Chapter 48 Med Surg

The recommended dietary intake of fiber is _____ grams per day. This intake, along with 1.5 to 2 L of fluids daily, should prevent constipation that occurs with fewer than _____ bowel movements per week.

25 to 30 g/day; three

A chemotherapeutic agent used to treat colon cancer

5-FU

Name at least four factors that may be associated with the development of irritate bowel syndrome.

Although no anatomic or biochemical abnormalities have been found that account for its common symptoms, various factors are associated with the syndrome: heredity, psychological stress or conditions such as depression and anxiety, a diet high in fat and stimulating or irritating foods, alcohol consumption, and smoking.

Electrolytes induce diarrhea

Saline agent- Colyte

Describe the physiological response that occurs when a patient has a Valsalva maneuver while straining during defecation.

forcible exhalation against a closed glottis followed by a rise in intrathoracic pressure and subsequent possible dramatic rise in arterial pressure.

The nurse is irrigating a colostomy. The catheters should be advanced into the stoma _______ to ______ inches.

2 to 3

A patient arrives in the emergency department with complaints of right lower abdominal pain that began 4 hours ago and is getting worse. The nurse assesses rebound tenderness at McBurney's point. What does this assessment data indicate to the nurse?

Appendicitis

Intestinal rumbling

Borborygmus

The nurse is performing an abdominal assessment for a patient with diarrhea and auscultates a loud rumbling sound in the left lower quadrant. What will the nurse document this sound as on the nurse's note?

Borborygmus

Polysaccharides and cellulose mix with intestinal contents

Bulk forming- Mineral oil

A highly reliable blood study used to diagnose appendicitis

CEA

The nurse is irrigating a colostomy when the patient says, "You will have to stop, I am cramping so badly." What is the priority action by the nurse?

Clamp the tubing and give the patient a rest period.

A patient is having a diagnostic workup for complaints of frequent diarrhea, right lower abdominal pain, and weight loss. The nurse is reviewing the results of the barium study and notes the presence of "string sign." What does the nurse understand that this is significant of?

Crohn's disease

Another name for regional enteritis

Crohn's disease

The most common bacteria associated with peritonitis

E. coli

Another term for fecal matter

Effluent

The nurse is caring for a patient who has malabsorption syndrome with an undetermined cause. What procedure will the nurse assist with that is the best diagnostic test for the illness?

Endoscopy with mucosal biopsy

List the common bacteria found in a patient who has developed peritonitis.

Escherichia coli, Klebsiella, Proteus, and Pseudomonas

Colon is irritated and sensory nerve endings stimulated

Fecal softener- Metamucil

A tubular fibrous tract that extends from an opening beside the anus into the anal canal

Fistula

The nurse is caring for a patient who has had an appendectomy. What is the best position for the nurse to maintain the patient in after the surgery?

High Fowler's

A patient with irritable bowel syndrome has been having more frequent symptoms lately and is not sure what lifestyle changes may have occurred. What suggestion can the nurse provide to identify a trigger for the symptoms?

Keep a 1- to 2- week symptom and food diary to identify food triggers.

The most popular over-the-counter medication purchased in the United States

Laxatives

Surfactant action hydrates stools.

Lubricant- Milk of Magnesia

The nurse is caring for an older patient experiencing fecal incontinence. When planning the care of this patient, what should the nurse designate as a priority goal?

Maintaining skin integrity

Dilated and anionic colon caused by a fecal mass

Megacolon

The nurse is admitting a patient with a diagnosis of diverticulitis and assess that the patient has a birdlike abdomen, no bowel sounds, and complains of severe abdominal pain. What is the nurse's first action?

Notify the physician

Hydrocarbons soften fecal matter

Osmotic agent- Dulcolax

The most common complication of colon cancer

Peritonitis

Magnesium ions alter stool consistency

Stimulant- Colace

An ileal outlet on the abdomen

Stoma

Intravenous nutrition used for inflammatory bowel disease

TPN

Painful straining at stool

Tenesmus

Name the hallmark signs of malabsorption syndrome.

The hallmarks of malabsorption syndrome from any cause are diarrhea or frequent, loose, bulky, foul-smelling stools that have increased fat content and are often grayish (steatorrhea).

A patient is being seen in the clinic for complaints of painful hemorrhoids. The nurse assess the patient and observes the hemorrhoids are prolapsed but able to be placed back in the rectum manually. The nurse documents the hemorrhoids as what degree?

Third degree

Straining at stool

Valsalva maneuver

The nurse is assigned to care for a patient 2 days after an appendectomy due to a ruptured appendix with resultant peritonitis. The nurse has just assisted the patient with ambulation to the bedside commode when the patient points to the surgical site and informs the nurse "something gave way." What does the nurse suspect may have occurred?

Wound dehiscence has occurred.

A disorder of malabsorption that inactivates pancreatic enzymes is ___________.

Zollinger-Ellison syndrome

Common clinical manifestations of Crohn's disease are ______ and ________.

abdominal pain & diarrhea

The majority of large bowel obstructions are caused by ___________.

adenocarcinoid tumors

The three most common causes of small bowel obstruction are _______, ________, and _______.

adhesions, hernias, neoplasms

A patient is admitted to the hospital after not having a bowel movement in several days. The nurse observes the patient is having small liquid stools, a grossly distended abdomen, and abdominal cramping. What complication can this patient develop related to this problem?

bowel perforation

What medications may be prescribed for the patient with constipation that will enhance colonic transit by increasing propulsive motor activity?

cholinergic agents (bethanechol [urecholine]), cholinesterase inhibitors (neostigmine [prostigmin]), or prokinetic agents (metoclopramide [reglan]). Prokinetic agents including serotonin (5-HT4) receptor agonists like prucalopride (reseller) and protons like lubiprostone (amities) stimulate chloride channels in the gut. Medical probiotics (ingested live organisms) may help some constipated individuals by creating improved bacterial balance.

The most common bacteria found in antibiotic-associated diarrhea is _______.

clostridium difficile

List six risk factors for colorectal cancer that the nurse can educate the public about.

increasing age; family history of colon cancer (Lynch syndrome) or polyps (familial adenomatous polyposis (FAP); previous colon cancer or adenomatous polyps; high consumption of alcohol; cigarette smoking; obesity; history of gastrectomy; history of IBD; high- fat, high- protein (with high intake of beef), low fiber diet; genital cancer (endometrial cancer, ovarian cancer) or breast cancer (in women).

The 2 diseases of the colon that are commonly associated with constipation are ______, & ________.

irritable bowel syndrome and diverticular disease

A patient is not having daily bowel movements and has begun taking a laxative for this problem. What should the nurse educate the patient about regarding laxative use?

laxatives should not be routinely taken due to destruction of nerve endings in the colon

The nurse is assessing a patient with appendicitis. The nurse is attempting to elicit a Rovsing's sign. Where should the nurse palpate for this indicator of acute appendicitis?

left lower quad

Name four complications associated with diverticulitis.

peritonitis, abscess formation, fistulas, and bleeding

The most common site for the presence of diverticulitis is the ________.

sigmoid

Malabsorption diseases may affect the ability of the digestive system to absorb the major water-soluble ________.

vitamin B12

A food to avoid for a patient with an ileostomy

Celery

Another food to avoid for a patient with an ileostomy

Corn

A patient is suspected to have diverticulosis without symptoms of diverticulosis. What diagnostic test does the nurse anticipate educating the patient about prior to scheduling?

Colonoscopy