Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/230

Click to flip

230 Cards in this Set

  • Front
  • Back
intestinal obstruction requires _________ tx
prompt
how many liters of fluid a day is secreted into the stomach and small intestine?
6-8L
bacteria from bowel may permeate into abd cavity
peritonitis
you will see greater distention with _____ intestinal obstruction
lower
Mechanical obstructions account for ____% of all obstructions
90
4 types of mechanical obstructions:
adhesions
hernias
neoplasms
carcinoma
what's the most common mechanical obstruction?
carcinomas
the outpouching of the mucosa thru the muscular intestinal wall
diverticulum
presence of multiple non inflamed outpouches
diverticulosis
inflammation of the diverticula
diverticulitis
even though diverticulitis is most common in the ______________, it can appear anywhere
sigmoid colon
never give _______ when there is an obstruction
barium
With non mechanical obstructions, you will hear:
hypoactive, low pitched gurgles
absent bowels sounds suggest:
paralytic ileus
Most commen GI congenital abnormality
Meckel's diverticulum
Protrusion of bowel or abd structure thru an opening
hernia
Conditions causing obstructions
meckel's diverticulum
hernia
volvulus
intussesception
hirschsprungs disease
adhesions
paralytic ileus
cancer
the most common type of hernia is the:
inguinal hernia
inguinal hernias are more common in________
men
surgical repair of hernia
herniorrhaphy
Protrusion of bowel or abd structure thru an opening
hernia
Protrusion of bowel or abd structure thru an opening
hernia
Conditions causing obstructions
meckel's diverticulum
hernia
volvulus
intussesception
hirschsprungs disease
adhesions
paralytic ileus
cancer
the most common type of hernia is the:
inguinal hernia
inguinal hernias are more common in________
men
surgical repair of hernia
herniorrhaphy
reinforcement of weakened area with wire, fascia, or mesh
hernioplasty
protrusion thru the femoral rind into femoral canal
femoral hernia
weak rectus muscle or umbilical opening fails to close after birth
umbilical hernia
umbilical hernia's are most common in
children
due to weakness of the abd wall at the site of a previous incision
ventral/incisional hernia
protrusion thru the inguinal ring and follows the spermatic cord or round ligament
indirect inguinal hernia
protrusion thru the posterior inguinal wall
direct inguinal hernia
twisting of the bowel onto itself (180 degrees)
volvulus
volvulus causes _______ & _______ because of decreased blood supply
obstruction and ischemia
where does volvulus take place?
large or small intestine
when one part of the bowel slips/telescope into another part located below it
intussusception
50% of intussusception cases happen in children:
< 1 year of age
what is the only preventable cancer?
colon
paralytic ileus causes:
neurogenic obstruction
bands of scar tissue between or around organs
adhesions
most common cause of bowel obstruction is:
adhesions
2nd common cause of Ca in Males, 3rd in females
bowel cancer
what country has the highest incidence of bowel Ca in the world?
U.S.
3rd most common Ca in the US
bowel cancer
absense of peristalsis due to the effect of trauma or toxins/meds/general anesthesia on nerves
paralytic ileus
often seen during the first 24-36 hours post operatively
paralytic ileus
increase fecal bulk and water content
bulk forming laxatives
disperses, prevents gas pockets
antiflatulents
decreases surface tension of feces, allows water penetrations
stool softener
inhibits GI motility
anticholinergics
increases osmotic pressure in intestines
saline/osmotics
irritates GI mucosa, pulls water into bowel
stimulant/irritants
destroy or inhibit bacterial growth
antibiotics
possible hypersensitivity if allergic to PCN
cephalosporins
what should a nurse teach a client about stimulant/irritant use?
it's not to be used long term
What route(s) can antibiotics be given?
IV
IM
PO-if not emergency
softens and delays drying of feces by increasing water retention in stool, lubricates intestinal wall
lubricants
2 examples of lubricants
mineral oil
fleet's mineral oil enema
how long does it take for saline/osmotics to produce semi liquid stools?
1-3h
an opening of a portion of the colon onto abd surface
colostomy
part of ileum is brought thru abd wall and stoma created
ileostomy
what type of diet is a pre op pt. on prior to bowel surgery?
clear liquid X 2 days prior
board like abdomen means:
peritonitis/perforation
intestinal obstruction means intestinal contents:
can't pass thru GI tract
most fluids are reabsorbed before they reach the:
colon
apparent mechanical obstruction without radiological evidence
pseudoobstruction
Obstipation
no passage of stool
the most common non mechanical obstruction:
paralytic ileus
most mechanical obstructions occur in the:
small intestine (ileum)
what is the narrowest part of the small intestine?
ileum
The majority of people with diverticulosis have no symptoms, however some may experience:
crampy abd pain in LLQ relieved by flatus/bm

h/o alternating constipation and diarrhea
diverticulitis can be diagnosed several ways incl:
barium enema
cbc
colonoscopy
ct scan
fecal occult blood
hematest
s/s of diverticulitis are:
abd pain localized over colon

llq tender, mass on palpation

fever
anorexia
leukocytosis
chills
nausea
s/s of partial occlusion 2ndary to atherosclerosis:
pain after eating/after meds
change in bowel habits
n/v
wt. loss
if there's a mechanical obstruction, what type of bowel sounds will you hear proximal to the obstruction?
high pitched/hyperactive (borborygmi)
millions of ppl have this and have no clue
diverticulosis
meckel's diverticulum symptoms mimic __________
appendicitis
meckel's diverticulum is symptomatic during:
the first 2 years
causes of hernias:
post surgery
heavy lifting
blunt trauma
rebound tenderness means:
when you push down, no pain, when you let go they feel pain
in what conditions do you see rebound pain?
meckel's diverticulum
appendicits
peritonitis
symptoms of meckel's diverticulum:
painless tar like stool
grossly bloody stools
abd pain
signs of obstruction
what kind of hernia is a medical emergency?
strangulated
what are some symptoms with a strangulated hernia?
n/v
cramp
abd distention
tachycardia
fever
treatment for meckel's diverticulum:
surgical removal of diverticulum
direct inguinal hernias are common in _______, males > females
elderly
symptoms of meckel's diverticulum:
painless tar like stool
grossly bloody stools
abd pain
signs of obstruction
symptoms of meckel's diverticulum:
painless tar like stool
grossly bloody stools
abd pain
signs of obstruction
what kind of hernia is a medical emergency?
strangulated
what kind of hernia is a medical emergency?
strangulated
what are some symptoms with a strangulated hernia?
n/v
cramp
abd distention
tachycardia
fever
what are some symptoms with a strangulated hernia?
n/v
cramp
abd distention
tachycardia
fever
treatment for meckel's diverticulum:
surgical removal of diverticulum
treatment for meckel's diverticulum:
surgical removal of diverticulum
direct inguinal hernias are common in _______, males > females
elderly
direct inguinal hernias are common in _______, males > females
elderly
meckel's diverticulum symptoms mimic __________
appendicitis
meckel's diverticulum is symptomatic during:
the first 2 years
causes of hernias:
post surgery
heavy lifting
blunt trauma
rebound tenderness means:
when you push down, no pain, when you let go they feel pain
in what conditions do you see rebound pain?
meckel's diverticulum
appendicits
peritonitis
intestinal obstructions can either be ________or________ ....and....__________or__________
partial complete
mechanical non mechanical
Intestinal contents, fluid and gas accumulate ________ to the obstruction
proximal
with a bowel obstruction, there is an increase in gastric and intestinal secretions and and increase in:
pressure and capillary permeability
with bowel obstructions, theres a ______in circulating blood volume (hypovolemia) and a_______in the reabsorption of fluids
decrease, decrease
what will happen with a bowel obstruction? htn or hypotension?
hypotension
NERD r/t bowel obstruction stands for:
necrosis
edema
rupture
distention
with bowel obstructions, there may be an _____________________ of fluid/electrolytes into the peritoneal cavity
extravasation
symptoms (manifestations) of bowel obstruction vary on:
level/length of bowel involved
degree the blood supply is interfered with
partial vs. complete
type of lesion producing obstruction
some possible s/s of bowel obstruction:
(10)
n/v
pain
distention
inability to pass flatus
constipation
hiccups
fam hx of colon ca
blood in stool
change in bowel patterns
s/s appear sooner and are more intense in the ______ intestine than the _______intestine
small
large
why do s/s appear soon and more intensly in the small intestine?
lumen is narrower
sm. bowel's more active
if there's an obstruction in the small intestine, there's a ___ onset
rapid
what type of vomiting would someone have with a smalll intestine obstruction?
projectile
what color would the emesis be in a person with a sm. bowel obstruction?
bile stained
_____relieves some of the pain of a small intestine obstruction
vomiting
what type of distention would there be in a person with a small intestine obstruction?
minimal
With a small intestine obs., there is ____________ pain
intermittent
with a large intestine obstruction, what will the stool look like?
ribbon like/unusual form
With a large intestine obstruction, does vomiting relieve pain?
no
what type of pain does someone fell with a large intestine obstruction?
colicky, persistant
with a small intestine obstruction, there is ___ fluid and electrolyte imbalances
severe
with a large intestine obstruction, there is _______ fluid and electrolyte imbalances
no major
adhesions from previous surgical interventions) account for ____% of all mechanical obstructions
50
neoplasms and hernia acount for ______% each of all mechanical obstructions
15
occurs after abd surgery, inflammatory responses, electrolyte imbalances, thoracic or lumbar fracture, grenery surgery
paralytic ileus
will there be bowel sounds with a paralytic ileus?
NO
when would you see fecal vomiting? (reverse peristalsis)
with a mechanical obst.
_____________ resolves by resting bowel and NPO
paralytic ileus
where would the pain be if there was a small intestine bowel obstruction?
upper/mid abd
when is it most common to see a paralytic ileus?
24-36 hrs post op
pseudoobstruction may be caused by:
collagen vascular, neurologic and endocrine cdisorders
interference with blood supply to intestine is:
rare
the most common causes of interference with blood supply to the intestine are:
emboli and
atherosclerosis of the mesenteric arteries
signs of infarcted bowel:
shock like
n/v
back pain
hematemesis and/or rectal bleeding
___________ infarctions are seen with complete occlusions
mesenteric
there may be __________ angina with a partial occlusion
abd
s/s of a complete occlusion secondary to embolus include passage of stool with ____or _________
blood
mucous
bowel sounds distal to obstruction:
hypoactive/absent
you will see fever, leukocytosis, shock, and intense abd pain from ischemic tissue with
complete occlusion 2ndary to embolus
caused by atrophy, weakness of bowerl wall, increase in intra luminal pressure, obesity and chronic constipation
diverticulum
diverticulum could be _________ or __________
congenital or acquired
__________ have a higher complication rate with diverticular disease
men
diverticular disease is associated with:
DEFICIENT DIETARY FIBER
how does diverticular disease effect men n women?
equally
divericular disease is prevalent in ________ diets low in __ and high in refined __________
western
fiber
carbs
diverticular disease may result in bowel narrowing from _________________________=obstruction
fibrotic stricture
with diverticular disease, fecal matter and bacteria may collect in pouch and harden into a ____
fecalith (mass)
fecalith = abscess, small perforations, ______
peritonitis
the elderly may be afebrile, normal ebc, with no abd tenderness in______
diverticulitis
what type of diet modification should a pt. with diverticulosis make?
high fiber
no seeds/nuts
to prevent constipation with diverticulosis, pt should use________laxatives
bulk
the pt with asymptomatic diverticulosis should increase:
fluid intake
what should the pt. with asymptomatic divericulosis notify the md about?
change in pattern of stoll
pain
fever
urinary sx
the pt. with asymptomatic diverticulosis should avoid increase intra abd pressure which means:
no straining, lifting, bending
treatment for symptomatic acute diverticulitis: allow
colon to rest
treatment for symptomatic acute diverticulitis: ___ status, ________ fluids
npo
parenteral
treatment for symptomatic acute diverticulitis: possible _ if alot of n/v
ng tube
treatment for symptomatic acute diverticulitis: control inflammation, possible _____
steroids
treatment for symptomatic acute diverticulitis: antibiotics to reduce
bacterial flora
treatment for symptomatic acute diverticulitis: soften mass with bulk preparations, ______---, __________
softeners, suppositories
treatment for symptomatic acute diverticulitis: observe for signs of possible
peritonitis
treatment for symptomatic acute diverticulitis: give ______ for pain
analgesics
treatment for symptomatic acute diverticulitis: no _____ or ________
laxatives or enemas
s/s of peritonitis:abd ______
pain
s/s of peritonitis: rigid board like and _____ _______
distended abd
s/s of peritonitis: decreased
bowel sounds
s/s of peritonitis: inability to___
pass flatus/feces
Nausea, vomiting, anorexia, fever, dehydraion,and tachycardia all s/s of
peritonitis
what are the high pitched, tinkling bowel sounds called in a mechanical obstruction?
borborygmi
s/s neurogenic obstruction incl: (4)
no b/s
no flatus
abd distention
abd pain
problems include:
gastric linging ulceration/perforation, bleeding
inflammation, may mimic appendicitis
bowel may twist around fibrous bands, intussusception, obstruction
meckel's diverticulum
if u dont treat hernia, they can slip into scrotum and can pull ____ and ____ into sac
peritoneum
bladder
indirect inguinal hernias are common in ______,___________,_________
infants
young
50 year olds
what type of hernia strangulates easily?
femoral
femoral hernias are more common in _____
women
symptoms of strangulation:
sharp abd pain
if an umbilical hernia is not closed by school age, it is
surgically repaired
in adults, umbilical hernias are more common in ______
females (after several pregnancies)
most commonly found in patients with:
-obesity
-mult. surgical procedures in same area
-inadequate wound healing froom poor nutrition and or infection
ventral/incisional hernia
what is used for a hernia pt. who is not a surgical candidate (elderly, mult comorbities)
truss
with hernia surgery, pt. may need bowel resection if strangulation, _________, ________
gagrene
necrosis
pt. who had hernia surgery must refrain from lifting heavy objects for ___-___wks
6 8
nsg care for hernia surgery: support _____
scrotom prn
nsg care for hernia surgery: encourage ________ and ______
deep breathing turning
nsg care for hernia surgery: do not encourage _____
coughing
nsg care for hernia surgery: observe for ____________
difficulty voiding
nsg care for hernia surgery: _________ for pain and edema on scrotom
ice bags
volvulus (twisting of bowel onto itslef 180 degrees) may be present in___ or____
infancy
asymptomatic
volvulus may be found around ______ or __________
tumor
meckel's diverticulum
Rx for volvulus?
long decompression tube/surgery
bilious vomiting, distention, pain, lower gi bleeding are s/s of:
volvulus
intussusception is most commonly at the ___________
ileocecal valve
males have 3X incidence as females
intussusception
occurrence higher with cystic fibrosis and celiac disease
intussusception
intussusception is one of the most common causes of obstruction in ___________
infancy
Newborn symptoms of hirschsprungs disease:
-doesn't pass meconium
-reluctance to ingest fluids
-bile staind vomitus
-abd distention
Infants symptoms of hirschsprungs disease:
-failure to thrive
-constipation
-abd
distention
-episodes of diarrhea n vomiting
-explosive watery stools
-fever, malaise
childhood symptoms of hirschsprungs disease:
constipations
-ribbon like, foul smelling stool
-abd distention
visible peristalsis
-poorly nourished
-anemia
failure of anal sphincter to relax preventing evacuation:
hirschsprungs disease
two other names for hirschsprungs:
toxic megacolon
congenital aganglionic megacolon
where is bowel cancer common?
r side large intestine
when do adhesions usually appear?
3rd day post op
what type of foods put you at risk for bowel cancer?
charred/well done foods
high intake red meat
little fiber
what age are you at risk for bowel ca.
any. esp over 50
#1 s/s of bowel ca?
change in habits
#2 s/s bowel ca
rectal bleeding
s/s bowel ca
narrow, ribbon like stool
alt. constipation/diarrhea
passage of mucous
rectal/abd pain
feeling of fullness
incomplete evacuation
anemia
fatigue
unexplained wt. loss
obstruction
3 tx for bowel ca
radiation
chemo
surgical resection
Na, K, Cl will be _____ with bowel obstruction.
decreased
wbc will _______ with strangulation/perforation
increase
If CEA was at a normal level, it would be ____
<5mcg/L
if the CEA was >__ indicative of inflammation
10
if the CEA was >__ be concerned/possible lesion
12
antidiarrheals decrease ____ by decreasing peristalsis
diarrhea
antiflatulents facilitae elimination via
belching, flatus
bulk forming laxatives increase peristalsis and
elimination
s/e of bulk forming laxatives:
n/v diarrhea, anorexia
what may cause false positive of the hemoccult test?
vit c
fe
bromide
iodine
if eating lot of red meat
what are permanent colostomys done for?
ca
ulcerative colitis
birth defects
what is the hartmann procedure?
temp colostomy done in 2 stages
with an ileostomy, fecal drainage is ________
continuous
APR stands for
abdominalperineal resection
and abdominoperineal resection is a _________ colostomy
permanent
kock pouch aka
continent ileostomy
part of ileum is used to form a pouch or ileal reservoir
kock pouch
inflammation of hair follicles, redness @ base of hair follicles, caused by removal of hair from its follicle by aggressive adhesives
folliculitis
peristomal skin problems:
candida
acute contact dermatitis
folliculitis
whats the most common peristomal skin problem?
irritant dermatitis