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48 Cards in this Set
- Front
- Back
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What are the manifestations of appendicitis?
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* preumbilical pain that localizes in the RLQ at McBurney's Point
* Anorexia *n/v * Localized tenderness * rebound tenderness * muscle guarding * Rovsing's sign |
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Name the surgery for appendicitis
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Appendectomy
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What is diverticulum?
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saccular out pouching of the intestinal mucosa through the smooth muscle of the intestinal wall in sigmoid colon
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What is diverticulosis?
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multiple noninflammed diverticula
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What is diverticulitis?
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an infection of the diverticular sacs holding stool and bacteria (fecalith) surrounding intestinal tissue becomes edematous
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What are the manifestations of diverticulitis?
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* usually asymptomatic
* abdominal pain localized over area * fever * elevated WBC * palpable mass |
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How is diverticulitis different in the elderly?
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* afebrile
* normal WBC * minimal abdominal pain |
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What diagnostic tests should be used with caution in diverticulitis?
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Barium study and Colonoscopy because of the risk for perforation
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What are the nursing interventions for diverticular disease?
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* High fiber diet
* Acute: - NPO - Bedrest - IVF - Broad spectrum antibiotics - advance diet slowly when acute episode subsides |
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What is inflammatory bowel disease?
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chronic recurrent inflammation of the intestinal track
- Usually peaks in 15-25 and 50 - Ulcerative colitis - Crohns disease |
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What is the pathology of Ulcerative colitis?
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* diffuse inflammation beginning in the rectum, spreading up in a continuous pattern causing ulcerations in mucosa and submucosa
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What are the manifestations of Ulcerative colitis?
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* Ulcerations cause bleeding and diarrhea
* F/E loss * protein loss * Pseudopolyps * abdominal pain |
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What is crohns disease?
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* affect all parts of the GI tract
* inflammation affects all layers of the bowel wall * have skip lesions * classic cobblestone appearance |
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What are nonspecific complaints of inflammatory bowel disease
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* Diarrhea (>10 per day)
* fatigue * abdominal pain * W/L * fever |
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What are the clinical manifestations of Ulcerative colitis>
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* bloody diarrhea
* abdominal pain |
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What are the manifestations of crohns disease?
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* diarrhea (non bloody)
* Colicky abdominal pain others: malabsorption nutritional deficiencies may have rectal bleeding |
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What are the complications of ulcerative colitis?
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* hemorrhage
* strictures * perforation * toxic megacolon (colonic dilation >5cm) |
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What are the complications of crohns disease?
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* Intestinal
- strictures and obstruction from scar tissue - fistula - peritonitis Extraintestinal - thromboembolism - arthritis - ankyosing spondylitis - osteoporosis - liver disease - skin lesions |
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What are the goals of treatment for Inflammatory bowel disease?
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* rest the bowel
* control inflammation * combat infection * correct malnutrition * alleviate stress * relieve symptoms * improve quality of life |
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Name the drugs used to treat Inflammatory bowel disease
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* Aminosalicylates
- Azulfidine * Antimicrobials (crohns) - Flagyl, cipro, biaxin * Corticosteroids - prenisone * Immunosuppressants - Imuran * Biologic Therapy - Remicade * Antidiarrheals * Vitamins and iron supplements |
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What is the purpose of Aminosalicylates?
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* decreases GI inflammation
* effective in achieving and maintaining remission * mild and moderate attacks * Newer formulations better tolerated |
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What are corticosteroids used for?
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* decrease inflammation
* used to achieve remission * helpful in acute flare ups |
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What are monitored in immunosuppressants
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* bone marrow suppressants
* take 3-6months |
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What are biologic therapies used for?
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* Inhibit tumor necrosis factor
* Induce and maintain remission |
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What are the indictions for surgical therapy in Inflammatory Bowel Disease
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* failure to respond to treatment
* frequent debilitating exacerbations * massive bleeding or obstruction * Development of dysplasia or carcinoma * Perforation |
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Name the surgical treatments for Inflammatory Bowel Disease
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* Total colectomy with ileoanal reservoir
* Total protocolectomy with permanent ileostomy |
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What is a total colectomy with an ileoanal reservoir?
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* Combination of two procedures done 12 - 18 weeks apart allowing pt to control defecation at anal sphincter
* Adaptation of the reservoir over 3-6 months |
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What is a total colectomy with permanent ileostomy?
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* One stage operation removing the colon, rectum, and anus
* continence is not possible |
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Name the post op care for IBD pts
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* Monitor ileostomy
* Output: 1500-2000mL/24hrs * Observe: - hemorrhage - abdominal abscess - small bowel obstruction - dehydration * Expect transient incontinence of mucous from manipulation of anal canal |
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Name the nutritional therapy for IBD
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* High calorie diet
* High protein diet * Low residue diet * Vitamin and iron supplements * Elemental diet * Parenteral nutrition |
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What should you assess for in IBD?
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* Diarrhea (blood?)
* Anorectal irritation * Weight loss * Anxiety * depression * S/S of F/E imbalance * S/S of anemia - pale weak |
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What should you teach a pt with IBD?
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* Importance of rest and diet management
* Perianal care * Ileostomy care * S/S of reoccurrence and when to seek care * Diversion activities to reduce stress |
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What is cholelithiasis?
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stones in the gallbladder
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What is cholecystitis?
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inflammation of the gallbladder usually associated with cholelithiasis
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What are the risk factors for cholelithiasis?
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* Women, multiparious, >40
* Estrogen therapy * Sedentary lifestyle * family Hx * Obesity |
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What is the pathology of cholelithiasis?
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* gallstones cause pain as they pass through the ducts
* may lodge and cause obstruction |
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What are the acute clinical manifestations of cholelithiasis?
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* Indigestion
* pain in the RUQ, R shoulder scapula * N/V * restlessness * Biliary colic (spasms) * occurs 3-6 hrs after a heavy meal or lying down * pain for hr followed by RUQ tenderness - Tachycardia/tachypnea - Diaphoresis - Prostration |
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What are the obstructive clinical manifestations of cholelithiasis?
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* Jaundice
* Dark amber urine * clay colored stools * Puritis * intolerance to fatty foods * steatorrhea |
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What are the complications of Cholelithiasis
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* Gangrenous cholecystitis
* pancreatitis * Cholangitis (infection of bile duct) * Biliary cirrhosis |
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What are the diagnostic tests for Cholelithiasis
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* H&P
* US - visualization * Labs: - Liver Fx Tests - WBC count - Serum bilirubin (^) - serum amylase (^) - ERCP - No urobilinogen |
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Name the conservative therapy for Cholecystitis and cholelithiasis
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* Cholecystitis
- Pain control - antibiotics - F/E balance - Low fat diet * Cholelithiasis - Endoscopic sphincterotomy - Lithotripsy |
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Name the surgical therapy for Cholelithiasis
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* Laparoscopic Cholecystectomy
* Open Cholecystectomy * T-tube inserted into duct to keep patency |
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Name the drug therapy used for Cholelithiasis
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* Medical dissolution therapy
- small stones - mildly symptomatic - poor surgical risks * May take 6months - 2yrs * Drugs - UDCA - Actigall - CDCA |
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Name the nursing interventions for cholelithiasis
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* Pain management
- oral meds asap - prevent constipation * N/V - Antiemetics - gastric decompression * Monitor for signs of obstruction * Assess for infection |
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What are the post op care for Laparoscopic cholecystectomy
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* Shoulder pain due to CO2
- SIMS position or lye flat * Clear liquid diet initially * Low fat diet for 4-6 weeks |
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What is the post op care for open cholecystectomy
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* Discharge in 2-3 days
* no heavy lifting for 4-6weeks * If T tube in place - maintain patency - assess drainage |
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What are the clinical manifestations of an intestinal obstruction
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* Abdominal Pain
* N/V * abdominal distention * Bowel sounds are high pitched above the obstruction * Can't fart High: * rapid onset * projectile vomiting with bile * vomiting relieves pain Distal small bowel: * Gradual * brown orange color * fecal smelling Lower obstruction: * colicky pain * waves of pain |
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Name the nursing interventions in intestinal obstruction
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* NPO
* NGT * IVF - UOP at least 30/hr * Analgesics * if no improvement after 24-48 hrs - do surgery |
