final GI II

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kbryant86
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264104
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final GI II
Updated:
2014-02-28 12:52:36
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adults
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adults final
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  1. Dx and nursing care of lower GI
    • stool culture
    • -gross examination
    • -microspoic exam
    • -occult bld
    • -ova and parasites

    care= collection and let Doc know if pt in on period
  2. small bowel series
    barium enema

    nsg care of these
    s= barium swallow followed all the way through GI

    b=Only see sigmoid

    • care= low risidue diet or clear liquid diet 24-48 hours proir
    • =enema or cathartic (laxative) prior
    • = NPO 8hrs

    post care= constipation
  3. nrsg care of sigmoidoscopy and colonoscopy

    nl and abnl
    • care= informed consent b/c of concious sedation
    • NPO
    • bowel preps

    nl= hyperactive BS, loose water stools, flatus

    abnl= abd pain, fever, chills, bleeding
  4. what is the primary risk with endoscopies?
    perforation
  5. diarrhea
    • THIS IS A SYMPTOM, NOT A DISORDER
    • acute chronic
  6. acute vs chronic diarrhea
    A= < 1 week and d/t infectious agent

    C= > 3-4 weeks, d/t inflamm bowel disorders
  7. Dx of diarrhea
    • stool culture
    • sigmoidoscopy
    • labs=
    • -e/lytes
    • -osmolality
    • -ABG
  8. complications of diarrhea
    • h2o and e.lyte loss
    • vascular collapse and hypovolemia shock
    • dec K, dec Mag
    • metabolic acidosis
  9. anti diarrhea meds
    NOT USED UNTIL cause of dia is ID'd

    • -absorbants and protectants
    • -opium and opium derivitives (slows transient time of stool thru bowel to absorb h2o out)
    • -anticholinergics
  10. nsg interventions for diarrhea
    • monitor and record I&O, vs, wt
    • listen for hyperactive BS
    • fluid and e.lyte replacement
    • infectious control
    • skin integrity
    • ready access to bathroom, bed comode, bedpan
  11. constipation
    can be a primary problem OR a symptom
  12. causes of constipation
    • avtivity
    • dietary
    • drugs
    • lg intestine issues= tumores, obstructions
    • psychogenic= American Pie "Shit Break"
    • system= parkinsons, MS, prego
    • chronic use of laxatives or enemas can build dependency
  13. S & Sx of constipation
    • dec BM
    • abd discomfort
    • straining
    • hard, dry stool
    • fecal impaction
    •  =palpate hard mass of feces in rectum
    •  =water mucous or liquid stool can pass in scant amounts
  14. types of diarrhea meds
    • bulk forming agents
    • wetting agents
    • irritant or stimulant laxatives
  15. bulk forming agents
    • like metamucil
    • mix agent w/ full glass of cool liquid
    • NOT for those w/ impaction of obstruction
  16. wetting agents
    • stool softeners
    • Docusate
    • ensure fluid intake
    • not w/n 1hr of PO meds
    • do not crush
    • short term use
  17. irritant or stimulant laxatives
    • Castor oil
    • assess for contraindications (obstructions)
    • give on empty stomach
    • do not crush
    • use < 1 week
  18. nrsg interventions of constipation
    • monitor stools
    • encourage fluids and activity
    • educate about BM routine, dietary fiber, use of laxatices
  19. appendicitis

    patho
    inflamm of appendix

    obstruction -> distention -> inc pressure -> inpaired bld supply -> inflam, edema, ulceration, infection
  20. stages of appendicitis
    • simple= inlfamm but intact
    • gangrenous
    • perforated
  21. S & Sx of appendicitis
    • continuous abd pain
    • upper abd pain -> RLQ pain
    • aggravated by moving, walking, coughing
    • rebound tenderness
    • low grade temp
    • anorexia
    • N/V
  22. Dx of appendicitis

    Tx
    • abd ultrasound, x-ray
    • CBC
    • inc WBC
    • inc bands

    • Tx:
    • -appendectomy
    • IV fluids
    • Abx
    • pain control
  23. complications of appendicitis
    • perforation
    • abcess
    • peritonitis
  24. Peritonitis
    • inflamm of peritoneum
    •  -double layered serous membrane
    •  -space b/w parietal and vicseral layers

    • sterile peritoneal cavity contaminated
    •  -chemical= usually from upper perforation (acidity
    •  -Bacterial= from lower perforation
  25. S & Sx of peritonitis
    • acute abd:
    •  -severe pain
    •  -rigid abd
    •  -dim or absent BS

    • systemic:
    •  -fever
    •  -inc HR and RR
  26. Dx of peritonitis

    Tx
    • WBC > 20,000
    • abd x-ray
    • paracentesis

    • Tx= meds
    • IV
    • bedrest in fowlers
    • NG
    • surgery
    •  -laparotomy (open)
    •  -peritoneal lavage -rinse it out
  27. complications of peritonitis
    • abcess
    • septicemia -> sepsis
    • hypovolemic shock
    • inc'd mortatilty rate
  28. Inflam bowel diseases
    • chrones
    • ulcerative colitis

    • etiology unknown
    • age; adolescents and young adults
    • Diseases of remission and exacerbations
  29. ulcerative colitis
    • LLQ pain
    • continuous movement from rectum up
    • granular, fraible, thin, blds easy tissue
    • 2-30 stools/day

    acute comp= toxic megacolon
  30. chrones disease
    • RLQ pain
    • patchy and skips around in bowel
    • cobblestone, ulcers and fissures
    • frequent stools

    acute comp= obstruction, fistula
  31. IBD Dx
    • endoscopies
    • upper and lower barium
    • stool exam and culture
    • CBC for anemia
    • Sed rate= blood test. If inc. rate, there is an immune response somewhere in the body
    • Serum albumin= malnutrition
  32. IBD meds
    • primary Tx = Anti-inflammatories
    • corticoid steroids, only during exacerbation
    • immunosurpressants
    • immune response modulators
    • antibio therapy
    • antidiarrheal agents cautiously, if at all
  33. IBD nutrition
    • high kilocalorie and protein
    • low fat, fiber, and residue
    • bland
    • avoid: raw veggie, whole grain bread, spicy
  34. U colitis complications
    • toxic megacolon
    • hemorrhage
    • perforation
  35. toxic megacolon
    • -acute motor paralysis and diliation of colon
    •  -triggered by laxative, meds, HyopK 
    • -Sx= fever, inc HR, dec BP, dehydration
  36. chrones complications
    • intestinal obstruction - rest the bowel
    • fistula - abscess, chills, fever, abd mass, UTI
  37. IBD surgery
    • resection of affected bowel
    • -cholectomy
    • -ostomy
    • -inc risk of fistula formation

    • UC is CURED with colectomy
    • Chrone's recurs after surgery b/c it is patchy
  38. intestinal obstruction:
    mechanical vs functional
    • mech= palpable
    • outside intestine - tumor pressing on intestine
    • within the intestine

    • fcnt= nothing stuck, just parastalsis fails
    • paralytic illeus
  39. small bowel obstruction types 1-3
    simple= 1 section of lumen obstructed (adhesions)

    closed loop= 2 sections of lumen (incarcerated hernia (sm bowel pushed through ulcer)

    stragulated= closed loop that is cutting off own blood supply
  40. intestinal obstruction S & Sx
    • abd pain
    • vomit- look for fecal matter in vomit
    • borbygmus
    • absent BS
    • Hypovolemia
    • HypoK
  41. complications of intestinal obstruction

    Tx
    • hypovolemic shock
    • gangrene
    • perforation

    • Tx= fluid and Elyte status
    • NG suction
    • NPO
    • laparotomy
  42. Diverticula
    • 1 of the small outpouching in colon
    • most common in sigmoid
  43. Diverticulosis


    complications of
    • presence of diverticulas
    • mostly asymptomatic
    • episodic, left sided pain

    comps= hemoorhage, diverticulitis
  44. diverticulitis

    complications of
    • inflam and bacterial proliferation w/n a diverticula
    • left sided pain, N/V, low greade fever
    • abd distended and tender

    comps= peritonitis, abcess formation, bowel obstruction, fistula formations, hemorrhage
  45. Dx of diverticular diseases

    Tx
    barium swallow, scopes, heme is stool, WBC shift left

    T= antibios, pain control, inc fiber diet, NPO for -itis, possibly surgery

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