

Front 29

Bulk forming agents should be mixed with ____ and should not be administered to a patient with _____.

Back 29

full glass of water
possible stool impaction or bowel obstruction

Front 30

____ is a wetting agent that reduce stool surface tension and form an emulsion of fat and water.

Back 30

Docusate

Front 31

4 types of osmotic and saline laxatives/cathartics are

Back 31

Lactulose
Sorbitol
MOM
Polyethylene glycol

Front 32

2 types of Irritant or stimulant laxatives are

Back 32

Bisacodyl and Senna
Castor Oil

Front 33

_____ work by stimulating the motility and secretion of intestinal mucosa.

Back 33

Stimulant laxatives

Front 34

Administer irritant or stimulant laxatives

Back 34

on an empty stomach.

Front 35

___ is a lubricant that acts by forming an oily coat on the fecal mass, preventing the reabsorption of water and therefore softer stool.

Back 35

Mineral oil

Front 36

Significant or chronic constipation or a fecal impaction may require the administration of an

Back 36

enema.

Front 37

____ uses 500-2000 mL and is the least irritating to the bowel.

Back 37

Saline enema

Front 38

____ use 500-1000mL of water to soften feces and irritate the bowel mucosa, stimulating peristalsis and evacuation.

Back 38

Tap water enema

Front 39

Soap suds enema is an _____.

Back 39

irritant enema

Front 40

_____ enemas use a hypertonic saline solution to draw fluid into the bowel and irritate the mucosa, leading to evacuation.

Back 40

Phosphate enemas

Front 41

_____ enemas instill mineral or vegetable oil into the bowel to soften the fecal mass. The instilled oil is retained over night or for several hours before evacuation.

Back 41

Oil retention

Front 42

Diagnostic tests for constipation include:

Back 42

-Ba enema
-sigmoidoscopy
-colonoscopy

Front 43

___, ___, and ____ help with constipation.

Back 43

Fluid, fiber and motility

Front 44

People on long term narcotics for pain should be on a _____.

Back 44

bowel program

Front 45

Caffeine inhibits ____.

Back 45

ADH

Front 46

Nsg care of pt with constipation includes

Back 46

-assess ABD (bowel sounds, tenderness, percussion)
-2500mL fluids per day
-assess impaction
-assess diet and exercise
-assess need for laxative or stool softeners

Front 47

The most common thing that stops up the appendix is a _____.

Back 47

fecolith

Front 48

Acute Inflammatory Bowel Disease Appendicitis is characterized by obstruction leading to

Back 48

infection
low grade fever
NV
loss of appetite

Front 49

Appendix is found in ____ but pain may radiate throughout ABD.

Back 49

RLQ

Front 50

An ____ may lead to gangrene, rupture, and peritonitis or abscess.

Back 50

appendicitis

Front 51

____ is inflammation of the peritoneum.

Back 51

Peritonitis

Front 52

____ is the lining covering the walls and the organs of the ABD.

Back 52

Peritoneum

Front 53

GI and GU infections can occur with ____ being the primary bacteria.

Back 53

E. coli

Front 54

Manifestations of peritonitis are

Back 54

acute ABD
tender board-like ABD
diminished or absent bowel sounds (ileus)
ABD distention
NV

Front 55

Nursing care for peritonitis includes:

Back 55

-Administer IV fluids
-Administer IV antibiotics- Flagyl, Rocephin, ancef (cephalosporins)
-NG tube for decompression
-Monitor Fld and electrolytes
-pain management
-psychosocial measures

Front 56

____ involves the mucosa and submucosa of the entire GI tract- mouth to anus.

Back 56

Crohn's

Front 57

2 types of acute inflammatory bowel disease are

Back 57

Appendicitis and Peritonitis

Front 58

____ is a Chronic Inflammatory bowel disease.

Back 58

Ulcerative colitis

Front 59

_____involves the mucosa and submucosa of the colon and rectum.

Back 59

Ulcerative colitis

Front 60

Ages for ulcerative colitis are

Back 60

15-35

Front 61

Ulcerative colitis begins in the ____ and/or _____.

Back 61

distal LI and/or rectum

Front 62

Chronic IBD (ulcerative colitis) initially begins with microscopic ____ and then formation of ___.

Back 62

hemorrhages
abscesses

Front 63

Manifestations of Chronic IBD (ulcerative colitis) are

Back 63

-mucosa becomes red, friable, edematous
-mucosa bleeds easily
-diarrheal stools of blood, mucous, pus
-30-40 stools per day during a flare up

Front 64

____ is typically chronic and intermittent, 5-30 stools/day with blood and mucous, cramping pain in LLQ, involves anemia, hypoalbuminemia and wt loss, fever rare, involves rectum and sigmoid colon, and continuous distribution.

Back 64

Ulcerative colitis

Front 65

Complications of acute ulcerative colitis are

Back 65

toxic megacolon, perforation, and massive hemorrhage

Front 66

Long term ulcerative colitis can lead to

Back 66

colorectal cancer

Front 67

_____ is slowly progressive and relapsing, no obvious blood or mucous in stool, cramping in RLQ, tenderness of mass in RLQ, involves anemia, wt loss, vitamin and mineral deficits, fever, malaise, fatigue, covers entire GI tract, has patchy or cobblestone appearance.

Back 67

Crohns disease

Front 68

Complications with acute Crohn's are

Back 68

obstruction
fistulization
abscess formation
malabsorption

Front 69

Long term Crohn's can lead to

Back 69

colon cancer

Front 70

The predominant manifestation of ulcerative colitis is _____.

Back 70

diarrhea

Front 71

Ulcerative colitis is with the primary use of

Back 71

short and long term anti-inflammatory drugs

Front 72

Sulfasalazine is an anti-inflammatory drug used for its local effect on the intestinal mucosa in _____.

Back 72

inflammatory bowel disease

Front 73

2 anti-inflammatory drugs used for IBD are

Back 73

sulfasalazine and mesalamine

Front 74

Antidiarrheals are prohibited with ulcerative colitis because it can cause _____.

Back 74

toxic megacolon

Front 75

During toxic megacolon the ____ stops working.

Back 75

transverse colon

Front 76

Diet for a pt with ulcerative colitis is individualized. 3 options are

Back 76

NPO, TPN or low residue

Front 77

A cure for UC is

Back 77

surgical removal of the colon or rectum.

Front 78

If the patient gets an ileostomy, they will have

Back 78

sludgy, watery, green poop that is very alkaline

Front 79

It a patient has a continent ileostomy they will have to

Back 79

cath themselves or have a plain stoma and wear a pouch.

Front 80

____ is known as regional enteritis.

Back 80

Crohn's disease

Front 81

The age of onset for Crohn's is often

Back 81

10-30 years old

Front 82

Crohn's can occur anywhere in the GI tract but mostly affects the _____ and the ____.

Back 82

terminal ileum and the right colon

Front 83

Crohn's disease is a disease of ____.

Back 83

malabsorption

Front 84

With Crohn's disease, B12 cannot be absorbed in the terminal ileum, therefore the patient may be ____.

Back 84

anemic

Front 85

People with Crohn's tend to form ____.

Back 85

fistulas

Front 86

____ begins as a shallow ulcer of the mucosa and submucosal layers.

Back 86

Crohn's

Front 87

With Crohn's the lumen of the bowel my have a ___ appearance.

Back 87

cobblestone

Front 88

Crohn's leads to complications such as

Back 88

ulcerations, strictures, SBO, fistulas, and abscesses

Front 89

Diagnostic tests for Crohn's disease include:

Back 89

stool culture
serum albumin, CBC
electrolytes
Upper GI
endoscopy
Ba enema
Colonoscopy with biopsy

Front 90

The Dx test of choice for detecting Crohn's disease is

Back 90

Colonoscopy with biopsy

Front 91

Dietary Management of the pt with Crohn's includes

Back 91

TPN then high calorie, high protein and low residue

Front 92

The antibiotic of choice for Crohn's disease is _____.

Back 92

flagyl

Front 93

Drugs for Crohn's are the same as UC...

Back 93

long-term and short-term anti-inflammatories, corticosteroids

Front 94

A person with Crohn's disease can take anti-diarrheals because ____ is not an issue.

Back 94

toxic megacolon

Front 95

Remicade may be given for Crohn's disease but can cause ____ and _____.

Back 95

thrombocytopenia and immunosuppression

Front 96

Surgical Tx for Crohn's includes removal of ____ and ____.

Back 96

obstructions and fistulas

Front 97

Nsg care for Crohn's pt includes

Back 97

care for diarrhea, fatigue, malabsorption/weight loss, multiple infections

Front 98

Nurses should monitor the following for Crohn's patients

Back 98

-CBC, albumin
-I and O
-Skin integrity
-diet and fluid intake
-ostomy care

Front 99

Low residue diet means to avoid

Back 99

-alcohol, prune juice
-whole grain breads, tolls, or cereal, breads or rolls with seeds, nuts, or bran
-desserts with dried fruits, nuts, seeds, coconut, rich pastries, pies,
-raw or cooked fruits, veggies
-tough or spiced meats
-fried foods
-flavored cheeses
-potato skins, potato chips, brown rice
-jam, marmalade
-chili sauce, popcorn, whole spices, olives, vinegar

Front 100

Colorectal cancer is the ____ leading cause of cancer death in US.

Back 100

3rd

Front 101

Risk factors for colorectal cancer are

Back 101

-polyps
-age
-IBD
-high sat. fat- red meat diet
-family history
-obesity
-smoking
-AA

Front 102

Nearly all tumors of colorectal cancer are adenomas rising from ____.

Back 102

polyps

Front 103

Most colorectal cancer occurs in the ___ and ____ areas.

Back 103

sigmoid and rectal

Front 104

Colorectal cancer is usually asymptomatic until it causes change in bowel habits because it is ______.

Back 104

slow growing

Front 105

Colorectal cancer spreads to

Back 105

other GI organs, kidney, brain, and lungs

Front 106

Symptoms of colorectal cancer include:

Back 106

-change in bowel habits- diarrhea, constipation, or feeling of incomplete emptying
-bright red or dark blood in stool
-narrow or thin stools
-ABD discomfort, frequent gas pain, bloating, fullness, cramps
-unexplained wt loss, constant tiredness, unexplained anemia (iron deficiency)

Front 107

Diagnostic tests for colorectal cancer include
annual digital rectal exam ___
annual guaiac testing for ____
flexible sigmoidoscopy every ___ years
colonoscopy every ____ years

Back 107

Diagnostic tests for colorectal cancer include
annual digital rectal exam 40 and over
annual guaiac testing for 50 and over
flexible sigmoidoscopy every 5 years
colonoscopy every 10 years

Front 108

Other Dx tests for colorectal cancer include

Back 108

CBC
CEA
CT and MRI

Front 109

CBC is performed to

Back 109

evaluate bleeding

Front 110

CEA is performed to

Back 110

evaluate prognosis, monitor Tx, and detect recurrence

Front 111

Management of colorectal cancer includes:

Back 111

-surgical resection of tumor and lymph nodes
-colon resection or colostomy
-radiation therapy (rectal
-chemotherapy- metastasis
-rectal Tx diff than colon

Front 112

After colorectal Tx, the pt will have

Back 112

serial CEA and colonoscopy 1 year post op and every 3-5 years after

Front 113

Mechanical Causes of Intestinal obstructions include

Back 113

hernias
diverticuli
tumors
adhesions
feces
IBD

Front 114

Functional causes of intestinal obstruction include

Back 114

ileus

Front 115

Most intestinal obstructions occur in the ____ but can be anywhere in the intestines depending on the underlying cause.

Back 115

SI

Front 116

Manifestations of intestinal obstructions are

Back 116

-cramping/colicky pain
-NV
-abnormal bowel sounds
-distention, tenderness
-hypovolemia
-F and E loss

Front 117

Bowel sounds in early intestinal obstruction are

Back 117

high pitched, tinkling, hyperactive

Front 118

Bowel sounds in late intestinal obstruction are

Back 118

greatly diminished or absent

Front 119

Nsg care for pt with intestinal obstruction includes:

Back 119

-NPO/Ng tube management
-monitor F and E
-Pain management
-respiratory management
-anxiety
-monitor VS

Front 120

Sac-like pockets of mucosa found in the muscular layer of the colon are called ____.

Back 120

diverticular disease

Front 121

Diverticular disease can be found anywhere in GI tract but most commonly found in the ____.

Back 121

sigmoid region

Front 122

Manifestations of diverticular disease include:

Back 122

-LLQ pain (mild to severe, steady, cramping)
-increased constipation or diarrhea
-possible NV
-weakness and fatigue
-low grade fever

Front 123

Complications associated with diverticular disease are

Back 123

-perforation leading to peritonitis and/or abscess formation
-bowel obstruction
-fistula formation
-lower GI bleed

Front 124

Dx tests for diverticular disease are

Back 124

-CBC w/ differential
-hemocult testing
-flexible sigmoidoscopy/ colonoscopy
-CT scan

Front 125

Tx for uncomplicated diverticular disease are

Back 125

diet changes, high fiber

Front 126

Tx for acute diverticular disease includes

Back 126

bowel rest and IV antibiotics

Front 127

Tx for complicated diverticular disease is

Back 127

bowel resection

Front 128

Nsg care for diverticular disease includes

Back 128

-VS
-assess ABD q4h
-assess for LGI bleed, hemocults
-maintain IV flds, I and O, antibiotics
-pain management
-anxiety
-dietary modifications