Term
|
Definition
| Increase in frequency, fluid volume, and volume of stools. |
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Term
| What are some reasons for diarrhea? |
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Definition
| many reasons: decreased fluid absportion, increased fluid secretion |
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Term
| What are some results of diarrhea? |
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Definition
dehydration electrolye imbalance hypovolemic shock |
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Term
| What is the difference between acute and chronic diarrhea? |
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Definition
Acute - infection Chronic - remission and exacerbation |
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Term
| How is diarrhea evaluated? |
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Definition
r/o infection hx WBC worms previous surgery stress change in diet medication use foreign travels physical exam |
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Term
| How is diarrhea therapeutically managed? |
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Definition
IV fluid replacement for dehydration preven spread of infection oral replacement therapy replace fluids, monitor and observe |
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Term
| What are some causes of diarrhea? |
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Definition
| Intestinal infection, bacterial, viral, parasitic, fungal overgrowth, food intolerance, malabsorption, medications, colon disease, irritable bowel syndrome, intestinal obstruction, emotional stress, infectious disease |
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Term
| What are the two major groups of inflammatory bowel disease? |
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Definition
| Chron's disease and ulcerative colitis |
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Term
| What is the causation of ulcerative colitis? |
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Definition
Exact unknown Infectious agent Autoimmune reaction |
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Term
When does ulcerative colitis usually occur? What ethnicity is most affected? |
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Definition
15-25 years 60-80 years Caucasian |
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Term
| What is ulcerative colitis characterized by? |
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Definition
diffuse inflammation primarily between the rectum and colon ulceration --> abcess formation small ulcers to large ulcers |
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Term
| At what site is ulcerative colitis? |
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Definition
| rectum to sigmoid colon, can migrate to entire colon |
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Term
| What is the impact of ulcerative colitis on the colon? |
|
Definition
| drainage from pus, sloughing, ulceration, bleeding, diarrhea containing blood and pus |
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Term
| What happens to the bowel with ulcerative colitis? |
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Definition
bowel narrows and shortens because of fibrous strictures remission and exacerbation |
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Term
| What are the symptoms of ulcerative colitis? |
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Definition
abdominal pain and cramping uncontrollable straining (tenemes) blood diarrhea (10-20/day) |
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Term
| What are findings of a physical assessment of a patient with ulcerative colitis? |
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Definition
fever weight loss anemia tachycardia dehydration protein loss decreased HG and HCT |
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Term
| What are some complications of ulcerative colitis? |
|
Definition
hemorrhage strictures --> obstruction systemic perforation toxic megacolon |
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Term
|
Definition
|
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Term
| What will the hgb and hct of a person with ulcerative colitis be? |
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Definition
|
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Term
| What will the WBCs, electrolytes, albumin of a person with ulcerative colitis look like? |
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Definition
|
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Term
| What diagnostic tests are performed on a pt with suspected colitis? |
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Definition
lab values stool for blood/pus/mucus/cultures sigmoidoscopy and colonoscopy |
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Term
What is the action of aminosalicylates?
How are they administered?
What are possible side effects?
What are some teaching points? |
|
Definition
inhibits prostogladin synthesis
administered orally/rectally
leukopenia and anemia
take after meals with full glass of H20 |
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Term
What are some examples of Corticosteriods?
When are they used for patients from IBS/ulcerative colitis?
How is it administered?
What are possible adverse effects? |
|
Definition
prednisone, medrol; solumedrol
used for patients with acute exacerbation until clinical improvement, taper off
administered po, iv, rectal
adverse: hypertension, resdistribution of fat, osteoperosis, Cushing's disease, mood swings, hirsutism, hyperglycemia |
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|
Term
What are some examples of sedatives used to treat ulcerative colitis?
What is their action? |
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Definition
valium
decrease restlessness and anxiety |
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Term
What are some examples of antidiarrheals used to treat ulcerative colitis?
What action is performed? |
|
Definition
lamodel (narcotic and atrepine)
action: GI motility |
|
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Term
What are some examples of immunosuppressants used to treat ulcerative colitis?
How are they administered?
What are some side effects?
What labs should be monitored while a pt is on this drug? |
|
Definition
cyclosporin, methotrexate
administered with food and milk, 2L fluid/day
side effects: bone marrow suppression, increased risk of infection
Labs: leukopenia, anemia, CBC |
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|
Term
| What percentage of patients suffering from ulcerative colitis need surgery? |
|
Definition
|
|
Term
| What are indicatinos for surgery for ulcerative colitis? |
|
Definition
| failed conventional treatment, exacerbation, more frequent, massive bleeding, perforation, strictures leading to bowel obstruction, tissue changes indicating malignant cells (increased risk for bowel cancer) |
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|
Term
| What are the procedures for ulcerative colitis? |
|
Definition
colostomy
ilieostomy
(sometimes reconstructed) |
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Term
| What is pre-op teaching for surgery for ulcerative colitis? |
|
Definition
as with abdominal surgery: cough, deep breathing, DVT prevention
esterostomal therapist: mark where to make stoma |
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Term
| What is some post op teaching for patients with ulcerative colitis? |
|
Definition
prevention of skin problems: assess stoma, irritation, excoriated skin pouch system
body image alteration, look at/work with stoma
patient goals: profiencient in self care, return to presurgical activities |
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Term
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Definition
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Term
|
Definition
|
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Term
| What are some foods that may cause gas in a patient with a stoma? |
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Definition
| alcohol, beer, chives, beans, eggs, fried foods, melons, onions, peppers, pickles, cabbage, soft drinks |
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Term
| What are some food that may cause stomal blockage in a patient with a stoma? |
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Definition
| bean sprouts, coconut, corn, popcorn, mushrooms, nuts, olives, peas and pickles, pineapple, skins and seeds |
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Term
| What are some foods that may help to control diarrhea in a pt with a stoma? |
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Definition
| applesauce, bananas, cheese, PB, oatmeal, potatoes, soda crackers, starchy foods, tapioca, yogurt |
|
|
Term
| What are some foods that may produce odor in a pt with a stoma? |
|
Definition
| asparagus, fish, garlic/onions, turnips, eggs, dried peas or lentils |
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|
Term
| What parts of the GI tract is affected by Crohn's disease? |
|
Definition
|
|
Term
| What is the peak incidence of Crohn's disease? |
|
Definition
ages 15-30
increase in women, Jewish upper middle class |
|
|
Term
| Describe the colon of a patient with Crohn's diease. |
|
Definition
segmented: disased/normal
most common in terminal ileum, jejunum, colon
granulations/cobblestones, creates deep fissures, can lead to fistulas
advanced: narrow lumen of bowel, promotes strictures, nodular swellings, deep ulcerations |
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Term
| What are clinical manifestations of Crohn's disease? |
|
Definition
severe diarrhea
major mulnutrition |
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Term
|
Definition
| outpuchin/herniations that push through the lining surrounding muscle, usually in sigmoid colon |
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|
Term
| How is diverticulosis treated? |
|
Definition
| high fiber diet, lots of water, exercise |
|
|
Term
|
Definition
| inflammation as stool gets caught into herniated wall, perforation may occur |
|
|
Term
| Should diverticulitis be treated with fiber? |
|
Definition
|
|
Term
| How is diverticulosis and diverticulitis treated? |
|
Definition
Diverticulosis -- only noted in colonscopy
Diverticulitis - abdominal pain in LLQ, intermittent, becomes more steady, tender abdomen, might feel mass, fever, chills, nausea, anorexia |
|
|
Term
| Why might the elderly be difficult to diagnose with diverticulitis? |
|
Definition
| afebrile, decreased inflammation |
|
|
Term
| What are possible complications of diverticular disease? |
|
Definition
| perforation, board like abdomen, fistulas, bowel obstruction, maroon colored stools |
|
|
Term
| What are diagnostic studies used to evaluate diverticular disease? |
|
Definition
physical exam
radiographic studies: barium enema
CAT scan with oral contrast
labs: CBC, urine, occult blood
endoscopic: colonscopy (contraindicated for acute/preforation) |
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Term
| What are therapeautic nursing interventions for diverticulosis? |
|
Definition
| increased fiber and fluids, decreased red meat and fat, bulk laxatives (metamucil/citracel), good BMI, strenuous interabdominal pressure |
|
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Term
| What are therapeautic nursing interventions for acute diverticulitis? |
|
Definition
| NPO, bedrest, parenteral fluids, maybe NG tube, antibiotic, WBC, clear liquid, low fiber |
|
|
Term
| What are some complications of diverticular disease? |
|
Definition
| perforation and peritonitis |
|
|
Term
| What are clinical manifestations of Crohn's disease? |
|
Definition
diarrhea
sever pain (intermittent or constant)
tender/distended abs
febrile
fatigue
weight loss/malnutrition/electrolyte imbalances/pain umbilicus |
|
|
Term
| What is the incidence of Hirschsprung? |
|
Definition
| 1 in 5000 births; 4:1 male to female ratio, strong heriditary, increased down syndrome |
|
|
Term
| What is the etiology of Hirshsprungs? |
|
Definition
| absence of ganglion cells in rectum |
|
|
Term
| How is Hirschsprung manifested? |
|
Definition
| delayed absence or passage of meconium w/ 1st 24 hours, prone to consipation |
|
|
Term
How is Hirschsprung disease evaluated?
look up in textbook |
|
Definition
|
|
Term
| How is Hirschsprung therapeutic managed? |
|
Definition
mild-moderate: stool softener, rectal irrigations
mod-severe: surgery with 2 step procedure, temp colostomy, want colon to return to normal size |
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|
Term
| Describe nursing care for a child with Hirschprung disease? |
|
Definition
assessment: constipation, foul smelling ribbon like or pellet stoosls
malnutrition
report changes in bowel sounds, diarrhea, vomiting, measure abdomen
abdominal distension
suspect entrocolitis
axillary temps |
|
|
Term
| How is Hirshchsprung surgically managed? |
|
Definition
preop bowel prp
prevent infection
good skin integrity |
|
|
Term
| What is some parent teaching for pts with Hirschsprung disease? |
|
Definition
| releive anxiety, teach technique for rectal irrigation, care of colostomy, need 24/7 support |
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