Nursing Bowel Elimination Test V

Front 1

Laxative therapy (psyllium)
how to take, short and long term effects, effects on the elderly

Back 1

Psyllium (Lilley 806): generic for Metamucil, needs to be taken with at least 8 ounces of fluid, bulk-forming laxative, stimulant, plant-derived laxative; among the safest, only bulk-forming laxatives can be used for long-term use

Front 2

Laxative therapy (cascar sagrada)
how to take, short and long term effects, effects on the elderly

Back 2

Cascara Sagrada (Lilley 810): generic for Neoloid, stimulant, plant-derived laxative, induce intestinal peristalsis, site of action: entire GI tract, effect proportional to dose, most likely laxative to cause dependence

Front 3

Laxative therapy (biscodyl)
how to take, short and long term effects, effects on the elderly

Back 3

Bisacodyl (Lilley 808): generic for Dulcolax, bulk-forming laxative, take with liberal amounts of water to avoid fecal impaction, all bulk-forming are OTC

Front 4

Laxative therapy

Back 4

-overuse of laxatives may cause dependence; can damage bowels; can cause intestinal problems; can cause your sphincter to not close properly and cause incontinence

Front 5

Pepto bismol – s/e r/t color of stool, which med not to take with it

Back 5

(Lilley 804, Drug book 192) Black tongue and dark stool may occur; do not take with aspirin-based products

Front 6

Milk of Magnesia – mechanism of action

Back 6

Commonly have laxative effect and frequent administration of these antacids alone cannot be tolerated; (Lilley 793) neutralizes stomach acid, stimulate secretion of mucus, PGs, and bicarbonate form the cells inside the gastric glands; (Lewis 1042) causes retention of fluid in intestinal lumen caused by osmotic effect

Front 7

GoLytely – mechanism of action

Back 7

Similar to MOM; (Lilley 809,810) induces totally cleansing of the bowel, used before colonoscopies, PEG contraindicated in patients with GI obstruction, gastric retention, bowel perforation, toxic colitis, toxic megacolon or ileus, relieve constipation by increasing water content of the feces which results in distention, peristalsis and evacuation; does not deplete electrolytes

Front 8

Bulk forming and stimulant laxatives

Back 8

See number 1
Bulk-forming: (Lilley 808) causes water to be pulled into the intestines, composed of natural and synthetic cellulose derivatives
Stimulant laxatives: (Lilley 806) increases peristalsis by stimulating the nerves

Front 9

Pepcid – uses

Back 9

(Lilley 795) H2 antagonist, reduces hydrogen ion secretion resulting in increase in pH in the stomach and relief of many of the symptoms of hyperacidity related conditions

Front 10

Simethicone – uses

Back 10

Treatment of flatulence, gastric bloating, post-op gas pain, and gas retention… it helps you pass gas

Front 11

Metamucil – use with chronic constipation pt teaching

Back 11

See number 1, Psyllium; take with adequate amounts of water, plenty of fluids; exercise; high-fiber diet
Contraindications: patients with abdominal pain, N/V; patients suspected of having appendicitis, biliary tract obstruction, or acute hepatitis; intestinal obstruction

Front 12

Small bowel obstruction – nursing intervention prioritize

Back 12

(Lewis 11062) Monitor for signs of dehydration and electrolyte imbalance, strict I&O, provide comfort measures, report urine output of less than 30 mL per hour, monitor VS, keep bedside commode nearby in case of diarrhea, prepare for surgery, NPO, monitor for metabolic alkalosis/acidosis

Front 13

Appendicitis definition

Back 13

Def: inflammation of the appendix

Front 14

Colorectal cancer – what signs and symptoms do you expect to see

Back 14

(Lewis 1064-65) hematochezia (passage of blood through the rectum; AKA rectal bleeding), melena (black tarry stools), abdominal pain, changes in bowel habits, weakness, anemia, weight loss; normally s/s do not appear until the disease is advanced; watch for bleeding, peritonitis, perforation, and fistula formation

Front 15

Appendicitis defining charcteristics

Back 15

Defining characteristics: pain localized at McBurney’s point; elevated WBC count; complications: perforation, peritonitis, abscesses

Front 16

Appendicitis Causes

Back 16

Causes: obstruction → distention → venous engorgement → accumulation of mucus and bacteria (feces) → gangrene and perforation

Front 17

McBurney’s point (assess for)

Back 17

McBurney’s point: halfway between umbilicus and right iliac crest, point where the appendix is located, in the lower right quadrant; assess for: pain, rebound tenderness

Front 18

Appendicitis laproscopic and for what reasons

Back 18

Laproscopic and for what reasons: surgery is generally performed laprascopically as soon as the diagnosis is made; done laprascopically to prevent perforation, etc.
- do not give laxatives or enemas because the increased peristalsis may cause perforation
- ice pack may be applied, never heat!
- most common cause of hot belly (pain in abdomen)
- keep pt NPO

Front 19

Colorectal cancer – what signs and symptoms do you expect to see

Back 19

Lewis 1064-65) hematochezia (passage of blood through the rectum; AKA rectal bleeding), melena (black tarry stools), abdominal pain, changes in bowel habits, weakness, anemia, weight loss; normally s/s do not appear until the disease is advanced; watch for bleeding, peritonitis, perforation, and fistula formation

Front 20

Irritable bowel syndrome medications for diarrhea

Back 20

Lewis 1046)
Medications (for diarrhea):
Metamucil – a bulking agent; Antidiarrheal agents: loperamide; Antidepressants; Antichilinergics: Bentyl; Lotronex (alosetron): diarrhea, for women, drug alert: may cause severe constipation, may cause ischemic colitis (reduced blood flow to intestine) (s/s: abdominal pain & blood in stool)

Front 21

Irritable bowel syndrome medications for diarrhea – s/s,

Back 21

/S: recurrent abdominal pain, stool pattern irregularities, diarrhea, constipation, abdominal distention, excessive flatulence, bloating, continual defecation urge, urgency, sensation of incomplete evacuation
IBS with diarrhea, IBS with constipation, IBS with constipation and diarrhea

Front 22

Irritable bowel syndrome medications for diarrhea interventions

Back 22

Interventions: high fiber diet; exercise; restriction of beans, fried foods, alcohol, spicy foods; diet containing 20g of dietary fiber; eliminate broccoli & cabbage (gas forming foods)

Front 23

Irritable bowel syndrome medications for diarrhea assessment findings

Back 23

Assessments findings: no specific physical findings; diagnosis made when patient displays characteristic symptoms and no other conditions are found; history and physical examination are important after diagnosis; symptom based criteria used for diagnosing

Front 24

IBS

Back 24

IBS :
Rome 2 criteria: abdominal discomfort for at least 12 weeks within 12 months that has at least 2 of the following characteristics: relieved with defecation, onset associated with a change in stool frequency, onset associated with a change in stool appearance

Front 25

Ulcerative colitis – family history, assessment findings

Back 25

(Lewis 1051)
Similar to Crohn’s disease
Family history: if someone in your family has it, you are more likely to get it; more likely to get Crohn’s also if family member has UC and vice versa
Assessment findings: chronic inflammation of the intestine
Moderate UC: mild or moderate severe diarrhea; 4 or 5 stools a day; increased bleeding; systematic symptoms such as fever, malaise, and anorexia
Severe UC: bloody diarrhea 10 to 20 times a day; fever; weight loss; tachycardia; dehydration
- unknown cause, no cure, autoimmune disease,

Front 26

Hepatitis A vs. B vs. C – type of infection and what patient occupation

Back 26

Hepatitis A: (Lewis 1089) transmitted by: fecal/oral route, spread by improper handwashing and contamination of food or drinking water; at risk: gays, clotting factor disorders, chronic liver disease, children in daycare, daycare workers, underdeveloped countries, crowded situations
Hepatitis B: (Lewis 1089) transmitted by: IV drug use, accidental needle sticks, mothers to infants, when blood or body fluids enter bodies of another, STDs; at risk: unprotected sex, hospital workers
Hepatitis C: (Lewis 1090) transmitted by: blood transfusion, hemodialysis, sharing needles, unprotected sex; at risk: drug users, nymphos, dialysis patients, occupational exposure

Front 27

Liver cirrhosis – most common cause

Back 27

Most common cause: excessive alcohol abuse

Front 28

Liver cirrhosis- biopsy what do you expect to find

Back 28

find fibrous scar tissue, changes in liver cells and alterations in lobular structures

Front 29

Liver cirrhosis-ascites (assessment and interventions - prioritize)

Back 29

Assessment: due to cirrhosis proteins move into lymph space, lymph is unable to move water and proteins so a build up occurs and it pulls water to it; in cirrhosis the liver has an inability to synthesize albumin and hyperaldosteronism, patients are at risk for spontaneous bacterial peritonitis
Interventions: focused on Na restriction, diuretics and fluid removal, aldactone in as effective diuretic, lasix or diuril may also be used, possible paracentesis; 3000 cal/day diet, high carb, high protein, low fat, low sodium

Front 30

liver cirrhosis- esophageal varices (assessment and interventions - prioritize)

Back 30

Assessment: factors that can cause bleeding: alcohol, poorly chewed food, acid reflux, N/V, coughing, sneezing, straining and lifting heavy objects, bleeding EV is the most life-threatening complication of cirrhosis
Interventions: observe for sign of bleeding, hematemesis (blood in vomit), melena (tarry stools); if there is hemorrhage, call doctor, monitor ABCs if bleeding; (Lewis 1114) balloon tamponade, if placed deflate every 8 to 12 hours to avoid necrosis, monitor for esophageal erosion, gastric regurgitation, and occlusion of airway, administer vasopressin; treat upper respiratory infections promptly, control coughing, inderal may reduce the risk of bleeding (1108)

Front 31

Liver biopsy – positioning and assessment for the before and after procedure

Back 31

(Lewis 944) before procedure check PT and PTT, ensure patients blood is typed and cross-matched, get baseline vitals, tell pt to hold breath after expiration, assure informed consent has been signed; after procedure, lay on right side for a minimum of 2 hours to splint puncture site, check vitals every 15 minutes x2, every 30 mins x4, every hour x4, keep pt flat in bed for 12 to 14 hours, assess pt for complications such as bile peritonitis, shock, and a collapsed lung

Front 32

Diarrhea – acute vs chronic findings and assessment

Back 32

(Lewis 1036) Findings: most commonly from infection: bacterial, viral, or parasite; explosive watery diarrhea, tenesmus (spasmodic contraction of anal sphincter) with pain and persistent desire to defecate, abdominal cramping or pain, can also have systemic manifestations, diarrhea can cause perianal skin irritations; leukocytes, blood, and mucus may also be present in stool; severe dehydration, electrolyte imbalance (hypokalemia), metabolic acidosis
Assessment: recent travel, stress, s/s of dehydration, weight loss

Front 33

Constipation – def and assessment

Back 33

(Lewis 1040) Decrease in normal BM intervals, retention of stool, hard or difficult to pass stools, can be caused from chronic laxative use, hemorrhoids are most common complication, discourage valsalva maneuver, colonic perforation may occur

Front 34

Small bowel obstruction – complications

Back 34

(Lewis 1060) Bacteria flourish when obstructed, peritonitis, hypovolemic shock, N/V, rapid dehydration, borborygmi (high-pitched stomach gurgling), fluid and electrolyte imbalance, immediately report urine output of less than 30 mL per hour; strangulation and gangrene are likely to develop if not treated

Front 35

NG tube what do you prioritize the sequence with irrigation and what do you do if no irrigation return

Back 35

- tubes placed by physician during gastric or esophageal surgery should not be irrigated or moved to prevent interruption of suture line
- don’t forget to check placement
- disconnect from suction, clean tubing
- inject slowly, evenly without force; withdraw, measure, discard; irrigate up to 3 times, until tube is clear; check for kinks; use declogging agent; place patient on right side
- check ease, rhythm, and rate of breathing

Front 36

21. Colostomy – pt teaching irrigation with new colostomy, illustration will be provide given information decide if a permanent or temporary colostomy

Back 36

Lewis 1075 Table 43-34 Patient and Family Teaching Guide
Permanent or Temporary (Lewis 1070):
1. If the distal bowel is left in place when the ostomy is made, the bowel walls can later be reconnected and the ostomy is temporary.
2. If the distal bowel is removed but the anal sphincter remains, an ileal pouch anal anastamosis is possible and the ostomy is temporary.
3. If the distal bowel and sphincter are removed, the anus will be sown shut and the ostomy is permanent.

Front 37

Diverticulosis – pt diet teaching, assessment findings

Back 37

(Lewis 1076) Patient teaching: diet high in fiber, decrease intake of fat and red meats, high level of physical activity, weight reduction for the obese
Usually no s/s, but if present abdominal pain and changes in bowel patterns
Diverticulitis: inflammation of diverticuli usually caused by stool entrapment, abdominal pain localized over affected area

Front 38

Incarcerated inguinal hernia with herniorrhaphy – appropriate nursing intervention

Back 38

(Lewis 1077) Inguinal hernia: most common type of hernia, occurs at a point of weakness in the abdominal wall where the spermatic cord in men and the round ligament in women
Indirect: protrusion through the inguinal ring
Direct: protrusion through the posterior inguinal wall
Appropriate nursing interventions: observe for distended bladder, keep accurate I&O, ice pack may help, coughing is not encouraged, splint when coughing, some people where a truss (pad placed over hernia held in place with a belt)
lying down and gently pushing againist it if incarcenated

Front 39

Discharge teaching for a patient with hemorrhoidectomy

Back 39

(Lewis 1083) Post-op there will be severe pain, importance of diet, care of anal area, sitz bath started 1-2 days after surgery 2-3 times a day for 7-10 days, stool softeners may be ordered by doctor, tell pt to avoid straining, anal strictures may develop & dilation may occur; may recur; regular check-ups to prevent further problems

Front 40

Acute pancreatitis – lab levels

Back 40

Serum amylase may elevate to over 200 U/L; urinary amylase may be over 3600 U/day; hyperglycemia; hyperlipidemia, hypocalcemia

Front 41

Gall bladder disease – type of stool pt presents with, lap chole what patient teaching is needed

Back 41

Remove bandages on puncture site day after surgery and patient can shower, report to physician redness, swelling, bile-colored drainage, or pus from incision, severe abdominal pain, nausea, vomiting, fever, chills, resume normal activities gradually, can return to work within 1 week of surgery, resume usual diet (may need to be low fat for several weeks after surgery)

Front 42

Colonoscopy – what should the have prepared the patient for and how

Back 42

Bowel prep varies depending on physician, clear liquids 1-2 days before, cathartic and/or enema may be used, GoLytely evening before 1 gallon (8 oz every 10 minutes), explain procedure

Front 43

Fleets enema – what position

Back 43

Left side – Sims