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49 Cards in this Set

  • Front
  • Back
What is the primary function of the small intestine
absorption of nutrients
Primary function of Large intestine
absorption of water and electrolytes
Assessment of GI
Labs
CBC, albumin, pre-albumin, fuaic, stool cultures, ANCA
Assessment of GI
diagnostics
x-ray ultrasound
Cat/mri
Barium studies
endoscopic
colonoscopy
camera capsule
When would a barium study be contraindicated
diverticlitis
active inflammation/fistula/perforation suspected
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
CONSTIPATION
what are the desired outcomes
indentify risk fctors
demonstrate behavior patterns to maintain normal elimination
CONSTIPATION
management
diet and exercise
medications
nutrition;high fiber
increased activity
fluid volume/hydration status
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
DIARRHEA
Risk factors
infection-c.diff E.coli
Medications-abx
malabsoption disorders (cystic fibrosis)
Overuse of laxative stool softeners
Nutritional therapy (tube feeding)
DIARRHEA
Complications
fluid and electrolyte imbalances
K deficiency
DIARRHEA
Outcomes
Identify risk factors
lifestyle changes to maintain normal elimination
DIARRHEA
Management
meds-lomotil, imodium
nutrition-low fiber diet as tolerted
fluid status-check weight, s/s dehydration
skincare!
DIARRHEA
When would use of lomitil be contraindicated
if you suspect a bacterial organism.
APPENDICITIS
Definition
finger-like extension attached to cecum and gets i nflamed. more common in men and younger ages
APPENDICITIS
What is the prime complication
perforation and peritonitis
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
APPENDICITIS
labs and diagnostics
CBC-WBC elevated
high C-reactive protein level
ulatrasound/CT
Rovsings sign
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
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
DIVERTICULITIS
define
pouches or sacs within intestinal mucosa that are imflammed
DIVERTICULITIS
What are the causes
incresed luminal pressure
chronic constipation
age
bowel ireegularity
DIVERTICULITIS
clinical manifestations
low grade fever
anorexia
bloating, distenstion,cramping
weakness/fatigue
Inflammation LL abd pain common
DIVERTICULITIS
Complication if untreated
perforation can lead to peritonitis, abscess and eventually septicemia, infection
DIVERTICULITIS
diagnostics
CT
barium endema
DIVERTICULITIS
GOALS
decrease amt of abnormal bacterial flora in the intestines and soften stools to facilitate movement
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
DIVERTICULITIS
Inpatient treatment
prevent FVD
pain management
surgery may be needed
DIVERTICULITIS
Teaching
increase fluid to 10 glassess/day
increase activity
increase fiber up to 25gm
DIVERTICULITIS
Goal of teaching
maintain normal fluid and electrolyte blaance
promote nutrition
promote elimination
DIVERTICULITIS
WHAT to AVOID
nuts, popcorn, pumpkin seeds smaller seeds are OK
COMPLICATIONS OF ACUTE IBD
bleeding
obstruction
abscess
peritonits
fisula formation
CHROHNS
etiology
idiopathic, chronic inflammation affected any part of GI, but most common in TERMINAL ileum or COLON
CHROHNS
patho
tranmural thicking
deep penetrating granuloma
CHROHNS
clinical manifestations
location: ileum, right colon
bleeding; rare but may occur
perianal involvement;common
fistulas;common
rectal involvement; 20%
diarrhea;less severe
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
CHROHNS
Management
coricosteroids
sulfonamides
ABX
parenteral nutrition
partial/complete colectomy
(ileostomy/anastomosis)
rectum can be perserved in some pts
recurrnace common
CHROHNS
complications
small bowel obstruction
right-side hydronephrosis
cholelithiasis
arthritis
terinitis
erythema nodosum
COLITIS
Patho
Mucosal ulceration
mucosal minute ulceration
COLITIS
clinical manisfestations
location;rectum L colon
Bleeding; common-severe
Perianal invol; rare-mild
Fistulas-rare
rectal invol: almost 100%
diarrhea; severe
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
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
COLITIS
Systemic complications
toxic mega colon
pperforation
hemorrhagemalignant neoplasms
pyelonephritis
management goals for IBD
remission
maintain remission
improve QOL
heal mucosa-thru nutrition and meds
decrease hospitalization/surgery
decrease complications
colonoscopy/CT
Interventions
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
COMMON MEDS
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
SURGICAL PROCEDURE
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.
3 types of colectomy
total ileoanastomis-viable rectum w/ an end to end anastomsis
total with traditional ileostom
total with content ileostomy-done through Koch pouch
CARE OF CLIENT WITH ILEOSTOMY
skin care
ostomy care
nutrition
meds-post op only for chrons
psych support