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81 Cards in this Set

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An inflammation of the appendix, a narrow blind tube that extends from the inferior part of the cecum; can occur at any age but is more common in young adults:
-Appendicitis
Most common causes are obstruction of the lumen by a fecalith (accumulated feces), foreign bodes, tumor of the cecum or appendix, or intramural thickening caused by excessive growth of lymphoid tissue; results in distention, venous engorgement, and the accumulation of mucus and bacteria, which can lead to gangrene and perforation:
-Etiology of Appendicitis
Describe signs and symptoms of appendicitis:
-Typically begins wit periumbilical pain, followed by anorexia, nausea, and vomiting
-Pain is persistent and continuous, localizing at McBurney's point (located halfway between the umbilicus and the right iliac crest)
-Localized tenderness, rebound tenderness, and muscle guarding, low-grade fever, coughing aggravates pain
-Complications of perforation, peritonitis, and abscesses
Describe nursing measures for a patient with appendicitis:
-Avoid self-treatment; laxatives and enemas are especially dangerous
-Patient should be NPO
-Apply ice bag may be applied to the right lower quadrant to decrease the flow of blood to the area and impede inflammatory process
-Heat is never used because it may cause the appendix to rupture
-Laparoscopy surgery
-Postop: observe for evidence of peritonitis; ambulation begins the day of surgery or the first postop day; diet is advanced as tolerated
Two immunologically related disorders that are referred to as IBD; both diseases are characterized by chronic inflammation of the intestine with periods of remission interspersed with periods of exacerbation; cause is unknown and there is no cure:
-Crohn's Disease
-Ulcerative Colitis
-An autoimmune disease
-Actual tissue damage is due to an overactive, inappropriate, and sustained inflammatory response
-Commonly occur during the teenage years and early adulthood, but both have a second peak in the sixth decade
-Etiology of IBD
This form of IBD: the inflammation involves all layers of the bowel wall; can occur anywhere in the GI tract from the mouth to the anus, but occurs most commonly in the terminal ileum and colon; skip lesions can occur; typically ulcerations are deep and longitudinal and penetrate between islands of inflamed edematous mucosa, causing the classic cobblestone appearance; may cause bowel obstruction and fistulas; leaks can allow bowel contents to enter the peritoneal cavity and form abscesses or peritonitis:
-Etiology of Crohn's Disease
This form of IBD usually starts in the rectum and moves in a continual fashion toward the cecum; spreads in a continuous pattern; inflammation and ulceration occur in the mucosal layers, the innermost layer of the bowel wall; fistulas and abscesses are rare; H20 and electrolytes are absorbed when the mucosal epithelium is healthy, but cannot be absorbed through inflamed mucosa resulting in diarrhea with large fluid and electrolyte losses; breakdown of cells results in protein loss through the stool
-Etiology of Ulcerative Colitis
Describe signs and symptoms of Crohn's disease:
-Localized: weight loss occurs from malabsorption if the small intestine occurs, rectal bleeding
-Systemic: fever
Describe signs and symptoms of ulcerative colitis:
-Bloody diarrhea and abdominal pain
-Mild disease: diarrhea may consist of 1-2 semiformed stools daily that contain small amounts of blood
-Moderate disease: 4-5 stools per day, increased bleeding, fever, malaise, and anorexia
-Severe disease: diarrhea is bloody, contains mucus, and occurs 10-20 stools per day, fever weight loss greater than 10%, anemia, tachycardia, and dehydration
Describe nutritional therapy for a patients with IBD:
-Essential that people with IBD eat a well balanced, healthy diet with sufficient calories, protein, and nutrients
-Cobalamin in injections monthly, or orally/nasal daily
-A food diary helps them identify problem foods to avoid
-Milk products are avoided
-High-fat foods also tend to trigger diarrhea
-Quit smoking
-May need parenteral nutrition or enteral feedings
-Supplemental iron
Describe 5 categories of drugs used for the treatment of IBD:
1.) aminosalicylates: suppresses proinflammatory cytokines and other inflammatory mediators (more effective for ulcerative colitis)
2.) antimicrobials: unknown mechanism of action (Metronidazole); successful against Crohn's disease
3.) Corticosteriods: used to achieve remission but not maintaining; helpful for acute flare ups; many side effects for long term use
4.) immunosuppressants: given orally and take 3-6 months to exhibit full effectiveness; effective with Crohn's disease
5.) biologic therapy: given IV to induce and maintain remission in pts with active Crohn's disease and in pts with draining fistulas
Describe nursing actions for a patient with IBD:
-During the acute phase: attention is focused on hemodynamic stability, pain control, fluid and electrolyte balance, and nutritional support; I & O; number and appearance of stools
-Teaching the patient strategies for managing stress
-Quit smoking
-Rest is important
-The pt must be kept clean, dry, and free of odor; a deodorizer should be placed in the room and have ready access to a toliet; meticulous perinanal skin care using plain water
-Dibucaine witch hazel, or other soothing compresses or prescribed ointment and sitz baths may reduce irritation and relieve discomfort of the anus
A saccular dilation or outpouching of the mucosa through the circular smooth muscle of the intestinal wall:
-Diverticulum
An infection of the diverticular sacs that is thought to be caused by obstruction with fecal matter; inflammation of the diverticula occurs, which can result in perfortion of one or more diverticula; may occur at any point within the GI tract but are most commonly found in the sigmoid colon:
-Diverticulitis
Etiology of this disease occurs in the sigmoid colon and are thought to be associated with high luminal pressures from a deficiency in dietary fiber intake and perhaps combined with a loss of muscle mass and collagen with the aging process; results from retention of stool and bacteria in the diverticulum, forming a hardened mass called a fecalith and causes inflammation and small perforations and can spread to surrounding area in the intestines causing the tissue to become edematous:
-Etiology of Diverticulitis
Describe the signs and symptoms of diverticulitis:
-Abdominal pain is localized over the involved area of the colon
-Left lower abdominal pain, fever, leukocytosis, and sometimes a palpable abdominal mass
Describe complications of diverticulitis:
-Perforation with peritonitis, abscess and fistula formation, bowel obstruction, ureteral obstruction, and bleeding
The most common cause of lower GI hemorrhage is:
-Diverticulitis
Describe nursing actions for a patient with diverticulitis:
-Encourage a high-fiber diet, mainly from fruits and veggies, and decreased intake of fat and red meat are recommended for prevention
-High-fiber diet
-Weight reduction (decreases intraabdominal pressure)
-Avoid straining at stool, vomiting, bending, lifting, and tight, restrictive clothing
-Acute diverticulitis: to allow the colon to rest and the inflammation to subside; kept NPO; bed rest and given parenteral fluids; observed for signs of peritonitis; broad spectrum antibiotic therapy; WBC count is monitored
-When acute attack subsides, oral fluids are given and progressed to semisolids; ambulation is permitted
A protrusion of a viscus through an abdominal opening or a weakened area in the wall of the cavity in which it is normally contained:
-Hernia
Hernias that easily return to the abdominal cavity are called:
-reducible
Hernias that cannot be placed back into the abdominal cavity are called:
-irreducible or incarcerated
When the hernia is irreducible and the intestinal flow and blood supply are obstructed, the hernia is:
-strangulated
This hernia is the most common type and occurs at the point of weakness in the abdominal wall where the spermatic cord in men and the round ligament in women emerge; can be direct (posterior inguinal wall) or indirect (through inguinal ring):
-Inguinal hernia
This type of hernia occurs when there is a protrusion through the femoral ring into the femoral canal; occurs below the inguinal (Poupart's) ligament as a bulge; becomes strangulated easily and occurs more often in women:
-Femoral hernia
This type of hernia occurs when the rectus muscle is weak (as with obesity) or the umbilical opening fails to close after birth:
-Umbilical hernia
This type of hernia is due to weakness of the abdominal wall at the site of a previous incision:
-Ventral or incisional hernias
Describe signs and symptoms of hernias:
-If the hernia becomes stragulated, the patient will experience severe pain and symptoms of a bowel obstruction, such as vomiting, cramping abdominal pain, and distention
Describe nursing actions for a patient with a hernia:
-If a patient wears a truss, check for skin irritation
-Observe for a distended bladder; I & O; apply ice bag; coughing is not encouraged, but deep breathing and turning should be done; the incision should be splinted during coughing and sneezing
-Restrict heavy lifting for 6-8 weeks
The surgical repair of a hernia is known as a:
-Herniorrhaphy
The reinforcement of the weakened area with wire, fascia, or mesh is known as a:
-Hernioplasty
Dilated hemorrhoidal veins; may be internal (occurring above the internal sphincter) or external (occurring outside the external sphincter):
-Hemorrhoids
Are thought to develop as a result of shearing forces during defecation which damages supporting muscles resulting in venules becoming dilates; most common reason for bleeding with defecation; may be precipitated by many factors, including pregnancy, prolonged constipation, straining in effort to defecate, heavy lifting, prolonged standing and sitting, and portal hypertension:
-Etiology of Hemorrhoids
Describe signs and symptoms of having hemorrhoids:
-Bleeding, anal pruritus, prolapse, and pain
-Internal: may be asymptomatic; can bleed resulting in blood on toilet paper after defecation or blood on the outside of stool
-External: blood clots cause pain and inflammation, and the hemorrhoids are described as thrombosed; cause intermittent pain, pain on palpation, itching, and burning
Describe nursing actions for a patient experiencing hemorrhoids:
-Teaching measures to prevent constipation, avoidance of prolonged standing or sitting, proper use of OTC drugs available for hemorrhoidal symptoms, and the need to seek medical care for severe symptoms
-Recommend sitz bath
-Privacy should be provided
-Pain meds may be given before BM to reduce discomfort
-If the pt does not have a BM within 2-3 days, an oil-retention enema is given
-Pt are taught the importance of diet, care of the anal area, symptoms of complications, and avoidance of constipation and straining
Occurs when intestinal contents cannot pass through the GI tract; may occur in the small intestine or colon and can be partial or complete:
-Intestinal Obstruction
The obstruction is a detectable occlusion of the intestinal lumen; most occur in the small intestine:
-Mechanical Obstruction
What is the most common cause of a small bowel mechanical obstruction? Second?
-1st: surgical adhesion
-2nd: hernias and tumors
What is the most common cause of large bowel mechanical obstruction?
-Carcinoma followed by volvulus and diverticular disease
The obstruction that may result from a neuromuscular or vascular disorder:
-Nonmechanical Obstruction
Lack of intestinal peristalsis and the presence of no bowel sounds and is the most common form of nonmechanical obstruction; occurs to some degree after any abdominal surgery:
-Paralytic (adynamic) Ileus
How can you tell whether postoperative obstruction is due to paralytic ileus or adhesion?
-Bowel sounds usually return before postoperative adhesions develop
What are causes of paralytic ileus?
-Peritonitis
-Inflammatory responses (acute peritonitis, acute appendicitis)
-Electrolyte abnormalities (especially hypokalemia)
-Thoracic or lumbar fractures
An apparent mechanical obstruction of the intestine without demonstration of obstruction by radiologic:
-Pseudo-obstruction
Bacteria flourish when this occurs in the small bowel; proximal bowel fluid, gas, and intestinal contents accumulate, bowel becomes increasingly distended, and intraluminal bowel pressure rises which leads to an increase in capillary permeability and extravasation of fluids and electrolytes into the peritoneal cavity; distal bowel collapses; bowel tissue becomes ischemic, then necrotic, and then may rupture; location determines the extent of fluid, electrolyte, and acid-base imbalances; may be partial or complete:
-Etiology of Intestinal Obstruction
What is the most dangerous intestinal obstruction?
-When the bowel becomes strangulated and the blood supply is cut off leading to massive infection and death
A closed-loop obstruction occurs when the lumen is blocked in two different spots; results in an isolated segment of bowel and obstruction proximal to that segment; strangulation and gangrene are likely to develop if treatment is not immediate:
-Volvulus
Describe signs and symptoms of intestinal obstruction:
-Vary depending on the location of the obstruction, and include nausea, vomiting, abdominal pain, distention, inability to pass flatus, and constipation
-Projectile vomit and contains bile and may be orange-brown and foul smelling like feces because of bacterial overgrowth
-Vomiting usually relieves pain in high intestinal obstructions
-Persistent, colicky abdominal pain is seen with lower intestinal obstruction; a characteristic sign of mechanical obstruction is pain that comes and goes in waves due to peristaltic waves trying to move bowel contents past the obstructed area
-Paralytic ileus produces a constant generalized discomfort
-Strangulation causes severe, constant pain that is rapid in onset
-Abdominal distention
-Abdominal tenderness and rigidity are usually absent unless strangulation or peritonitis has occurred
-Temp rarely rises above 100F unless strangulation or peritonitis has occured
Describe what bowel sounds may occur for intestinal obstructions:
-High-pitched sounds above the area of obstruction due to overworking of peristalsis
-Bowel sounds may also be absent as in paralytic ileus
-Borborygmi: audible abdominal sounds produced by hyperactive intestinal motility
Describe nursing actions for a patient with an intestinal obstruction:
-Preventing fluid and electrolyte deficiencies and early recognition of deteriorations in the patient's condition
-Determine the location, duration, intensity, and frequency of abdominal pain and whether abdominal tenderness or rigidity is present
-Onset, frequency, color, odor, and amount of vomitus should be recorded
-Nurse auscultates for bowel sounds and documents their character and location; inspects the abdomen for scars, visible masses, and distention; and perhaps for muscle guarding and tenderness
-A urinary catheter is usually ordered to monitor hourly urine outputs
-Mouth and nose care
The third most common form of cancer and the second leading cause of cancer-related deaths in the US; has an insidious onset, and symptoms do not appear until the disease is quite advanced; regular screening is necessary; 1/2 occur in the rectosigmoid area:
-Colorectal Cancer
What is considered the gold standard for colorectal cancer screening and the distention and removal of precancerous polyps:
-Colonoscopy
More common in men than women, and mortality rates are highest among African American men and women:
-Etiology of Colorectal Cancer
Describe major risk factors for the development of colorectal cancer;
Major risk factors include increasing age, family or personal history of colorectal cancer, colorectal polyps, and IBD, obesity, smoking, alcohol, and a large intake of red meat
What can help decrease the risk of developing colorectal cancer?
-Physical exercise, diet with large amounts of fruits, veggies, and grains
Describe sigs and symptoms of colorectal cancer:
-Hematochezia (passage of blood through rectum) or melena (black, tarry stools), abdominal pain, and/or changes in bowel habits
-Weakness, anemia, and weight loss
-Symptoms vary from right-side and left-side of the colon
-Right: usually asymptomatic
-Left: rectal bleeding (most common), alternating constipation and diarrhea, change in stool caliber (ribbonlike, narrow), and sensation of incomplete evacuation
________ during colonoscopy can be used to resect colorectal cancer in situ and is considered successful when the resected margin of the polyp is free of cancer, the cancer is well differentiated, and there is no apparent lymphatic or blood vessel involvement:
-Polypectomy
_______ is recommended when a patient has positive lymph nodes at the time of surgery or has metastatic disease.
-Chemotherapy
_______ ______ may be used postoperatively as an adjuvant to surgery and chemotherapy or as a palliative measure for patients with metastatic cancer.
-Radiation Therapy
Describe nursing actions for a patient with colorectal cancer:
-Encourage all pts over 50 to have regular colorectal cancer screening
-Teaching proper positioning, providing information regarding ostomy, surgical options, fears about life changes
-Perineal dressing is reinforced and changed frequently during the first several hours after surgery when drainage is likely to be most profuse
-All drainage is carefully assessed for amount, color, and consistently and is usually serosanguineous
-Nurse should examine the wound regularly and record bleeding, excessive drainage, and unusual odor
-Wound is usually irrigated with a normal saline solution when the dressings are changed, several times a day and aseptic technique is always used
-Partially closed wound and drains are in place, the nurse assesses the incision for suture integrity and signs and symptoms of wound inflammation and infection; drainage is examined for amount, color, and characteristics
-Nurse monitors for edema, erythema, and drainage around the suture line, fever, and elevated WBC count
-Sitz bath, antipruitic agents, and use of a pressure-reducing chair cushion provides comfort
This diagnostic study directly visualizes entire colon up to ileocecal valve with flexible fiberoptic scope; pt's position is changed frequently during procedure to assist with advancement of scope to cecum; test is used to diagnose inflammatory bowel disease, detect tumors, diagnose diverticulosis, and dilate strictures; procedure allows for biopsy and removal of polyps without laparotomy:
-Colonoscopy
Describe nursing actions for a patient undergoing a colonscopy:
-Before: a bowel prep is done; type of varies depending on physician (clear liquids for 1-2 days, enema given night b4, or drink 1 gallon of GoLYTELY the night b4); explain to pt that flexible scope will b inserted while pt is in side-lying position; sedation will be given
-After: be aware the pt may experience abdominal cramps caused by stimulation of peristalsis because the bowel is constantly inflated with air during procedure; observe for rectal bleeding and signs of perforation; check VS
This diagnostic study directly visualize rectum and sigmoid colon with lighted flexible endoscope; sometimes special table is used to tilt patient into knee-chest position; may detect tumors, polyps, inflammatory and infectious diseases, fissures, and hemorrhoids:
-Sigmoidoscopy
Describe nursing actions for a patient undergoing a sigmoidoscopy:
-Administer enemas evening before and morning of procedure; pt may have clear liquid day before, or no dietary restrictions may be necessary; explain to pt knee-chest position (unless pt is older or very ill), need to take deep breaths during insertion of scope, and possible urge to defecate as scope is passed; encourage pt to relax and let abdomen go limp; observe for rectal bleeding after polypectomy or biopsy
This diagnostic study is a fluoroscopic x-ray examination of colon using contrast medium, which is administered rectally (enema); double-contrast or air-contrast barium enema is test of choice; air is infused after thick barium lows through the transverse colon:
-Lower GI series
Describe nursing actions for a patient undergoing a lower GI series:
-Before: administer laxatives and enemas until colon is clear of stool evening before procedure; admin clear liquid diet evening before procedure; keep pt NPO for 8 hr before test; instruct pt about being given barium by enema; explain that cramping and urge to defecate may occur during procedure and that pt may be placed in various positions on tilt table
-After: give fluids, laxatives, or suppositories to assist in expelling barium; observe stool for passage of contrast medium
In this diagnostic study; form, consistency, and color are noted; specimen examined for mucus. blood, pus, parasites, and fat content; test for occult blood (guaiac test, Hemoccult, Hematest) are done:
-Fecal Analysis (guaiac, bile pigment, fat content, ova parasite)
Describe nursing actions for a patient undergoing a fecal analysis:
-Observe pt's stools; collect stool specimens; check stools for blod with Hemoccult or Hematest; keep diet free of red meat for 24-48 hr before guaiac test
Describe nursing actions and rationale for testing stool for occult blood:
-Explain purpose of the test
-Perform hand hygiene
-Obtain a small sample of stool and thinly smear stool in the first box of the guaiac paper
-Apply a second fecal specimen from a different portion of the stool to the slide's second box
-Close slide cover, and turn the packet over to the reverse side; after waiting 3-5 min, open cardboard flap and apply 2 drops of developing solution on each smear
-Interpret color within 60 seconds (blue positive for blood)
-After interpreting, apply 1 drop of developer to the quality control section and interpret within 10 sec
Describe nursing actions and rationale for administering an enema:
-Sterile technique is unnecessary
-Wear gloves
-Place client in left side-lying (Sims) position with right knee flexed
-Solution should always to be room temperature (never cold)
-Lube 2.5-3 inches and insert approximately 3-4 inches for adults
-Hold tubing until end of fluid instillation
-Raise solution about 12 inches above rectum
-Place layers of tp around tubing as it is withdrawn; explain feeling of distention is normal
-Encourage to retain solution as long as possible for approximately 10-15 minutes (differs depending on solution)
-Assist to toilet; observe character of feces; assist client as needed with washing anal area
Describe action, use, route, side effects, and nursing implications for Dulcolax (bisacodyl) or castor oil:
-Action: Agents irritate intestinal mucosa to increase motility; agents decrease absorption in small bowel and colon
-Indications: prepare bowel for diagnostic procedures
-Risks: cause severe cramping; not for long-term use; chronic use causes fluid and electrolyte imbalances; not for clients who are pregnant or breast-feeding
-Route: PO and rectally
What classification is Dulcolax and castor oil a part of?
-Stimulant laxatives
Describe action, use, route, side effects, and nursing implications for Metamucil:
-Action: High-fiber content absorbs water and increases solid intestinal bulk; agents stretch intestinal wall to stimulate peristalsis; absorbs water and increases solid intestinal bulk
-Indications: least irritating, most natural, and safest cathartics; drugs of choice for chronic constipation; relieves mild diarrhea, if treating diarrhea, admin less water
-Risks: cause obstruction if not mixed with at least 240 mL of water or juice and swallowed quickly; caution is necessary with bulk forming laxatives that also contain stimulants; not for whom large fluid intake is contraindicated; follow each dose with 8oz water
-Side effects: bronchospasm, cramps, intestinal or esophageal obstruction, nausea or vomiting
-Route: PO
What classification is Metamucil a part of?
-Bulk-forming agents
Describe action, use, route, side effects, and nursing implications of Colace and mineral oil:
-Action: stool softeners are detergents that lower surface tension of feces, allowing water and fat to penetrate; increase secretion of water by intestine
-Indications: for short-term therapy to relieve straining on defecation
-Risks: are of little value for treatment of chronic constipation
-Route: PO (prevention) and rectally (soften fecal impaction)
-Side effects: throat irritation, mild cramps, rashes
-Nursing: assess bowel sounds and for abdominal distention; assess for diarrhea b4 admin; admin with a full glass of water
What classification is Colace or mineral oil a part of?
-Stool-softeners
Describe action, use, route, side effects, and nursing implications of Lomotil:
-Action: inhibits excess GI motility with subsequent decrease in diarrhea
-Side effects: dizziness, constipation, dry eyes, dry mouth, urinary retention
-Route: PO
-Implications: assess frequency and consistency of stools and bowel sounds; assess fluid and electrolyte balance
What classification is Lomotil a part of?
-Anti-cholinergic
Describe action, use, side effects, route, and nursing implications of Golytely and Colyte:
-Action: acts as an osmotic agent, drawing water into the lumen of the GI tract for the evacuation of the GI tract without water or electrolyte imbalance
-Route: PO
-Side effects: abdominal fullness, diarrhea, bloating, cramps, nausea, vomiting
-Nursing implications: assess for abdominal distention, presence of bowel sounds, and usual pattern of bowel function; pt should fast 3-4 hr prior to admin and never have solid foods 2 hr prior
What classification is Golytely a part of?
-Osmotics