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173 Cards in this Set

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GI Drug ingredient that causes diarrhea.
Magnesium
GI drug ingredient that causes constipation.
Aluminum
When do you give antiacids in relation to other meds?
2 hours apart.
What are 2 symptoms of Irritable Bowel Syndrome?
Altered Bowel Functions (Change in frequency or consistency)
Abdominal Pain in the left lower quadrant.
What is the cause of Irritable Bowel Syndrome?
No definite cause.
Other symptoms of IBS besides pain and altered bowel functions.
nausea, belching, bloating, anorexia.
Irritable Bowel Syndrome stool characteristics?
Diarrhea or constipation or alternate between the two.
Risk factors of IBS?
High fat diet, carbonated beverages, alcohol and caffeine, lactose intolerance, stress, multiple food allergies, chronic use of aspirin products.
What is the diagnostic tool for IBS?
Barium enema - picks up spasms in colon and rules out other bowel disorders.
What are 4 parts of the management of IBS?
Client education (identify foods that aggravate symptoms)
Diet Changes
Medications
Stress management
What types of medications are used for IBS?
Diarrhea - lomitil, imodium
Pain - anticholinergics, antispasmodics
A defect in the muscle wall as a result of weakness of the muscle (can be congenital or acquired), obesity, heavy lifting, straining, abdominal surgery.
Hernia
What is an inguinal hernia?
When a portion of the bowel herniates into the inguinal canal. In males, herniation can be seen in the scrotum.
What are 4 types of hernias?
Inguinal, Femoral, Umbilical, Incisional.
What is a femoral hernia?
It is noted in the femoral area and protusion is into the femoral ring.
What is an umbilical hernia?
Some newborns are born with it due to a weakness in the wall. Can be acquired in adulthood due to obesity, straining, etc.
What is an incisional hernia?
A hernia that occurs at the site of previous surgery usually due to inadequate healing caused by post-op infection.
What are the 3 classes of hernias?
Reducible, Irreducible, Strangulated.
What is a reducible hernia?
The hernia can be repositioned or replaced back into abdominal cavity by using gentle pressure - force is never used.
What is an irreducible hernia?
The hernia CANNOT be repositioned or put back. Also called incarcerated.
What is a strangulated hernia?
Pressure surrounding hernia and cutting off blood supply. Portion of blood with no blood supply. SURGICAL EMERGENCY!
What are the S&S of strangulation?
Nausea, vomiting, abdominal pain and distention, fever, tachycardia.
What happens to a strangulated hernia that is not cared for?
Necrosis or perforation.
How is a patient assessed for hernia?
Through inspection with client lying down and then standing. (when lying down, hernia will reduce - standing, protrude)
What is a way that hernia can be assessed besides having the client lie down and stand up?
The client can perform the valsalva maneuver - hernia can be seen and is palpable.
Where is an inguinal hernia palpated?
Through the scrotum, especially when the patient coughs.
What are 2 ways hernias are managed?
Nonsurgical (truss), surgical (herniorrhaphy, hernioplasty)
How is a hernia truss applied?
A belt or padding is applied to the patient while the patient is lying down.
What is a hernioplasty?
A surgical repair with reinforcement of abdominal wall with wire or mesh.
What are the risk factors for colorectal cancer?
Genetics, Age, Polyps, Diet, Inflammatory Bowel Disease
Facts about the genetic risk factor for Colorectal Cancer.
With an immediate relative w/colorectal CA, chance is 3-4 times greater than with no relatives with Colorectal CA.
What is the typical age for colorectal cancer?
Over 50 years of age.
What is the biggest risk factor in the diet for colorectal cancer?
High fat foods, fried or broiled meats (release carcinogens), and refined carbs (pastries)
What are the post-op measures for Hernioplasty?
NO COUGHING with deep breating. Male inguinal - apply ice to scrotum, use scrotal support, first voiding may be problme, order pain meds for first void.
What are the symptoms of colorectal cancer?
Change in bowel habits (consistency or frequency), blood in stool and anemia, symptoms of obstruction.
What are the diagnostic tools of colorectal cancer?
CBC (H&H dec. if bleeding), Chemistries (liver enzymes elevated), fecal occult blood, carcinoembryonic antigen (CEA), Radiographic (barium enema)
What is a nursing intervention before giving a client a fecal occult blood test for colorectal cancer?
Tell the patient to not eat red meat 48 hours prior to the test.
Why would liver enzymes be elevated when testing for colorectal cancer?
If the cancer metastasized to the liver.
What is the Carcinoembryonic antigen (CEA) test?
To test for Colorectal Cancer - not an absolute test.
What are the radiographic tests for colorectal cancer?
Barium enema, CT scan of abdomen, endoscope (colonoscopy or sigmoidoscopy)
What are nursing interventions for fecal occult blood test?
Avoid vitamin C supplements, avoid aspirin products, avoid meat 48 hrs. prior to test.
What is the routine for submitting stool specimens to check for colorectal cancer?
Submit specimens for 3 consecutive days.
What are 3 ways to manage colorectal cancer?
Radiation, Chemotherapy, surgery.
What are side effects to radiation treatment of colorectal cancer?
Extreme fatigue and diarrhea.
What are side effects for chemotherapy in the treatment of colorectal cancer?
Bone marrow depression, anemia (assess blood counts), low WBC's, problems with mucous membranes and skin breakdown.
Why is skin breakdown a problem with chemotherapy in colorectal cancer treatment?
Chemotherapy targets rapidly dividing cells such as in the skin, bone marros, and mucous membranes)
What are 4 types of surgery for colorectal cancer?
Hemicolectomy and colon resection
Colostomy
Anastomosis
Abdominal perineal resection
What is a hemicolectomy and colon resection?
Excising diseased portion of the bowel.
What is a colostomy?
The bowel is brought out to the surface temporarily or permanently.
What is an anastomosis?
The two healthy ends of the bowel are joined together
What is an abdominal perineal resection?
Removal of the signoid colon, rectum and anus through an abdominal and perineal incision. Signoid colostomy is done.
Preop considerations for colorectal cancer.
Information regarding potential nerve damage, bowel prep, IV or PO antibiotics, NG tube insertion.
What complications could happen with the abdominal perineal resection?
Perineal nerves may be damaged, client may have urinary incontinence and sexual disfunction.
What is involved in the bowel prep before colorectal cancer surgery?
Cleansing laxative or enema prior to surgery (Go-Lytely) to clear all fecal material from bowels.
When are antibiotics started for colorectal cancer surgery?
The day before surgery to reduce the risk of infection.
Why is an NG tube inserted after colorectal cancer surgery?
For decompression.
What is the post-op care for client with ostomy?
Same as abdominal surgery + stoma assessment and management, diet, psychosocial issues
What are diet considerations for client with ostomy?
Stay away from gas-forming foods (cabbage, onions, turnips, mushrooms, beans, brussel sprouts, spinach, cheese, eggs, beer, carbonated beverages, fish, highly seasoned foods, some fruit drinks, corn, pork, peas, coffee, high-fat foods)
What are normal characteristics of a stoma?
Slight amount of blood, reddish pink color, moist, protrude 2 cm from skin.
What if a stoma is purple or black?
Notify surgeon (sign of impaired circulation)
What are some psychosocial issues with an ostomy?
Body image disturbance, sexuality, urinary incontinence.
How do the stools look for each type of ostomy?
Small bowel - liquid
Ascending colon - liquid
Transverse colon - semi-solid
Descending, sigmoid colon - solid
Definition of intestinal obstruction.
Partial or complete blockage of small or large bowel that impedes the digestive process.
What are the 3 causes of intestinal obstruction?
Mechanical (tumor, adhesions)
Nonmechanical (nothing physical)
Vascular insuffiency (thrombus or embolus)
What are the assessments for an intestinal obstruction?
Abdominal pain, nausea/vomiting, bowel changes, distention, altered bowel sounds, visible peristaltic waves.
What are the S&S of a complete obstruction?
No flatus or stool.
What are 2 ways to diagnosis intestinal obstruction?
Laboratory test (inc. WBC's, dec. electrolytes), Radiographic (CAT scan of abdomen)
What is the definitive test for intestinal obstruction?
There is no diagnostic test that definitively diagnoses intestinal obstruction.
What is the management of intestinal obstruction?
NPO, NG or NI tube for decompression, F&E replacement, pain management, antibiotics.
What intervention is done to replace F&E that are lost during an intestinal obstruction?
IV fluids.
Why is pain management difficult with an intestinal obstruction?
Narcotic analgesics are avoided so symptoms are not masked. Also a side effect of narcotic analgesics is the slowing down of peristalsis.
When are antibiotics given to a patient with an intestinal obstruction?
If there is a possibility of strangulation.
How is a nasointestinal tube used?
Inserted by physician, extends into small bowel, weight on end allows peristalsis to move it through the small bowel, may have order to advance tube at intervals.
What are 2 surgical techniques used in intestinal obstruction?
Tumor removal, correction of a twisted intestine.
What are hemorrhoids?
Unnaturally swollen or distended veins in the rectum.
2 common symptoms of hemorrhoids
Bleeding or prolapse.
What are some interventions for the management of hemorrhoids?
Hygiene, cold packs, sitz bath, topicals (hydrocortisone, tucks, witch hazel), high fiber diet, fluids to prevent constipation, stool softeners.
Foods to avoid with hemorrhoids
caffeine, spicy foods, alcohol.
What surgical management is done for hemorrhoids?
hemorrhoidectomy
What are post-op interventions for hemorrhoidectomy?
Side-lying position, avoid prolonged sitting, ice packs on PO day 1, after rectal packing is removed - switch to heat application, sitz bath (careful of feeling faint during sitz bath)
What intervention is done post op from hemorrhoidectomy before the first BM?
Medicate with analgesics because of painful defecation
What is malabsorption syndrome?
Interference with the intestinal ability to absorb nutrients. The type of nutrients not absorbed depends on the type and location of abnormality in GI tract.
What are some causes of malabsorption syndrome?
Bile salt or enzyme deficiency
Overgrowth of intest. bacteria
Changes in mucosal lining
Altered lymphatic circulation
Decrease in Gastric Surface area
Altered lymphatic & vascular circ.
What does an enzyme deficiency indicate?
A problem in the pancrase or small bowel.
Why does altered lymphatic circulation occur?
Due to radiation treatments for cancer, cancer itself, or by inflammation.
What causes changes in the mucosal lining?
Inflammatory Bowel Disease
What are the symptoms of malabsorption syndrome?
Diarrhea or increased stool mass (caused by unabsorbed nutrients), steathorrea, weight loss, iron def. anemia, bloating & flatus, fat malabsorption (ADEK), bone pain, edema
Why is bruising seen in malabsorption syndrome?
Due to Vitamin K malabsorption
Why is bone pain experienced in malabsorption syndrome?
Vit. D deficiency - osteomalacia
Why is edema seen in malabsorption syndrome?
There is a problem with protein absorption.
How is malabsorption syndrome managed?
Dietary changes, nutrient supplements, enzyme replacements.
What dietary changes are recommended with malabsorption syndrome?
Low fat diet. lactose free diet if milk causes a problem.
What medications are used in malabsorption syndrome?
Antibiotics for bacterial cause.
Antidiarrheals and anticholinergics to inhibit gastric motility
Name 2 causes of appendicitis.
Obstruction (hardened fecal material, tumor in the area, intestinal worms), ulceration of mucosa (viral/fungal)
What happens when the appendix is inflamed?
Perforation can occur in 24-36 hours.
What are some assessments for appendicitis?
Abdominal pain
Nausea/vomiting
Abdominal tenderness
Low grade fever, elevated wbc count
Where is abdominal pain in appendicitis?
Early-epigastric or periumbilical area
Later-shifts to RLQ (McBirneys point)
Where is McBirney's point?
Midway between umbilicus and anterior illiac crest on the right side.
What are 2 ways that appendicitis is treated surgically?
Laporoscopically, Traditionally (abdominal incision)
What are nursing interventions pre-op for appendectomy?
NPO, IV Fluids, pt. in Semi Fowlers position to facilitate drainage into lower abdomen. NO HEAT - can lead to perforation.
What is peritonitis?
Inflammation of the epitheleal lining of the abdominal cavity (normally sterile)
What are some S&S of Peritonitis?
Abdominal pain, tenderness, rigid distended abdomen (filling w/gas & fluid), N, V, Anorexia, Dec. bowel sounds, dec. urine output, inc. WBC's, + blood cultures, respiratory difficulties.
What are post-op nursing interventions for appendectomy?
Drainage tube if abcess formation, NG tube for decompression if peritonitis, post-op antibiotics.
What are non-surgical measures for peritonitis?
NPO, NG tube, IV fluids & antibiotics, analgesics, O2 PRN, I&O, daily weight.
What is the surgical management of peritonitis?
Repair the cause of peritonitis and remove additional fluid and foreign material.
Post-op nursing interventions for peritonitis?
Semi fowler's position to promote drainage and facilitate breathing.
What is gastroenteritis?
Severe diarrhea and vomiting due to inflammation of mucous membrane lining of the GI tract.
What are the 2 types of gastroenteritis?
Viral (rotavirus, norwalk virus) and Bacterial (E-coli, campylobacter, shigellosis)
How is viral gastroenteritis acquired?
Picked up through fecal/oral route through contaminated water or food.
How is bacterial gastroenteritis acquired?
Through contaminated water or food or through direct contact with infected person or animal.
Signs & symptoms for Gastroenteritis?
Recent travel, N, V, Diarrhea, muscle aches, headache, weakness, inc. bowel sounds, abdominal tenderness, symptoms of dehydration (d/t V & diarrhea)
What is the typical duration of viral gastroenteritis?
24-48 hours
What is the typical duration for E-coli Gastroenteritis?
10 days
How is gastroenteritis diagnosed?
From a stool culture (to identify the bacteria or virus)
What is the management of gastroenteritis?
IV fluids (F&E), diet (bland to reg), antibiotics for bacteria infection, skin care (sore butt), teaching (good hand washing, fluid replacement, don't share personal items.)
What meds are NOT given for gastroenteritis?
Antiemetics and antidiarrheals because that would prevent the organism from coming out.
What are some causes of Chronic Inflammatory Bowel Diseases?
No single cause, unknown, genetics, ethnicity, age (15-65), immune system
What are some diagnostic tests for chronic inflammatory bowel disease?
CBC (low H&H casued by anemia d/t chronic blood loss), ESR (inc. d/t inflammatory process), electrolytes (dec. d/t frequent diarrhea and malabsorption of nutrients, barium enema (identifies depth & dist. of lesions), colonoscopy (best for direct visualization)
What are complications of Chronic Inflammatory Bowel Disease?
Hemorrhage (GI bleeding), Abscess formation (from ulcerations), fissures (cracks, openings in lining, malabsorption, bowel obstruction, fistulas, toxic megacolon, risk of colorectal CA, pancreatitis.
What is ulcerative colitis?
Infalmmatory disease of the large bowel and rectum.
What are characteristics of ulcerative colitis?
involves the mucosal layer of rectum & colon, red edematous ulcers, remissions & exacerbations.
What are the clinical manifestations of ulcerative colitis?
Bloody diarrhea (10-20/day), pain/cramping, anorexia, weight loss.
What types of medications are used to treat ulcerative colitis?
salicylate compounds, corticosteroids, immunosuppressives, antidiarrheals.
What are immunosuppressives given with for ulcerative colitis?
Given with corticosteroids for reducing dose needed of corticosteroids. (not effective alone)
What foods are avoided with ulcerative colitis?
fried foods, raw fruits and vegetables, whole grain foods, nuts, popcorn
What type of diet is recommended with ulcerative colitis?
NPO w/ IV fluid replacement during exacerbation, possible TPN, possibly liquid supplement (Ensure), low residue, low fiber diet.
What nursing interventions are done for ulcerative colitis for GI bleeding?
check stool for occult or obvious blood, monitor H&H, fluid volume deficit, electrolyte imbalance. Notify physician of obvious changes.
What are some pernieal skin care interventions for ulcerative colitis?
mild soap, sitz bath, ointments.
What is the surgical intervention for ulcerative colitis?
total colectomy (large bowel removal) with ileostomy
What is post-op care for total colectomy with ileostomy?
Monitor stool characteristics (initially-loose, dk green w/ some blood, after few days - stool volume decreases, pasty consistency, color yellow-green to yellow-brown, pouch system worn at all times, drainage is continuous.
Why is skin care important with an ileostomy?
The proteolytic enzymes and bile salts are very irritating to the skin.
What is Crohn's disease?
A chronic inflammatory bowel disease that may affect any portion of the GI system.
What are S&S of Crohn's Disease?
Patchy involvement through all layers of the bowel, terminal ileum most commonly affected, edematous thickened wall, inflamed nodules and deep ulcerations, cancer may occur after 15-20 years of the disease.
What are the slinical manifestations of Crohn's disease?
Severe diarrhea (5-6/day), steatorrhea, rarely bloody, abd. pain, abd. tenderness w/ palpable mass in RLQ, low grade fever, malabsorption of nutrients & weight loss.
What is the clinical management of Crohn's disease?
Medications, nutrition, prevention of complications.
What medications are used for Crohn's disease?
Salicylate compounds, corticosteroids, immunosuppressives, antidiarrheals.
What type of nutrition interventions are done for Crohn's disease?
High protein, high calorie, high vitamin, low residue diet, supplements, TPN, F&E replacement.
What is the surgical intervention for Crohn's disease?
Surgical bowel resection (anastomosis followed by colostomy) removal of diseased portion of bowel is controversial d/t disease reoccurs.
What interventions are done for colostomy care?
Assess color, drainage, edema of colostomy, monitor for obstruction, check for bleeding.
What is diverticular disease?
Herniations along weak areas of the colon become trapped by undigested food and bacteria leading to inflammation, obstruction, perforation and bleeding.
What are the causes of diverticular disease?
Age (over 60) and low fiber diet
How is diverticular disease assessed?
It it asymptomatic unless perforated. Perforated - abdominal pain and S&S of peritonitis.
What is the clinical management of diverticular disease?
Antibiotics (for infection), analgesics (for ain), anticholinergics (decrease gastric motility), rest, diet (acute - NPO, long term-gradually increase fiber to high fiber), surgery if complications occur
What is avoided with diverticular disease?
Laxatives and enemas
Why is it recommended that you don't strain, bend, lift, with diverticular disease?
It can increase intrabdominal pressure and lead to perforation.
What is acute cholecystitis
Inflammation of the gall bladder usually d/t gallstones and obstruction of cystic ducts or bacterial invasion.
What is chronic cholecystitis?
Repeated acute episodes with the gallbladder muscle becoming fibrotic, contracted and dysfunctional
What are contributing factors of acute cholecystitis?
Age (after 40), female (more than male), genetics (family tendency), sedentary lifestyle, obesity, increased cholesterol, diabetes
What are S&S of cholecystitis?
Pain in RUQ (radiating to shoulder or scapula), anorexia, N, V, dyspepsia, flatulence, eructations (burping), abdominal fullness, fever, jaundice & steatorrhea, rebound tenderness with peritonitis.
What are diagnostic tests for cholecystitis?
Liver function studies, CBC (inc. WBC), serum & urine amylase (inc. amylase with pancreatic involvement), abdominal ultrasound (most common), cholangiography (IV contrast injected, xrays taken over 1-2 hr. period)
What is the clinical management of cholecystitis?
Diet (small, frequent meals), decrease fat & volume of food, analgesics (demoral), morphine is avoided d/t cauases spasms, antiemetics, bile acids and fat soluable vitamin replacement (ADEK) with gallstones.
What do bile acids do in the treatment of cholecystitis?
dissolve gallstones - may take up to 2 years to dissolve stones.
What is a non-surgical treatment of cholecystitis?
Shock wave lithotripsy. noninvasive shock waves are used to shatter gallstones.
What are precautions for lithotripsy?
No pacemaker, no pregnant, limit on number and size of stones the client has, no hx of pancreatic or liver disease.
What are post-op nursing interventions for lithotripsy?
Slight spasms in RUQ for ~2 days, no restrictions after procedure.
Name some complications of cholecystitis?
Pancreatitis (with chronic), Cholangitis (obstruction and inflammation of common bile duct), Perforation (can lead to peritonitis)
What is the surgical managemenet of cholecystitis?
Traditional/open cholecystectomy or laboroscopic cholecystectomy
What are post-op interventions for traditional cholecystectomy?
Pain control (demoral - no morphine), antiemetics, prevention of resp. complications, NPO with NG tube, T-tube care, surgical drain (JP) care.
What are post-op interventions for laporoscopic cholecystectomy?
May or may not stay overnight in hospital, abdominal discomfort d/t free air, resumption of usual activities in 1-3 weeks.
What is acute pancreatitis?
inflammation of the pancrease due to premature activation of pancreatic enzymes that destroy the pancrease (autodigestion)
What does the pancreas do?
Manufactures and secretes enzymes for carb, fat and protein digestion.
What are the causes of pancreatitis?
gallstone obstruction, excessive alcohol ingestion, trauma, tumors, metabolic, renal or GI complications, viral infection, drug toxicity, abdominal surgery or invasive procedure.
What are the S&S of Acute pancreatitis?
Abdominal pain (sudden, mid-epigastric or LLQ), weight loss, N, V, jaundice, discoloration of abdomen & flank(pancreatic enzyme leakage), dec. or absent bowel sound, W&W of peritonitis, behavioral changes, impending shock (d/t pancreatic hemorrhage)
How is acute pancreatitis diagnosed?
Inc. serum/urine amylase and serum lipase, inc. liver function tests if liver involvement, inc. wbc and glucose d/t inflammation, dec. ca and mg, abdominal ct scan and ultrasound.
What are complications of acute pancreatitis?
paralytic ileus, pleural effusion (collection of fluid in plural space), multisystem failure (NHP)
What are the parts of Multisystem failure?
ARDS (acute respiratory distress syndrome), DIC (disseminated intravascular coagulation), shock, renal failure.
What is done for management of acute pancreatitis?
Pin (demoral), NPO, IV fluids, NG tube, antacids, histamine receptor antagonists, anticholinergics, comfort measures, surgery with complications
What is the special thing about suction and giving meds?
Discontinue suction for 20-30 minutes following medication administration
What is special about post-op care of acute pancreatitis?
Meticulous skin care due to drainage tubes with fluid coming out.
What is chronic pancreatitis?
Progressive destruction of the pancreas due to recurrent episodes of acute pancreatitis resulting in calcification of the pancreatic tissue.
What are S&S of chronic pancreatitis?
Intense abdominal pain, ascities, LUQ mass (if cyst), respiratory symptoms (if fluid buildup), loss of exocrine function (steatorrhea, clay colored stools, frequent defecation), wt. loss, jaundice, dark urine, signs of diabetes,
What is clinical management of chronic pancreatitis?
comfort, nutrition, prevention of complications and recurrences
What diet is recommended for chronic pancreatitis?
inc. carbs, proteins, dec. fat, TPN or TEN, supplements.