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120 Cards in this Set
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What would labs show with Ulcerative Colitis?
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Hemoglobin and hematocrit may be low due to bleeding, WBC may be increased, elevated ESR, decreased serum potassium, magnesium and albumin. H7H will be low related to a bleed.
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What type of diet should a patient with ulcerative colitis be on?
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High protein, low residue, dairy avoidant, well balanced diet. Increase electrolytes especially vitamin C, Bcomplex and Vitamin K.
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A sudden distended abdomen in ulcerative colitis indicates...
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Toxic Megacolon
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A barium eneme in Ulcerative Colitis would be done to detect...
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The extent of the disease, to detect polyps, carcinoma and strictures of the bowel.
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General tx. for Ulcerative colitis..
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Bed rest, IV fluids and a clear liquid diet.
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General tx. for pts. with dehydration and severe diarrhea...
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TPN to rest the intestinal tract and restore nitrogen balance. Thoses with anemia are tx. with FE supplementation.
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What is the mainstay drug for Ulcerative Colitis?
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Azulifidine (Pentesa or Dipentum if sulfa allergy)
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What Corticosteroids are used to tx inflammation in Ulcerative Colitis?
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Prednisolone IV to induce remission of acute severe disease, Prednisone for moderate disease, Hydrocortisone (Cortef) enema for proctitis and left sided colitis.
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What surgical measures are done when a pt. with Ulcerative Colitis does not respond to drug/non-curative tx.?
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Temporary loop colostomy to rest the bowel, subtotal colectomy, ileostomy and hartman's pouch, colectomy with ileorectal anastomosis.
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Curative reconstructive surgeries include...
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Total Proctolectomy with permanent end ileostomy, Total Proctolectomy with continent ileostomy, total colostomy with ileal resevoir, The ultimate goal is to remove the entire colon and rectum to cure Ulcerative Colitis.
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Complications of Ulcerative Colitis include:
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Perforation, hemorrhage, toxic megacolon, abscesses, stricture, fistula, malnutrition, lyte imbalances, anemia, skin lesions, arthritis, colon malignancy, liver disease, eye lesions, growth retardation in pre pubescent children, possible infertility in females.
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S/S of toxic megacolon:
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fever, tachycardia, abdominal distention, peritonitis, leukocytosis, dilated colon on Xray, life threatening.
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Nursing assessment for Ulcerative Colitis would include:
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1) assess for patterns of stress that would exacerbate sx.
2) assess for lactose intolerance3) assess for herbal remedies used 4) assess for number and consistency of bowels moved and if bleeding is present 5) listen for hyperactive bowel movements 6) assess weight |
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Nursing interventions for pts with Ulcerative Colitis:
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1) Give sedatives and tranquilizers to provide general rests and to slow peristalsis. 2) beware of skin breakdown around anus 3) Relieve painful rectal spasms with Anodyne suppositories 4) Report any sudden abdominal distention 5) Reduce physical activity 6) provide a bedside commode
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Transmural inflammatory disease that can affect any part of the GI tract usually the small of large intestinal tract.
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Crohn's Disease
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What do the intestines look like in Chrohn's Disease?
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Intestinal tissue is thickened and edematous with ulcers that enlarge and deepen and form transverse and longitudinal linear ulcers that interact resembling a cobblestone appearance. The deep penetration of these ulcers may form fissures, abscesses and fistulas.
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The healing and fibrosis of Chrohn's disease may form...
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Stricture
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The highest incidence in Chrohn's disease occurs in ages..
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15-35 Caucasian Jewish
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The three types of Crohn's disease are...
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Inflammatory, Fibrostenotic (stricturizing), and perforating
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What are the s/s of Crohn's disease?
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Crampy pain in the RLQ, chronic diarrhea or semi-soft to liquid stools with blood or streatorrhea, fever if an abscess is present, fecal urgency and tenesmus, palpable RLQ mass or fullness.
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A rectal exam in a pt. with Crohn's disease may reveal...
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Perirectal abscess, fistula, fissure, or skin tags which represent healed lesions
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Specific s/s of the inflammatory pattern of Crohn's Disease...
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Malabsorption, weight loss and lessened abdominal pain.
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Specific s/s of the fibrycystic pattern of Crohn's disease...
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A particular small bowel obstruction, diffuse abdominal pain, nausea and vomiting and bloating.
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Specific s/s of the perforated pattern in Crohn's disease...
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Sudden, perufse diarrheadue to enteric fistula, fever and localized tendernessrelated to abscess, or other fistula s/s such as pneumaturia (gas or air in the urine)and recurrent UTIs.
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A CBC and ESR in Chrohn's disease would show...
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Mild Leukocytosis, Thrombocytosis, anemia, elevated ESR and hypoalbumineemia.
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An upper GI and SB follow through would show a classic______ sign at the terminal ileum which suggests a constriction of the intestinal segment in Crohn's disease.
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String
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What is the dx procedure of choice for Crohn's Disease?
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Colonoscopy which would show the presence of skip lesions, cobblestoning, ulcerations, and rectal sparing.
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What are the goals for medication management in Crohn's Disease?
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Managing s/s, improving nutrition and avoiding surgical intervention if possible.
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What are the classic diagnostic s/s of Crohn's Disease??
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Weight loss, H2o and lyte imbalances, Iron, Vitamin mineral and protein deficiencies.
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During an acute attack of Crohn's disease what is usuall required?
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Bowel rest
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What type of diet is assumed for clients with Crohn's Disease?
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Elemental diet (Vivonex)p.o or via N/G tube, TPN and for milder cases a low residue diet, and the avoidance of untolerable foods, dietary supplements for extra nutrition and calories.
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Meds. for tx. of Crohn's includes:
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Aminosalicylics (Anti-inflammatorys, 5 ASA), suppositories, enemas for involvement, Azulfidine, ABT (Flagyl and Cipro), Corticosteroids, antidiarrheals, fish oil, antispasmotics, bulk agents, antidepressants (Elavil and Pamelor), Remicade to block inflammation.
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What two drugs are the first line of defense for Crohn's Disease?
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Aminosalicylics and Sulfasalzine
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What is the surgical tx for Crohn's
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Segmental Bowel Resection with anastomosis, subtotal colectomy with anastomosis, total colectomy with ileostomy.
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What is the nursing assessment for Crohn's Disease?
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Frequency and consistency of stools, have the pt. describe the location severity and onset of abd. pain or cramping, ask about weight loss and anorexia and daily weights, have aptients describe foods which cause exacerbations, determine if pt smokes and amount, ask about family hx R/T G.I diseases.
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What type of a diet should a pt. with Crohn's Disease be on?
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Low residue fat and fiber, with high calories and protein, high minerals and vitamins.
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Diarrhea can lead to...
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Metabolic acidosis
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In Crohns Disease: R/T the loss of Potassium, what should the client be monitored for?
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Dysrythmias and Muscle Spasms
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What is Fish Oil used for in Crohn's Disease?
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Helps maintain remission
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What are the s/s of Diverticulum Disorders?
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Out pouching or herniation of the mucous membrane lining of the bowel through a defect in the muscular layer, low intake of dietary fiber, greater than 60 y/o, abscess formation perforation bleeding and peritonitis (which would require surgery.
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What part of the colon does Diverticulitis affect?
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The Sigmoid Colon
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A congenital predisposition is likely in Diverticulum disorders when present in...
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Those under 40 y/o
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s/s of Diverticulosis
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Constipation from spastic colon, bowel irregularity, diarrhea, crampy pain in LLQ radiating to back, low grade fever, nausea and anorexia. The pain worsens after eating or just prior to BM, sudden masssive hemorrhage may be the first sign,periodic abdominal distention.
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s/s of Diverticulitis
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Fibrotic narrowing of large bowel, LLQ cramps, constipation with narrow stools,occult bleeding., weakness,fatigue, low grade fever and nausea.
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What is the difference between Diverticulitis and Diverticulosis?
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Diverticulosis is a pre-condition of having multiple Diverticuli and Diverticulitis is the inflammation of one or more Diverticulum.
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Ruptured diverticuli R/T acute diverticulitis produce _____ or _____ with abdominal rigidity. or can produce what signsof shock and sepsis.
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Abscesses or Peritonitis. Hypotension, chills and high fever.
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If a diverticuli ruptures near a blood vessel, what could result?
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Hemmorrhage
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Diet for Diverticulosis
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High fiber with avoidance of nuts and seeds
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Diet for Diverticulitis
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Liquid or low residue
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Medical management of Diverticulitis includes:
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Bed rest, liquid or low residue diet, stool softeners, broad spectrum ABT, pain meds and antispasmotics, vasopressin to control bleeding, blood transfusion, NPO, IV and Ng placment for peritonitis or massive bleed.
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Surgical management for Diverticulitis:
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Segment of intestine affected removed and the intestine anastomatized and temporary colostomy to rest the colon.
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Hemorrhage usually occurs where with Diverticulitis?
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Right colon
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What are the three major types of Cholecystitis?
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Acute, Acalcalous and Chronic
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Acute inflammation of the gallbladder usually caused by gallstone obstruction.
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Acute Cholecystitis
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A secondary bacterial infection which may occur with acute Cholecystitis and may progress to this...
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Empyema ( Purulent effusion of the Gallbladder)
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S/S of acute cholecystitis..
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Biliary colic pain that lasts more than 4 hours and increases with movement including respirstions, N&V, low grade temp, jaundice, RUQ guarding, and Murphy's sign (Inability to take in a deep breath when examiners fingers are pressed below the hepatic margin.)
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Why is there jaundice in acute cholecystitis?
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The stones block the common bile duct
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How is cholecystitis tx?
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IV fluids, NG suction and ABT
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Oral meds which can decrease the size of stones in cholecystitis or dissolve small ones: and what are side effects of these meds?
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Chenodeoxochloric acid, ursodeoxychloric acid (Actigall): Diarrhea, abnormal LFT increased serum cholesterol
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Cholecystitis pain can be treated by Demerol but not with_______ ...why??
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Morphine because it causes spasms in the Sphincter of Oddi
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What are the two types of Cholecystitis stones?
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Pigment and cholesterol (most frequent) stones
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Who is more likely to develope cholecystitis?
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Women are 4 X as likely
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Acute gastritis is caused by:
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Excess alcohol ingestion, drug effects, severe physical stress or trauma, ingestion of a noxious substance, radiation exposure, bacterial contamination of food or water.
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Acute gastritis is an erosive disease and is believed to be the cause of most...
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GI bleeds
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The painless bleed of gastritis is associated with what?
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ASA and NSAIDS
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Pt teaching for gastritis would include what?
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Receptor antagonists, proton pump inhibitors, temporary IV fluids for severe fluid loss and pt is monitored for bleeding, counseling re: alcohol abuse.
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Histamine receptor antagonists and proton pump inhibitors do what?
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Reduce the acid secretion of the stomach.
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What are the two types of Chronic Gastritis?
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A and B
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Type A Chronic Gastritis causes what?
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Results in decreased secretion in gastric secretions from an autoimmune attack on the parietal cells in the fundus of the stomach.
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What do the parietal cells of the stomach normally secrete?
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Intrinsic factor
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Since chronic gastritis lessens the secretion of intrinsic factor, what can this result in?
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Pernicious Anemia
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Is chronic gastritis usually caused by type A or B?
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Type B
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Type B Chronic Gastritis is usually caused by what?
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Helicobacter Pylori Bacteria
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H Pylori is aquired from...
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Contaminated water or food
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Chronis Gastritis affects what part of the stomach??
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The fundus and antrum
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The s/s of Chronic Gastritis are called Dyspepsia syndrome, what are they?
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Recurrent pain in the upper center of the abdomen, feeling of fullness or flatulence, early satiety, bloating and nausea.
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Tx for Chronic Gastritis:
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Histamine receptor antagonists, antacids, prokinetic agents, diet and lifestlye changes, reduce dietary fat, small frequent meals, avoid foods that cause s/s.
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PUD is most common in which part of the anatomy?
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The duodenum rather than the stomach
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Men are usually affected by this condition more than women until after menopause when the incidence among women is almost equal to men.
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PUD
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S/S of PUD:
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dull, gnawing pain in the midepigastric area or back, pain is relieved by taking an antacid or eating, sharp tenderness when gentle pressure is applied to the epigastric area slightly mid line.
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Interventions and tx. for PUD?
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Histamine receptor antagonists to reduce gastric acid secretion. (Zantac, Pepcid and Axid), cytoprotective agents to protect mucosal cells from acid(Cytotec), and ABT (tx of H. Pylori).
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What type of a diet should someone with PUD be on?
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There is little evidence to support the theory that bland diets are beneficial, Discourage alcohol, cigarette smoking, and caffeinated beverages because they increase gastric acid. DECREASE milk and cream.
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Why should milk and cream be eliminated from the diet of someone with PUD?
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They are potent acid stimulators
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What races are most at risk for developing PUD?
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African americans and Hispanics
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What age group is most at risk for developing PUD?
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Older adults
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What is Zollinger-Ellison Syndrome?
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An ulceration syndrome of the duodenum or jejenum caused by a gastrin producing tumor.
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What are the Histamine receptor antagonists that reduce gastric acid?
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Zantac, Pepcid, Axid, Tagamet
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What are the mucosal protective/ Cytotec meds?
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Sucralfate, Misoprostol and Enprostil
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What are the Proton-Pump inhibitors that reduce acid?
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Prilosec, Prevacid, Protonix,Aciphex,Nexium.
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What are the effects and types of antacids?
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They neutralize free hydrochloric acid to prevent irritation and promote mucosal healing. Aluminum products, combo of aluminum and magnesium, calcium products and simethicone products.
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What antacids are constipating?
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Aluminum and calcium
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What are the physiological manifestations of SLE?
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B-Lymphocytes produce antibodies that attack cells immune complexes. Blood vessels producing inflammation and disrupting flow of blood and oxygen to tissues.
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SLE affects multiple systems including:
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Renal,CV and skin
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What age of onset is average in SLE?
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30 y/o
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What is the medical tx for SLE?
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Antimalarial drugs for mild systemic affects of SLE. Apply topical corticosteroids for skin involvement. Pain control to include non-steroidal- anti inflammatories and also minimizes the need for corticosteroids.
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The epididymis is a reservoir for
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Sperm
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Epididymitis occurs most often in
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Older males
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Epididymitis is most often caused by...
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Ascending infection via the ejaculatory duct to the vas deferens or a surgical procedure causing a secondary infection. Urinary reflux, sexual transmission.
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The most common agent causing epididymitis is
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UTI- E coli or STD from Gonorrhea
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Epidiymitis causes what to happen?
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Excess fluid in the scrotal sac which can cause diminished blood flow and nerve supply and the heat from the inflammatory process can affect spermatogenesis.
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S/S from Epididymitis
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Severe scrotal pain, scrotal swelling, waddle walk, increased temp of scrotum, Urethral discharge and since urethritis is usually present at the same time burning with urination, frequency, urgency and general malaise, N&V.
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Tx for epididymitis
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Bed rest with scrotal elevation, ABT, analgesics for pain, the sperm cord can be injected to relieve pain.
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ABT for STD infection...
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Combo of Rocephin X 1 dose and then Doxycycline X 10 days.
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ABT for E Coli
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Ofloxacin B.I.D X 10 days
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Two types of Prostatitis...
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bacterial and non bacterial
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Most common type of Prostatitis
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Non- Bacterial
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Prostatitis usually affects what age group?
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Young and middle aged men
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Bacterial Prostatitis can be either _____ or _____ and is often caused by the same bacteria that cause_______.
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Acute, Chronis, UTIs
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Non bacterial Prostatitis can be caused by
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C. Trachomatis or Urethritis
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Explain the pathophysiology of Prostatitis...
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The prostate gland becomes swollen, inflamed and painful because of a bacterial infection or another inflammatory response. When it becomes swollen it compresses the urethra that it surrounds and causes urinary obstruction.
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s/s of acute prostatitis...
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Sudden chills, moderate to high fever, body aches
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s/s of chronic Prostatitis....
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Bladder irritability, frequency, dysuria, nocturia, urgency, hematuria, pain in lower back, lower rectum and penile head.
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Tx of acute prostatitis
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ABT for 10-14 days or ABT for 30 days to prevent chronic infection. Force fluids, rest, stool softeners, and local applications of heat with sitz baths, suprapubic catheter.
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What happens when Prostatitis is not properly tx. with a full dose of ABT?
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Recurrent infections can lead to fibrotic tissue and hardening of the prostate which then will not allow ABT to work.
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ABT for Prostatitis includes:
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Trimethoprim/sulfamethoxazole, Carbenicillin, Ciprofloxin
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ABT is not effective if prostate calculi are present, what is the tx then?
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Surgical removal or Prostatectomy
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ABT for chronic infections in Prostatitis would include:
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1-2 weeks of Tetracycline, Doxycycline, or Erythromycin, Prostatic massage, Anticholinergics, and hot sitz baths.
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S/S of snake bites...
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pain, erythema, edema, bleeding, tissue necrosis, fever, chills, malaise, weakness, joint and muscle pain, neurotoxicity(restlessness, vertigo and paralysis), SOB, laryngospasms, wheezing, tachycardia, and thready pulse, hypotension and circulatory collapse, coagulation disorders, seizures, coma, respiratory and circulatory failure, death.
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What is the tx for snake bites?
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epinephrine is the drug of choice. When less severe administer oral antihistamines, analgesics, tetanus prophylaxis and antibiotics.
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How does Frost Bite damage tissues?
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Cellular water freezes and changes to ice crystals that damage the cells. Cellular injury depends on degree of freezing.
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