Podcast
Questions and Answers
Which of the following mechanisms primarily contributes to constipation when fecal matter remains in the rectal cavity for an extended period?
Which of the following mechanisms primarily contributes to constipation when fecal matter remains in the rectal cavity for an extended period?
- Continued absorption of water from the fecal mass. (correct)
- Reduced absorption of bile salts, leading to harder stools.
- Increased peristaltic movement, compacting the feces.
- Increased secretion of electrolytes into the fecal mass.
A patient reports experiencing infrequent bowel movements (less than three times a week) and straining during defecation. Which condition is most likely indicated by these symptoms?
A patient reports experiencing infrequent bowel movements (less than three times a week) and straining during defecation. Which condition is most likely indicated by these symptoms?
- Diarrhea
- Obstipation
- Constipation (correct)
- Fecal impaction
A nurse is teaching a patient about managing constipation. Which dietary modification is most appropriate to recommend?
A nurse is teaching a patient about managing constipation. Which dietary modification is most appropriate to recommend?
- Increasing fiber intake through fruits, vegetables, and whole grains. (correct)
- Limiting physical activity to reduce bowel stimulation.
- Increasing intake of processed foods low in fiber.
- Decreasing fluid intake to reduce stool volume.
A patient with a history of constipation is prescribed a bulk-forming laxative. What is the primary mechanism of action of this type of laxative?
A patient with a history of constipation is prescribed a bulk-forming laxative. What is the primary mechanism of action of this type of laxative?
Which of the following conditions involves inflammation of the colon?
Which of the following conditions involves inflammation of the colon?
A patient is diagnosed with diverticulosis. Which dietary recommendation is most appropriate for managing this condition and preventing diverticulitis?
A patient is diagnosed with diverticulosis. Which dietary recommendation is most appropriate for managing this condition and preventing diverticulitis?
Following an appendectomy, a patient develops peritonitis. Which of the following signs and symptoms would the nurse expect to observe?
Following an appendectomy, a patient develops peritonitis. Which of the following signs and symptoms would the nurse expect to observe?
A patient is scheduled for a colectomy. What does this surgical procedure involve?
A patient is scheduled for a colectomy. What does this surgical procedure involve?
What physiological change occurs when a patient repeatedly ignores the urge to have a bowel movement?
What physiological change occurs when a patient repeatedly ignores the urge to have a bowel movement?
Which of the following is a potential cause of constipation related to medication use?
Which of the following is a potential cause of constipation related to medication use?
Which metabolic condition may contribute to constipation by interfering with normal bowel innervation and function?
Which metabolic condition may contribute to constipation by interfering with normal bowel innervation and function?
Which of the following is a common sign and symptom associated with constipation?
Which of the following is a common sign and symptom associated with constipation?
A patient reports experiencing a sensation of incomplete emptying after bowel movements. Which condition is most likely indicated by this symptom?
A patient reports experiencing a sensation of incomplete emptying after bowel movements. Which condition is most likely indicated by this symptom?
What cardiovascular risk is most associated with straining during bowel movements (Valsalva maneuver) in a patient with a history of heart failure?
What cardiovascular risk is most associated with straining during bowel movements (Valsalva maneuver) in a patient with a history of heart failure?
What is a potential consequence of chronic constipation that involves the development of grossly dilated loops of the colon?
What is a potential consequence of chronic constipation that involves the development of grossly dilated loops of the colon?
Which diagnostic test is LEAST likely to be used in the initial evaluation of constipation?
Which diagnostic test is LEAST likely to be used in the initial evaluation of constipation?
Which of these interventions is considered a first-line treatment for chronic constipation?
Which of these interventions is considered a first-line treatment for chronic constipation?
Besides increased fiber intake, what lifestyle modification is recommended to help alleviate constipation?
Besides increased fiber intake, what lifestyle modification is recommended to help alleviate constipation?
What type of agent is psyllium (Metamucil), commonly recommended for constipation relief?
What type of agent is psyllium (Metamucil), commonly recommended for constipation relief?
For which specific type of constipation are medications like methylnaltrexone (Relistor) typically prescribed?
For which specific type of constipation are medications like methylnaltrexone (Relistor) typically prescribed?
During the nursing assessment of a patient with constipation, what is an important element to gather regarding their history?
During the nursing assessment of a patient with constipation, what is an important element to gather regarding their history?
A study suggests that using a defecation posture modification device (DPMD) may primarily help with constipation by:
A study suggests that using a defecation posture modification device (DPMD) may primarily help with constipation by:
Based on evidence-based practice, what impact does using a defecation posture modification device (DPMD) have on bowel movement duration?
Based on evidence-based practice, what impact does using a defecation posture modification device (DPMD) have on bowel movement duration?
What is a common characteristic of diarrhea resulting from food poisoning?
What is a common characteristic of diarrhea resulting from food poisoning?
Which of the following assessment findings would be MOST indicative of dehydration in a patient with diarrhea?
Which of the following assessment findings would be MOST indicative of dehydration in a patient with diarrhea?
An older adult patient is experiencing frequent diarrhea. What potential complication related to perirectal skin should the nurse monitor for?
An older adult patient is experiencing frequent diarrhea. What potential complication related to perirectal skin should the nurse monitor for?
Which of the following diarrhea-related complications poses the greatest risk of mortality in older adults?
Which of the following diarrhea-related complications poses the greatest risk of mortality in older adults?
A patient with diarrhea has recently completed a course of antibiotics. Which diagnostic test is most appropriate to perform?
A patient with diarrhea has recently completed a course of antibiotics. Which diagnostic test is most appropriate to perform?
A patient has been experiencing diarrhea for 2 weeks with no improvement. Which diagnostic test might be considered?
A patient has been experiencing diarrhea for 2 weeks with no improvement. Which diagnostic test might be considered?
A patient with diarrhea is prescribed loperamide (Imodium). Which of the following findings would cause the nurse to question the order?
A patient with diarrhea is prescribed loperamide (Imodium). Which of the following findings would cause the nurse to question the order?
A patient is experiencing diarrhea related to antibiotic use. Besides medications, the nurse should recommend which of the following?
A patient is experiencing diarrhea related to antibiotic use. Besides medications, the nurse should recommend which of the following?
A patient with diarrhea reports black, tarry stools. What is the MOST important action for the nurse to take?
A patient with diarrhea reports black, tarry stools. What is the MOST important action for the nurse to take?
A patient with diarrhea is being discharged home. What dietary instruction is MOST appropriate?
A patient with diarrhea is being discharged home. What dietary instruction is MOST appropriate?
Which of the following findings suggests that a patient with diarrhea should seek medical care?
Which of the following findings suggests that a patient with diarrhea should seek medical care?
A patient is admitted with severe diarrhea and dehydration. Which of the following laboratory results would the nurse expect to find?
A patient is admitted with severe diarrhea and dehydration. Which of the following laboratory results would the nurse expect to find?
Which of the following nursing interventions is MOST important to prevent falls in an older adult patient experiencing diarrhea?
Which of the following nursing interventions is MOST important to prevent falls in an older adult patient experiencing diarrhea?
A nurse is caring for a patient with diarrhea. Which nursing diagnosis takes the highest priority?
A nurse is caring for a patient with diarrhea. Which nursing diagnosis takes the highest priority?
What is the rationale for assessing a patient's recent travel history when evaluating the cause of their diarrhea?
What is the rationale for assessing a patient's recent travel history when evaluating the cause of their diarrhea?
A patient reports experiencing infrequent bowel movements and straining during defecation. Which nursing diagnosis is MOST appropriate based on this information?
A patient reports experiencing infrequent bowel movements and straining during defecation. Which nursing diagnosis is MOST appropriate based on this information?
A nurse is teaching a patient about strategies to manage constipation. Which recommendation is MOST appropriate to promote regular bowel movements?
A nurse is teaching a patient about strategies to manage constipation. Which recommendation is MOST appropriate to promote regular bowel movements?
A patient is prescribed a high-fiber diet to manage constipation. Which food choice BEST exemplifies a high-fiber option that the nurse should recommend?
A patient is prescribed a high-fiber diet to manage constipation. Which food choice BEST exemplifies a high-fiber option that the nurse should recommend?
A patient is experiencing diarrhea as a side effect of antibiotic use. Which dietary adjustment is LEAST likely to help in managing the diarrhea?
A patient is experiencing diarrhea as a side effect of antibiotic use. Which dietary adjustment is LEAST likely to help in managing the diarrhea?
A nurse is providing education to a patient with chronic diarrhea related to irritable bowel syndrome. Which statement is MOST appropriate for the nurse to include?
A nurse is providing education to a patient with chronic diarrhea related to irritable bowel syndrome. Which statement is MOST appropriate for the nurse to include?
A nurse is caring for a patient receiving enteral feedings who develops diarrhea. What is the MOST appropriate initial action to address this issue?
A nurse is caring for a patient receiving enteral feedings who develops diarrhea. What is the MOST appropriate initial action to address this issue?
A nurse is reviewing the laboratory results of a patient with severe diarrhea. Which finding is MOST concerning and requires immediate attention?
A nurse is reviewing the laboratory results of a patient with severe diarrhea. Which finding is MOST concerning and requires immediate attention?
A patient with constipation is prescribed docusate sodium (Colace). The patient asks the nurse how this medication works. Which explanation is MOST accurate?
A patient with constipation is prescribed docusate sodium (Colace). The patient asks the nurse how this medication works. Which explanation is MOST accurate?
A nurse is providing discharge instructions to a patient recovering from an episode of acute diarrhea. Which instruction regarding dietary intake is MOST appropriate?
A nurse is providing discharge instructions to a patient recovering from an episode of acute diarrhea. Which instruction regarding dietary intake is MOST appropriate?
A nurse is assessing a patient who reports having frequent, watery stools for the past three weeks. Based on this information, how should the nurse classify this patient's diarrhea?
A nurse is assessing a patient who reports having frequent, watery stools for the past three weeks. Based on this information, how should the nurse classify this patient's diarrhea?
A patient reports that they have not had a bowel movement in 5 days. What is the most appropriate initial nursing intervention?
A patient reports that they have not had a bowel movement in 5 days. What is the most appropriate initial nursing intervention?
A patient is suspected of having diarrhea caused by an infection. What characteristic of the stool is MOST indicative of an infectious etiology?
A patient is suspected of having diarrhea caused by an infection. What characteristic of the stool is MOST indicative of an infectious etiology?
A patient is diagnosed with constipation. The doctor prescribed an increase in fluids to 2-3 L per day. Which patient statement indicates an understanding of this instruction?
A patient is diagnosed with constipation. The doctor prescribed an increase in fluids to 2-3 L per day. Which patient statement indicates an understanding of this instruction?
A nurse is teaching a patient methods to prevent traveler's diarrhea. Which of the following recommendations is MOST important?
A nurse is teaching a patient methods to prevent traveler's diarrhea. Which of the following recommendations is MOST important?
A nurse observes the patient using a DPMD (dorsal penile displacement maneuver) or footstool during defecation. What is the intended outcome of this action?
A nurse observes the patient using a DPMD (dorsal penile displacement maneuver) or footstool during defecation. What is the intended outcome of this action?
What is the primary purpose of inserting an orogastric or nasogastric (NG) tube with suction in a patient with abdominal distention related to peritonitis?
What is the primary purpose of inserting an orogastric or nasogastric (NG) tube with suction in a patient with abdominal distention related to peritonitis?
Which of the following complications of peritonitis is directly related to fluid shifting into the abdomen?
Which of the following complications of peritonitis is directly related to fluid shifting into the abdomen?
A patient is diagnosed with diverticulosis after a routine colonoscopy. What does this diagnosis indicate?
A patient is diagnosed with diverticulosis after a routine colonoscopy. What does this diagnosis indicate?
Which of the following factors is thought to contribute to the development of diverticulosis, although not definitively confirmed by research?
Which of the following factors is thought to contribute to the development of diverticulosis, although not definitively confirmed by research?
Why are colonoscopies typically avoided in patients with acute diverticulitis?
Why are colonoscopies typically avoided in patients with acute diverticulitis?
A patient with diverticulitis presents with steady pain in the left lower quadrant, nausea, and constipation. Which of the following diagnostic tests is most appropriate to confirm diverticulitis and rule out complications?
A patient with diverticulitis presents with steady pain in the left lower quadrant, nausea, and constipation. Which of the following diagnostic tests is most appropriate to confirm diverticulitis and rule out complications?
A patient is being treated for mild diverticulitis at home. Which of the following dietary recommendations is most appropriate during the initial 2-3 days of treatment?
A patient is being treated for mild diverticulitis at home. Which of the following dietary recommendations is most appropriate during the initial 2-3 days of treatment?
For a patient hospitalized with severe diverticulitis, which intervention is the highest priority?
For a patient hospitalized with severe diverticulitis, which intervention is the highest priority?
Which symptom, if reported by a patient with diverticulitis, would warrant immediate notification of the health-care provider?
Which symptom, if reported by a patient with diverticulitis, would warrant immediate notification of the health-care provider?
A patient with a history of diverticulitis is experiencing constipation. Which of the following interventions is most appropriate?
A patient with a history of diverticulitis is experiencing constipation. Which of the following interventions is most appropriate?
An older adult patient with diverticulitis reports blood in their stool but is not overly concerned due to impaired vision. What is the most important nursing consideration in this situation?
An older adult patient with diverticulitis reports blood in their stool but is not overly concerned due to impaired vision. What is the most important nursing consideration in this situation?
Which of the following medications is known to increase the risk of diverticulitis?
Which of the following medications is known to increase the risk of diverticulitis?
A patient with diverticulitis is prescribed an antispasmodic medication. What is the primary purpose of this medication?
A patient with diverticulitis is prescribed an antispasmodic medication. What is the primary purpose of this medication?
A patient with diverticulitis is scheduled for a bowel resection with anastomosis. What does this surgical procedure involve?
A patient with diverticulitis is scheduled for a bowel resection with anastomosis. What does this surgical procedure involve?
What vital sign changes are indicative of a potential fluid volume imbalance in a patient with peritonitis or diverticulitis?
What vital sign changes are indicative of a potential fluid volume imbalance in a patient with peritonitis or diverticulitis?
A patient with Crohn's disease is scheduled for a strictureplasty. What is the primary goal of this surgical procedure?
A patient with Crohn's disease is scheduled for a strictureplasty. What is the primary goal of this surgical procedure?
Why is a Kock pouch typically not recommended for patients with Crohn's disease?
Why is a Kock pouch typically not recommended for patients with Crohn's disease?
A patient with Crohn's disease is experiencing frequent diarrhea. Which dietary recommendation is most appropriate?
A patient with Crohn's disease is experiencing frequent diarrhea. Which dietary recommendation is most appropriate?
What is the primary difference between ulcerative colitis and Crohn's disease in terms of location?
What is the primary difference between ulcerative colitis and Crohn's disease in terms of location?
A patient with ulcerative colitis is prescribed sulfasalazine. What is an important nursing consideration related to this medication?
A patient with ulcerative colitis is prescribed sulfasalazine. What is an important nursing consideration related to this medication?
A patient with ulcerative colitis is experiencing frequent diarrhea. Which of the following electrolyte imbalances is most likely to occur?
A patient with ulcerative colitis is experiencing frequent diarrhea. Which of the following electrolyte imbalances is most likely to occur?
A patient with inflammatory bowel disease (IBD) is prescribed infliximab. What potential adverse effect should the nurse closely monitor the patient for?
A patient with inflammatory bowel disease (IBD) is prescribed infliximab. What potential adverse effect should the nurse closely monitor the patient for?
A patient with Crohn's disease is prescribed budesonide. What specific instruction should the nurse provide regarding the administration of this medication?
A patient with Crohn's disease is prescribed budesonide. What specific instruction should the nurse provide regarding the administration of this medication?
In a newly diagnosed patient with ulcerative colitis, which diagnostic test is most useful in determining the extent and severity of the disease?
In a newly diagnosed patient with ulcerative colitis, which diagnostic test is most useful in determining the extent and severity of the disease?
A patient with long-standing ulcerative colitis is at increased risk for which of the following complications?
A patient with long-standing ulcerative colitis is at increased risk for which of the following complications?
What is the primary action of 5-aminosalicylates in the treatment of IBD?
What is the primary action of 5-aminosalicylates in the treatment of IBD?
A patient with IBD is prescribed azathioprine. What is a critical nursing implication for this medication?
A patient with IBD is prescribed azathioprine. What is a critical nursing implication for this medication?
A patient with Crohn's disease is experiencing malabsorption. Which intervention is most appropriate to address this issue?
A patient with Crohn's disease is experiencing malabsorption. Which intervention is most appropriate to address this issue?
Which of the following is a common trigger that can exacerbate ulcerative colitis symptoms?
Which of the following is a common trigger that can exacerbate ulcerative colitis symptoms?
A patient with severe ulcerative colitis is experiencing toxic megacolon. What is the primary concern associated with this complication?
A patient with severe ulcerative colitis is experiencing toxic megacolon. What is the primary concern associated with this complication?
Which of the following is the primary goal of therapeutic measures for Crohn's disease, given that there is currently no cure?
Which of the following is the primary goal of therapeutic measures for Crohn's disease, given that there is currently no cure?
A patient with Crohn's disease is experiencing frequent cramping after meals, which is leading to decreased food intake. What is the most likely consequence of this behavior?
A patient with Crohn's disease is experiencing frequent cramping after meals, which is leading to decreased food intake. What is the most likely consequence of this behavior?
A patient diagnosed with Crohn's disease develops a fistula between the small bowel and the skin. Which type of fistula is this?
A patient diagnosed with Crohn's disease develops a fistula between the small bowel and the skin. Which type of fistula is this?
A patient with Crohn's disease is prescribed infliximab. What is the primary mechanism of action of this medication?
A patient with Crohn's disease is prescribed infliximab. What is the primary mechanism of action of this medication?
Which diagnostic finding is most indicative of Crohn's disease when analyzing a biopsy specimen from the affected area?
Which diagnostic finding is most indicative of Crohn's disease when analyzing a biopsy specimen from the affected area?
What is the rationale behind using antibiotics in the treatment of Crohn's disease?
What is the rationale behind using antibiotics in the treatment of Crohn's disease?
A patient with Crohn's reports increased frequency of bowel movements that are watery. Besides anti-diarrheal medications, which type of laxative could paradoxically help reduce the irritation and frequency?
A patient with Crohn's reports increased frequency of bowel movements that are watery. Besides anti-diarrheal medications, which type of laxative could paradoxically help reduce the irritation and frequency?
Which of the following is a risk factor that increases a person's likelihood of developing Crohn's disease?
Which of the following is a risk factor that increases a person's likelihood of developing Crohn's disease?
Why are patients with Crohn's disease monitored for malignant or premalignant lesions?
Why are patients with Crohn's disease monitored for malignant or premalignant lesions?
How do multiphase CT enterography and magnetic resonance enterography (MRE) contribute to the diagnosis and management of Crohn's disease?
How do multiphase CT enterography and magnetic resonance enterography (MRE) contribute to the diagnosis and management of Crohn's disease?
A Crohn's disease patient's care plan includes the nursing diagnosis 'Risk for Deficient Fluid Volume'. Which assessment finding would most strongly support this diagnosis?
A Crohn's disease patient's care plan includes the nursing diagnosis 'Risk for Deficient Fluid Volume'. Which assessment finding would most strongly support this diagnosis?
Which of the following is the rationale for maintaining IV fluid replacement for a patient with Crohn's disease?
Which of the following is the rationale for maintaining IV fluid replacement for a patient with Crohn's disease?
A patient is prescribed an oral enteric-coated budesonide. Which of the following is the most important instruction the nurse should give to the patient about taking this medication?
A patient is prescribed an oral enteric-coated budesonide. Which of the following is the most important instruction the nurse should give to the patient about taking this medication?
Which assessment best reflects that goals for a patient, experiencing Crohn's disease symptoms, are being successfully met?
Which assessment best reflects that goals for a patient, experiencing Crohn's disease symptoms, are being successfully met?
In managing Crohn's disease, why is it important to monitor a patient's weight daily?
In managing Crohn's disease, why is it important to monitor a patient's weight daily?
Which diagnostic finding is most indicative of ulcerative colitis based on laboratory tests?
Which diagnostic finding is most indicative of ulcerative colitis based on laboratory tests?
A patient with ulcerative colitis is scheduled for a colonoscopy. What is the primary purpose of this procedure in diagnosing and managing the patient's condition?
A patient with ulcerative colitis is scheduled for a colonoscopy. What is the primary purpose of this procedure in diagnosing and managing the patient's condition?
What is the rationale behind avoiding high-fiber foods, caffeine, spicy foods, and milk products in the dietary management of ulcerative colitis?
What is the rationale behind avoiding high-fiber foods, caffeine, spicy foods, and milk products in the dietary management of ulcerative colitis?
A patient with severe ulcerative colitis is scheduled for a proctocolectomy with ileostomy. What does this surgical procedure entail?
A patient with severe ulcerative colitis is scheduled for a proctocolectomy with ileostomy. What does this surgical procedure entail?
What is the primary advantage of an ileoanal pouch (restorative proctocolectomy) compared to a proctocolectomy with ileostomy?
What is the primary advantage of an ileoanal pouch (restorative proctocolectomy) compared to a proctocolectomy with ileostomy?
A patient who underwent an ileoanal pouch procedure reports an increased frequency of bowel movements and abdominal cramping. Which complication is most likely indicated?
A patient who underwent an ileoanal pouch procedure reports an increased frequency of bowel movements and abdominal cramping. Which complication is most likely indicated?
A patient with ulcerative colitis reports significant weight loss over the past two months. Which nursing intervention is most appropriate to address this issue?
A patient with ulcerative colitis reports significant weight loss over the past two months. Which nursing intervention is most appropriate to address this issue?
What is the primary nursing intervention for a patient experiencing perianal skin irritation related to frequent loose stools?
What is the primary nursing intervention for a patient experiencing perianal skin irritation related to frequent loose stools?
A patient with ulcerative colitis expresses anxiety and fear related to the unpredictability of their bowel movements. Which nursing intervention is most appropriate to address this concern?
A patient with ulcerative colitis expresses anxiety and fear related to the unpredictability of their bowel movements. Which nursing intervention is most appropriate to address this concern?
What information should the nurse prioritize when teaching a patient about potential symptoms of dehydration related to diarrhea?
What information should the nurse prioritize when teaching a patient about potential symptoms of dehydration related to diarrhea?
Following a new diagnosis of ulcerative colitis, a patient asks about the long-term risks associated with the condition. What should the nurse include in their response?
Following a new diagnosis of ulcerative colitis, a patient asks about the long-term risks associated with the condition. What should the nurse include in their response?
Which of the following is the priority nursing intervention when caring for a patient experiencing acute pain related to increased peristalsis and cramping from ulcerative colitis?
Which of the following is the priority nursing intervention when caring for a patient experiencing acute pain related to increased peristalsis and cramping from ulcerative colitis?
A patient with ulcerative colitis is prescribed an anti-inflammatory medication. What is the primary goal of this medication in managing the patient's condition?
A patient with ulcerative colitis is prescribed an anti-inflammatory medication. What is the primary goal of this medication in managing the patient's condition?
A patient is scheduled for leukocyte scintigraphy. What is the purpose of this diagnostic test in the evaluation of inflammatory bowel disease?
A patient is scheduled for leukocyte scintigraphy. What is the purpose of this diagnostic test in the evaluation of inflammatory bowel disease?
Which assessment finding would be most concerning in a patient with ulcerative colitis?
Which assessment finding would be most concerning in a patient with ulcerative colitis?
What is the primary rationale for nurses to keep perianal skin clean, dry, and protected after bowel movements?
What is the primary rationale for nurses to keep perianal skin clean, dry, and protected after bowel movements?
What physiological factor is thought to contribute to the symptoms of Irritable Bowel Syndrome (IBS)?
What physiological factor is thought to contribute to the symptoms of Irritable Bowel Syndrome (IBS)?
Which of the following actions should be prioritized when providing skin care to a patient with frequent diarrhea?
Which of the following actions should be prioritized when providing skin care to a patient with frequent diarrhea?
Why might a physician recommend a special elemental liquid formula for a patient experiencing malabsorption?
Why might a physician recommend a special elemental liquid formula for a patient experiencing malabsorption?
A patient with Inflammatory Bowel Disease (IBD) is experiencing significant weight loss. Besides nutritional supplements, what other intervention might be essential?
A patient with Inflammatory Bowel Disease (IBD) is experiencing significant weight loss. Besides nutritional supplements, what other intervention might be essential?
A patient diagnosed with Irritable Bowel Syndrome (IBS) reports experiencing alternating episodes of constipation and diarrhea. Which classification of IBS is most appropriate for this patient?
A patient diagnosed with Irritable Bowel Syndrome (IBS) reports experiencing alternating episodes of constipation and diarrhea. Which classification of IBS is most appropriate for this patient?
What distinguishes Irritable Bowel Syndrome (IBS) from Inflammatory Bowel Disease (IBD)?
What distinguishes Irritable Bowel Syndrome (IBS) from Inflammatory Bowel Disease (IBD)?
How does stress management contribute to the overall treatment of Irritable Bowel Syndrome (IBS)?
How does stress management contribute to the overall treatment of Irritable Bowel Syndrome (IBS)?
Which of the following is an important consideration regarding dietary management for patients with Irritable Bowel Syndrome (IBS)?
Which of the following is an important consideration regarding dietary management for patients with Irritable Bowel Syndrome (IBS)?
What is the purpose of using psyllium (Metamucil) for a patient with Irritable Bowel Syndrome (IBS)?
What is the purpose of using psyllium (Metamucil) for a patient with Irritable Bowel Syndrome (IBS)?
What is the rationale behind keeping a food diary for patients with Irritable Bowel Syndrome (IBS)?
What is the rationale behind keeping a food diary for patients with Irritable Bowel Syndrome (IBS)?
Which of the following is the BEST initial action for a nurse to take when caring for a patient newly diagnosed with Crohn's disease?
Which of the following is the BEST initial action for a nurse to take when caring for a patient newly diagnosed with Crohn's disease?
A patient newly diagnosed with Crohn's disease expresses feelings of anxiety and uncertainty about managing the condition. Which intervention is most appropriate?
A patient newly diagnosed with Crohn's disease expresses feelings of anxiety and uncertainty about managing the condition. Which intervention is most appropriate?
A nurse identifies that a patient with IBD is having difficulty coping with their condition. Which of the following outcome statements would indicate successful coping?
A nurse identifies that a patient with IBD is having difficulty coping with their condition. Which of the following outcome statements would indicate successful coping?
An IBS patient has identified that the consumption of dairy products makes their symptoms worse, what is the most appropriate intervention?
An IBS patient has identified that the consumption of dairy products makes their symptoms worse, what is the most appropriate intervention?
Which of the following factors is LEAST likely to contribute to the development of an umbilical hernia?
Which of the following factors is LEAST likely to contribute to the development of an umbilical hernia?
A patient is diagnosed with an irreducible hernia. What does this finding indicate?
A patient is diagnosed with an irreducible hernia. What does this finding indicate?
Following a herniorrhaphy, a patient reports severe pain and a tense, distended abdomen. What is the priority nursing intervention?
Following a herniorrhaphy, a patient reports severe pain and a tense, distended abdomen. What is the priority nursing intervention?
A patient preparing for discharge after a laparoscopic inguinal hernia repair asks about resuming activities. Which instruction is MOST appropriate?
A patient preparing for discharge after a laparoscopic inguinal hernia repair asks about resuming activities. Which instruction is MOST appropriate?
Following an inguinal hernia repair, a male patient develops scrotal swelling. Which intervention is MOST appropriate for the nurse to implement initially?
Following an inguinal hernia repair, a male patient develops scrotal swelling. Which intervention is MOST appropriate for the nurse to implement initially?
A patient with a history of celiac disease presents with fatigue, weight loss, and frequent, foul-smelling stools. What is the MOST likely cause of these symptoms?
A patient with a history of celiac disease presents with fatigue, weight loss, and frequent, foul-smelling stools. What is the MOST likely cause of these symptoms?
A patient with suspected lactose intolerance is advised to undergo diagnostic testing. Which test is MOST likely used to confirm this diagnosis?
A patient with suspected lactose intolerance is advised to undergo diagnostic testing. Which test is MOST likely used to confirm this diagnosis?
Which dietary modification is MOST important for a patient newly diagnosed with celiac disease?
Which dietary modification is MOST important for a patient newly diagnosed with celiac disease?
A patient with malabsorption is at risk for developing hypoprothrombinemia. Which vitamin deficiency is MOST likely the cause?
A patient with malabsorption is at risk for developing hypoprothrombinemia. Which vitamin deficiency is MOST likely the cause?
A patient with prolonged malabsorption develops neuromuscular hyperirritability and tetany. Which electrolyte imbalance is MOST likely responsible?
A patient with prolonged malabsorption develops neuromuscular hyperirritability and tetany. Which electrolyte imbalance is MOST likely responsible?
What should a nurse emphasize when teaching a patient about preventing hernias?
What should a nurse emphasize when teaching a patient about preventing hernias?
A nurse is assessing a patient who reports a bulge in the groin area that disappears when lying down. The patient denies pain but reports a feeling of heaviness. What type of hernia does this MOST likely indicate?
A nurse is assessing a patient who reports a bulge in the groin area that disappears when lying down. The patient denies pain but reports a feeling of heaviness. What type of hernia does this MOST likely indicate?
A patient who had abdominal surgery several years ago reports a bulge near the incision site, especially when straining. Which type of hernia is MOST likely present?
A patient who had abdominal surgery several years ago reports a bulge near the incision site, especially when straining. Which type of hernia is MOST likely present?
A patient with celiac disease is reading food labels. Which ingredient should the patient AVOID to prevent triggering symptoms?
A patient with celiac disease is reading food labels. Which ingredient should the patient AVOID to prevent triggering symptoms?
An older adult patient with lactose intolerance is concerned about maintaining adequate calcium intake. What dietary suggestion is MOST appropriate for the nurse to recommend?
An older adult patient with lactose intolerance is concerned about maintaining adequate calcium intake. What dietary suggestion is MOST appropriate for the nurse to recommend?
What does the presence of high-pitched, tinkling bowel sounds proximal to an obstruction and muffled or absent sounds distal to it indicate?
What does the presence of high-pitched, tinkling bowel sounds proximal to an obstruction and muffled or absent sounds distal to it indicate?
Which assessment finding is MOST concerning in a patient with a bowel obstruction and suggests a potential complication requiring immediate intervention?
Which assessment finding is MOST concerning in a patient with a bowel obstruction and suggests a potential complication requiring immediate intervention?
A patient with a bowel obstruction is at risk for fluid volume deficit. Besides monitoring vital signs and urine output, what other assessment should the nurse prioritize?
A patient with a bowel obstruction is at risk for fluid volume deficit. Besides monitoring vital signs and urine output, what other assessment should the nurse prioritize?
A patient with a large bowel obstruction due to carcinoma is not a good surgical candidate. What alternative therapeutic measure might be considered to facilitate fecal movement?
A patient with a large bowel obstruction due to carcinoma is not a good surgical candidate. What alternative therapeutic measure might be considered to facilitate fecal movement?
A patient with a bowel obstruction has an elevated hematocrit. What does this laboratory finding suggest about the patient's condition?
A patient with a bowel obstruction has an elevated hematocrit. What does this laboratory finding suggest about the patient's condition?
A patient with a complete mechanical bowel obstruction is scheduled for surgery. What is the primary goal of surgical intervention in this situation?
A patient with a complete mechanical bowel obstruction is scheduled for surgery. What is the primary goal of surgical intervention in this situation?
A patient with a large bowel obstruction reports crampy lower abdominal pain. What additional assessment finding would support the diagnosis of large bowel obstruction?
A patient with a large bowel obstruction reports crampy lower abdominal pain. What additional assessment finding would support the diagnosis of large bowel obstruction?
A nurse is caring for a patient with a bowel obstruction who has a nasogastric (NG) tube in place. What is the primary purpose of the NG tube in this situation?
A nurse is caring for a patient with a bowel obstruction who has a nasogastric (NG) tube in place. What is the primary purpose of the NG tube in this situation?
A patient has been NPO for several days due to a bowel obstruction and requires nutritional support. Which method of nutritional support is MOST appropriate?
A patient has been NPO for several days due to a bowel obstruction and requires nutritional support. Which method of nutritional support is MOST appropriate?
What is the potential consequence of an untreated large-bowel obstruction that involves a life-threatening condition due to compromised blood flow?
What is the potential consequence of an untreated large-bowel obstruction that involves a life-threatening condition due to compromised blood flow?
A patient with a bowel obstruction is experiencing extreme thirst, drowsiness, and general malaise. What is the underlying cause of these symptoms?
A patient with a bowel obstruction is experiencing extreme thirst, drowsiness, and general malaise. What is the underlying cause of these symptoms?
A patient with a bowel obstruction is being assessed for pain. Which characteristic of pain is MOST important for the nurse to document?
A patient with a bowel obstruction is being assessed for pain. Which characteristic of pain is MOST important for the nurse to document?
A patient with a bowel obstruction vomits fecal material. What does this finding suggest about the location and severity of the obstruction?
A patient with a bowel obstruction vomits fecal material. What does this finding suggest about the location and severity of the obstruction?
A patient with a large bowel obstruction is being considered for a cecostomy. What is the primary purpose of this procedure?
A patient with a large bowel obstruction is being considered for a cecostomy. What is the primary purpose of this procedure?
A patient with a bowel obstruction has been NPO and is receiving IV fluids. What electrolyte imbalance is the patient MOST at risk for due to nasogastric suctioning?
A patient with a bowel obstruction has been NPO and is receiving IV fluids. What electrolyte imbalance is the patient MOST at risk for due to nasogastric suctioning?
Which of the following meals would be LEAST appropriate for a patient adhering to a low-FODMAP diet?
Which of the following meals would be LEAST appropriate for a patient adhering to a low-FODMAP diet?
A patient with IBS is starting a low-FODMAP diet. What initial guidance should the nurse provide regarding the duration of the elimination phase?
A patient with IBS is starting a low-FODMAP diet. What initial guidance should the nurse provide regarding the duration of the elimination phase?
Which of the following statements best captures the rationale behind restricting FODMAPs in individuals with IBS?
Which of the following statements best captures the rationale behind restricting FODMAPs in individuals with IBS?
A patient with diarrhea-predominant IBS (IBS-D) has not responded to loperamide or dietary changes. Which medication might be considered next, particularly if diarrhea has persisted for over six months?
A patient with diarrhea-predominant IBS (IBS-D) has not responded to loperamide or dietary changes. Which medication might be considered next, particularly if diarrhea has persisted for over six months?
A construction worker with IBS reports increased abdominal pain and bloating after starting a high-protein diet. Which of the following FODMAPs is LEAST likely to be contributing to his symptoms?
A construction worker with IBS reports increased abdominal pain and bloating after starting a high-protein diet. Which of the following FODMAPs is LEAST likely to be contributing to his symptoms?
A patient with a history of abdominal surgery presents with a distended, firm, and tender abdomen, and reports nausea. Which of the following is the MOST concerning finding that suggests a possible small-bowel obstruction?
A patient with a history of abdominal surgery presents with a distended, firm, and tender abdomen, and reports nausea. Which of the following is the MOST concerning finding that suggests a possible small-bowel obstruction?
A patient with IBS is prescribed an antispasmodic medication. What specific symptom is this medication intended to alleviate?
A patient with IBS is prescribed an antispasmodic medication. What specific symptom is this medication intended to alleviate?
What is the primary rationale for using low-dose tricyclic antidepressants (TCAs) in patients with IBS and diarrhea?
What is the primary rationale for using low-dose tricyclic antidepressants (TCAs) in patients with IBS and diarrhea?
Which of the following physiological factors INCREASES the risk of developing hemorrhoids?
Which of the following physiological factors INCREASES the risk of developing hemorrhoids?
A patient is diagnosed with external hemorrhoids. Which assessment finding is MOST consistent with this condition?
A patient is diagnosed with external hemorrhoids. Which assessment finding is MOST consistent with this condition?
A client with IBS reports feeling overwhelmed by the dietary restrictions of the low-FODMAP diet. Which intervention would be most appropriate?
A client with IBS reports feeling overwhelmed by the dietary restrictions of the low-FODMAP diet. Which intervention would be most appropriate?
A patient with thrombosed external hemorrhoids is seeking non-pharmacological pain relief. Which of the following interventions is MOST appropriate?
A patient with thrombosed external hemorrhoids is seeking non-pharmacological pain relief. Which of the following interventions is MOST appropriate?
A patient with constipation-predominant IBS (IBS-C) is prescribed linaclotide (Linzess). How does this medication help to alleviate constipation?
A patient with constipation-predominant IBS (IBS-C) is prescribed linaclotide (Linzess). How does this medication help to alleviate constipation?
A patient experiences increased flatulence and bloating regardless of their dietary intake. What is the MOST likely cause of these symptoms based on the characteristics of FODMAPs?
A patient experiences increased flatulence and bloating regardless of their dietary intake. What is the MOST likely cause of these symptoms based on the characteristics of FODMAPs?
Following a hemorrhoidectomy, a patient reports severe pain. While NSAIDs and acetaminophen are prescribed, what should be avoided due to potential complications?
Following a hemorrhoidectomy, a patient reports severe pain. While NSAIDs and acetaminophen are prescribed, what should be avoided due to potential complications?
A patient presents with severe rectal pain and bright red bleeding after a bowel movement. The patient reports a history of chronic constipation. Which condition is MOST likely?
A patient presents with severe rectal pain and bright red bleeding after a bowel movement. The patient reports a history of chronic constipation. Which condition is MOST likely?
A patient with IBS is considering using probiotics to manage symptoms. Which statement provides the MOST accurate guidance regarding probiotic use in IBS?
A patient with IBS is considering using probiotics to manage symptoms. Which statement provides the MOST accurate guidance regarding probiotic use in IBS?
Which of the following non-pharmacological interventions is MOST appropriate for promoting healing of anal fissures and reducing discomfort?
Which of the following non-pharmacological interventions is MOST appropriate for promoting healing of anal fissures and reducing discomfort?
During the nursing assessment of a patient with suspected IBS, what aspect of their symptom presentation is MOST crucial to document?
During the nursing assessment of a patient with suspected IBS, what aspect of their symptom presentation is MOST crucial to document?
A patient with a history of IBS is admitted for an unrelated surgical procedure. What is an important nursing consideration regarding their IBS management during their hospital stay?
A patient with a history of IBS is admitted for an unrelated surgical procedure. What is an important nursing consideration regarding their IBS management during their hospital stay?
A patient with suspected celiac disease is undergoing diagnostic testing. Which test result would MOST strongly suggest the patient has celiac disease?
A patient with suspected celiac disease is undergoing diagnostic testing. Which test result would MOST strongly suggest the patient has celiac disease?
A patient is diagnosed with an anorectal abscess. What signs and symptoms would the nurse expect to see?
A patient is diagnosed with an anorectal abscess. What signs and symptoms would the nurse expect to see?
A patient with IBS reports significant anxiety related to unpredictable bowel movements. What intervention is MOST appropriate to address this aspect of their condition?
A patient with IBS reports significant anxiety related to unpredictable bowel movements. What intervention is MOST appropriate to address this aspect of their condition?
A patient newly diagnosed with celiac disease is overwhelmed by the dietary changes required. What is the MOST important initial intervention the nurse should recommend?
A patient newly diagnosed with celiac disease is overwhelmed by the dietary changes required. What is the MOST important initial intervention the nurse should recommend?
A patient is recovering from an incision and drainage of an anorectal abscess. Which nursing intervention is MOST important in promoting healing and preventing complications?
A patient is recovering from an incision and drainage of an anorectal abscess. Which nursing intervention is MOST important in promoting healing and preventing complications?
Besides dietary modifications and medication, what additional information can the nurse provide to a patient with IBS to enhance their self-management skills?
Besides dietary modifications and medication, what additional information can the nurse provide to a patient with IBS to enhance their self-management skills?
A patient with lactose intolerance is planning a diet. Which of the following dairy products is MOST likely to be tolerated without causing significant symptoms?
A patient with lactose intolerance is planning a diet. Which of the following dairy products is MOST likely to be tolerated without causing significant symptoms?
A patient presents with melena. Where is the MOST probable site of bleeding?
A patient presents with melena. Where is the MOST probable site of bleeding?
The nurse is caring for a patient experiencing severe diarrhea due to malabsorption. Which nursing intervention is MOST critical to implement?
The nurse is caring for a patient experiencing severe diarrhea due to malabsorption. Which nursing intervention is MOST critical to implement?
A patient is experiencing hematochezia. Which area of the gastrointestinal tract is the MOST likely source of the bleeding?
A patient is experiencing hematochezia. Which area of the gastrointestinal tract is the MOST likely source of the bleeding?
A post-operative patient reports abdominal distention, cramping pain, and inability to pass flatus. Which condition should the nurse suspect?
A post-operative patient reports abdominal distention, cramping pain, and inability to pass flatus. Which condition should the nurse suspect?
A patient with lower GI bleeding develops tachycardia and worsening hypotension. What should the nurse do FIRST?
A patient with lower GI bleeding develops tachycardia and worsening hypotension. What should the nurse do FIRST?
A patient being evaluated for lower GI bleeding has decreased hemoglobin and hematocrit levels. What does this finding suggest?
A patient being evaluated for lower GI bleeding has decreased hemoglobin and hematocrit levels. What does this finding suggest?
In a patient experiencing a small bowel obstruction, what is the MOST immediate physiological consequence that the nurse should anticipate?
In a patient experiencing a small bowel obstruction, what is the MOST immediate physiological consequence that the nurse should anticipate?
A patient diagnosed with a nonmechanical bowel obstruction (paralytic ileus) has hypokalemia. How does hypokalemia contribute to this condition?
A patient diagnosed with a nonmechanical bowel obstruction (paralytic ileus) has hypokalemia. How does hypokalemia contribute to this condition?
A patient with suspected lower GI bleeding has stools that appear normal. What diagnostic test would be appropriate to assess for occult blood?
A patient with suspected lower GI bleeding has stools that appear normal. What diagnostic test would be appropriate to assess for occult blood?
When providing education to a patient with anorectal problems, such as hemorrhoids or fissures, which dietary instruction is the MOST beneficial for preventing complications and promoting healing?
When providing education to a patient with anorectal problems, such as hemorrhoids or fissures, which dietary instruction is the MOST beneficial for preventing complications and promoting healing?
A patient with a long history of abdominal surgeries is admitted with a suspected small bowel obstruction. What is the MOST likely cause of this obstruction?
A patient with a long history of abdominal surgeries is admitted with a suspected small bowel obstruction. What is the MOST likely cause of this obstruction?
A patient with a small bowel obstruction is experiencing significant abdominal distention. What physiological process directly leads to this distention?
A patient with a small bowel obstruction is experiencing significant abdominal distention. What physiological process directly leads to this distention?
A patient is diagnosed with intussusception. What is the underlying mechanism of this condition?
A patient is diagnosed with intussusception. What is the underlying mechanism of this condition?
The nurse is assessing a patient with a suspected small bowel obstruction. Which assessment finding would indicate a potential complication requiring immediate intervention?
The nurse is assessing a patient with a suspected small bowel obstruction. Which assessment finding would indicate a potential complication requiring immediate intervention?
A patient with celiac disease is experiencing persistent symptoms despite adhering to a gluten-free diet. What should the nurse consider as a potential cause?
A patient with celiac disease is experiencing persistent symptoms despite adhering to a gluten-free diet. What should the nurse consider as a potential cause?
A patient with lactose intolerance reports abdominal discomfort after consuming dairy. Which of the following strategies would be MOST effective in helping the client manage their symptoms while still consuming dairy products?
A patient with lactose intolerance reports abdominal discomfort after consuming dairy. Which of the following strategies would be MOST effective in helping the client manage their symptoms while still consuming dairy products?
A patient with a small bowel obstruction is at risk for decreased venous and arterial capillary pressure. What is the MOST significant consequence of this decreased pressure?
A patient with a small bowel obstruction is at risk for decreased venous and arterial capillary pressure. What is the MOST significant consequence of this decreased pressure?
A nurse is providing dietary teaching to a client with celiac disease. Which of the following grains should the nurse advise the client to AVOID?
A nurse is providing dietary teaching to a client with celiac disease. Which of the following grains should the nurse advise the client to AVOID?
A patient presents with hematochezia. What is the priority initial nursing action?
A patient presents with hematochezia. What is the priority initial nursing action?
Which dietary factor is MOST strongly associated with an increased risk of developing colorectal cancer?
Which dietary factor is MOST strongly associated with an increased risk of developing colorectal cancer?
A patient with colorectal cancer is experiencing persistent nausea and vomiting. Where is the tumor most likely located?
A patient with colorectal cancer is experiencing persistent nausea and vomiting. Where is the tumor most likely located?
Which screening method offers the BEST combination of direct visualization and tissue sampling for colorectal cancer detection?
Which screening method offers the BEST combination of direct visualization and tissue sampling for colorectal cancer detection?
A patient is scheduled for a colectomy with anastomosis. What does this surgical procedure involve?
A patient is scheduled for a colectomy with anastomosis. What does this surgical procedure involve?
What is the primary mechanism of action of monoclonal antibody therapy, such as bevacizumab, in treating colorectal cancer?
What is the primary mechanism of action of monoclonal antibody therapy, such as bevacizumab, in treating colorectal cancer?
Following surgical resection of a colorectal tumor, a patient develops peritonitis. What is the MOST likely cause of this complication?
Following surgical resection of a colorectal tumor, a patient develops peritonitis. What is the MOST likely cause of this complication?
A patient recovering from colorectal cancer surgery asks about the purpose of CEA blood tests. Which explanation is MOST accurate?
A patient recovering from colorectal cancer surgery asks about the purpose of CEA blood tests. Which explanation is MOST accurate?
Which of the following is a potential complication of colorectal cancer that may require emergent surgical intervention?
Which of the following is a potential complication of colorectal cancer that may require emergent surgical intervention?
A patient undergoing treatment for colorectal cancer develops a tumor extension to the peritoneum. Which complication is MOST associated with this?
A patient undergoing treatment for colorectal cancer develops a tumor extension to the peritoneum. Which complication is MOST associated with this?
What is the PRIORITY nursing diagnosis for a patient experiencing significant changes in bowel habits and blood in the stool, suggestive of colorectal cancer?
What is the PRIORITY nursing diagnosis for a patient experiencing significant changes in bowel habits and blood in the stool, suggestive of colorectal cancer?
A patient is prescribed cetuximab (Erbitux) for colorectal cancer. How does this medication work to inhibit cancer growth?
A patient is prescribed cetuximab (Erbitux) for colorectal cancer. How does this medication work to inhibit cancer growth?
What is the rationale for using immunological tests in home screening kits for colon cancer?
What is the rationale for using immunological tests in home screening kits for colon cancer?
Besides surgery, what other treatment modalities may be used in managing colorectal cancer and potentially improving survival rates?
Besides surgery, what other treatment modalities may be used in managing colorectal cancer and potentially improving survival rates?
A patient presents with a change in bowel habits, rectal bleeding, and unexplained weight loss. Which diagnostic test should the nurse anticipate as MOST likely to be ordered FIRST?
A patient presents with a change in bowel habits, rectal bleeding, and unexplained weight loss. Which diagnostic test should the nurse anticipate as MOST likely to be ordered FIRST?
What finding in a post-operative colorectal cancer patient with a perineal wound drain should be immediately reported?
What finding in a post-operative colorectal cancer patient with a perineal wound drain should be immediately reported?
Which of the following intestinal surgeries involves removing the entire colon, rectum, and anus, typically resulting in a permanent ileostomy?
Which of the following intestinal surgeries involves removing the entire colon, rectum, and anus, typically resulting in a permanent ileostomy?
Following a colectomy with anastomosis, a patient experiences abdominal distention, fever, and increasing pain. What complication should the nurse suspect?
Following a colectomy with anastomosis, a patient experiences abdominal distention, fever, and increasing pain. What complication should the nurse suspect?
A patient with a Kock pouch continent ileostomy reports difficulty inserting the catheter. What is the MOST likely cause?
A patient with a Kock pouch continent ileostomy reports difficulty inserting the catheter. What is the MOST likely cause?
A patient who underwent a hemicolectomy asks about the expected changes in their bowel movements. What is the MOST accurate response?
A patient who underwent a hemicolectomy asks about the expected changes in their bowel movements. What is the MOST accurate response?
What dietary modification is MOST appropriate for a patient recovering from a colectomy to minimize cramping and excessive peristalsis?
What dietary modification is MOST appropriate for a patient recovering from a colectomy to minimize cramping and excessive peristalsis?
A patient with a new ileostomy is concerned about managing the effluent. Which characteristic is expected with a conventional ileostomy?
A patient with a new ileostomy is concerned about managing the effluent. Which characteristic is expected with a conventional ileostomy?
Which question is MOST important to ask a patient during data collection when assessing risk factors for colorectal cancer?
Which question is MOST important to ask a patient during data collection when assessing risk factors for colorectal cancer?
Following an abdominoperineal resection, a patient expresses concern about body image and sexuality. What nursing intervention is MOST appropriate?
Following an abdominoperineal resection, a patient expresses concern about body image and sexuality. What nursing intervention is MOST appropriate?
A patient is scheduled for a lower anterior resection. Which explanation BEST describes this procedure?
A patient is scheduled for a lower anterior resection. Which explanation BEST describes this procedure?
What is the MOST important instruction to provide a patient managing a continent ileostomy (Kock pouch)?
What is the MOST important instruction to provide a patient managing a continent ileostomy (Kock pouch)?
A patient with a new colostomy reports feeling overwhelmed and anxious. Which nursing intervention would be MOST appropriate initially?
A patient with a new colostomy reports feeling overwhelmed and anxious. Which nursing intervention would be MOST appropriate initially?
A patient is receiving parenteral nutrition (PN) due to imbalanced nutrition related to anorexia after colorectal surgery. What is the MOST important nursing action?
A patient is receiving parenteral nutrition (PN) due to imbalanced nutrition related to anorexia after colorectal surgery. What is the MOST important nursing action?
A patient is scheduled for an ileocolectomy. What anatomical structures will be removed during this procedure?
A patient is scheduled for an ileocolectomy. What anatomical structures will be removed during this procedure?
During the evaluation phase of a patient's care plan for fear related to colorectal cancer diagnosis, which outcome indicates effective nursing interventions?
During the evaluation phase of a patient's care plan for fear related to colorectal cancer diagnosis, which outcome indicates effective nursing interventions?
A patient with diarrhea related to a possible infection is being discharged. Which instruction is MOST important to emphasize to the patient, their family, and healthcare staff?
A patient with diarrhea related to a possible infection is being discharged. Which instruction is MOST important to emphasize to the patient, their family, and healthcare staff?
A patient is admitted with frequent diarrhea. What is the priority nursing intervention to prevent skin breakdown?
A patient is admitted with frequent diarrhea. What is the priority nursing intervention to prevent skin breakdown?
A patient with diarrhea is at risk for deficient fluid volume. What is the MOST accurate way to assess the effectiveness of fluid replacement therapy?
A patient with diarrhea is at risk for deficient fluid volume. What is the MOST accurate way to assess the effectiveness of fluid replacement therapy?
Which of the following assessment findings is MOST indicative of peritonitis following a ruptured appendix?
Which of the following assessment findings is MOST indicative of peritonitis following a ruptured appendix?
A patient is suspected of having appendicitis. What intervention should be avoided?
A patient is suspected of having appendicitis. What intervention should be avoided?
A patient with peritonitis is being treated with fluid and electrolyte replacement. What assessment finding indicates that the treatment is effective?
A patient with peritonitis is being treated with fluid and electrolyte replacement. What assessment finding indicates that the treatment is effective?
What is the PRIMARY reason for maintaining a patient with peritonitis NPO?
What is the PRIMARY reason for maintaining a patient with peritonitis NPO?
A patient undergoing evaluation for possible appendicitis reports right lower quadrant pain. Which assessment finding would suggest the pain is likely due to appendicitis?
A patient undergoing evaluation for possible appendicitis reports right lower quadrant pain. Which assessment finding would suggest the pain is likely due to appendicitis?
Following an appendectomy, a patient develops a fever and abdominal distension. What complication is MOST likely?
Following an appendectomy, a patient develops a fever and abdominal distension. What complication is MOST likely?
A patient is diagnosed with peritonitis secondary to a ruptured diverticulum. Which laboratory result would the nurse anticipate?
A patient is diagnosed with peritonitis secondary to a ruptured diverticulum. Which laboratory result would the nurse anticipate?
What is the PRIMARY goal of antibiotic therapy in a patient with peritonitis?
What is the PRIMARY goal of antibiotic therapy in a patient with peritonitis?
A patient with a history of cirrhosis develops peritonitis. What is a potential cause of peritonitis in this patient population?
A patient with a history of cirrhosis develops peritonitis. What is a potential cause of peritonitis in this patient population?
Which of the following is a postoperative instruction for a patient following a laparoscopic appendectomy to promote healing and prevent complications?
Which of the following is a postoperative instruction for a patient following a laparoscopic appendectomy to promote healing and prevent complications?
A patient is being evaluated for appendicitis. Which sequence of assessment techniques is MOST appropriate?
A patient is being evaluated for appendicitis. Which sequence of assessment techniques is MOST appropriate?
What is the significance of a patient with appendicitis keeping their right leg flexed?
What is the significance of a patient with appendicitis keeping their right leg flexed?
Flashcards
Appendicitis
Appendicitis
Inflammation of the appendix.
Colectomy
Colectomy
Surgical removal of all or part of the colon.
Colitis
Colitis
Inflammation of the colon.
Colostomy
Colostomy
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Constipation
Constipation
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Diarrhea
Diarrhea
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Diverticulitis
Diverticulitis
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Diverticulosis
Diverticulosis
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Expected Outcome for Constipation
Expected Outcome for Constipation
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Best Time for Defecation
Best Time for Defecation
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DPMD or Footstool
DPMD or Footstool
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Recommended Daily Fluid Intake For Constipation
Recommended Daily Fluid Intake For Constipation
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Definition of Diarrhea
Definition of Diarrhea
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Chronic Diarrhea Duration
Chronic Diarrhea Duration
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Main Causes of Acute Infectious Diarrhea
Main Causes of Acute Infectious Diarrhea
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Chronic Diarrhea Causes
Chronic Diarrhea Causes
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Diarrhea Prevention
Diarrhea Prevention
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Characteristics of Diarrhea Stools
Characteristics of Diarrhea Stools
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Recommended Daily Fiber Intake
Recommended Daily Fiber Intake
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Enteral Feeding Formula
Enteral Feeding Formula
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Natural ways to treat constipation
Natural ways to treat constipation
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Medications Causing Constipation
Medications Causing Constipation
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Anal Conditions & Constipation
Anal Conditions & Constipation
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Medical Conditions Causing Constipation
Medical Conditions Causing Constipation
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Diet & Constipation
Diet & Constipation
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Symptoms of Constipation
Symptoms of Constipation
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Fecal Impaction
Fecal Impaction
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Valsalva Maneuver
Valsalva Maneuver
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Megacolon
Megacolon
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Diagnostic Tests for Constipation
Diagnostic Tests for Constipation
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Lifestyle Changes for Constipation
Lifestyle Changes for Constipation
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Bulk-Forming Agents
Bulk-Forming Agents
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Stool Softeners
Stool Softeners
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Defecation Posture Modification Device (DPMD)
Defecation Posture Modification Device (DPMD)
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Expected outcome of diarrhea treatment
Expected outcome of diarrhea treatment
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Why obtain patient history about diarrhea?
Why obtain patient history about diarrhea?
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Why use transmission precautions for diarrhea?
Why use transmission precautions for diarrhea?
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Why give antidiarrheal medications?
Why give antidiarrheal medications?
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Why keep skin clean and dry with diarrhea?
Why keep skin clean and dry with diarrhea?
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Risk for Deficient Fluid Volume is related to?
Risk for Deficient Fluid Volume is related to?
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Expected Outcome: Maintaining a stable weight, vital signs
Expected Outcome: Maintaining a stable weight, vital signs
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Appendix
Appendix
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What happens due to the small size of the appendix?
What happens due to the small size of the appendix?
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Appendicitis: Signs and Symptoms
Appendicitis: Signs and Symptoms
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McBurney point location
McBurney point location
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CBC result in appendicitis?
CBC result in appendicitis?
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Peritonitis
Peritonitis
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Common causes of peritonitis
Common causes of peritonitis
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Abdominal Distention Relief
Abdominal Distention Relief
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Peritonitis Treatment
Peritonitis Treatment
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Ostomy Purpose
Ostomy Purpose
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Post-Peritonitis Surgery
Post-Peritonitis Surgery
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Peritonitis Complications
Peritonitis Complications
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Diverticulum
Diverticulum
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Diverticulosis Definition
Diverticulosis Definition
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Diverticulitis Cause
Diverticulitis Cause
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Diverticular Disease Risk
Diverticular Disease Risk
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Diverticula Development
Diverticula Development
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Diverticulosis Factors
Diverticulosis Factors
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Diverticulosis Location
Diverticulosis Location
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Diverticulitis Risk Factors
Diverticulitis Risk Factors
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Diverticulitis Symptoms
Diverticulitis Symptoms
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Diverticulitis Diagnosis
Diverticulitis Diagnosis
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Food Poisoning Diarrhea
Food Poisoning Diarrhea
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Hypokalemia Symptoms
Hypokalemia Symptoms
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Diarrhea: Signs & Symptoms
Diarrhea: Signs & Symptoms
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Diarrhea: Causes
Diarrhea: Causes
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Diarrhea: Diagnostic Tests
Diarrhea: Diagnostic Tests
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Diarrhea: Therapeutic Measures
Diarrhea: Therapeutic Measures
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Diarrhea: Fluid Replacement
Diarrhea: Fluid Replacement
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Antidiarrheal Medications
Antidiarrheal Medications
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Probiotics for Diarrhea
Probiotics for Diarrhea
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Fecal Transplant
Fecal Transplant
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When to Seek Medical Care (Diarrhea)
When to Seek Medical Care (Diarrhea)
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Diarrhea: Dehydration Signs
Diarrhea: Dehydration Signs
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Diarrhea: Dehydration Lab Values
Diarrhea: Dehydration Lab Values
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Diarrhea: Data Collection
Diarrhea: Data Collection
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Enteritis
Enteritis
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Deficient Fluid Volume (Risk)
Deficient Fluid Volume (Risk)
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Crohn Disease
Crohn Disease
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Crohn's Location
Crohn's Location
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Skip Lesions
Skip Lesions
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Intestinal Obstruction (Crohn's)
Intestinal Obstruction (Crohn's)
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Fistulas (Crohn's)
Fistulas (Crohn's)
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Enterovaginal Fistula
Enterovaginal Fistula
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Enterovesicular Fistula
Enterovesicular Fistula
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Crohn's Main Symptoms
Crohn's Main Symptoms
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Crohn's Lab Findings
Crohn's Lab Findings
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Imaging Tests for Crohn's
Imaging Tests for Crohn's
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Crohn's Confirmation
Crohn's Confirmation
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Crohn's Management Goal
Crohn's Management Goal
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Crohn's Medication Classes
Crohn's Medication Classes
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Mild Crohn's Treatment
Mild Crohn's Treatment
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Strictureplasty
Strictureplasty
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Small Intestine Resection with Anastomosis
Small Intestine Resection with Anastomosis
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Colectomy with Ileorectal Anastomosis
Colectomy with Ileorectal Anastomosis
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Proctectomy
Proctectomy
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Proctocolectomy with Ileostomy
Proctocolectomy with Ileostomy
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Ileostomy
Ileostomy
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5-Aminosalicylates
5-Aminosalicylates
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Biologic Response Modifiers
Biologic Response Modifiers
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Corticosteroids for IBD
Corticosteroids for IBD
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Immunomodulators for IBD
Immunomodulators for IBD
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Ulcerative Colitis
Ulcerative Colitis
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Symptoms of Ulcerative Colitis
Symptoms of Ulcerative Colitis
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Systemic symptoms of ulcerative colitis
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Why fructans and GOSs cause gas.
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Key Data to Collect for IBS
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Study Notes
- The lower gastrointestinal (GI) system consists of the small and large intestines, rectum, and anus.
Constipation
- It is defined as having bowel movements less than three times a week or when the fecal mass remains in the rectal cavity for an extended period of time.
- Prolonged feces retention leads to continuous water absorption, resulting in smaller, drier, harder, and more difficult-to-pass stools.
- Ignoring the need to defecate reduces muscular and rectal mucous membrane sensitivity, necessitating a stronger stimulus for defecation.
- Obstipation refers to prolonged constipation.
Etiology of Constipation
- Narcotics, tranquilizers, and aluminum-containing antacids are among the medications that cause constipation by decreasing large intestine motility.
- Rectal or anal disorders, such as hemorrhoids or fissures, encourage delaying defecation, because of pain.
- Metabolic or neurological disorders such as diabetes mellitus, hyperparathyroidism, hypothyroidism, multiple sclerosis, systemic lupus erythematosus, or stroke can disrupt normal bowel innervation and function.
- Colon cancer obstruction prevents normal bowel function.
- Reduced intake of dietary fiber and fluids lowers fecal bulk and causes constipation.
- Reduced mobility, weakness, and fatigue reduce the strength of the muscles needed for defecation, which is more common in older adults.
Signs and Symptoms of Constipation
- Abdominal pain and distention
- Indigestion
- Rectal pressure
- Sensation of incomplete emptying
- Intestinal rumbling
- Headache
- Fatigue
- Decreased appetite
- Straining during bowel movements
- Hard, dry stool
Complications of Constipation
- When the fecal mass gets too dry to pass, fecal impaction occurs.
- Ulcers can form when a mass of stool puts pressure on the colon mucosa.
- Small amounts of liquid stool may leak around the fecal mass, resulting in liquid stool incontinence.
- Straining during bowel movements (Valsalva maneuver) can cause cardiac, neurological, and respiratory problems.
- Cardiac rupture and death may result from straining if the patient has a history of heart failure, hypertension, or recent myocardial infarction.
- Megacolon, grossly dilated loops of the colon, can form proximal to the dry fecal mass and obstruct the colon.
- Abdominal distention develops, and loops of bowel may be felt through the abdominal wall in severe cases.
Diagnostic Tests for Constipation
- Constipation is commonly self-diagnosed or diagnosed via history and physical examination, including a rectal exam.
- Radiographic or magnetic resonance imaging (MRI) defecography, sigmoidoscopy, colonoscopy, or anorectal manometry may be used to determine the underlying causes of chronic constipation.
Therapeutic Measures for Constipation
- Treatment is determined by the underlying cause
- Lifestyle changes and bulking medicines (fibers) are first-line treatments for chronic constipation
- These include increased physical activity, increased water consumption, warm water or caffeinated beverages in the morning, responding to the urge to defecate, and exercises to strengthen abdominal muscles
- Psyllium or docusate sodium are examples of bulk-forming agents or stool softeners
- Lubiprostone and linaclotide are examples of laxatives that can be used for severe constipation
- Enemas and rectal suppositories are only used in extreme situations and are stopped after an acute episode has passed
- Methylnaltrexone and naloxegol are available for opioid-induced constipation, which usually necessitates intervention
Nursing Process for Constipation
- Establish a rapport with the patient and provide privacy to collect data due to the sensitivity and embarrassment patients may experience when discussing bowel habits and history
- The onset and duration of constipation, previous and current elimination patterns, occupation, lifestyle (stress, exercise, nutrition), history of laxative or enema use, medical-surgical history, and current medications being taken should all be included
- Make a note of the color, consistency, and odor of the stool, as well as any intestinal symptoms
- Abdomen is inspected for distention and symmetry after the interview, then auscultated and palpated
- Fissures, external hemorrhoids, or irritation may be visible on inspection of the perianal area
Nursing Diagnoses, Planning, and Implementation for Constipation
- Constipation is related to irregular defecation habits
Expected Outcome for Constipation
- Soft, formed stool will pass every 1 to 3 days without straining
Implementation for Constipation
- Identify normal defecation pattern, diet and fluid intake, medications, surgeries, and laxative use to help identify contributing factors
- Set a specific time for defecation to promote the urge reflex, such as after a meal when bowels are most active
- Use a DPMD or footstool to promote flexion of the hips, which promotes defecation
- Encourage a high-fiber, high-residue diet to decrease constipation
- Reinforce teaching the physiology of defecation and the importance of responding to the urge to defecate when it occurs to help prevent constipation
- Reinforce teaching to increase fluid to 2 to 3 L per day to soften feces, if not contraindicated
- Reinforce teaching to increase activity through a daily walking program and abdominal exercises designed to improve the muscle tone to improve peristalsis and promote more spontaneous defecation
Evaluation for Constipation
- The treatment plan is effective if the patient has developed a regular bowel function pattern and is satisfied with the outcomes
Diarrhea
- Fecal matter travels rapidly through the intestine, resulting in decreased absorption of water, electrolytes, and nutrients
- Defined as three or more loose or watery stools in a 24-hour period, with severe diarrhea defined as more than 20 bowel movements per day
- Acute diarrhea normally subsides within a few days, while chronic diarrhea persists for more than 14 days
Pathophysiology and Etiology of Diarrhea
- Acute diarrhea is commonly caused by infections, which can lead to enteritis, and is self-limiting
- The main causes are viruses, bacteria, and protozoa found in contaminated food or water
- Diarrhea can also be caused by food intolerances or allergies, dairy products, wheat, sugar substitutes, excessive caffeine, and high-fat or fried foods
- Diarrhea can be a side effect of medications such as antibiotics
- Inflammatory disorders such as Crohn disease or ulcerative colitis can cause chronic diarrhea
- Radiation therapy for cancer can impair absorption, resulting in frequent, watery stools
- Increased motility disorders can be caused by an irritable bowel or a neurologic disorder
- Enteral feedings can cause diarrhea
Prevention of Diarrhea
- Proper handling, storage, and refrigeration of fresh foods minimizes contact with infectious agents
- Hand hygiene and cleaning of the kitchen, food preparation areas, and serving items are extremely important
- Enteral feedings should be given using full-strength formula rather than diluting the formula
- This reduces the risk of formula contamination
- Routine vaccinations should be kept up to date to prevent travelers' diarrhea and specific vaccines, such as yellow fever or typhoid, are required depending on the destination country and must be completed prior to travel
- Improving food-safety-related behaviors and practices are Healthy People 2030 goals
Signs and Symptoms of Diarrhea
- Foul-smelling stools with undigested food particles and mucus
- Stools may contain blood and/or pus
- Food poisoning often has an explosive onset and may be accompanied by nausea and vomiting
- Abdominal cramping, intestinal rumbling, and thirst
- Fever implies an infection
- Weakness and dehydration from fluid loss
Diagnostic Tests for Diarrhea
- Diarrhea diagnosis is determined by the onset and progression of the condition, presence of fever, laboratory examinations, and visual inspection of the stool for bacteria, pus, or blood
- Stool is examined for red blood cells (RBCs), white blood cells (WBCs), mucus, and appearance
- Stool tests for bacterial pathogens should be completed for diarrhea lasting more than 1 week or if the patient has severe illness and/or high-risk comorbidities
- Grossly bloody diarrhea should be tested for Shiga toxin to identify Shiga-toxin-producing E. coli
- C. difficile testing is performed if the patient has recently used antibiotics
- Additional diagnostic testing for unresolved or chronic diarrhea can include cultures to identify the specific causative organism, endoscopy, colonoscopy, computed tomography (CT), and blood tests
Therapeutic Measures for Diarrhea
- Goal is to treat the underlying condition
- Replacing fluids and electrolytes is also important via the oral route which is preferred, however IV fluid replacement may be necessary for dehydration, especially in the very young or very old
- Motility of the intestines can be decreased with the use of loperamide or diphenoxylate for three or more watery stools per day without fever
- Patients with fever or dysentery may benefit from bismuth subsalicylate
- Antimicrobial agents are prescribed for some infections
- A Lactobacillus granule probiotic supplement can be used to help restore normal flora if diarrhea is believed to be caused by antibiotics altering the normal flora of the bowel
- Fecal transplant can restore normal intestinal flora in patients who are ill or have chronic conditions
Nursing Process for Diarrhea
- Ask about a known cause, signs and symptoms, and when they began
- Usual dietary habits and any changes, as well as recent exposure to contaminated food or water are noted
- Identify medications, such as antibiotics or laxatives, which might be contributing to the diarrhea
- Inquire about recent travel to determine geographic location and exposure to an infected person or someone with similar symptoms
- Document stool consistency, color, odor, and frequency
- Observe for dehydration symptoms such as tachycardia, hypotension, decreased skin turgor, weakness, thready pulse, dry mucous membranes, and oliguria
- Obtain the patient's height and weight to establish a baseline
- Abnormal labs indicating dehydration include increased serum osmolality, increased urine specific gravity, and increased hematocrit
- Decreased serum potassium may result from intestinal loss of potassium
Nursing Diagnoses, Planning, and Implementation for Diarrhea
- Diarrhea related to infection or possible ingestion of irritating foods
- Risk for Deficient Fluid Volume related to frequent passage of stools and insufficient fluid intake
Expected Outcome for Diarrhea
- Formed, soft stool will be maintained every 1 to 3 days
Implementation for Diarrhea
- Obtain patient history, including medications, about diarrhea to help identify cause
- Monitor and record stool characteristics, amount, and frequency to plan care
- Utilize transmission precautions and consider a private patient room to prevent infection transmission
- Give antidiarrheal medications as ordered to control diarrhea
- Keep skin clean, dry, and protected with a moisture barrier after each bowel movement or use a fecal incontinence appliance to protect perianal skin from contact with liquid stools and their enzymes
- Reinforce teaching hand hygiene by patient, family, and health-care staff to prevent the spread of infection
- Weigh the patient daily and record intake and output (I&O; including diarrheal stools) to determine fluid balance
- Encourage oral intake and/or maintain IV fluid replacement as ordered to maintain fluid balance and prevent dehydration
- Reinforce teaching the patient signs and symptoms of dehydration to report to allow prompt treatment
Evaluation for Diarrhea
- Goals have been met if frequency of diarrheal stools is decreased and balance of fluids is achieved
Appendicitis
- Inflammation of the appendix, the small, finger-like appendage attached to the cecum of the large intestine
Signs and Symptoms of Appendicitis
- Includes abdominal pain, anorexia, nausea, vomiting, diarrhea, fever, and increased WBCs
- Pain usually localizes to the right lower quadrant at McBurney point
- Physical examination reveals slight abdominal muscular rigidity (guarding), normal bowel sounds, and local rebound tenderness in the right lower quadrant of the abdomen
- Rovsing sign, pain in the right lower quadrant when the left lower quadrant is palpated, may be present
- The patient might keep the right leg flexed for comfort and experience increased pain if the leg is straightened
Diagnostic Tests for Appendicitis
- A complete blood count (CBC) reveals elevated leukocyte (WBC) and neutrophil counts
- An ultrasound, CT scan, or MRI reveals an enlargement in the area of the cecum
Therapeutic Measures for Appendicitis
- Surgery for nonperforated appendicitis should be performed quickly after diagnosis (within 12 hours) via either laparoscopic or open methods, where Laparoscopic surgery allows for faster healing and fewer complications
- The patient is NPO (nothing by mouth)
- Heating pads, laxatives, or enemas should be avoided because they can all cause or complicate a rupture
- IV fluids and antibiotic therapy are started if the appendix has ruptured, with surgery possibly being delayed for several weeks while the infection resolves
- If infection is present, a drain may be inserted into the abdomen by a radiologist or during surgery
Complications of Appendicitis
- Perforation of the inflamed appendix can cause peritonitis
- An abscess of the appendix, a localized collection of pus, can be treated with IV antibiotics and surgical drainage, with an appendectomy approximately 6 weeks later
Peritonitis
- Inflammation of the peritoneum that can be life-threatening
Pathophysiology and Etiology of Peritonitis
- Trauma, ischemia, or perforation in an abdominal organ causes leakage of the organ's contents into the peritoneal cavity, causing inflammation and infection
- The tissues become edematous and begin leaking fluid with increasing amounts of blood, protein, cellular debris, and WBCs
- The intestinal tract responds with hypermotility, soon followed by paralysis (paralytic ileus)
- Common causes are a ruptured appendix, peptic ulcer, gangrenous gallbladder, perforated colon, pancreatitis, peritoneal dialysis, diverticulitis, incarcerated hernia, or gangrenous small bowel
- May also be a spontaneous complication of cirrhosis due to ascites
Signs and Symptoms of Peritonitis
- Generalized abdominal pain evolves into localized pain at the site of the perforation or leakage
- The affected area is extremely tender and aggravated by movement
- Rebound tenderness and abdominal rigidity (board-like) are present
- Decreased peristalsis results in bloating, fullness, anorexia, nausea and vomiting, and no bowel movement or flatus
- Infection causes fever, increased WBCs, and an elevated pulse
- Dehydration signs can be present
- Can cause sepsis and be life-threatening
Diagnostic Tests for Peritonitis
- Tests include WBCs to identify elevation, an abdominal x-ray or CT scan to show distention or perforation, paracentesis and laboratory analysis to identify a causative organism, or exploratory surgery to identify the cause
Therapeutic Measures for Peritonitis
- Patient is NPO
- Fluid and electrolyte replacement is crucial to correct hypovolemia and prevent or treat shock
- Antibiotics are used to treat or prevent sepsis
- Abdominal distention is relieved through insertion of an orogastric (or NG) tube with suction
- Surgery may be performed to excise, drain, or repair the cause
- An ostomy may be formed to divert stool, allowing resolution of the infection
- After surgery, the patient usually has a wound drain, an NG tube, and a urinary catheter
Complications of Peritonitis
- Intestinal obstruction
- Hypovolemia caused by the shift of fluid into the abdomen
- Septicemia
- Shock
- Death
Diverticulosis and Diverticulitis
- A diverticulum is a small outpouching of the colon wall, while diverticulosis is when multiple diverticula are present without evidence of inflammation
- Diverticulitis occurs when increased pressure within the colon or stool trapped in a diverticulum causes a tear, and inflammation and infection develop
- The diverticulum may rupture if an abscess develops, resulting in peritonitis
Etiology and Risk Factors
- Exact cause of diverticula development is unknown
- Low-fiber diets are thought to play a part in the development of diverticulosis
- Pressure within the bowel caused by chronic constipation may lead to diverticula development, most commonly in the sigmoid colon
- More common in people older than 60
- Diet low in fiber and high in fats and red meat, obesity, sedentary lifestyle, and smoking may increase diverticulitis risk
- Medications such as NSAIDs, opioids, and steroids can increase risk
Signs and Symptoms of Diverticulosis and Diverticulitis
- Most people with diverticulosis do not experience symptoms
- Steady or crampy pain in the left lower quadrant of the abdomen is the most common symptom of diverticulitis
- Nausea, vomiting, and bowel habit changes with constipation can occur
- Other symptoms include bleeding, fever, and fatigue
Diagnostic Tests for Diverticulosis and Diverticulitis
- Diverticulitis is confirmed with a CT scan, especially if complications such as an abscess are suspected
- Diverticulosis is typically found with flexible sigmoidoscopy or colonoscopy, but these methods should not be used with diverticulitis due to the risk of perforation
- WBCs are checked for infection
- A stool specimen can show infection or occult blood
Therapeutic Measures for Diverticulosis and Diverticulitis
- Treatment is dictated by the severity of the attack; mild cases can be treated at home with over-the-counter analgesics such as acetaminophen, an antibiotic, and a liquid diet for 2 to 3 days
- Severe diverticulitis necessitates hospitalization for pain control, IV antibiotics and fluids while being NPO, and drainage of any abscesses
- A progressive diet is started at the end of the acute period
- Surgery may be considered for perforation, abscess, or bowel obstruction using a bowel resection to remove the diseased area of the colon and/or a temporary colostomy to allow inflammation to subside, followed by a reconnection of the colon at a later date
Nursing Process for an Inflammatory or Infectious Disorder
- Identifying pain is essential, with Increased pain possibly indicating bowel rupture and peritonitis
- Monitor for abdominal distention
- Vital signs are monitored for fever and other signs of sepsis
- Reduced urinary output, dropping blood pressure, and rising pulse rate reflect fluid volume imbalance
Nursing Diagnoses, Planning, and Implementation for an Inflammatory or Infectious Disorder
- Acute pain related to inflammatory process
- Risk for Deficient Fluid Volume related to diarrhea or fluid shifting from the circulation to the peritoneal cavity
Expected Outcome for an Inflammatory or Infectious Disorder
- The patient will report that pain is relieved or at an acceptable level within 30 minutes of reporting it
- The patient will maintain vital signs and urine output within normal limits at all times
Implementation for an Inflammatory or Infectious Disorder
- Have the patient rate pain using a rating scale to determine pain level
- Give analgesic or antispasmodic medications as ordered to relieve pain
- Use relaxation exercises and positioning such as semi-Fowler to reduce tension on the abdomen and pain
- Record I&O to determine fluid balance
- Weigh patient daily to determine fluid loss
- Monitor vital signs and urine output and report changes to detect change from normal limits
- Maintain IV fluid replacement as ordered to maintain fluid balance if output is greater than intake
Inflammatory Bowel Disease (IBD)
- Crohn disease and ulcerative colitis
Crohn Disease
- An autoimmune inflammatory bowel disease that can involve any part of the GI tract
- Characterized by the body having an inappropriate immune response to intestinal microbes
- Commonly affects the terminal portion of the ileum, or first part of the large intestine, with inflamed areas alternating with healthy tissue (skip lesions)
- Obstruction occurs as the disease progresses because the intestinal lumen narrows with inflamed mucosa and scar tissue
- Inflammation extends through the intestinal mucosa promoting formation of abscesses, fistulas, and fissures along with pain, peritonitis, or sepsis
Etiology of Crohn Disease
- Has not been identified, but it tends to occur within the family, triggered by infections or environmental agents
- Most often diagnosed between the ages of 15 and 30
- Smoking increases risk
Signs and Symptoms of Crohn Disease
- Crampy abdominal pain
- Chronic intermittent diarrhea (with or without blood)
- Weight loss
- Fatigue
- Mild to severe symptoms with periods of remission and exacerbations, with patients avoiding eating to prevent pain
- Chronic diarrhea results in fluid deficit and electrolyte imbalance
- Inflammatory symptoms can affect the eyes, liver, bile ducts, skin, and joints
- Physical or psychological stress may trigger exacerbations
Diagnostic Tests for Crohn Disease
- Laboratory testing looks for anemia, infection, liver function, low albumin, stool infections, and occult blood
- Imaging tests include multiphase CT enterography and magnetic resonance enterography (MRE)
- Confirmed by granulomas in the biopsy specimen via endoscopy (colonoscopy and sigmoidoscopy), with multiple biopsies of the diseased colon and terminal ileum
- Other tests include capsule endoscopy, ultrasound, double balloon enteroscopy, and chromoendoscopy
Therapeutic Measures for Crohn Disease
- No cure; the goal of Crohn disease management is to achieve and maintain remission
- Medication therapy is individualized, with meds decreasing intestinal inflammation to promote mucosa healing
- Mild/low-risk Crohn disease is treated with oral enteric-coated budesonide
- High-risk and moderate-to-severe Crohn disease is treated with a biologic agent with/without an immunomodulator
- Antibiotics can reduce bacterial counts in the intestine to decrease inflammation
- Antidiarrheal medications, such as diphenoxylate with atropine or loperamide, and bulk-forming laxatives may reduce loose stools and skin irritation
- Surgery is indicated for obstruction, stricture, fistula, abscess, excessive bleeding, perforation, toxic megacolon, or symptoms that do not respond to treatment, however, it doesn't cure Crohn disease, as it can recur elsewhere in the GI tract
- Surgery is open or laparoscopic and include strictureplasty, resection of an affected area in the small intestine with anastomosis, colectomy with ileorectal anastomosis, proctectomy, or proctocolectomy with ileostomy
- Healthy diet and fluid intake, and multivitamin/mineral supplements may be needed
- Foods that increase symptoms, such as dairy products, fatty food, and fresh fruits and vegetables, should be limited
Ulcerative Colitis
- Occurs in the large intestine and rectum and is similar to Crohn disease
- Characterized by recurring episodes of multiple ulcerations and diffuse inflammation in the superficial mucosa and submucosa of the colon
- Lesions spread in a continuous pattern
Etiology of Ulcerative Colitis
- Possible causes are infection, allergy, and autoimmune response; however, an exact cause is unknown
- Environmental agents such as pesticides, tobacco, radiation, and food additives may precipitate an exacerbation
- Usually begins before age 30 with heredity playing a role
Signs and Symptoms of Ulcerative Colitis
- Diarrhea with blood or pus
- Abdominal and rectal pain
- Rectal bleeding
- Fecal urgency with straining
- Weight loss
- Fever
- Fatigue
- Severe dehydration
- Fluid and electrolyte imbalance
- Calcium loss
- Anemia
- Symptoms are usually intermittent with diet or psychological stress possibly triggering or worsening an attack, and other parts of the body affected
Complications of Ulcerative Colitis
- Malnutrition less frequent compared to Crohn disease
- Hemorrhage
- Toxic megacolon
- Perforation
- Peritonitis
- Osteoporosis
- Increased risk for colorectal cancer
Diagnostic Tests for Ulcerative Colitis
- Diagnosis involves history and physical examination with lab tests, with stool specimens examined to rule out bacterial or amoeba organisms
- Examination of the stool confirms blood presence, and electrolytes may be depleted from chronic diarrhea
- Protein loss and elevated alkaline phosphatase indicate liver dysfunction and malabsorption
- Visualization via colonoscopy to see the whole colon or a flexible sigmoidoscopy to view the lower colon is done
- Biopsy specimens, barium enema, ultrasound, CT scan, and MRI are also used
- Leukocyte scintigraphy detects infection and inflammation in the colon
Therapeutic Measures for Ulcerative Colitis
- Diet, lifestyle changes, medications, and surgery
- Many of the medication classes used with Crohn disease are used for ulcerative colitis
- Foods that cause gas or diarrhea should be avoided, and fluids should be increased
- Surgery is considered for excessive bleeding, severe symptoms, perforation, or toxic megacolon with the entire colon and rectum being removed for a proctocolectomy with ileostomy, which is curative
- May also opt for an ileoanal pouch (restorative proctocolectomy) where the anal sphincter of the rectum is preserved, but is not curative
Nursing Process for Inflammatory Bowel Disease
- Includes a history of symptoms, including onset, duration, and severity, as well as correlation between exacerbations of symptoms and dietary changes or stress
- Note any food allergies, food intolerances, caffeine, nicotine, and alcohol intake
- Nutritional status and dehydration signs are identified
- Perianal area is observed for irritation and excoriation
- Emotional status, coping skills, and verbal and nonverbal behavior is identified
- Anxiety, sleep disturbances, depression, and denial can be problems along with an altered body image if surgery is planned
Nursing Diagnoses, Planning, and Implementation for IBD
- Acute Pain related to increased peristalsis and cramping
- Diarrhea related to the inflammatory process
- Risk for Deficient Fluid Volume related to diarrhea and insufficient fluid intake
- Anxiety related to symptoms and frequency of stools and treatment
- Impaired Skin Integrity related to frequent loose stools
- Imbalanced Nutrition: Less Than Body Requirements related to malabsorption
Expected Outcomes for IBD
- The patient will state that pain is relieved, maintain normal bowel function, maintain vitals and fluid output, reduce anxiety, maintain skin integrity, and maintain weight
Implementation for IBD
- Ask patient to rate pain on a scale to determine pain level and document qualities of the pain, associating it with meals or activities
- Give analgesics and medications to relieve cramping
- Document characteristics of stools
- Ensure the patient has quick access to a bathroom
- Administer antidiarrheal medication as prescribed
- Keep the environment clean and odor-free
- Teach to avoid dairy, high-fiber foods, caffeine, alcohol, and nicotine
- Weigh patient daily and recording I&O
- Document and report signs of deficient fluid volume
- Maintain IV fluids and encourage fluid intake
- Teach symptoms of dehydration
- Answer questions and listen to promote confidence
- Keep perianal skin clean, dry, and protected with a moisture barrier
- Provide sitz baths
- Weigh weekly and provide special liquid as ordered
- Maintain parenteral nutrition (PN) as ordered
Irritable Bowel Syndrome (IBS)
- Not a disease, but rather a functional problem where the Colon mucosa is not damaged, and there is no increased risk of colorectal cancer
- Characterized by abdominal pain and altered bowel habits and may be classified as IBS with diarrhea, IBS with constipation, IBS mixed (diarrhea and constipation) or unclassified
Etiology of IBS
- Cause is unknown; however, there is a hereditary tendency as it is more common in women than men and in those who are young to middle aged
- Nerve conduction abnormalities, intestinal inflammation, and the microbiome, intestinal muscle contractions, immune response are influencing factors, as well as stresses or food intolerances
Signs and Symptoms of IBS
- Chronic abdominal pain
- Altered bowel habits (constipation or diarrhea)
- Feeling of incomplete evacuation
- Fecal urgency
- Mucus with stools
- Depression
- Anxiety
Diagnostic Tests for IBS
- Based on history and physical examination along with stool examination, lab work, colonoscopy, flexible sigmoidoscopy, CT scan, or lower GI series to rule out other disorders
- IBSchek is an antibody test identifying 2 antibodies created in response to bacterial infections from food poisoning which result in watery diarrhea
Therapeutic Measures for IBS
- Symptoms can generally be controlled with diet, lifestyle, stress management, and meds
- Treatment relies on what bowel patterns are being exhibited
- Adequate hydration, exercise, rest, and avoiding food triggers, especially those that cause gas and contain gluten or FODMAPs, are important
- A high-fiber and high-bran diet and supplements or polyethylene glycol may help to form softer, larger stools to relieve constipation
- Some avoiding lactose, fructan, and/or gluten can help with symptoms, eating smaller, frequent meals can be helpful reducing bowel contractions
- Dietary diaries can help identify flare-up triggers
- Stress management and behavioral therapy are helpful relaxing both the bowel, and the body
- Medications depend on IBS type, where Constipation is treated with psyllium or polyethylene glycol and Diarrhea is treated with loperamide, Bile acid sequestrants With severe diarrhea-prominent IBS, Low-dose tricyclic antidepressants, such as desipramine, and Antispasmodics are given with the implementation of antibiotics and multistrain probiotics
Nursing Process for Irritable Bowel Syndrome
- Height, weight, and symptoms, including pain, are documented along with diet, timing of symptoms, effects on self-esteem, socialization, knowledge, and readiness
- Personal and family roles as IBS is a significant cause of missed work and school, social withdrawal, and embarrassment
Nursing Diagnoses, Planning, and Implementation for IBS
- Constipation related to irregular motility of GI tract
- Diarrhea related to irregular motility of GI tract
- Readiness for Enhanced Health Self-management related to desire to manage symptoms of IBS
Expected Outcome for IBS
- The patient will maintain regular bowel function pattern, verbalize understanding of self-care measures, and express satisfaction with the outcomes
Implementation for IBS
- Identify normal bowel pattern, diet and fluid intake, and medications
- Increase fluid intake
- Give medication as ordered
- Reinforce teaching the benefits of increasing fiber
- Obtain history and medications
- Monitor and record stool, giving medications as ordered
- Keep skin clean, dry, and protected
- Encourage food diary and encourage dietitian referral if needed
- Reinforce teaching about IBS symptoms, aggravating factors, and treatments,
Hernias
- Abnormal protrusion of an organ or structure through a weakness or tear in the wall of the cavity normally containing it- abdominal wall
- Hernial sac is formed by the peritoneum protruding through the weakened muscle wall happening from increased intra-abdominal pressure
- Umbilical hernias are seen most often in obesity, ascites, peritoneal dialysis, or multiple pregnancies
- Inguinal hernias (direct or indirect) are located in the groin where the spermatic cord in males or the round ligament in females emerges from the abdominal wall
- Femoral hernias occur in the groin below the inguinal ligament and are uncommon
- Ventral (incisional) hernias usually result from weakness in the abdominal wall after abdominal surgery
Prevention of Hernias
- Congenital defects cannot be prevented
- Reducing strain on abdominal muscles helps prevent hernias, with a support binder or avoid lifting is suggested
- Healthy lifestyle of maintaining normal weight, not smoking, and eating high-fiber foods, is recommended
Signs and Symptoms of Hernias
- Unless complications occur, few symptoms are associated with hernias
- Abnormal bulging can be seen in the affected area, especially when straining or coughing, with possibly a heaviness or dull discomfort
- Herniation may disappear when the patient lies down if it is a reducible hernia; if not and with occurring adhesions or edema, the hernia is irreducible or incarcerated
Complications of Hernias
- An incarcerated hernia may become strangulated if the blood and intestinal flow are completely cut off in the trapped loop of bowel, but only seldomly develops in adults
- Incarceration and strangulation leads to an intestinal obstruction possibly resulting in gangrene and bowel perforation resulting in nausea, vomiting, abdominal pain, and possibly fever
Therapeutic Measures for Hernias
- Diagnosis from physical examination
- Treatment options include no treatment, observation of the hernia, short-term support devices, or surgical repair
- A supportive truss or brief applies pressure to keep the reduced hernia in place with surgical repairs recommended for inguinal hernias
- Surgical procedures are often done laparoscopically as Herniorrhaphy, involving making an incision in the abdominal wall, or Hernioplasty involving placing mesh over weakened muscles
- Bowel resection or a temporary colostomy may be necessary if the hernia is strangulated
Hernia Nursing Care
- Instruct patient to avoid activities increasing abdominal pressure such as coughing or lifting heavy objects
- Teach signs of incarceration or strangulation
- Teach to apply support truss prior to getting out of bed with focus on skin integrity
- Care following inguinal hernia repair is similar to any postoperative care teaching of avoiding coughing if possible, scrotal care with icepacks, and reporting any abnormalities such as redness, fever or incontinence
Absorption Disorders
- Malabsorption occurs when the GI system cannot absorb one or more of the major nutrients, which can be caused by ileal dysfunction, jejunal diverticula, parasitic disease, celiac disease, enzyme deficiency, and IBD
- Primary malabsorption disorders are celiac disease and lactose intolerance
- Gluten is a protein found in wheat, barley, and rye that causes malabsorption of protein in gluten sensitive patients
- Lactose intolerance is the Deficiency in lactase causing a high concentration in the intestines, ultimately leading to osmotic retention of water in the colon and watery stools
Signs and Symptoms of Absorption Disorders
- Weight loss, fatigue, and general malaise resulting from malnutrition
- Loose, bulky, foul gray stools with increased fat and gas along with abdominal pain often occurs in Celiac
- Lactose causes excessive gas, abdominal cramping and loose stools
Complications of Absorption Disorders
- Vitamin K deficiency and bleeding
- Calcium deficiency, bone pain and tetany
- Folic acid, vitamin B12, and iron deficiency, glossitis, stomatitis, anemia, and dry rough skin
- Celiac disease leads to dermatitis herpetiformis
Diagnostic Tests for Disorders of Malabsorption
- Hematocrit decreased if anemia is present
- Mean corpuscular volume Increased B12 malabsorption
- Thickened intestinal mucosa, terminal ileum narrowing, or a change in fecal transit time are indicative of malabsorption syndrome
- tTG, sudan stains, 72 hour collection, upper GI and biopsies are also completed
- IMPORTANT to test before making any diet changes
Therapeutic Measures for Disorders of Malabsorption
- Dietician consult is essential
- Avoiding gluten and lactose
Malabsorption Disorders Nursing Cares
- Ensure intake of electrolyte balanced fluids
- Monitor skin integrity, and perianal skin and protect when necessary
- I&O
- Ensure intake of electrolyte balanced fluids
- Monitor skin integrity, and perianal skin and protect when necessary
Intestinal Obstruction
- When the flow of intestinal contents are blocked
- Mechanical obstruction is blockage
- Nonmechanical obstruction is impaired peristalsis
Small Bowel Obstruction
- Etiology is adhesions, hernias, neoplasms, IBD, foreign bodies, strictures, volgulus, intussusception
- Volvulus, bowel turns occluding lumen
- Intussusception, bowel telescopes in itself
- Nonmechanical obstructions etiology can be abdominal surgery, hypokalemia, peritonitis, spinal injuries, trauma, and vascular insufficiency
Small Bowel Obstruction - Signs & Symptoms
- Acute small bowel obstructions consists of nausea, vomiting, cramping abdominal pain, obstipation (No flatus/ stool), Peristaltic waves proximal to the obstruction
- Fecal vomiting is a late sign
- Sharp sustained pain may indicate perforation
- Dehydrations includes thirst, drowsiness, altered mentation
- May also hear high pitched tinkling sounds
- In nonmechanical bowel sounds are not present
Diagnostic Test - Small Bowel Obstructions
Radiographic, CT, increased leukocytes with strangulation, hematocrit increased dehydrations and electrolyte decreased
- Dilated loops of bowel are seen in diagnostic imaging
Small Bowel Obstructions - Treatment
NPO, NG suction, IV electrolytes, Surgery and possible removal
Large Bowel Obstruction
- Etiology is sigmoid colon caused by carcinoma, IBD, diverticulitis, or benign tumors and stool
- Signs and Symptoms:
- Constipation
- distended bowel
- abdominal pain cramping
- Late sign of fecal, or blood vomiting
- High pitched to tinkling sounds
- localized pain
Large Bowel Obstruction - Treatment
If impaction, enemas and manual removal for the surgical stent, temporary colostomy or removal
Nursing Interventions for Bowel Obstructions
- Accurately assess for tenderness, and listen to bowel sounds in each quadrant
- Assess and document drainage
- Monitor skin and fluid loss
- Assess pain and vitals
- Monitor input and output
- With NG tubes, assess patency and placement
Nursing Diagnosis with Bowel Obstructing and Goals
- Acute pain: Goal is reduce pain
- Fluid volume: Goal is maintain fluid balance and report abnormals Electrolyte balances: Goal is monitor levels and vitals, and maintain
- Pain must be evaluated frequently
Anorectal Problems
- Hemorrhoids
- Anal Fissures
- Anorectal Abscess
Hemorrhoids
- Enlarged veins in anal tissue caused by pressure, common during pregnancy
- Internal hemorrhoids can be common during pregnancy
- External are painful and can be problematic
- Hemorrhoidectomy is a removal surgery but can be painful
- Treatment is aimed at preventing constipation can include 2-3 liters of fluid, increase fiber, stool softeners
Symptoms from Hemorrhoids are
- Itching
- Prolapse
- Bleeding
Fissures
- Cracks or ulcers of anal canal due to constipation or straining
- May see bright red bleeding and pain
- Treatment revolves around increasing bowel softener and promoting circulation
Anorectal Abscess
- Collection of pus
- Symptoms: include pain, redness, swelling, fever, sometimes drainage
- Treat with surgical incision drainage
Lower Gastrointestinal Bleeding
- Etiology: bleeding from polyps, anus due to fissures, hemorrhoids IBD and diverticulitis or cancer
- Lower GI Bleeding from the colon can cause hemetochezia or bright red blood
- Upper GI Bleeding can be melena or dark tarry blood
Significant Blood loss due to GI causes the following
- Hypotension
- Lightheadedness
- Nausea
- Diaphoresis
- Pale and cool skin
Diagnostics for Lower and Upper GI Bleeding
- Thorough history assessment of bowel patterns and stool
- Decreased hematocrite/hemoglobin
- Stool Sample
- Digital examination, CT angiogram, Sigmidoscopy, colonoscopy
Management for GI Bleeding
- Treating cause and preventing shock
- Correct vital signs
- Prevent fall risk
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