Test 6
antiemetics
(promethazine, ondansetron) prevent nausea and vomiting drowsiness contraindicated in patients with dysrhythmias/prolonged QT intervals (antidepressant/antipsychotic)
diverticulitis nursing management
- 2 L/day fluid - soft foods with increased fiber - avoid anything with seeds/nuts
celiac disease s/s
- Diarrhea, steatorrhea, abd pain, abd distention, flatulence, wt loss ( more common among children) - Non-GI symptoms-fatigue, general malaise, depression, hypothyroidism, migraine HA, osteopenia, anemia, seizures, paresthesia in the hands & feet, red & shiny tongue - Ridges in the enamel of the adult teeth, discoloration or yellowing - Rash (dermatitis herpetiformis)
large bowel obstruction medical management
- NG aspiration and decompression IMMEDIATELY - metal colonic stent - temp or perm colostomy
irritable bowel syndrome nursing management
- Pt education on use of a bowel habit diary (Bristol scale) - Promote self-care activities (sleep & dietary habits) - Encourage use of food diary - Encourage to eat at regular times & avoid triggers - Avoid fluid consumption with meals - Discourage ETOH & smoking - Stress management
irritable bowel syndrome medical management
- Relieve ABD pain and constipation or diarrhea - Lifestyle modification- stress reduction, adequate, sleep, reg exercise - Add soluble fiber to diet (psyllium) - Identifying & restricting irritating foods - Low-FODMAP diet (?)
diverticulitis s/s
- acute onset LLQ cramping - change in bowel habits - bloating, fever, nausea - can lead to fistula formations
appendicitis
- appears between 10-30 y/o - most common reason for abd surgery - insufficient emptying causes appendix to become inflamed and edematous
diverticulitis medical management
- clear liquid diet until inflammation subsides, then progress to high-fiber, low -fat diet
peritonitis diagnostics
- elevated WBC - Low H&H if blood loss has occurred
hemorrhoids management
- good personal hygiene - high residue diet - increase in fluid intake - don't strain on BM
appendicitis post-surgery
- high fowler's (reduces tension on incision) - incentive spirometer q 2h while awake - assess BS (lack of = complications) - NPO until bowel sounds return - ambulation same day of surgery
proctitis risk factors
- infection - IBD - celiac disease - being GAY
appendicitis discharge instructions:
- make appt for suture removal in 1-2 weeks - avoid heavy lifting
peritonitis what happens?
- the intestinal tract responds immediately with hypermotility followed by paralytic ileus
large bowel obstruction s/s
- unlike small bowel, symptoms develop slowly - sigmoid or rectum - constipation may be only Sx for weeks - Fe def anemia - crampy pain
How long does it typically take for hyperosmolar laxatives to produce a bowel movement?
2-8 hours
How long do stool softeners typically take to act?
24-48 hours
appendix
A small, fingerlike extension of the vertebrate cecum; contains a mass of white blood cells that contribute to immunity. Fills with digestive byproducts and empties into the cecum
small bowel obstruction nursing priority
ASSESS FOR F and E Imbalances assess/measure NG output
small bowel obstruction nursing management
ASSESS FOR F&E imbalances - assess for return of bowel function - assess function of NG tube and measure output
Loperamide (Imodium)
Antidiarrheal. Used for IBS-D - cleaning diarrhea off loafers (Loperamide)
Diphenoxylate with atropine (Lomotil)
Antidiarrheal. Used for IBS-D. - cleaning diarrhea of tie-dye socks (Lomotil is an opioid, so its only used for severe cases. Causes dizziness drowsiness. No operating heavy machinery. No take with CNS depressants, alcohol or MAOIs)
How long does it typically take for bulk forming laxatives to produce a stool?
Approximately 12 hours
When should hyperosmolar laxatives not be taken?
At bedtime
Why should stimulant or irritant laxatives not be taken with antacids or milk?
Because it causes enteric coating to dissolve too quickly.
What should be avoided in patients with diabetes mellitus when using bulk forming laxatives?
Bulk forming products contain dextrose, galactose, and sucrose.
CRP
C-reactive protein. increased levels can indicate inflammation, infection, and other disease processes
irritable bowel syndrome
Chronic functional disorder characterized by recurrent abd pain assoc. with disordered BM, including diarrhea, constipation, or both w/o an identifiable cause
small bowel obstruction s/s
Crampy pain that is colicky, Pt may pass blood and mucus but no fecal matter or flatus Central Distention
appendicitis and constipation
DO NOT GIVE LAXATIVES - Laxatives + appendicitis = perforation
What can long-term use of lubricant laxatives cause?
Deficiency syndromes with low vitamin absorption.
celiac disease diagnosis
Definitive dx- immunoglobulin A(IgA) anti tissue transglutaminase (tTG) serologic test & Endoscopy w biopsies of proximal small intestine
When should lubricant laxatives not be administered in relation to food or other medications?
Do not administer within 2 hours of food or other medications.
What is a common stool softener?
Docusate (Colace)
Diverticula may occur anywhere in the small intestine or colon, but most commonly occur in the ascending colon.
False. Most commonly occur in the sigmoid colon.
The patient with irritable bowel syndrome (IBS) should select foods low in fiber in order to minimize intestinal irritation. T/F
False. The patient should add soluble fiber to diet. psyllium/Metamucil
What risk is associated with aspiration of lubricant laxatives?
It may cause lipid pneumonia.
appendicitis diagnostics
Lab studies (CBC, CRP) ^ WBC CRP ^ in first 12 hours CT or US Confirms diagnosis Pregnancy testing Just to rule out pregnancy UA Rules out UTI
What is a common hyperosmolar laxative that may be given to patients with liver failure?
Lactulose
What should not be taken with bisacodyl?
Milk or antacids.
What should not be used with stool softeners due to the risk of hepatotoxicity?
Mineral oil or other laxatives
small bowel obstruction medical management
NG for up to 3 days
What is a common example of a bulk forming laxative?
Psyllium (Metamucil)
irritable bowel syndrome diagnostics
Rome IV Criteria
What dietary restriction should be considered when using saline laxatives?
Sodium restrictions
functional or paralytic obstruction
The intestinal musculature cannot propel the contents along the bowel The blockage also can be temporary and the result of the manipulation of the bowel during surgery
How do bulk forming laxatives work?
They absorb water to increase the bulk and moisture of stool.
What condition are stimulant or irritant laxatives used to treat?
They are used to treat constipation from prolonged bed rest or poor diet.
What do stimulant or irritant laxatives do?
They increase peristalsis depending on the agent.
When should bulk forming laxatives not be used in relation to certain medications?
They may NOT be used within 2 hours of antibiotics, anticoagulants, digitalis, and salicylates.
What can happen to bulk forming agents in the intestine if there is insufficient water?
They may become hardened.
How can lubricant laxatives affect anticoagulants, contraceptives, and digitalis?
They may reduce their effectiveness.
What should stimulant or irritant laxatives not be taken with?
They should not be taken with antacids or milk.
high residue diet
This diet increases the amount of fiber and whole grains ingested it helps prevent constipation
What are hyperosmolar laxatives used for?
To cleanse the bowel in preparation for endoscopic exams or surgery, and to eliminate toxic material quickly
A patient with constipation is prescribed psyllium (Metamucil) but his healthcare provider. What essential teaching will the nurse give to the patient?
To prevent esophageal or gastric obstruction, psyllium (Metamucil) should be given with a full glass of water or juice and followed be another full glass of liquid.
What are lubricant laxatives used for?
To soften stool in conditions where straining should be avoided.
Decompression of the bowel through a nasogastric tube is necessary for all patients with small bowel obstruction. t/f
True
Diarrhea is defined as the increased frequency of more than three bowel movements per day. T/F
True. Diarrhea > 3 BM per day
What color may stimulant laxatives turn urine and stool?
Urine may turn reddish pink or yellow brown; stool may turn reddish.
Lubiprostone (Amitiza)
Used for IBS-C and chronic constipation Increases fluid secretion in intestine, promotes motility. - Lubing the intestines up Can cause diarrhea, nausea (take w/ food)
What should bulk forming laxatives be taken with?
Water
When are stool softeners particularly useful?
When it is important to reduce straining at stool
When should hyperosmolar laxatives not be taken in relation to tetracyclines?
Within 1-3 hours
When should lubricant laxatives not be taken in relation to meals or medication?
Within 2 hours of meals or medication.
colorectal polyps
a mass of tissue that protrudes into the lumen of the bowel - benign are more common, still removed so they don't become malignant - mostly asymptomatic
gluten
a protein found in wheat, rye, oats, and barley
irritable bowel syndrome s/s
abd pain caused by eating and frequently relieved by defecation - alternating diarrhea and constipation - bloating
The etiology of cancer of the colon and rectum is predominantly _____________________, a malignancy arising from the epithelial lining of the intestine.
adenocarcinoma
diverticulosis s/s
alt constipation and diarrhea - nausea, anorexia, bloating, abd distention
________________, the most common cause of acute surgical abdomen in the United States, is the most common reason for emergency abdominal surgery.
appendicitis
In Crohn's disease, the common clinical manifestations include abdominal pain and _____________.
diarrhea
hemorrhoids
dilated portions of veins in the anal canal - common in pregnancy
low residue diet
eliminates or limits foods that are high in bulk and fiber
colicky pain
fluctuates in intensity from severe to mild and most often occurs in waves; usually related to spasms in the intestines
peritonitis as condition progresses
hypotension, oliguria or anuria. (signs the pt is becoming septic)
peritonitis nursing management
hypovolemia, anuria, oliguria = intensive care (sepsis) - decrease in temp and HR, softening of abd, return of bowel sounds and passing of flatus.
diverticulitis
inflammation of the diverticula
peritonitis
inflammation of the peritoneum (membrane lining the abdominal cavity and surrounding the organs within it)
proctitis
inflammation of the rectal mucosa
Dicyclomine (Bentyl)
irritable bowel syndrome. Antidiarrheal. Used for Abd pain
probiotics
live microbes used for diarrhea following antibiotic therapy. They restore the normal flora of the intestine following diarrhea
peritonitis medical mangement
main focus is to identify the source of infection, maintain organ function and prevent complications. - fluid and electrolyte replacement - O2 therapy (fluid in abd cavity, it restricts lung expansion)
celiac disease
malabsorption syndrome caused by an immune reaction to gluten
Secondary peritonitis
most common. due to any sort of bowel perforation.
Tertiary peritonitis
occurs as a result of a suprainfection in a patient who is immunocompromised
mechanical obstruction
occurs when intestinal contents are prevented from moving forward due to an obstacle or barrier that blocks the lumen
rebound tenderness
pain that increases when pressure (as from a hand) is removed
rosving's sign
palpation of LLQ causes RUQ pain seen in appendicitis
paralytic ileus
paralysis of intestinal peristalsis
appendicitis complications
perforation 6-24 h after onset of pain get them into surgery quickly
peritonitis s/s
rebound tenderness, muscular rigidity, laying still w/fast shallow breaths, distended abd, ascites, fever
Rome IV Criteria
recurrent abd pain @ least once daily for 3 months. Also need 2 or more of following - Abd pain r/t defecation - Abd pain assoc with a change in frequency of stool - Abd pain assoc with a change in form/appearance of stool
Primary peritonitis
spontaneous bacterial peritonitis
edematous
swollen
diverticulosis
the presence of multiple diverticula without inflammation or symptoms
appendicitis s/s
vague periumbilical pain that progresses to RLQ - constipation - anorexia - nausea - Rebound tenderness - Rosving's sign (if we palpate LLQ, that will elicit pain in PLQ)
