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Lower GI

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cdunbar4's version from 2016-10-22 01:45

Diarrhea

Question Answer
Definitionpassage of at least 3 liquid/loose stools per day
When is it chronic?if it lasts longer than 4 weeks
causesinfections; food or drug; some other pathology
viral causes rotavirus; norovirus
bacterial causese.coli; shigella; salmonella; staph; c. diff; c. perfringens; camplyobacter jejuni
parasitic causesgiardia lamblia; cryptosporidium
Diagnostics used if diarrhea persistsstool cultures (blood, Ova & Parasites, mucus); CBC (anemia)
Collaborative care depends onthe cause: if it is a food or drug, eliminate it from ingestion!
If losses are severe, what parenteral administrations can help to replace?fluids, electrolytes, vitamins & nutrition
Anti-diarrheal drug examplesbismuth subsalicylate (Pepto-Bismol); calcium polycarbophil (Mitrolan); diphenoxylate with atropine (Lomotil)
C. Diff can survive for up to how many days?70
If c.diff doesn't resolve after antibiotic therapy ceases, what antibiotics can be used to treat it?metronidazole or vancomycin
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Fecal Incontinence

Question Answer
Definitioninvoluntary passage of stool; occurs when normal structures that maintain continence are disrupted
Causes?Neuro, muscular or trauma (OB)
Risk Factors urinary stress incontinence; constipation & diarrhea
What is fecal impaction?accumulation of hardened feces in the rectum or sigmoid colon that cannot be expelled
Result of fecal impaction?Incontinence occurs as liquid stool seeps around the mass of hardened feces
Surgeries that can damage the sphincters and pudendal nerveshemmorrhoidectomy and colectomy
Neurologic conditions that interfere with defecationstroke, spinal cord injury, MS, Parkinson's and diabetic neuropathy
Nursing Goalspredictable patterns of BM; maintain perianal skin integrity; participate in work and social activities and avoid self-esteem problems r/t problems with bowel control
Bowel traininglearn usual pattern per patient and try to duplicate (if unsure, try w/in 30 minutes of bfast)
3 options that can help to facilitate or expedite BM if ambulation isn't workingglycerin suppository (dulcolax); phosphate enema (Fleets); or digital stimulation (esp. if neuro)
Last resort to get BM rectal tube (last resort because it stifles the sphincter response)
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Constipation

Question Answer
"normal" amount of BM's a day3 daily or 1 every 3 days (varies with each person→ find out their norm
Causesinsufficient fiber intake; ↓ physical activity; drugs (opioids); some diseases like Parkinson's or MS (slow transit time); emotions/stress
Bulk forming drug examplepsyllium (Metamucil)→ absorbs water, ↑ bulk = stimulates peristalsis
stool softeners and lubricants drug examplesdocusate (Colace); mineral oil (Fleet's oil) → lubricates stool making it easier to pass (does NOT effect peristalsis)
saline and osmotic solution drug examplesMg salts (MOM); Na phosphates (Fleet Enema); lactulose (Constulose); polyethylene glycol (Miralax) → cause retention of fluid in intestinal lumen by osmotic effect
stimulants drug examplessenna; biscodyl (Dulcolax) → ↑ peristalsis by irritating colon wall and stimulating enteric nerves
Clinical Manisdiscomfort, lack of stools, distention, bloating, flatus
Most common complicationhemorrhoids
Disorders that you need to be careful with (think about Valsalva Maneuver and the change in pressure before/after)?HF, CAD, cerebral edema → patients "bear down" and ↑ intra-abd/thoracic pressure = ↓ venous return to the heart (these patients can't compensate as quickly) = dizzy/fall
Diagnosticsgood h & p for normal/baseline, diet/exercise, laxatives?
pictures that can be taken if there is an obstruction or structure problemxray, barium enemas, c-scope, sigmoidscope
collaborative care↑ fluid/fiber & activity
enemas act quickly, what is a risk of using these to diagnose?perforation!
Foods high in fiberapples, beans, broccoli, squash, blackberries, raspberries, bran cereal, whol grain bread, canned peas
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Acute Abdominal Pain

Question Answer
common causesabd compartment syndrome; acute pancreatitis; appendicitis; obstruction; "-itis'"; PID; perforation; aneurysm; ruptured ectopic pregnancy
Clinical ManisPAIN; n/v, diarrhea, constipation, farting, fatigue, fever, vomitting
DiagnosticsH&P usually tells the story. Pain: freq., onset, timing, duration, location...
Nursing AssessmentsVS (watch for ↑ pulse & ↓ BP could go into shock); ↑ temp = inflammation or infection; I/O; skin color;
If bowel sounds are diminished, what could this indicate?obstruction, peritonitis, paralytic ileus
Why is sudden relief of pain a bad sign?it popped = ↓ pressure (and pain)
Nursing Goals↓ pain, ↓ inflammation, no complications, normal nut'l status
Palpation techniquesbe very careful, don't push as the abdomen is "board-like" and can perforate easily
Nursing ManagmentF/E, pain, anxiety; calm & quiet; NG tube (most often); assess and re-assess
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Chronic Abdominal Pain

Question Answer
acute pain is more likely sharp, chronic is...dull, feels like pressure
causesMany! IBS, PUD, pancreatitis, PID, hepatitis → get a good H&P!!
H&P questionsPain OLDCARTS
Diagnosticssame as acute (get a picture of insides)...maybe an exploratory lap if you can't figure out what is wrong
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