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49 Cards in this Set
- Front
- Back
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What is the primary function of the small intestine
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absorption of nutrients
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Primary function of Large intestine
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absorption of water and electrolytes
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Assessment of GI
Labs |
CBC, albumin, pre-albumin, fuaic, stool cultures, ANCA
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Assessment of GI
diagnostics |
x-ray ultrasound
Cat/mri Barium studies endoscopic colonoscopy camera capsule |
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When would a barium study be contraindicated
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diverticlitis
active inflammation/fistula/perforation suspected |
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CONSTIPATION
Risk factors |
medications;narcotics, calcium channel blockers,iron,diuertics,anticonvulsants,anti-parkinson drugs
Nutrition;lack of fiber decreased fluid intake lack of activity develepmental ocnsiderations |
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CONSTIPATION
what are the desired outcomes |
indentify risk fctors
demonstrate behavior patterns to maintain normal elimination |
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CONSTIPATION
management |
diet and exercise
medications nutrition;high fiber increased activity fluid volume/hydration status |
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CONSTIPATION
Types of meds used |
Bulk-forming agents(metamucil) take w/ full glass water
lubricants(mineral oil)-greases stool for easy pass laxatives-ducolax, stimulant stool softeners Colace Osmotic agents (golytely)-can induce diarrhea, used as a prep for colonoscopy |
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DIARRHEA
Risk factors |
infection-c.diff E.coli
Medications-abx malabsoption disorders (cystic fibrosis) Overuse of laxative stool softeners Nutritional therapy (tube feeding) |
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DIARRHEA
Complications |
fluid and electrolyte imbalances
K deficiency |
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DIARRHEA
Outcomes |
Identify risk factors
lifestyle changes to maintain normal elimination |
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DIARRHEA
Management |
meds-lomotil, imodium
nutrition-low fiber diet as tolerted fluid status-check weight, s/s dehydration skincare! |
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DIARRHEA
When would use of lomitil be contraindicated |
if you suspect a bacterial organism.
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APPENDICITIS
Definition |
finger-like extension attached to cecum and gets i nflamed. more common in men and younger ages
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APPENDICITIS
What is the prime complication |
perforation and peritonitis
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APPENDICITIS
clinical manifestations |
periumbilical pain followed by nauses RLQ 50-60% vomit
tenderness at mcburney's point rebound tenderness low-grade fever present atypically with flank pain and URQ pain |
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APPENDICITIS
labs and diagnostics |
CBC-WBC elevated
high C-reactive protein level ulatrasound/CT Rovsings sign |
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APPENDICITIS
what is rovsings sign McBurneys point |
palpating LLQ wil result in pain in RLQ + sign
midway b/w umbilicus and anterior-superior iliac spine |
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APPENDICITIS
Outcomes |
relieve pain-TC&DB, splinting, meds, HOB elevated(relieves incisional pressure
Eliminate infection-IV ABX prevent FVD-IV therapy until BS then ice chips then adv. optomize nutrition-watch BS prevent anxiety |
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DIVERTICULITIS
define |
pouches or sacs within intestinal mucosa that are imflammed
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DIVERTICULITIS
What are the causes |
incresed luminal pressure
chronic constipation age bowel ireegularity |
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DIVERTICULITIS
clinical manifestations |
low grade fever
anorexia bloating, distenstion,cramping weakness/fatigue Inflammation LL abd pain common |
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DIVERTICULITIS
Complication if untreated |
perforation can lead to peritonitis, abscess and eventually septicemia, infection
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DIVERTICULITIS
diagnostics |
CT
barium endema |
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DIVERTICULITIS
GOALS |
decrease amt of abnormal bacterial flora in the intestines and soften stools to facilitate movement
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DIVERTICULITIS
Ways to reach goal |
clear liquid during acute phase
high fiber, low fat (avoid high fiber if infection is present) ABX bulk-froming laxatives |
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DIVERTICULITIS
Inpatient treatment |
prevent FVD
pain management surgery may be needed |
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DIVERTICULITIS
Teaching |
increase fluid to 10 glassess/day
increase activity increase fiber up to 25gm |
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DIVERTICULITIS
Goal of teaching |
maintain normal fluid and electrolyte blaance
promote nutrition promote elimination |
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DIVERTICULITIS
WHAT to AVOID |
nuts, popcorn, pumpkin seeds smaller seeds are OK
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COMPLICATIONS OF ACUTE IBD
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bleeding
obstruction abscess peritonits fisula formation |
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CHROHNS
etiology |
idiopathic, chronic inflammation affected any part of GI, but most common in TERMINAL ileum or COLON
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CHROHNS
patho |
tranmural thicking
deep penetrating granuloma |
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CHROHNS
clinical manifestations |
location: ileum, right colon
bleeding; rare but may occur perianal involvement;common fistulas;common rectal involvement; 20% diarrhea;less severe |
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CHROHNS
Diagnostic and labs |
radiography;regional, skip lesions, narrowing of colon, thickening of bowel wall, mucosal edema, stenosis, fistulas
SIGMOIDOSCOPY-m/b unremarkable unless have fistulas COLONOSCOPY; distinct ulcerations seperated by normal mucosa in R colon +ASCS and ELEV SED RATE |
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CHROHNS
Management |
coricosteroids
sulfonamides ABX parenteral nutrition partial/complete colectomy (ileostomy/anastomosis) rectum can be perserved in some pts recurrnace common |
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CHROHNS
complications |
small bowel obstruction
right-side hydronephrosis cholelithiasis arthritis terinitis erythema nodosum |
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COLITIS
Patho |
Mucosal ulceration
mucosal minute ulceration |
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COLITIS
clinical manisfestations |
location;rectum L colon
Bleeding; common-severe Perianal invol; rare-mild Fistulas-rare rectal invol: almost 100% diarrhea; severe |
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COLITIS
diagnostic findings/labs |
radiography; diffuse involvement no narrowing of colon, no mucosal edema, stenosis rare, shortening of colon
SIGMOIDOSCOPY- abnormal inflamed mucosa COLONOSCOPY- friable mucosa w/pseudoployps in L colon |
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COLITIS
Management |
corticosteroids
sulfonamides-useful in preventing recurrence bulk hydrophilic agents ABX proctocolectomy with ileostomy rectum preserved in only a few pts cured by colectomy |
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COLITIS
Systemic complications |
toxic mega colon
pperforation hemorrhagemalignant neoplasms pyelonephritis |
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management goals for IBD
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remission
maintain remission improve QOL heal mucosa-thru nutrition and meds decrease hospitalization/surgery decrease complications colonoscopy/CT |
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Interventions
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NUTRITIONAL THERAPY-bowel rest, modify diet to decrease GI symptoms and maintain nurtitional intake.
prone to osteoporosis from Ca deficiency, HIGH PROTEIN, HIGH CAL, LOW FIBER/RESIDUE diet PHARMACOLOGICAL THERAPY SURGERY |
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COMMON MEDS
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AMINOSALICYLATES (5ASA)- first line of defense, benefits are odsed related, MED NEEDS TO BE IN DIRECT CONTACT
CORTICOSTEROIDS-short burst IMMUNOMODULATORY-steroid sparring, use when steroids are not working ABX-decrease acute symptoms BIOLOGICAL THERAPIES-stop tissue necrosis factoer |
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SURGICAL PROCEDURE
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stricturplasty-sm ballon, where obstruction a cut is made lengthwise. done endoscopically only as far as scope goes
COLECTOMY-total/subtotal Ileostomy Ileoanal anastamosis-temp ileostomy until J pouch is healed. |
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3 types of colectomy
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total ileoanastomis-viable rectum w/ an end to end anastomsis
total with traditional ileostom total with content ileostomy-done through Koch pouch |
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CARE OF CLIENT WITH ILEOSTOMY
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skin care
ostomy care nutrition meds-post op only for chrons psych support |
