Elimination

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Michealbledsoe
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205960
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Elimination
Updated:
2013-03-10 23:51:49
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Gastro intestinal
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Elimination/Gastro/intestinal
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  1. what does the GI tract consist of
    • Mouth
    • Teeth
    • Pharnyx
    • Esophagus
    • pyloric spinchter
    • Small Intestine
  2. What does the small intestine consist of
    Duodenum, Jejunum, ileum
  3. Lower GI tract
    • Ileum,
    • Cecum,
    • leads to large intestine (which consist of)
    • Ascending
    • transverse
    • decending
    • sigmoid
    • rectum
    • anus
  4. Blood supply to the intestines is supplied by what
    Superior mesenteric artery and inferior mesenteric artery
  5. assessment related to lower GI tract
    Nursing history (subjective) Pain, indigestion, gas, nausea, vomiting, change in bowel movements, aids in elimination, constipation, and diarrhea
  6. Complications of constipation
    Arterial hypertension, fecal impaction, fissures, diverticulosis (asymptomatic)
  7. what is diverticulosis
    asymptomatic outpockets in the sigmoid colon, not to be confused with diverticulitis which is inflammation of the sigmoid colon.
  8. what is recommended diet for diverticulosis
    low residue, high fiber, low calorie
  9. meds to promote bowel function
    exlax, correctol, ducolax & senna (laxitives or peristalsis stimulants

    Colace (stool softener)

    Glycerin suppositories (hyper osmotic, draws water into large intestines)

    Bulk formers (metimucil, citrucil, fibercon)
  10. how soon does colace act
    within 24 hours and is a stool softner
  11. what does caffeine cause and how
    constipation from water loss thru urination
  12. diarrhea medication
    lometil lowers motility (slows down peristalsis)
  13. what meds encourage constipation
    Imodium and Kaopectate
  14. what does patient need with bulk formers and why
    water to help bulk expand
  15. Physical exam
    • Inspection
    • auscultation
    • percussion
    • palpation
    • (in that order)
  16. how long to listen to bowel sounds before determining them to be absent
    3 to 5 mins in each quadrant
  17. percussion may yield
    dull sounds over spleen or tympani over areaas with a lot of gas
  18. where do you hear bowel sounds best
    lower right quadrant
  19. diagnostic test
    colonoscopy, endoscopy and ERCP
  20. Characteristics of barium enema
    • removes volvulous obstruction, allows visualization of contrast medium detects
    • diverticulitis
    • lesions
    • polyps
    • colitis
    • obstruction
    • bleeding

    is instilled thru rectal tube and xray taken
  21. Barium enema prep
    NPO @ midnight
  22. Flexible protoscopy, sigmoidoscopy
    Exam of rectum, anus and sigmoid with a flexible scope...lay pt in left lateral position
  23. for lower portion of colon (flexible protoscopy and sigmoidoscopy
    lay patient in SIMS with right leg flexed done for rectal bleeding and diverticulum
  24. Colonoscopy
    to view entire LARGE intestine, to be done by 40 or ten years sooner if family history of colon cancer (for conscious sedation give fentanyl and versed)
  25. after surgery and pt has return of bowel sounds diet will be
    clear liquid and advance to regular diet
  26. ambulation after surgery will be
    immediate
  27. why would pt have NG tube
    to decompress the bowel from build up pf gas
  28. ilistomy pts are more prone to what
    skin breakdown
  29. what is bowel surgery
    resection with end to end anastomosis removal of tumor and portions of the bowel on the other side of growth
  30. what is an Ileostomy
    located in right lower quadrant below belt line, made in the ileum (small intestine)  which is largest portion of GI tract
  31. what is an end ileostomy
    if everything distal to ostomy was removed (would be permanent)
  32. what is an continent ileostomy
    created internally out of intestines so that it can be catheterized and drained
  33. what is an ileoanal reservior (ileo-anal anastomosis)
    ileum is connected to anus and entire large intestine is removed. Done as 3 month procedure. Anus must be functioning. Ileum is hooked up right to anus, temp procedure where loop ostomy is made for 3 months then take down done. ileum is pulled down and large intestine is removed. Ileum is attached to anal canal.
  34. What is the Hartmans procedure
    Every thing distal to ostomy remains, part of intestine is pulled thru abdominal wall and folded over like a turtleneck. Need high stoma because it is very liquidy and has a lot of gastric juices (stoma is made and everything distal to it is sewn shut)
  35. how should healthy stoma look
    Beefy red
  36. what is a kock pouch (continent ileostomy)
    Created from segment of terminal ileum (initially bag can hold 100-600ml but after 6 months bag can hold at least a liter of feces) done as loop ostomy and take down done after 3 months
  37. colostomy is for
    Colon (transverse, ascending, descending and sigmoid)
  38. ileostomy is for
    ileum
  39. colostomies can be (length wise)
    temp or perm
  40. why would a colostomy be temp
    if area needs to rest due to illness, diverticulitis, or trauma (ostomy substitutes for anus)
  41. Type of temp colostomies
    Loop, double-barreled, Hartsman
  42. loop colostomy is
    incision is made and loop is created and rod or bridge is added to divert stool
  43. double barreled colostomy is
    abdomen would be cut and the sections (2 stomas) would sit beside each other. blood supply would still be intact, proximal would be one functioning stoma and distal would be one non functioning stoma. both need to be bagged.
  44. Permanent colostomy
    End colostomy (everything distal would be removed)
  45. what is diverticulosis
    out pockets formed outside the colon because pressure from stool causes weakness and pockets can form. (Asymptomatic)  Low fiber diet during treatment, high fiber diet after treatment. Antibiotics given, bentyl (for spasms)
  46. what is diverticulitis
    obstruction in outpockets of colon causing inflammation and can lead to peritonitis (inflammation of the peritoneum) pain and cramping in left lower quadrant. will have symptoms
  47. what is an ileal conduit
    urinary diversion (urinary version of colostomy)
  48. Abdominoperineal resection
    for colon cancer, permanent colostomy, surgical removal of anus, rectum and sigmoid with formation of abdominal stoma. Will heal by granulation (secondary intention from inside out) Stoma is brought out from abdominal wall in sigmoid. involves 2 surgeries. rectal area must me closed up.
  49. post op care
    • maintain elimination
    • relieve pain
    • allow rest
    • nutritional measures (protein)
    • fluids and electrolytes (level of consciousness & hydration status, skin turgur, blod pressre and mucous membranes) 
    • reduce anxiety
    • prevent infection (antibiotics)
  50. what to expect post op
    • foley
    • NG tube
    • (decompression of gas in bowel)
    • possible ostomy
    • wound care
    • preventing complications
    • I&O
    • Bowel sounds
    • Ambulate
  51. post op pain managment mat conscist of
    PCA pump
  52. What meds may be ordered for nausea post op
    zpfran, phenergan and  tiagan
  53. why would patient be on IV therapy post op
    Because pt may be NPO
  54. what is appendicites
    inflammation of the veriform appendix. (a long narrow wormshaped tube connected to the cecum below the ileocecal valve) Function not really understood. Fills with digestive juices and feces which usually comes out. Becomes a problem when it gets obstructed by feces or parasite causes an infection. Usually affects adolecents and young adults.
  55. How does appendicites start (Charateristic of)
    Starts with peri umbilical pain localized in lower right quardrant, fever of about 101, and lack of appitite.Pain will occur when you apply pressure but increase when you release pressure (rebound pain.McBurneys point) there will be an elevated white blood cell count (sign of infection)
  56. What is a Robsing test
    test for appendicites by applying pressure to lower left quadrant it will increase intensity of pain on lower right qardrant 
  57. what happenc if appendicites pain ignored
    can become inflammed and rupture and cause peritonitis
  58. What is peritonitis
    Inflammatory involvement of the peritoneum caused by rupture orperforation of any  internal organ enclosed within the cavity or associated structure. (spleen, liver, appendix or gastric ulcer.
  59. What is the peritoneum
    Serious membrane lining that covers organs and lines abdominal cavities.
  60. S&S of peritonitis
    Fever, abd distention, decreased or no bowel sounds, N&V, dehydration, increased pulse and blood pressure, Pain, rebound tenderness, board like abdomen
  61. Treatment of peritonitis
    Broad spectrum antibiotics, NG suction, O2 also an iso tonic solution like ringers lactate or 0.9 NS
  62. What is chrons disease
    regional enteritis transmural colitis  (inflammatory disease of the colon and GI tract) Usually found in Jewish. Affects terminal ileum adjacent to right colon
  63. What can chrons cause
    Since ileum is responsible for absorption of nutrients,  B-12 vitamin is not absorbed therefore pt may need ENFOROM injections (Z-track). Pt may also be on lomatil to decrease motility of bowel.
  64. Where can chrons occur
    Can involve all layers of the bowel, can occur anywhere along the GI tract and usually surgery is not recommended because it can reoccur in another area. Pain is usually in lower right quadrant. Fistulas may form.
  65. Complication and treatment of Chrons
    Malnutrition is a complication and treatment may consist of TPN for vitamins.
  66. Diet for Chrons
    Bland, low residue (Pasta, tender meat, canned or cooked veggie) easy to digest food
  67. chrons mouth
    Chrons can start anywhere on GI tract from mouth to anus
  68. Anal tags are a side effect of what
    Crohns disease
  69. What can Crohns do to the tongue
    Cause glossitis (inflammation of the tongue)
  70. Crohns can do what to the anus
    cause anal fissures
  71. what is enteritis
    inflammation of intestine, can cause loud bowel sounds, gas, weight loss, diarrhea, dehydration and N&V
  72. What is Ulcerative colitis
    Inflammation and ulceration of the large bowel, goes in and out of remission
  73. S&S of ulcerative colitis
    characterized by up to 20 bloody bowel movements a day, abdominal pain and cramping. can cause metabolic acidosis (because increased bowel movements cause body to lose alkalinity) . must check CBC and hematocrit
  74. treatment for Ulcerative colitis
    low residue, high calorie, high protein diet  Possible cure could be to remove colon and adding end ileostomy (removing everything distal to ileostomy) steroids might be ordered to reduce inflammation and steroidal enemas
  75. Why does ulcerative colitis cause metabolic acidosis
    (because increased bowel movements cause body to lose alkalinity)
  76. where does ulceritive colitis form
    in the lining of the large intestine and rectum
  77. Crohns is most likely to do what to intestine
    cause polyps, perforation and narrowing of intestine
  78. Difference between polyp and diverticulum
    • Polyp = inside the colon
    • Diverticulum = outside the colon
  79. in elderly don't confuse diverticulitis with
    Constipation
  80. What is an anorectal abscess
    collection of pus in the tissue near the rectum
  81. S&S of anorectal abscess
    Tender, red, swollen, foul smelling drainage, maybe fever and abdominal pain
  82. Treatment for anorectal abscess
    Drain if it gets bigger, sitz bath, heals by secondary intention, change dressings and pack with petroleum gauze. No enemas, LOW RESIDUE diet, can cause a fistula if left untreated
  83. What is an anal fistula
    abnormal tube like passage from anal canal to an opening located behind the anus
  84. Cause of anal fistula
    rupture or drainage of an anal abscess
  85. S&S of anal fistula
    drainage of bloody pus, mucous and stool. might have feces from vagina or bladder
  86. Treatment of anal fistula
    sitz bath, stool softener, and analgesics for pain
  87. What is an anal fissure
    Slit like ulcer resembling a crack in the anus
  88. Cause of anal fissure
    trauma from passage of hard stool
  89. treatment of anal fissure
    analgesics, steroidal suppositories, stool softeners, sitz baths
  90. what are pilonidal cyst
    usually found in men (hairy men) in sacrum area.  Hair that causes inflammation. frequently seen in ppl that had trauma to buttocks (like riding in jeeps, the bouncing...Military)
  91. Treatment for pilonidal cyst
    shave the area, sitz baths, incision and drainage, may have to sew close or pact and heal by secondary intention, and antibiotic for the infection.
  92. what are Vascular occlusions
    Hemorrhoids which are vericose veins in the anal area from pregnancy, chronic constipation or heredity
  93. S&S of hemorrhoids
    Itching and bleeding
  94. Treatment for hemorrhoids
    over the counter creams, avoid straining, increase fluids, increase fiber, stool softeners like colace, bulk formers like metimucil etf (drink lots of fluids) (sometimes sclerotherapy can be done) rubber band ligation...tie off with a rubber band and it will cut off blood supply and it will fall off.
  95. Diet for hemorrhoids
    20-35 grams of fiber and beans high in fiber. also fruits and veggies, lots of fluids (mobility helps)
  96. obstructions consist of
    when intestinal contents can not pass thru the lumen of the bowel. The higher the obstruction the more intense the S&S. The lower the obstruction the more subtle the S&S are. Vomiting with high obstructions and bowel sounds are hyperactive (from narrowing of opening) then the stop all together once completely obstructed. Abdominal pain and distention can be dx with xray womiting is rare in low bowel obstruction.
  97. Treatment for bowel obstruction
    NPO, NG tube, (to decompress the bowel) IV fluids (isotonic fluids) , monitor I&O, rectal tube may be used, may need an ostomy. 85% occur in large intestine and 15% in small intestine. Rectal tube may be inserted to decompress the lower bowel. (may or may not need surgery)
  98. Concerns with bowel obstruction
    worry about fluid disturbances from 3rd spacing and hypovolemia from vomiting. also constipation and abdominal distention
  99. What is familial polyposis
    when lots of polyps run in the family you would start colonoscopies 10 years earlier. @ 100% risk for development of cancer so most ppl opt to get large intestines removed
  100. what is neurogenic obstruction
    non mechanical can be caused by peritonitis, impaired movement of the intestinal content because of no peristalisis. Common after surgery. (related to nerves)  Abdominal distention, decreased or absent bowel sound and vomiting are common in ppl with Parkinson, muscalar dystrophy and diabetes. High blood sugar levels can cause nerve issues. no surgery needed, just rest...usually spontaneously resolves itself
  101. perilytic ileus  (what is it)
    lack of peristalsis after surgery, may include vomiting
  102. Adhesion bowel obstruction
    problem outside of the intestine, caused from scar tissue from previous surgery or radiation therapy. Tissue will be moist and inflamed and will adhere to part that its not supposed to. (will require surgery)
  103. What is a Vovulous
    Obstruction caused in intestinal wall, from abuse of enemas and laxitives. Intestines will twist from weakness in bowel. looks like the ace of spades. Barium enema could treat this. (lower GI)
  104. what is interssuption
    Caused in intestinal wall from weakness...intestine telescopes into each other....barium enema could be treatment.  May need coloctomy or resection, may be caused from tumor or cancer in large intestine from tumor by sigmoid. (associated with familial polyposis)
  105. Cancer tumor obstruction
    Primarily in large intestine. most are in sigmoid or rectal area.
  106. What is a Inguinal Hernia
    Most common with males, can be laproscopically repaired. Decreased swelling use ice. also elevating the scrotum to decrease swelling
  107. Incisional hernia
    Weakness in muscle wall caused by surgery leading to protrusion
  108. Femoral hernia
    most common in women
  109. 3 different classifications of hernia
    • Strangulated
    • Irreducible or incarcerated
    • reducible
  110. characteristics of strangulated
    the worst kind, blood supply is totally obstructed, so blood flow to intestine in obstructed, and can become inadequated (can cause lack of O2 become necrotic and die)
  111. characteristics incarcerated or irreducible
    means it is stuck and cannot be pushed back in. Can become obstructed and strangulated.
  112. characteristics of reducible
    Can push on it and it goes back inside of abdominal contents. (like in infants) pops out when infants cry. complications low.
  113. Vascular abnormality
    Mesenteric ischemia, impaired blood supply to intestine d/t occlusion of the mesenteric arteries/vessels. Can cause part of intestines to die. Can be caused by clogged arteries (may need resection)
  114. causes of vascular abnormality
    mesenteric ischemia can be caused by coronary artery disease, blood clot, atherosclerosis (hardening or the arteries) may do an angiogram.  in emergency do by pass surgery and possible put in a stint in arteries.
  115. Children with acute diarrhea (causes and treatment)
    rotavirus (can cause gastro-enteritis) a nosocomial infection, leading cause of illness in children under 5. (viral so no anti biotics) uses oral replacement therapy...pedialyte, bacterial infections may be salmonella and shigella (treat with anti-biotics) watch wet diapers, body temp, sunken fontanel from dehydration
  116. ped obstructions intestinal atresia
    ...can be congentinal, with newborn there will be no meconium at birth. baby would have distended abdomen. 1/3rd of babies will have down syndrome.
  117. Mega colon in children
    absence of parasympathetic nerve cells in bowel wall, can cause mega colon
  118. Hirschsprungs disease
    congentinal, lack of nerve cells in bowel wall. nerves wont tell fecal matter to push thru and causes mega colon from lack of nerve innervation. Most common in males and males w down syndrome...need resection
  119. imperforated anus
    absense of anal opening. Fistulat likely to develop, need to do surgery
  120. most common obstruction in kids is
    interssusception. Barium enema is best treatment.  Children with this will have very loud shrill cry. stool will be red and jelly like (from blood and mucous)
  121. umbilical hernia most common in
    Children, majority close by age 3 or 4. mostly in kids tissue doesn't close around umbilicus
  122. Meckles Diverticulum
    Diverticulum would need to be removed, found in terminal ileum, most occurs in childhood. DX with meckles scan, frequently confused with appendicitis
  123. Parasites
    organisms that live on or inside another organism, Usually dx by stool sample called O&P (ovum and parasite)
  124. Protozoal infection
    • Giardiasis
    • amebiasis
    • crytoporiodosis
  125. Roundworms (Ascariasis)
    TRANSMITTED BY ORAL ROUTE
  126. Pinworms
    come out at night and lay eggs by anus. most common in children.  kids scratches and kid puts it in mouth. (yuck) and that's how they pass it. Treatment is to go in at night with flashlight (see little white lines) and use cellulose tape and pull for sample.
  127. Hook worms
    from contaminated soil (in foot)  site of entry called groundage
  128. Trichinosis
    caused from uncooked (improperly) meat (pigs mostly) embeds in muscle and confirmed by muscle biopsy
  129. Tapeworm
    helminth, may see in toilet. Can be dx with stool O&P.  Have to make sure entire worm is expelled.

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