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IBS & Abdominal Trauma

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cdunbar4's version from 2016-11-05 16:15

IBS etiology, treatment

Question Answer
What do we mean by "Common Functional Bowel Disorder?"no known organic (structural or biochemical) cause is seen...no physical abnormalities seen but patient may have alterations in bowel patterns
Women or men more likely?women
Disorders it is usually associated withdepression, anxiety, sexual abuse, PTSD
Diagnostics are used in order to rule out other disorders (cancer, IBD, etc.)....listen to patient!
What is the best type of nurse you can be for a patient with IBS? Get a trusting relationship with them → usually a stress/anxiety component, don't let more stress exacerbate the problem
Rome criteriaabdominal discomfort or pain for at least 3months (with onset of at least 6 months before that has 2 of the following: relief with defecation; onset associated with a change in stool frequency; onset associated with a change in stool appearance
Treatment is directed at psychologic and dietary factors
If what 6 s/s occur, it may signal something serious...weight loss, persistent diarrhea, fever, rectal bleeding, severe constipation, rectal bleeding, anemia and fever
Differential DiagnosisMalabsorption, dietary factors, infection, colorectal cancer, IBD, psychological disorders, gynecologic disorders, PUD
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IBS CC

Question Answer
Collaborative Care (based on dominant sx & their severity & on psychosocial factors)medical management, diet, psychological or behavioral options
Possible CC interventionsdiet mod, fiber therapy, antispasmodics, anti-diarrhea medication, laxatives, pain treatment (antidepressants)
Antidepressant used to treat IBSCymbalta
Nutrition Therapy-eliminate gas producing foods...which are?brown beans, brussel sprouts, cabbage, grapes, cauliflower, raw onions, plums, raisins
Nutrition therapy-eliminate: fructose, sorbitol AND determine if lactose intolerant
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IBS Drug Therapy

Question Answer
Antispasmodicsdicyclomine (Bentyl)→ has anticholinergic SE's
Opioidloperamide (Imodium) ↓'s intestinal transit and enhances intestinal water absorption and sphincter tone
antidiarrhealalosetron (Lotronex) Only prescribed for women with severe IBS & diarrhea who haven't responded to other IBS therapies
Anticholinergicsanticholinergics, tricyclic antidepressants, SSRI's, Serotonin Antagonists
Tricyclic Antidepressantsimipramine (Tofranil) has anticholinergic effects
SSRI'ssertraline; escitalopram
Serotonin Antagonistsmost widely prescribed for chemo-induced n/v
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Abdominal Trauma

Question Answer
Usually occurs as a result ofblunt trauma or penetration injuries
complicationslaceration of organs can cause peritonitis and sepsis; compartment syndrome intra-abdominally; hypovolemic shock
Manis guarding/splinting; distention; ↓ bowel sounds; contusions, abrasion; acute pain; scapula pain via phrenic nerve; hematemesis or hematuria;
S/S of hypovolemic shock↓ LOC; tachypnea; tachycardia; ↓ BP; ↓ pulse pressure
The key is diagnosis, then intervention is driven by that. What kind of diagnostics are used.CBC baseline & urinalysis; ABGs; prothrombin time; electrolytes; BUN & creatinine; & type crossmatch
What will happen to the Hct and Hgb?Will remain normal because fluid and blood are being lost at the same rate...deficiencies will be evident after fluid resuscitation begins.
Blood in urine may be a sign of?Damage to kidney or bladder
What is a diagnostic peritoneal lavage?Inserting a large angiocatheter or peritoneal dialysis catheter into abdomen; syringe attmetps to aspirate blood. IF <10mL → 1L of saline solution is infused & then drained to evaluate.
Evaluation of peritoneal lavage? (If +, immediate surgery is needed!)Observed for gross abnormalities (esp. blood) Positive findings = RBC count is >100,000/uL; WBC >500/uL; high amylase; presence of bacteria, bile or fecal matter
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