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112 Cards in this Set
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- Back
- 3rd side (hint)
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How would you characterize ulcerative colitis? |
inflammation and ulceration of the colon and rectum
- there is wound/opening/cavity - colon may become hyperemic and edematous - may develop abscess then ulceration - since GI is not sterile, there may be pus formation or abscess along with ulceration |
ulcers forming in lower GI |
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what are the clinical manifestations of ulcerative colitis? |
- bloody diarrhea - abdominal pain - 4 to 5 BM/day - fever, malaise, anorexia - weight loss - anemia, tachycardia - dehydration |
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why does bloody diarrhea occur in a pt. with ulcerative colitis? |
the inflammatory process increases peristaltic movement so there is not enough time to reabsorb water leading to watery loose stools with blood due to ulcerations in the GI tract |
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why might a patient with ulcerative colitis experience weight loss? |
because of diarrhea along with anorexia |
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why would a patient with ulcerative colitis experience anemia with resulting tachycardia? |
the patient experiencing bloody diarrhea can become anemic due to the bleeding and RBC loss which means there is less oxygenation to the body --> heart compensates by tachycardia |
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why would a patient with ulcerative colitis experience dehydration? |
dehydration can be linked to water loss by diarrhea |
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what are the goals involved in treating ulcerative colitis? |
- rest the bowel - control inflammation - combat infections - alleviate stress - symptomatic relief |
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what collaborative care does ulcerative colitis entail? |
- drug therapy - surgical intervention - nutritional therapy - monitor hydration status - monitor fluid and electrolyte status |
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why would alleviating stress be of interest in treating ulcerative colitis? |
alleviate stress because of parasympathetic response during vagal stimulation |
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what types of drug therapy would be useful in treating ulcerative colitis? |
- antimicrobial - corticosteroid - sedative - antidiarrheal |
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what is an example of an antimicrobial drug that is most commonly used for ulcerative colitis? |
Generic: Metronidazole Trade: Flagyl |
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what is an example of a corticosteroid that is used for ulcerative colitis?
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prednisone |
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what is an example of a sedative that is used for ulcerative colitis and why? |
Generic: diazepam Trade: Valium Reason: decrease anxiety and alleviate stress |
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what is an example of an antidiarrheal that is used for ulcerative colitis and why?
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Lomotil Reason: prevent worsening of diarrhea or dehydration or to allow pt, to become functional in daily living |
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what is the main problem with using Flagyl and how would you address it? |
main side effects of nausea and vomiting Health teaching: reassure pt. it is a common side effect that will go away once medication is finished. |
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what needs to be considered when recommending antidiarrheal? |
- knowing the problem of diarrhea is caused by inflammation supports use of antidiarrheal - if source is ingestion of toxins or bacteria, then antidiarrheal is not the first option because it is the body's defense mechanism to flush out foreign body or any source of infection |
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what is a protocolectomy? |
surgical removal of rectum and all or part of the colon |
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what is another term for TPN? |
hyperalimentation |
total parenteral nutrition |
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what is the risk in providing TPN for a patient? |
since it goes directly into circulation to provide nutrition, the pt. is at risk for hyperglycemia --> therefore, it is common for a pt. to be on accucheck monitoring and insulin coverage despite being nondiabetic |
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what is the nursing responsibility regarding a patient with an ileostomy? |
there will be watery stool from the patient, so the nurse's priority would be to prevent skin breakdown from the acid |
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how would the nurse prevent skin breakdown in a pt. with an ileostomy? |
the least skin exposed to the secretion = less irritation
--> collecting device should be well approximated (no skin contact between fecal matter/drainage and the patient's skin but should not be too tight) |
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why is it important that the collecting device be well approximated? |
too tight --> compromises circulation too loose --> allows drainage to come into contact with skin and cause irritation if there is skin exposure --> use barrier cream |
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what is the normal expected appearance of the stoma? what is abnormal? |
normal: beefy red abnormal: purple |
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what nutritional therapy is expected for a patient with ulcerative colitis and why? |
Diet: low residue, low ruffage Reason: - don't want too much bulk or fiber so it doesn't cause stimulation to the bowel - high caloric and high protein stimulates healing in ulceration and provides nutritional energy - pt. may be NPO to support resting bowel but then will be switched to TPN |
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what is Crohn's disease? |
it is a chronic non-specific inflammatory disease of the bowel characterized by: - inflammation of segments of GIT, most often seen in the terminal ileum, jejunum, and colon - areas involved are usually discontinuous with segments of normal bowel - cause is unknown |
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what are the clinical manifestations of crohn's disease? |
- diarrhea - fatigue - abdominal pain - weight loss - malnutrition - dehydration - fever |
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how might you distinguish between the clinical manifestations of ulcerative colitis and crohn's disease? |
ulcerative colitis has bloody diarrhea crohn's disease has diarrhea but not bloody |
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what are the goals in nursing therapeutics regarding crohn's disease? |
- control inflammatory process - relieve symptoms - correct nutritional and metabolic problems |
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what nutritional therapy would you expect for a patient with crohn's disease and why? |
low residue and low roughage because non-roughage foods allow the GI to rest and minimize bowel activity; they digest easily |
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what is roughage? |
fibrous indigestible material in vegetable foodstuffs that aids the passage of food and waste products through the gut Ex: dietary fiber |
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what drugs are involved in treatment of crohn's disease and why? |
- sulfasalazine: effective to decrease infection in large intestine - corticosteroid: decrease inflammation - flagyl |
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what is diverticulitis? |
inflammation of the diverticula |
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what is diverticulosis? |
non inflamed diverticula |
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what is diverticulum? |
saccular dilation or out pouching of the mucosa through the circular smooth muscle of the intestinal wall, common in sigmoid colon |
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what is the cause of diverticulosis? |
cause is unknown but deficiency in dietary fiber has been associated with its development |
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what health teaching can you provide to prevent a patient from developing diverticulosis? |
to eat high fiber diet to prevent occurrence of diverticulosis |
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what are clinical manifestations of diverticular disease? |
can be asymptomatic - crampy abdominal pain LLQ, relieved by flatus or BM - alternating constipation and diarrhea - fever, chills, n/v, anorexia - increase in WBC (would occur in inflammatory process) |
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what collaborative care/nursing therapeutics are involved in treating diverticular disease? |
- uncomplicated diverticula --> increase fiber in diet - bulk laxative - increase fluid intake - weight reduction - prevent intra-abdominal pressure - NPO bed rest in acute case - no "seeds" in diet |
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what type of laxative would be helpful for diverticular disease? for example? |
bulk laxative Ex: Psyillium (Metamucil) |
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what should the nurse consider when giving Metamucil to a patient? |
Patient should be able to drink 8-10 glasses of water Nursing Responsibility: encourage pt. to drink water otherwise laxative has the opposite effect in which it increases blockage if pt. is dehydrated and can increase constipation |
Psyillium |
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what is fecalith? |
it is a particle not digested or broken down but would lodge into out pouching and create inflammation in the case of diverticular disease it is a "stone" made of feces due to hardening of feces into lumps of varying size inside the colon which may appear whenever chronic obstruction of transit occurs as in chronic constipation |
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Name the abdominopelvic regions |
1. right hypochondriac region 2. epigastric region 3. left hypochondriac region 4. right lumbar region 5. umbilical region 6. left lumbar region 7. right iliac region 8. hypogastric region 9. left iliac region |
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what is a hiatal hernia? |
hiatal hernia is a protrusion of a portion of the stomach into the esophagus through an opening, or hiatus, in the diaphragm |
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what is a herniation? |
a herniation is the protrusion of an organ from one cavity to another cavity, passing through a weakened muscle wall |
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what delineates the thoracic cavity and abdominal cavity? |
the diaphragm |
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what is an inguinal hernia? |
common hernia in males in which the intestine passes through the weakened inguinal canal, into the scrotal sac |
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what are the types of hiatal hernias? |
1. sliding hiatus hernia 2. paraesophageal hiatus hernia |
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what is a sliding hiatus hernia? |
part of the stomach slides into the thoracic cavity but can also revert back to its original position |
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what is a paraesophageal (or "rolling") hiatus hernia? |
when the fundus of the stomach rolls through the diaphragm and forms a pocket |
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what clinical manifestations would a patient with hiatal hernia experience? |
- heartburn (usually accompanied after meal due to increased pressure in stomach or can occur when pt. lays down due to gravity and dependency causing pressure to push up into thoracic cavity) - dysphagia - severe burning when bending over |
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what kind of pain does a patient with hiatal hernia experience when bending over? |
severe burning pain |
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why does the patient with hiatal hernia experience pain when bending over? |
increased intra-abdominal pressure creates pain however, the pain is relieved by upright position due to the concept of dependency |
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what is conservative treatment? |
treatment that does not involve surgery |
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what conservative therapies are involved in hiatal hernia? |
- reduce intra-abdominal pressure - use antacids and antisecretory agents (ex: pantoprazole, nexium) - weight loss management |
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how would you reduce intra-abdominal pressure for a patient with hiatal hernia? |
Teach patient to: - eat small meals - wear loose clothing - avoid heavy lifting - stop alcohol and tobacco use (irritants) - Keep HOB elevated to sleep (by gravity it would help decrease intra-thoracic pressure) |
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what drugs are useful for treating hiatal hernia? |
- H2 receptor blockers - PPIs - Cholinergics - Prokinetics |
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what are some examples of H2 receptor blockers you can use for hiatal hernia? |
Generic: Cimetidine, Ranitidine, Famotidine Trade: Tagamet, Zantac, Pepcid |
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why would a cholinergic be useful for treating hiatal hernia?
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Reason: used to decrease LES pressure and increase gastric emptying Ex: Bethanechol |
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what are some examples of proton pump inhibitors you can use for hiatal hernia?
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Generic: Lansoprazole, Pantoprazole, Esomeprazole
Trade: Prevacid, Protonix, Nexium |
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why would a prokinetic be useful for treating hiatal hernia? |
Reason: motility enhancing, increasing forward flow of peristaltic movement Ex: Metoclopramide (Reglan) - promotes gastric emptying - prevents nausea and vomiting |
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what diagnostic studies might you expect for a patient with hiatal hernia? |
- barium swallow - endoscopic visualization of lower esophagus - upper GI endoscopy - motility studdies |
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what is another name for upper GI endoscopy and what does it mean? |
upper GI series: tube with camera at the end to visualize structures |
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why is barium swallow helpful as a diagnostic study for hiatal hernia? |
it shows protrusion of gastric mucosa through the esophageal hiatus the patient drinks barium so wherever it accumulates allows visualization in x-ray Note: can also be given in enema |
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what should the patient know about barium swallow after the procedure? |
after the procedure, barium is constipating --> pt. should increase fluid intake, fiber, activity/movement |
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what nonconservative therapies might you expect for a patient with hiatal hernia? |
- surgery - reduction of the herniated stomach into abdomen - herniotomy - herniorraphy - gastropexy |
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what does reduction mean in the medical sense when referring to reduction of the herniated stomach into abdomen? |
it refers to bringing it back into its position does not mean reducing size or cutting it to make the stomach small Ex: ORIF (open reduction internal fixation): surgery for broken bone (means they cut to open and put the bone back to its original position so it is aligned) |
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what is a herniostomy? |
excision of the hernia sac if there is any loose cavity, then the sac is being removed |
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-rraphy |
means to repair |
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what is a herniorraphy? |
closure of hiatal defect if the esophageal sphincter is loosened, it is easy for the stomach to go up so herniorrpahy clips it so stomach can't go out by making it narrower |
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what is a gastropexy? |
attachment of the stomach subdiaphragmatically to prevent reherniation |
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what are the complications that can follow a hiatal hernia? |
- GERD - esophagitis - hemorrhage from erosion - stenosis of esophagus - ulcers in herniated part of stomach - strangulation of the hernia - regurgitation with tracheal aspiration |
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what is esophagitis? |
inflammation of the esophagus |
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what is gastritis? |
inflammation of the gastric mucosa? |
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formation of scar tissue from ulcers in herniated part of stomach increase the risk of..? |
stenosis of esophagus due to constant irritation that may lead to swallowing difficulty |
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how would acute gastritis be treated? |
eliminating the cause if vomiting occurs: rest, NPO status, and IVF may be prescribed |
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why might an NGT may be used in acute gastritis? |
in severe cases an NGT may be used to: - decompress - monitor for bleeding - for lavage of the precipitating agent from the stomach - to keep the stomach empty |
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what does lavage mean? |
to withdraw, remove, drain washing out or irrigation of an organ or cavity, such as the stomach or intestine |
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what does gavage mean? |
to introduce introduction of material into the stomach by a tube |
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what are the causes of chronic gastritis? |
- drug - alcohol - H. pylori - pernicious anemia |
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how can be H. pylori be monitored or checked? |
- breath - serum - stool |
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why is intrinsic factor important? |
intrinsic factor leads to vitamin B12 absorption inadequate Vit. B absorption leads to immature RBCs resulting in decreased oxygenation |
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how would pernicious anemia lead to chronic gastritis? |
lack of intrinsic factor --> inadequate Vit. B absorption --> immature RBCs --> decreased oxygenation and nutrient delivery --> mucosa membrane slowly thins --> muscle layer becomes exposed --> inflammatory response results |
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what are the risk factors for gastritis? |
- drug related - female - over age 60 - Hx of ulcer disease - use of anticoagulants - use of corticosteroids - chronic debilitating disorder - diet - H. pylori infection |
Ex: cancer, CHF, diabetes Ex: alcohol, spicy foods |
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what is an example of a drug that can put a pt. at risk for gastritis? |
NSAIDs Ex: Ibuprofen |
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why is being a female considered a risk factor for gastritis? |
- emotional --> stress and anxiety increases gastric acid secretions - menstrual period (loss of blood volume --> more prone to anemia--> decreased oxygenation and maintenance of mucosa layer) --> physiologic stress |
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what are symptoms for acute gastritis? |
- anorexia - nausea and vomiting - epigastric tenderness - feeling of fullness, bloating |
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what is anorexia? |
lack of appetite |
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what are symptoms for chronic gastritis? |
symptoms of acute gastritis + pernicious anemia (loss of intrinsic factor --> loss of absorption of cobalamin) |
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what are common diagnostic studies for gastritis? |
- Hx of drug and alcohol use - endoscopic exams with biopsy - for H. pylori: breath, serum, stool, urine tests - stool for occult blood - serum for anemia or lack of IF - serum for antibodies to parietal cells & IF |
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what is the term to describe presence of blood in stool? |
melena (can be microscopic or macroscopic) |
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what does occult blood indicate? |
inflammation and bleeding in GI |
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how would you distinguish bleeding between an upper GI bleed versus a lower GI bleed? |
upper GI: dark because it is mixed with HCL acid lower GI: more brightly colored |
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if not corrected, what can gastritis lead to? |
gastritis can lead to peptic ulcer disease |
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what are the characteristics of the content in the ileum? |
watery |
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what are the types of ulcerations? |
- gastric ulceration - duodenal ulcerations - physiologic stress ulcer |
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how does loss of blood lead to a physiologic stress ulcer? |
loss of blood --> hypotension --> decrease O2 supply --> decrease integrity of mucosa --> increased exposure of muscle layer |
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what are the clinical manifestations of Peptic Ulcer Disease? |
- may have no pain (initially) - burning or cramp like - back like |
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what are the complications of peptic ulcer disease? |
- hemorrhage - perforation - peritonitis - gastric outlet obstruction |
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how does perforation lead to septic shock? |
rupture --> unsterile stomach content is released into sterile abdominal cavity --> massive inflammatory response --> septic shock
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what pain would a patient with peritonitis experience? |
Abdominal muscle contracts to preventmovement --> board like abdomen and intense pain
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how might peptic ulcer disease complicate into gastric outlet obstruction? |
scar tissue may decrease lumen of the outlet of duodenum (erosion --> gastritis --> acute ulcer --> chronic ulceration --> scar tissue) pt. feels constantly full and may feelN/V due to decreased forward flow |
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what collaborative care/nursing therapeutics are involved in treating PUD?
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- adequate rest - bland diet - cessation of smoking (gastric irritant) - aspirin & NSAIDs - drugs - nutritional therapy |
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why is adequate rest important in treating peptic ulcer disease? |
Physically: in order to conserve oxygen supply to maximize oxygenation to GI Psychologically: decreased stress and anxiety prevents release of gastric acid & the increase in gastric motility that would increase secretion as well |
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what does a bland diet mean? |
- six small meals per day - no spices and no extremes in temperature so it is less irritating |
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what nutritional therapy is beneficial for a patient with PUD? |
- eliminate spicy food, carbonated beverages, tea, coffee |
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what drugs would you expect to be prescribed for a patient with peptic ulcer disease? |
- H2 blockers - PPIs - ABT - antacid - anticholinergics - cytoprotective drugs |
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how would H2 blockers be useful in treating PUD? |
Decrease HCl acid secretion to promotehealing of ulcer, blocks release of what is being created
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how do PPIs work in treating PUD? |
- decrease HCL acid by decreasing enzymes that produce gastric acid - inhibits the enzyme that stimulates HCL acid production |
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when is an antibiotic useful in treating PUD? |
when there is ulceration secondary to infection brought about by normal flora (H. pylori) |
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why are anticholinergics used for treating PUD? |
decrease stimulation of hydrochloric acid |
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what are side effects of anticholinergics? |
- dry mouth - urinary retention - dilated pupils - blurry vision |
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why are cytoprotective drugs useful in treating PUD? |
protects exposure of layer of stomach by forming a coat around the stomach lining --> decreased effect of HCL acid to autodigest Ex: Sucralfate (Carafate) |
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