Ch 43 Lower Gi Problems

Front 1

How long is the entire GI tract form mouth to anus?

Back 1

30 feet

Front 2

What is the length of the small intestines?

Back 2

23-26 feet

Front 3

What is the main function of the small intestines?

Back 3

Absorption of nutrients

Front 4

What are two types of contraction in the small intestines?

Back 4

- segmentation (churning motion)
- intestinal peristalsis (propels contents toward colon)

Front 5

What is the main function of the large intestines?

Back 5

Absorption of water

Front 6

Someone with severe diarrhea is a risk of having _______ from loss of bicarb.

Back 6

Metabolic acidosis

Front 7

What is a KUB?

Back 7

X ray of the GI tract

Front 8

Why would clotting factors be affected in someone with a lower GI problem?

Back 8

Vit K is made in the colon

Front 9

Nursing Implications for a Barium enema?

Back 9

- liquid diet a day before
- NPO 8 hrs before procedure
- Admin laxative before if ordered
- Admin laxative after procedure
- Stools may be white for 1 to 2 days

Front 10

Nursing Implications for a colonoscopy?

Back 10

- Usually a liquid diet 2 days before
- NPO 8 hours before day of
- Admin or instruct pt in bowel preparation procedure (GoLytely)
- Conscious sedation may be used
- After procedure: report any abd pain, chills, fever, rectal bleeding or mucupurulent discharge
- Avoid heavy lifting for 7 days and high fiber foods for 1-2 days if polyp removed.

Front 11

Low residue diet is referred to as?

Back 11

White diet

Front 12

Types of high fiber foods are?

Back 12

whole wheat, fruits with the skin

Front 13

What are 3 indications that parenteral nutrition is required?

Back 13

- Pts with inability to absorb nutrients via the GI tract
- Pts whose nutrient needs cannot be met with enteral feedings within 7-10 days
-Pts with severe malnutrition or catabolism where the GI tract is not usable within 3-5 days

Front 14

What is the ratio of cal to mL in parenteral nutrition?

Back 14

1 cal/mL

Front 15

How many cal do you get from D5%?

Back 15

200 cal

Front 16

IBD
characterized by?
cause?
cure?
treatment?

Back 16

Chronic, recurrent inflammation of the intestinal tract, periods of remission interspersed with periods of exacerbation
- Cause is unknown
- No cure
- Treatment relies on meds to treat inflammation and maintain remission

Front 17

What are the two types of IBD?

Back 17

- Ulcerative colitis: inflammation and ulceration of the colon and rectum
- Crohn's disease: inflammation of segments of the GI tract

Front 18

IBD
occurs at what age?
when does it peak?
what factors play a role in it?

Back 18

- Occurs at any age
- Peaks at 15- 25 years
- genetic and environmental factors

Front 19

IBD is catgorized as an _______ disease.

Back 19

Autoimmune disease: antigen initiates the inflammation; actual tissue damage is from inappropriate sustained immune response

Front 20

Ulcerative Colitis
Diffuse inflammation beginning in the _____ and spreading up the ______ in a ________ pattern.

Back 20

- rectum
- colon
- continuous

Front 21

Ulcerative Colitis
What two layers of the large intestines does it affect?

Back 21

Submucosa and mucosa

Front 22

Ulcerative colitis affects food absorption?

Back 22

No bc it is in the large intestines

Front 23

How to the ulcerations happen in ulcerative colitis?

Back 23

Multiple abscesses develop in the intestinal glands, these go through the submucosa leaving ulcerations.
The ulcerations cause bleeding and diarrhea.

Front 24

What other losses are causes by Ulcerative colitis?

Back 24

- F & E losses
- Protein losses

Front 25

Crohn's disease is?
can affect what part of the body?
most often seen where?

Back 25

- A chronic, nonspecific inflammatory bowel disorder of unknown origin
- Can affect any part of the GI tract from the mouth to the anus
- Most often seen in the terminal ileum and colon

Front 26

Crohn's disease involves what layers of the bowel wall?
what does it look like?

Back 26

- all layers
- Cobblestone, Skip lesions: segments of normal bowel occurring between diseased portions

Front 27

Crohn's disease can narrow what? and what may this cause?

Back 27

- Narrowing of the lumen with stricture development
- may cause a bowel obstruction

Front 28

What are possible developments in Crohn's disease?

Back 28

- peritonitis
- abscesses or fistula tracts that communicate with other loops of bowel, skin, bladder, rectum, or vagina

Front 29

What is the most common cause of an acute attack of IBD?

Back 29

- stress

Front 30

How many BM do pts with Crohn's disease have?

Back 30

10-14 a day

Front 31

How many BM do pts with Ulcerative Colitis have?

Back 31

4-5 a day

Front 32

What are the nonspecific complaints of IBD?

Back 32

- Diarrhea
- Fatigue
- Abdominal pain
- Weight loss
- Fever

Front 33

Ulcerative Colitis
S/S

Back 33

- bloody diarrhea
- abd pain
- tenesmus (spasms of anus, cramping)
- rectal bleeding

Front 34

Crohn's Disease
S/S

Back 34

- Depends on anatomic site, extent of the disease process, and presence of complications
- nonbloody diarrhea
- colicky abd pain
- malabsorption
- nutrional deficiencies

Front 35

Ulcerative Colitis
Complications

Back 35

- more contained in the GI tract
- Intestinal complications:
- hemorrhage
- strictures
- perforation
- toxic megacolon (causes perforation)
- Dilation and paralysis of the colon

Front 36

Crohn's Disease
Intestinal Complications

Back 36

- strictures and obstruction from scar tissue
- fistulas
- peritonitis

Front 37

Crohn's Disease
Extraintestinal Complications

Back 37

Inflammation throughout the body
- thromboembolism
- arthritis
- ankylosing spondylitis (spine conpression)
- osteoporosis
- liver disease
- skin lesions

Front 38

What do you give after a double contrast barium enema?

Back 38

Laxative and hydration

Front 39

What are the goals of treatment for IBD?

Back 39

- rest of bowel
- control inflammation
- combat infection
- correct malnutrition
- alleviate stress
- symptomatic relief
- improve quality of life

Front 40

What are the classes of drug therapy for IBD?

Back 40

- Aminosalicylates (5-ASA)
- Antimicrobials (prevent/ treat secondary infection)
- Corticosteriods (decrease inflammation, helpful for acute flareups)
- Immunosuppressants (useful for pts that do not respond to top three)
- Biologic therapy (inhibit tumor necrosis factor)

Front 41

What is the principal drug used for IBD?

Back 41

Sulfasalazine (Azulfidine)
- Aminosalicylates
- decreases GI inflammation
- effective in achieving and maintaining remission
- mild to moderately severe attacks
- skin and urine can turn yellow/orange

Front 42

_________ and ________ are mainstays for ulcerative colitis.

Back 42

Aminosalicylates
Corticosteroids

Front 43

What are the diagnostic studies for IBD?

Back 43

- CBC
- Electrolyte levels
- Protein levels
- Stool cultures: Pus, Blood, Mucus

Front 44

Post- operative care of ileostomy

Back 44

- stoma should be pink and moist
- peristomal skin care
- output could be 1500 to 2000 mL/ day (watery)
- patient may have transient incontinence of mucus

Front 45

What should a person with IBD diet look like?

Back 45

- High calorie
- High protein
- Low residue
- Vitamin and iron supplements
- Elemental diet
- Parenteral nutrition might be necessary

Front 46

What are the goals in nursing management of a patient with IBD?

Back 46

- Experience a decrease in number and severity of acute exacerbations
- Maintain normal F & E balance
- Free from pain and discomfort
- Comply with medical regimen
- Improve quality of life

Front 47

The majority of colorectal cancer arise from ________ polyps.

Back 47

Adenomatous

Front 48

Colorectal Cancer
Risk factors?

Back 48

- family or personal history of colorectal cancer
- increased age
- colorectal polyps
- IBD
- obesity
- smoking
- alcohol
- large amt of red meat

Front 49

Colorectal Cancer
How do the tumors spread?

Back 49

Through the walls of the intestine into musculature into the lymphatic and vascular system

Front 50

Colorectal Cancer
Most common sites of metastasis?

Back 50

- Regional lymph nodes
- Liver
- Lungs
- Peritoneum

Front 51

Colorectal Cancer
S/S

Back 51

- Passing blood through rectum
- Melena
- Abd pain
- Anemia
- Weight loss
- Rectal bleeding (left sided lesions)
- Weakness

Front 52

Colorectal Cancer
S/S of left sided lesions

Back 52

- Rectal bleeding
- Alternating constipation and diarrhea
- Narrow, ribbonlike stools
- Sensation of incomplete evacuation

Front 53

Colorectal Cancer
S/S of right sided lesions

Back 53

- Usually asymptomatic
- Vague abdominal discomfort
- Colicky abdominal pain
- Iron deficiency anemia
- Occult bleeding

Front 54

When should you recieve your first colonoscopy?

Back 54

- Age of 50 then every 7-10 yrs after that

Front 55

Colorectal cancer
Once cancer has spread to distant sites, surgery is ?

Back 55

Pallative

Front 56

What are the three kinds of intestinal obstruction?

Back 56

- Mechanical
- Non mechanical
- Partial vs complete

Front 57

What are diabetics at risk for in terms of intestinal obstruction? why?

Back 57

Intestinal gangrene bc of decreased blood flow

Front 58

What are examples of mechanical intestinal obstruction?

Back 58

- Adhesions (scar tissue)
- Hernias
- Tumors
- Volvulus (twist of bowel)
- Intussusception (telescoping of bowel)

Front 59

What are examples of non mechanical intestinal obstruction?

Back 59

- Paralytic ileus (slowing down of peristalsis)
- Mesenteric vascular occulsion infarction

Front 60

Intestinal Obstruction
S/S?

Back 60

- Abd pain
- Vomiting
- Loud, frequent, high pitched bowel sounds leading to absent bowel sounds
- Abdominal distention
- Dehydration
- Shock

Front 61

Intestinal Obstruction
Treatment?

Back 61

Medical
- Decompression
- NPO
- F & E
Surgical
- Release of adhesions
- Resection
- Colostomy

Front 62

What kind of acid base balance would to see in a person with an intestinal obstruction?

Back 62

Metabolic alkalosis due to vomiting

Front 63

Diverticula are?

Back 63

small outpouchings or herniations of the mucosal lining of the GI tract

Front 64

Why do diverticula form?

Back 64

- increased intraluminal pressure
- decreased muscle strength in colon wall
- decreased fecal volume

Front 65

What are the three types of Diverticular disease?

Back 65

- Diverticulosis ( multiple asymptomatic diverticula)
- Diverticulitis (trapped feces and bacteria combine to produce acute inflammation and infection
- Meckles (congenital, similar to appendix, open into distal ileum

Front 66

S/S of Diverticulitis

Back 66

- LLQ abd pain
- low grade fever
- N/V
- Bowel irregularity
- Diarrhea/constipation
- Abd tenderness/ distention

Front 67

Medical treatment for Diverticulosis

Back 67

- high fiber diet
- bulk laxatives

Front 68

Medical treatment of Diverticulitis

Back 68

- NPO or clear liquids
- bowel rest
- bulk laxatives
- stool softners
- antibiotics
- anticholinergics
- analgesics
- IV therapy

Front 69

How does a bulk laxative work?

Back 69

- absorbs water
- increases bulk
- stimulates peristalsis
- must be taken with at least 8 oz of water

Front 70

Complications of Diverticulitis

Back 70

- Perforation with peritonitis
- Abscess and fistula formation
- Bowel obstruction
- Bleeding

Front 71

What kinds of food help in the formation of diverticula? What foods do you need?

Back 71

- low fiber diet and processed foods
- high fiber

Front 72

Post op care of ostomy
what should stoma look like?

Back 72

- pink, moist
- dark red or black indicates ischemic necrosis
- look for excessive bleeding
- observe for possible seperation of suture securing stoma to abd wall

Front 73

How should the pouch be cut for an ostomy?

Back 73

Pouch should be cut 1/8" larger than stoma to allow for stoma swelling

Front 74

When should you start to observe the stool from an ostomy?

Back 74

2-4 days postop

Front 75

What should the stool look like in each location:
- Ascending stoma (right side)
- Transverse stoma
- Descending stoma

Back 75

- liquid stool
- pasty
- normal, solid stool

Front 76

What needs to be taught upon discharge to a person with lower GI problems?

Back 76

- Diet
- Meds
- Disease process
- S/S of complications
- Health maintence

Front 77

What are some community resources for a person with lower GI problems?

Back 77

- Home care
- American Cancer Society
- Support groups