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Nursing 111: Test 4 Objectives
Module III: Unit C
62
Other
Undergraduate 1
04/02/2009

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Cards

Term
What is diarrhea?
Definition
Increase in frequency, fluid volume, and volume of stools.
Term
What are some reasons for diarrhea?
Definition
many reasons: decreased fluid absportion, increased fluid secretion
Term
What are some results of diarrhea?
Definition

dehydration

electrolye imbalance

hypovolemic shock

Term
What is the difference between acute and chronic diarrhea?
Definition

Acute - infection

Chronic - remission and exacerbation

Term
How is diarrhea evaluated?
Definition

r/o infection

hx

WBC

worms

previous surgery

stress 

change in diet

medication use

foreign travels

physical exam

Term
How is diarrhea therapeutically managed?
Definition

IV fluid replacement for dehydration

preven spread of infection

oral replacement therapy

replace fluids, monitor and observe

Term
What are some causes of diarrhea?
Definition
Intestinal infection, bacterial, viral, parasitic, fungal overgrowth, food intolerance, malabsorption, medications, colon disease, irritable bowel syndrome, intestinal obstruction, emotional stress, infectious disease
Term
What are the two major groups of inflammatory bowel disease?
Definition
Chron's disease and ulcerative colitis
Term
What is the causation of ulcerative colitis?
Definition

Exact unknown

Infectious agent

Autoimmune reaction

Term

When does ulcerative colitis usually occur?

What ethnicity is most affected?

Definition

15-25 years

60-80 years

Caucasian

Term
What is ulcerative colitis characterized by?
Definition

diffuse inflammation primarily between the rectum and colon

ulceration --> abcess formation

small ulcers to large ulcers

Term
At what site is ulcerative colitis?
Definition
rectum to sigmoid colon, can migrate to entire colon
Term
What is the impact of ulcerative colitis on the colon?
Definition
drainage from pus, sloughing, ulceration, bleeding, diarrhea containing blood and pus
Term
What happens to the bowel with ulcerative colitis?
Definition

bowel narrows and shortens because of fibrous strictures

remission and exacerbation

Term
What are the symptoms of ulcerative colitis?
Definition

abdominal pain and cramping

uncontrollable straining (tenemes)

blood diarrhea (10-20/day)

 

Term
What are findings of a physical assessment of a patient with ulcerative colitis?
Definition

fever

weight loss

anemia

tachycardia

dehydration

protein loss

decreased HG and HCT

Term
What are some complications of ulcerative colitis?
Definition

hemorrhage

strictures --> obstruction

systemic perforation

toxic megacolon

Term
Lewis pg 1053
Definition
Term
What will the hgb and hct of a person with ulcerative colitis be?
Definition
decreased due to anemia
Term
What will the WBCs, electrolytes, albumin of a person with ulcerative colitis look like?
Definition

elevated

off

decreased

Term
What diagnostic tests are performed on a pt with suspected colitis?
Definition

lab values

stool for blood/pus/mucus/cultures

sigmoidoscopy and colonoscopy

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

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

Term

What are some examples of sedatives used to treat ulcerative colitis?

What is their action?

Definition

valium

decrease restlessness and anxiety

Term

What are some examples of antidiarrheals used to treat ulcerative colitis?

What action is performed?

Definition

lamodel (narcotic and atrepine)

action: GI motility

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

Term
What percentage of patients suffering from ulcerative colitis need surgery?
Definition
25-45%
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)
Term
What are the procedures for ulcerative colitis?
Definition

colostomy

ilieostomy

(sometimes reconstructed)

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

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

Term
pg. 1017
Definition
Term
LDH 1073 or 1075
Definition
Term
What are some foods that may cause gas in a patient with a stoma?
Definition
alcohol, beer, chives, beans, eggs, fried foods, melons, onions, peppers, pickles, cabbage, soft drinks
Term
What are some food that may cause stomal blockage in a patient with a stoma?
Definition
bean sprouts, coconut, corn, popcorn, mushrooms, nuts, olives, peas and pickles, pineapple, skins and seeds
Term
What are some foods that may help to control diarrhea in a pt with a stoma?
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
Term
What parts of the GI tract is affected by Crohn's disease?
Definition
any part
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

Term
What are clinical manifestations of Crohn's disease?
Definition

severe diarrhea

major mulnutrition

Term
What is diverticulosis?
Definition
outpuchin/herniations that push through the lining surrounding muscle, usually in sigmoid colon
Term
How is diverticulosis treated?
Definition
high fiber diet, lots of water, exercise
Term
What is diverticulitis?
Definition
inflammation as stool gets caught into herniated wall, perforation may occur
Term
Should diverticulitis be treated with fiber?
Definition
Low fiber.
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)

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
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

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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