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18 Cards in this Set
- Front
- Back
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predisone and budesonide
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corticosteroids
- acute tx - good for chrons and Ulcerative colitis |
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Imuran, Cyclosporin, Methotrexate
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- Take 3-6 months to be effectice
- Suppress bone marrow - pancreatic inflammation ** No methotrexate in pregnancy** - all good for crohns and UC |
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Infliximab (Remicade)
adalimumab (Humira) |
- biological therapy
- immunosupressants - Crohns and UC - inhibit tumor necrosis factor - given IV to induce or maintain remission - may reactivate hepatitis, TB, and promote lymphoma |
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normal ostomy output
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can be as much as 1500-2000 mL/ 24 hrs
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Diagnostics to avoid in divertiulitits
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Bareium enema and colonoscopy
- perforation and paritinitis risk |
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Most common cause of lowere GI hemorrhage
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Divertilulitis
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IBs fiber amount
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>20 grams per day
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Diverticulosis fiber amount
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25-30 grams per day
- may need fiber supplements |
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1/2 of all colorectal cancers occur where?
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rectosigmoid area- 85% rise from polyps
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Colorectal screening guidelines from CDC
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- begin age 50 through age 75 (age 75+ screening depends on clinical decision)
- Earlier for high risk pts - 3 consecutive fecal occult blood samples every year - flexible sigmoidoscopy every 5 yrs **colonoscopy every 10 year- gold standard for screening** |
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Hematochezia
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- bloody stools, left side of colon
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Melena
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- dark, bloody stools (kind of eggplant covered)
- right side of colon |
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stoma care
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- assessed q 8h
- color should be pink, rose, brick red - dusky blue= ischemia - brown/black = necrosis - pale =anemia - red to purple = inadequate blood supply - edema is mild to moderate post op (2-3 weeks) - moderate - severe = obstrution or trauma small amount of bleeding especially when touched - moderate to large--> REPORT TO SURGEON! lowere GI bleed? |
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pouch care
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- should contain odros and drainage and protect skin
- barriers should last 5-7 days (depends on many factors) - hard to seal if has creases - ful bags are heavy and may pull seal away **EMPTY when 1/3 full! |
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post op ostomy diet
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- no diet restrictions except limit intake of gas and odor producing foods:
- beans, cabbage, cauliflower, broccoli, brussel spouts, asparagus, potatoes, corn, noodles, wheat |
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ileostomy
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- change pounch q 4-7 days
- control not possible - watery - observe for K, Na, and fluid deficits |
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Ileostomy output
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24-48 h post op: negligible
high volume (1000-1800) with perstalsis - as small bowel adapts may be ~500 mL/day - increase fluids to 2-3L/day (includes sports drinks (electrolytes), not just H2O) - more excessive loss related to heat and sweating - educated pt on s/s of electrolye imbalance -low fiber, increase gradually - chew foods extremely well especially: - popcorn, coconut, mushrooms, olives, stringy vegetables, food with skins, dried fruits, meats with casing (sausage, etc.), shrimp/lobster ** High risk for obstruction of stoma! |
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adaptation to ostomy
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-psychological
ADL's resumes within 8 weeks - no heavy lifting - no sports where trauma of stoma is possible - bathing and swimming is OK - sexual dysfunction - female arousal only affected if complete vagina removed, pregnancy possible but may need to be limited - psychological and social will affect sexual dysfunction also |
