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42 Cards in this Set
- Front
- Back
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diarhhea causes
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decreased fluid absorption(fluid reabsorption large intestine)
increased fluid secretion(abnormality in bowel) motility disturbances(increase peristalsis) |
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clinical manifestations of diarhhrea
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acute-bacterial/viral
chronic- 2 weeks or more & reoccurs |
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should immodium be used
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diarhhrea is defense wants to get bacteria out
non ifectious will get immodium |
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complications of diarhhea
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dehydration
electrolyte imbalance |
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signs of electrolyte imbalance
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cramping, confusion, lightheadness, muscle spasm,twitches
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diagnostic studies
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ask- travel, diet, meds, previous surg,
family history-IBS, personal contacts stool spec/culture Ova & parasite Endoscopy, Barium swallow(pill w/camera CBC(HMG,HCT low could be bleed)(WBC-infection), iron/folate levels |
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dehydration
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may see falsely elevated HMG HCT
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cause of decreased fluid absorption
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laxative abuse
mucusoal damage: Crohns Disease. radiation, ulcerative colitis, ischemic bowel disease disease( decreased blood supply, infarction |
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cause increased fluid secretion
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infectious bacterial endotoxins
antibiotics(disturbed normal flora) C-diff(isolation) sorbitol(artificial sweetner) hormonal-adenoma of pancreas |
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cause of motility disturbances
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IBS. gasterectomy(dumping syndrome)
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Nursing diagnosis for Diarhhrea
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diarrhea related to acute infection process
deficient fluid volume related to excessive fluid loss impaired skin integrity |
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fecal incontinence
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motor : contraction of muscles, anus flaccid
sensory: dementia, stroke, spinal injuries, degenerative disease(Parkisons,MS,ALS fecal impaction-liquid caused by increased fluid secretions to counteract |
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diagnose fecal incontinence
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rectal exam, abdominal XRAY, sigmoidscopy
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Management of fecal incontinence
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anti-diarrheal(Immodium)only for non infectious
bowel/bladder training suppositories high fiber diet/increased liquid |
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assess constipation
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change in "normal frequency" hard stool
decrease frequency abdominal pain, distension, bloating headache, nausea, flatulence, palpable mass |
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causes of constipation
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colonic disorders-IBS, Diverticular
drug induced:antacids-calcium,aluminum antidepressants, anticholinergics(slows bowel) barium sulfate(increase fluids), iron(use colase chaser) endocrine- hypothyroidism, diabetes collagen vascular( scleroderma) Neurogenic-megacolon, MS, Parkinsons |
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complications of constipation
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valsava manuever & syncope
diverticulosis obstipation secondary to constipation may cause bowel perforation |
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treatment for constipation
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laxatives (use cautiously)
enemas-oil retention to loosen feces- avoid soap suds, hypotonic and phosphate high fiber foods-insoluble(whole wheat, bran) soluble(oat bran, fruits, vege) increase fluids to 3000ml |
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appendicitis
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inflammation of the appendix, inferior part of cecum
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what causes appendicitis
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obstruction of lumen by feces, foreigne bodies(poppy seeds) tumors
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perforation of appendix
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sudden relief of pain with abdominal distension
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complications of appendicitis
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gangrene, perferation and peritonitis
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how does appencitis present
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persisitent, constant periumbical pain radiates to RLQ
pain localizes at McBirneys point halfway between umbilicus/right illiac crest rebound tenderness& muscle guarding right kneeflexion relieves pain coughing aggravates pain Rovsings sign positive |
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rovsings sign
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LLQ palpation result's in more pain than right side (considered sign of addencitis)
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diagnosis of appendicitis
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complete history and physical
CBC-look for elevated WBC 16000 urine analysis-check ureters |
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theraputic measures
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NPO- IV fluids-antibiotics
ice bag lower right quardrant Pain meds only after diagnosis surgery for perforation |
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periotinitis
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inflammatory process in peritonium that results in extracellular fluid shifts
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causes of peritonitis
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blood born infections(septicemia)
cirrhosis of the liver perfs/rupt of bowel pancreatitis peritoneal dialysis abdominal surgery- temp taken check for infection |
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signs of peritonitis
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abdominal pain, tenderness, distension, rigidity
high fever,tachycardia, tachypnea 101 fever or more nausea, vomitting alteration in bowel sounds |
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Diagnostic for Inflammatory Bowel Disease
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CBC-iron def. anemia, folate levels(colon cancer), RBC decreased, WBC elevated
serum electrolytes occult blood in stool & puss and mucous stool culture(infection) Sigmoidoscope/colonoscopy, biopsy barium enema |
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ulcerative colitis
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mucosa& submucosa or rectum, sigmoid colon and upper colon
multiple abssess/ulcerations, bleeding, & diarrhea fluid& electrolyte imbalances, protein loss pseudopolps & shortening of colon |
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assessment ulcerative colitis
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bloody diarrhea & lower abdominal pain
fever, weight, loss, tchycardia, dehydration toxic megacolon and possible perforation & peritonitis |
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treatment ulcerative colotis
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antimicrobials-PO/enema, long term- sulfasazine(Azulfidine)mesalamine(Rowasa)
immunsuppresssives-Imuran(increase fluid intake/nephrotoxic) Imferon(iron) cortocosteroids, anticholinergics,sedatives antidiarrheal-lomotil(controlled sub)immodium, NO Kayopectate-not absorbed well Imferon(iron)-Ztract vitamins, folic acid, b12, potassium if on steroids |
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nursing post op ulcerative colitis`
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NPO w/NG tube
Stoma drainage -1500-2000/day strict I & O monitor for hemorrage, dehyd. assess bowel sounds-SBO asses drains, good skin/perianal care_nupracaine ointment, sitz contact eneterostomal therapist emotional support |
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nutritional mgmt ulcerative colitis
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NPO, TPN,
high calorie, high protein, high protein, low residue diet |
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foods to avoid with ulcerative colitis
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whole grain breads, cereals, bran, nuts, cheeses, except cheddar
peas, beans, raw vege, all vege not strained, fruits with skin/seeds |
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crohns disease
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affects anywhere in GI tract from colon, duodenum, stomach & esophagus
inflammation involves ALL layers can have segments of normal bowel cobblestone appearance, abscess/fistula forming with bladder, vagina & bowel |
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assessment crohns
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non bloody diarrhea RLQ pain that is intermittent or constant
fever, fatigue, weight loss, malnutrition, dehydration, electrolyte imbalance, anemia, increased peristalsis extrainterstitial manisfestations- finger clubbing, arthritis |
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complications of crohns
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scar tissue with narrowing & SBO
fistula between bowel & urinary tract bowel perf. adn peritonitis fat malabsorption causeing def A<D<E<K Gluten intolerance systemic similar to UC cholelithiasis & nephrolilthiasis(oxalate absorp) |
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diverlticulosis
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outpouching mucosal smooth muscle of the intestinal wall
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diverticulitis
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inflammation of the diverticuli at any point in GI tract more common in sigmoid colon
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pathophysiology of diverticulitis
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5% population by age 40
50% by age 80 |
