Hehi Test 4 - Lower Gi

Front 1

Iritable bowel syndrome
(aka: spastic colon or spastic colitis)

chronic symptoms:

causes:

treatment:

teaching:

Back 1

chronic symptoms: abdominal pain, alternating diarrhea and constipation, no anatomic abnormality

causes: stress, ingestion of irritants, lactose intolerance, abuse of laxitives, hormonal changes (menstruation)

treatment: counseling, strict dietary restrictions -DO NOT HELP, rest, if from lax. use bowel retraining may be needed

teaching: avoid irritants, keep diary, deal w/ stress, inc fiber and drink fluids

Front 2

Inflammatory bowel disease

peak onset:

2 types

Back 2

peak onset 15-25yrs old

-ulcerative colitis
-crohn's disease

Front 3

Ulcerative Colitis:
where does it occur?

classic symptom?

Back 3

inflammation w/ edema in DISTAL colorectal area, can involve entire colon, sloughing occurs -> bloody mucous stools -> scarring dec elastic and absorptive properties of the colon

**15-20 diarrhea per day –> metabolic imbalances, acidosis, (Na, K, Ca, bicarbonate)
-LLQ abdominal cramps

Front 4

Crohn's Disease
where does it occur?

Why would you not give a bulk forming laxitive to those w/ Crohn's?

Back 4

PROXIMAL colon and illeocecal junction (RLQ pain), inflammation involves ALL layers of intestinal wall

appearance is a "skipping" or "cobblestone" effect.

morphologic changes in colon affect function, potential for STRICTURE & FISTULA formation

Not going to give a bulk forming laxitive b/c of the potential for stricture.
Fistula is common going to bladder – dangerous b/c of bacteria transfer into bladder.

**diarrhea 4-6 times per day

Front 5

Nursing management of Crohn's Disease?

pharmocological?

other therapy?

Back 5

- Pharmacologic therapy: sulfasalazine, corticosteroids, immunosuppressive, antibiotics, vit B12, iron-dextran comples, antidiarrheals

-dietary restrictions when symptomatic

- "bowel rest" - TPN

- discourage dietary fiber b/c of strictures

- post surgical care

-antidiarrheal therapy goal: decrease intestinal motility

Front 6

Diverticular Disease:

r/t

Back 6

small outpouchings or herniations of the mucosal lining of the GI tract (typically in colon); adult onset > 35yo; western cultures

r/t low fecal volume and inc intraluminal pressure and dec smooth muscle tone

asymptomatic = diverticulosis
inflation and infection = diverticulitis

Front 7

Diverticular disease classic presentation
pain in ______
assessments tools:
Nursing management:

Back 7

pain in LLQ, low grade fever, n/v, painful abdominal exam, occult bleeding

CT or abdominal US
Barium profiling
endoscopy

-high fiber diets when NOT symptomatic
-bowel rest when symptomatic - anticholinergic therapy (dry up and slows down - SLUD)
-BULK FORMING stool softeners & plenty of water (b/c of dec fecal volume and smooth muscle tone)
-antibiotic therapy
-post surgical care

Front 8

Colostomies

Illeostomies

Back 8

colostomy: part of the colon or rectum is removed and the remaining colon is brought to the abdominal wall - performed b/c colorectal cancer, inflammatory bowel dx, diverticulitis, Hirschsprung's dx, or not having an anus; semi-solid poop comes out; closer to normal function of colon; select appropriate CLOSED pouch; teach stoma toileting

- the closer to the anus to where the problems is the less problems

illeostomy: when the ileum (lowest part of SI) is brought to the abdominal wall to form a stoma - performed b/c of UC, chron's dx, polyps of colon - waste is liquid or mushy; more concern of nutrient absorption and acid base imbalance; teach stomal management; OPAQUE pouch

Front 9

End and Loop Illeostomy

Back 9

End Illeostomy - single opening

Loop Illeostomy - 2 openings - 1 for drainage of feces, 1 for drainage of mucous

Front 10

Nursing management issues for patients with colostomies and illeostomy

Back 10

- wound/ stoma care
- fluid and electrolytes
- patient education
- self concept concerns
- skin care
- grief resolution
- social isolation
- stigmatization
- sexual dysfunction

Front 11

Observing for vascular insufficiency of stoma what color is healthy and what is concerning?

Back 11

Good – pink/healthy
Any discoloration – not getting enough perfusion, will fall off and die.

Front 12

You will need to record volume and consistency of stomal output. What volume level is concerning and need to report to the surgeon?

Back 12

> 500ml/ 24hrs - watch for electrolyte imbalances

< 500 monitor trends