Gastrointestinal Disorders and Management

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to Lesson

Podcast

Play an AI-generated podcast conversation about this lesson
Download our mobile app to listen on the go
Get App

Questions and Answers

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?

  • Diarrhea
  • Obstipation
  • Constipation (correct)
  • Fecal impaction

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?

<p>Absorbing water and increasing fecal mass to stimulate bowel movements. (B)</p> Signup and view all the answers

Which of the following conditions involves inflammation of the colon?

<p>Colitis (C)</p> Signup and view all the answers

A patient is diagnosed with diverticulosis. Which dietary recommendation is most appropriate for managing this condition and preventing diverticulitis?

<p>A high-fiber diet to prevent constipation (B)</p> Signup and view all the answers

Following an appendectomy, a patient develops peritonitis. Which of the following signs and symptoms would the nurse expect to observe?

<p>Rigid, board-like abdomen with severe pain and fever (D)</p> Signup and view all the answers

A patient is scheduled for a colectomy. What does this surgical procedure involve?

<p>Removal of a portion of or the entire colon (C)</p> Signup and view all the answers

What physiological change occurs when a patient repeatedly ignores the urge to have a bowel movement?

<p>The musculature and rectal mucous membrane become less sensitive to the presence of feces. (D)</p> Signup and view all the answers

Which of the following is a potential cause of constipation related to medication use?

<p>Antacids containing aluminum, which can decrease intestinal motility. (C)</p> Signup and view all the answers

Which metabolic condition may contribute to constipation by interfering with normal bowel innervation and function?

<p>Diabetes mellitus (A)</p> Signup and view all the answers

Which of the following is a common sign and symptom associated with constipation?

<p>Abdominal pain and distention (C)</p> Signup and view all the answers

A patient reports experiencing a sensation of incomplete emptying after bowel movements. Which condition is most likely indicated by this symptom?

<p>Fecal impaction (A)</p> Signup and view all the answers

What cardiovascular risk is most associated with straining during bowel movements (Valsalva maneuver) in a patient with a history of heart failure?

<p>Cardiac rupture (D)</p> Signup and view all the answers

What is a potential consequence of chronic constipation that involves the development of grossly dilated loops of the colon?

<p>Megacolon (B)</p> Signup and view all the answers

Which diagnostic test is LEAST likely to be used in the initial evaluation of constipation?

<p>Colonoscopy (A)</p> Signup and view all the answers

Which of these interventions is considered a first-line treatment for chronic constipation?

<p>Increased dietary fiber intake (A)</p> Signup and view all the answers

Besides increased fiber intake, what lifestyle modification is recommended to help alleviate constipation?

<p>Responding promptly to the urge to defecate (C)</p> Signup and view all the answers

What type of agent is psyllium (Metamucil), commonly recommended for constipation relief?

<p>Bulk-forming agent (D)</p> Signup and view all the answers

For which specific type of constipation are medications like methylnaltrexone (Relistor) typically prescribed?

<p>Opioid-induced constipation (A)</p> Signup and view all the answers

During the nursing assessment of a patient with constipation, what is an important element to gather regarding their history?

<p>Past elimination patterns and laxative use (A)</p> Signup and view all the answers

A study suggests that using a defecation posture modification device (DPMD) may primarily help with constipation by:

<p>Straightening the anal canal to decrease straining. (C)</p> Signup and view all the answers

Based on evidence-based practice, what impact does using a defecation posture modification device (DPMD) have on bowel movement duration?

<p>Decreases bowel movement duration (C)</p> Signup and view all the answers

What is a common characteristic of diarrhea resulting from food poisoning?

<p>Explosive onset, often with nausea and vomiting (D)</p> Signup and view all the answers

Which of the following assessment findings would be MOST indicative of dehydration in a patient with diarrhea?

<p>Tachycardia and decreased skin turgor (A)</p> Signup and view all the answers

An older adult patient is experiencing frequent diarrhea. What potential complication related to perirectal skin should the nurse monitor for?

<p>Perirectal skin excoriation (C)</p> Signup and view all the answers

Which of the following diarrhea-related complications poses the greatest risk of mortality in older adults?

<p>Cardiac arrhythmias (B)</p> Signup and view all the answers

A patient with diarrhea has recently completed a course of antibiotics. Which diagnostic test is most appropriate to perform?

<p>Stool test for <em>C. difficile</em> (A)</p> Signup and view all the answers

A patient has been experiencing diarrhea for 2 weeks with no improvement. Which diagnostic test might be considered?

<p>Endoscopy or colonoscopy (D)</p> Signup and view all the answers

A patient with diarrhea is prescribed loperamide (Imodium). Which of the following findings would cause the nurse to question the order?

<p>Presence of fever (C)</p> Signup and view all the answers

A patient is experiencing diarrhea related to antibiotic use. Besides medications, the nurse should recommend which of the following?

<p>Probiotic supplement (C)</p> Signup and view all the answers

A patient with diarrhea reports black, tarry stools. What is the MOST important action for the nurse to take?

<p>Notify the healthcare provider immediately (B)</p> Signup and view all the answers

A patient with diarrhea is being discharged home. What dietary instruction is MOST appropriate?

<p>Progress to a low-residue diet as tolerated (A)</p> Signup and view all the answers

Which of the following findings suggests that a patient with diarrhea should seek medical care?

<p>Blood in the stool (D)</p> Signup and view all the answers

A patient is admitted with severe diarrhea and dehydration. Which of the following laboratory results would the nurse expect to find?

<p>Increased hematocrit (A)</p> Signup and view all the answers

Which of the following nursing interventions is MOST important to prevent falls in an older adult patient experiencing diarrhea?

<p>Ensure quick, safe access to bathroom facilities (C)</p> Signup and view all the answers

A nurse is caring for a patient with diarrhea. Which nursing diagnosis takes the highest priority?

<p>Risk for Deficient Fluid Volume (D)</p> Signup and view all the answers

What is the rationale for assessing a patient's recent travel history when evaluating the cause of their diarrhea?

<p>To identify potential exposure to infectious organisms or contaminated food/water (B)</p> Signup and view all the answers

A patient reports experiencing infrequent bowel movements and straining during defecation. Which nursing diagnosis is MOST appropriate based on this information?

<p>Constipation related to irregular defecation habits. (A)</p> Signup and view all the answers

A nurse is teaching a patient about strategies to manage constipation. Which recommendation is MOST appropriate to promote regular bowel movements?

<p>Establish a regular time for defecation, such as after a meal. (C)</p> Signup and view all the answers

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?

<p>All-bran buds (A)</p> Signup and view all the answers

A patient is experiencing diarrhea as a side effect of antibiotic use. Which dietary adjustment is LEAST likely to help in managing the diarrhea?

<p>Increasing intake of sugar substitutes. (B)</p> Signup and view all the answers

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?

<p>&quot;An irritable bowel or neurologic disorder may cause increased motility problems.&quot; (D)</p> Signup and view all the answers

A nurse is caring for a patient receiving enteral feedings who develops diarrhea. What is the MOST appropriate initial action to address this issue?

<p>Ensure the enteral feeding is full-strength rather than diluting the formula. (A)</p> Signup and view all the answers

A nurse is reviewing the laboratory results of a patient with severe diarrhea. Which finding is MOST concerning and requires immediate attention?

<p>Significantly decreased blood pressure and increased heart rate. (A)</p> Signup and view all the answers

A patient with constipation is prescribed docusate sodium (Colace). The patient asks the nurse how this medication works. Which explanation is MOST accurate?

<p>&quot;It draws water into the bowel to soften the stool.&quot; (B)</p> Signup and view all the answers

A nurse is providing discharge instructions to a patient recovering from an episode of acute diarrhea. Which instruction regarding dietary intake is MOST appropriate?

<p>Start with clear liquids and gradually advance to easily digestible foods. (B)</p> Signup and view all the answers

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?

<p>Chronic diarrhea (C)</p> Signup and view all the answers

A patient reports that they have not had a bowel movement in 5 days. What is the most appropriate initial nursing intervention?

<p>Inquire about the patient's normal bowel pattern, diet, and laxative use. (A)</p> Signup and view all the answers

A patient is suspected of having diarrhea caused by an infection. What characteristic of the stool is MOST indicative of an infectious etiology?

<p>Foul smell and presence of blood or mucus (B)</p> Signup and view all the answers

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?

<p>&quot;I will drink at least eight to twelve 8-ounce glasses of water each day.&quot; (D)</p> Signup and view all the answers

A nurse is teaching a patient methods to prevent traveler's diarrhea. Which of the following recommendations is MOST important?

<p>Ensuring routine vaccinations are up to date and destination specific vaccines are administered prior to travel. (B)</p> Signup and view all the answers

A nurse observes the patient using a DPMD (dorsal penile displacement maneuver) or footstool during defecation. What is the intended outcome of this action?

<p>To promote flexion of the hips. (D)</p> Signup and view all the answers

What is the primary purpose of inserting an orogastric or nasogastric (NG) tube with suction in a patient with abdominal distention related to peritonitis?

<p>To relieve abdominal distention. (D)</p> Signup and view all the answers

Which of the following complications of peritonitis is directly related to fluid shifting into the abdomen?

<p>Hypovolemia (A)</p> Signup and view all the answers

A patient is diagnosed with diverticulosis after a routine colonoscopy. What does this diagnosis indicate?

<p>The presence of multiple diverticula without inflammation. (A)</p> Signup and view all the answers

Which of the following factors is thought to contribute to the development of diverticulosis, although not definitively confirmed by research?

<p>Low-fiber diets (B)</p> Signup and view all the answers

Why are colonoscopies typically avoided in patients with acute diverticulitis?

<p>Due to the risk of perforation. (D)</p> Signup and view all the answers

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?

<p>CT scan (A)</p> Signup and view all the answers

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?

<p>Liquid diet (D)</p> Signup and view all the answers

For a patient hospitalized with severe diverticulitis, which intervention is the highest priority?

<p>Providing pain control and IV antibiotics. (B)</p> Signup and view all the answers

Which symptom, if reported by a patient with diverticulitis, would warrant immediate notification of the health-care provider?

<p>Increased abdominal pain with abdominal rigidity (A)</p> Signup and view all the answers

A patient with a history of diverticulitis is experiencing constipation. Which of the following interventions is most appropriate?

<p>Advise the patient to increase dietary fiber and fluid intake gradually. (B)</p> Signup and view all the answers

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?

<p>Assess the patient's stool characteristics and report findings to the health-care provider. (B)</p> Signup and view all the answers

Which of the following medications is known to increase the risk of diverticulitis?

<p>Nonsteroidal anti-inflammatory drugs (NSAIDs) (D)</p> Signup and view all the answers

A patient with diverticulitis is prescribed an antispasmodic medication. What is the primary purpose of this medication?

<p>To relieve abdominal pain and cramping. (C)</p> Signup and view all the answers

A patient with diverticulitis is scheduled for a bowel resection with anastomosis. What does this surgical procedure involve?

<p>Removing the diseased portion of the colon and reconnecting the remaining sections. (D)</p> Signup and view all the answers

What vital sign changes are indicative of a potential fluid volume imbalance in a patient with peritonitis or diverticulitis?

<p>Reduced urinary output, dropping blood pressure, and rising pulse rate (D)</p> Signup and view all the answers

A patient with Crohn's disease is scheduled for a strictureplasty. What is the primary goal of this surgical procedure?

<p>To widen narrowed areas of the intestine, improving passage of intestinal contents. (C)</p> Signup and view all the answers

Why is a Kock pouch typically not recommended for patients with Crohn's disease?

<p>The disease process may affect the pouch, leading to complications. (D)</p> Signup and view all the answers

A patient with Crohn's disease is experiencing frequent diarrhea. Which dietary recommendation is most appropriate?

<p>Limit foods that exacerbate symptoms, such as dairy products and fatty foods, and maintain adequate fluid intake. (C)</p> Signup and view all the answers

What is the primary difference between ulcerative colitis and Crohn's disease in terms of location?

<p>Crohn's disease can occur anywhere in the GI system, while ulcerative colitis is limited to the large intestine and rectum. (A)</p> Signup and view all the answers

A patient with ulcerative colitis is prescribed sulfasalazine. What is an important nursing consideration related to this medication?

<p>Assessing for sulfa allergy. (B)</p> Signup and view all the answers

A patient with ulcerative colitis is experiencing frequent diarrhea. Which of the following electrolyte imbalances is most likely to occur?

<p>Hypocalcemia. (A)</p> Signup and view all the answers

A patient with inflammatory bowel disease (IBD) is prescribed infliximab. What potential adverse effect should the nurse closely monitor the patient for?

<p>Infections. (C)</p> Signup and view all the answers

A patient with Crohn's disease is prescribed budesonide. What specific instruction should the nurse provide regarding the administration of this medication?

<p>Instruct the patient to avoid grapefruit and grapefruit juice. (A)</p> Signup and view all the answers

In a newly diagnosed patient with ulcerative colitis, which diagnostic test is most useful in determining the extent and severity of the disease?

<p>Endoscopy with biopsy. (D)</p> Signup and view all the answers

A patient with long-standing ulcerative colitis is at increased risk for which of the following complications?

<p>Colon cancer. (B)</p> Signup and view all the answers

What is the primary action of 5-aminosalicylates in the treatment of IBD?

<p>To decrease inflammation and suppress the immune system. (D)</p> Signup and view all the answers

A patient with IBD is prescribed azathioprine. What is a critical nursing implication for this medication?

<p>Monitoring for signs and symptoms of infection. (C)</p> Signup and view all the answers

A patient with Crohn's disease is experiencing malabsorption. Which intervention is most appropriate to address this issue?

<p>Providing an elemental formula or parenteral nutrition. (D)</p> Signup and view all the answers

Which of the following is a common trigger that can exacerbate ulcerative colitis symptoms?

<p>Diet or psychological stress. (D)</p> Signup and view all the answers

A patient with severe ulcerative colitis is experiencing toxic megacolon. What is the primary concern associated with this complication?

<p>Perforation of the colon. (D)</p> Signup and view all the answers

Which of the following is the primary goal of therapeutic measures for Crohn's disease, given that there is currently no cure?

<p>Achieving and maintaining remission of the disease. (B)</p> Signup and view all the answers

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?

<p>Weight loss and malnutrition. (B)</p> Signup and view all the answers

A patient diagnosed with Crohn's disease develops a fistula between the small bowel and the skin. Which type of fistula is this?

<p>Enterocutaneous. (B)</p> Signup and view all the answers

A patient with Crohn's disease is prescribed infliximab. What is the primary mechanism of action of this medication?

<p>Decreasing intestinal inflammation as a biologic agent. (C)</p> Signup and view all the answers

Which diagnostic finding is most indicative of Crohn's disease when analyzing a biopsy specimen from the affected area?

<p>Presence of granulomas. (B)</p> Signup and view all the answers

What is the rationale behind using antibiotics in the treatment of Crohn's disease?

<p>To reduce bacterial counts that may contribute to inflammation. (D)</p> Signup and view all the answers

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?

<p>Bulk-forming laxatives. (D)</p> Signup and view all the answers

Which of the following is a risk factor that increases a person's likelihood of developing Crohn's disease?

<p>Smoking. (C)</p> Signup and view all the answers

Why are patients with Crohn's disease monitored for malignant or premalignant lesions?

<p>Chronic inflammation can cause these lesions. (A)</p> Signup and view all the answers

How do multiphase CT enterography and magnetic resonance enterography (MRE) contribute to the diagnosis and management of Crohn's disease?

<p>By providing detailed images of the intestines. (D)</p> Signup and view all the answers

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?

<p>Frequent episodes of diarrhea. (C)</p> Signup and view all the answers

Which of the following is the rationale for maintaining IV fluid replacement for a patient with Crohn's disease?

<p>To maintain fluid balance when output exceeds intake. (A)</p> Signup and view all the answers

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?

<p>Swallow the tablet whole and do not chew. (B)</p> Signup and view all the answers

Which assessment best reflects that goals for a patient, experiencing Crohn's disease symptoms, are being successfully met?

<p>Reports that pain is controlled, the patient has stable vital signs and urinary output, and regular, comfortable bowel elimination. (D)</p> Signup and view all the answers

In managing Crohn's disease, why is it important to monitor a patient's weight daily?

<p>To determine fluid loss. (B)</p> Signup and view all the answers

Which diagnostic finding is most indicative of ulcerative colitis based on laboratory tests?

<p>Positive stool sample for blood in the presence of anemia. (B)</p> Signup and view all the answers

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?

<p>To visualize the entire colon and obtain biopsy specimens for microscopic examination. (A)</p> Signup and view all the answers

What is the rationale behind avoiding high-fiber foods, caffeine, spicy foods, and milk products in the dietary management of ulcerative colitis?

<p>These substances may stimulate intestinal motility and exacerbate symptoms like diarrhea and cramping. (B)</p> Signup and view all the answers

A patient with severe ulcerative colitis is scheduled for a proctocolectomy with ileostomy. What does this surgical procedure entail?

<p>Complete removal of the colon and rectum, with the end of the ileum brought to the abdominal surface as an ostomy. (D)</p> Signup and view all the answers

What is the primary advantage of an ileoanal pouch (restorative proctocolectomy) compared to a proctocolectomy with ileostomy?

<p>It avoids the need for a permanent ostomy bag, allowing stool to be evacuated through the anus. (B)</p> Signup and view all the answers

A patient who underwent an ileoanal pouch procedure reports an increased frequency of bowel movements and abdominal cramping. Which complication is most likely indicated?

<p>Pouchitis. (C)</p> Signup and view all the answers

A patient with ulcerative colitis reports significant weight loss over the past two months. Which nursing intervention is most appropriate to address this issue?

<p>Assess the patient’s nutritional status and collaborate with a dietitian to develop an appropriate meal plan. (D)</p> Signup and view all the answers

What is the primary nursing intervention for a patient experiencing perianal skin irritation related to frequent loose stools?

<p>Providing meticulous skin care and barrier creams to protect the perianal area. (A)</p> Signup and view all the answers

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?

<p>Provide the patient with information about their condition and encourage them to express their feelings. (A)</p> Signup and view all the answers

What information should the nurse prioritize when teaching a patient about potential symptoms of dehydration related to diarrhea?

<p>Decreased urine output and dizziness. (D)</p> Signup and view all the answers

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?

<p>Increased risk of osteoporosis and colorectal cancer are potential long-term complications. (B)</p> Signup and view all the answers

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?

<p>Assessing pain level using a standardized scale and administering prescribed analgesics. (D)</p> Signup and view all the answers

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?

<p>To reduce inflammation in the colon and alleviate symptoms. (B)</p> Signup and view all the answers

A patient is scheduled for leukocyte scintigraphy. What is the purpose of this diagnostic test in the evaluation of inflammatory bowel disease?

<p>To detect areas of infection and inflammation in the colon. (D)</p> Signup and view all the answers

Which assessment finding would be most concerning in a patient with ulcerative colitis?

<p>Ten to twenty liquid stools per day. (C)</p> Signup and view all the answers

What is the primary rationale for nurses to keep perianal skin clean, dry, and protected after bowel movements?

<p>To prevent skin breakdown and excoriation due to contact with fecal enzymes. (C)</p> Signup and view all the answers

What physiological factor is thought to contribute to the symptoms of Irritable Bowel Syndrome (IBS)?

<p>Overly sensitive bowel nerves. (C)</p> Signup and view all the answers

Which of the following actions should be prioritized when providing skin care to a patient with frequent diarrhea?

<p>Protecting the skin with a moisture barrier after each bowel movement. (B)</p> Signup and view all the answers

Why might a physician recommend a special elemental liquid formula for a patient experiencing malabsorption?

<p>To provide nutrients that are absorbed in the upper bowel, allowing the colon to rest. (A)</p> Signup and view all the answers

A patient with Inflammatory Bowel Disease (IBD) is experiencing significant weight loss. Besides nutritional supplements, what other intervention might be essential?

<p>Maintaining parenteral nutrition (PN) if the patient cannot tolerate oral intake. (C)</p> Signup and view all the answers

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?

<p>IBS mixed. (D)</p> Signup and view all the answers

What distinguishes Irritable Bowel Syndrome (IBS) from Inflammatory Bowel Disease (IBD)?

<p>IBS is considered a functional disorder without visible damage to the colon. (A)</p> Signup and view all the answers

How does stress management contribute to the overall treatment of Irritable Bowel Syndrome (IBS)?

<p>By relaxing the bowel and improving overall health. (A)</p> Signup and view all the answers

Which of the following is an important consideration regarding dietary management for patients with Irritable Bowel Syndrome (IBS)?

<p>Avoiding food triggers, especially those that cause gas or contain gluten or FODMAPs. (D)</p> Signup and view all the answers

What is the purpose of using psyllium (Metamucil) for a patient with Irritable Bowel Syndrome (IBS)?

<p>To form softer, larger stools and relieve constipation. (A)</p> Signup and view all the answers

What is the rationale behind keeping a food diary for patients with Irritable Bowel Syndrome (IBS)?

<p>To identify specific food and stress triggers for flare-ups. (D)</p> Signup and view all the answers

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?

<p>Assessing the patient's knowledge about the disease and its management. (A)</p> Signup and view all the answers

A patient newly diagnosed with Crohn's disease expresses feelings of anxiety and uncertainty about managing the condition. Which intervention is most appropriate?

<p>Recommending the patient speak with someone of similar age from the Crohn’s &amp; Colitis Foundation. (A)</p> Signup and view all the answers

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?

<p>The patient is able to state strategies for effective coping. (B)</p> Signup and view all the answers

An IBS patient has identified that the consumption of dairy products makes their symptoms worse, what is the most appropriate intervention?

<p>Recommend the patient find alternatives to dairy products, such as almond milk. (B)</p> Signup and view all the answers

Which of the following factors is LEAST likely to contribute to the development of an umbilical hernia?

<p>Regular strenuous exercise involving heavy lifting with proper form (D)</p> Signup and view all the answers

A patient is diagnosed with an irreducible hernia. What does this finding indicate?

<p>The herniated mass cannot be easily returned to the abdominal cavity due to adhesions or edema. (B)</p> Signup and view all the answers

Following a herniorrhaphy, a patient reports severe pain and a tense, distended abdomen. What is the priority nursing intervention?

<p>Immediately notify the health care provider about the patient's condition. (C)</p> Signup and view all the answers

A patient preparing for discharge after a laparoscopic inguinal hernia repair asks about resuming activities. Which instruction is MOST appropriate?

<p>Avoid lifting, driving, and sexual activity for 2 to 6 weeks, as directed by your healthcare provider. (D)</p> Signup and view all the answers

Following an inguinal hernia repair, a male patient develops scrotal swelling. Which intervention is MOST appropriate for the nurse to implement initially?

<p>Apply ice packs to the scrotum and elevate it on a pillow. (B)</p> Signup and view all the answers

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?

<p>Malabsorption of nutrients due to gluten sensitivity. (A)</p> Signup and view all the answers

A patient with suspected lactose intolerance is advised to undergo diagnostic testing. Which test is MOST likely used to confirm this diagnosis?

<p>Lactose tolerance test or hydrogen breath test. (A)</p> Signup and view all the answers

Which dietary modification is MOST important for a patient newly diagnosed with celiac disease?

<p>Following a strict gluten-free diet. (B)</p> Signup and view all the answers

A patient with malabsorption is at risk for developing hypoprothrombinemia. Which vitamin deficiency is MOST likely the cause?

<p>Vitamin K (C)</p> Signup and view all the answers

A patient with prolonged malabsorption develops neuromuscular hyperirritability and tetany. Which electrolyte imbalance is MOST likely responsible?

<p>Hypocalcemia (C)</p> Signup and view all the answers

What should a nurse emphasize when teaching a patient about preventing hernias?

<p>Use proper body mechanics, maintain a healthy weight, and consume a high-fiber diet. (C)</p> Signup and view all the answers

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?

<p>Reducible hernia (C)</p> Signup and view all the answers

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?

<p>Ventral (incisional) hernia (A)</p> Signup and view all the answers

A patient with celiac disease is reading food labels. Which ingredient should the patient AVOID to prevent triggering symptoms?

<p>Modified food starch derived from wheat (C)</p> Signup and view all the answers

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?

<p>Consume small portions of dairy products with lactase enzyme supplements or choose lactose-free dairy alternatives (D)</p> Signup and view all the answers

What does the presence of high-pitched, tinkling bowel sounds proximal to an obstruction and muffled or absent sounds distal to it indicate?

<p>Mechanical obstruction (B)</p> Signup and view all the answers

Which assessment finding is MOST concerning in a patient with a bowel obstruction and suggests a potential complication requiring immediate intervention?

<p>Sharp, sustained abdominal pain (D)</p> Signup and view all the answers

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?

<p>Skin turgor (D)</p> Signup and view all the answers

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?

<p>Placement of a stent to expand the colon (B)</p> Signup and view all the answers

A patient with a bowel obstruction has an elevated hematocrit. What does this laboratory finding suggest about the patient's condition?

<p>The patient is dehydrated. (C)</p> Signup and view all the answers

A patient with a complete mechanical bowel obstruction is scheduled for surgery. What is the primary goal of surgical intervention in this situation?

<p>To remove the obstruction and restore bowel continuity (A)</p> Signup and view all the answers

A patient with a large bowel obstruction reports crampy lower abdominal pain. What additional assessment finding would support the diagnosis of large bowel obstruction?

<p>Constipation (C)</p> Signup and view all the answers

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?

<p>To decompress the bowel and relieve symptoms (D)</p> Signup and view all the answers

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?

<p>Total parenteral nutrition (TPN) (D)</p> Signup and view all the answers

What is the potential consequence of an untreated large-bowel obstruction that involves a life-threatening condition due to compromised blood flow?

<p>Bowel strangulation and necrosis (A)</p> Signup and view all the answers

A patient with a bowel obstruction is experiencing extreme thirst, drowsiness, and general malaise. What is the underlying cause of these symptoms?

<p>Dehydration (D)</p> Signup and view all the answers

A patient with a bowel obstruction is being assessed for pain. Which characteristic of pain is MOST important for the nurse to document?

<p>The location and character of the pain (C)</p> Signup and view all the answers

A patient with a bowel obstruction vomits fecal material. What does this finding suggest about the location and severity of the obstruction?

<p>The obstruction is severe and located higher in the GI tract. (D)</p> Signup and view all the answers

A patient with a large bowel obstruction is being considered for a cecostomy. What is the primary purpose of this procedure?

<p>To create an opening for stool diversion (D)</p> Signup and view all the answers

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?

<p>Hypokalemia (D)</p> Signup and view all the answers

Which of the following meals would be LEAST appropriate for a patient adhering to a low-FODMAP diet?

<p>Lentil soup with a side of whole-wheat bread and a pear. (C)</p> Signup and view all the answers

A patient with IBS is starting a low-FODMAP diet. What initial guidance should the nurse provide regarding the duration of the elimination phase?

<p>Follow the elimination phase for 2-6 weeks, then systematically reintroduce FODMAPs to identify triggers. (B)</p> Signup and view all the answers

Which of the following statements best captures the rationale behind restricting FODMAPs in individuals with IBS?

<p>FODMAPs are poorly absorbed and rapidly fermented, causing gas, bloating, and altered bowel habits. (A)</p> Signup and view all the answers

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?

<p>Alosetron (Lotronex). (D)</p> Signup and view all the answers

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?

<p>Lactose from protein shakes. (C)</p> Signup and view all the answers

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?

<p>Abdominal distension and firmness. (D)</p> Signup and view all the answers

A patient with IBS is prescribed an antispasmodic medication. What specific symptom is this medication intended to alleviate?

<p>Abdominal pain from bowel spasms. (A)</p> Signup and view all the answers

What is the primary rationale for using low-dose tricyclic antidepressants (TCAs) in patients with IBS and diarrhea?

<p>TCAs slow down intestinal motility, reducing diarrhea. (B)</p> Signup and view all the answers

Which of the following physiological factors INCREASES the risk of developing hemorrhoids?

<p>Increased pressure in the veins of the anal tissue. (A)</p> Signup and view all the answers

A patient is diagnosed with external hemorrhoids. Which assessment finding is MOST consistent with this condition?

<p>Severe pain, itching, and potential for thrombosis. (A)</p> Signup and view all the answers

A client with IBS reports feeling overwhelmed by the dietary restrictions of the low-FODMAP diet. Which intervention would be most appropriate?

<p>Refer the client to a registered dietitian to develop an individualized meal plan. (C)</p> Signup and view all the answers

A patient with thrombosed external hemorrhoids is seeking non-pharmacological pain relief. Which of the following interventions is MOST appropriate?

<p>Alternating ice and heat to relieve edema and pain. (A)</p> Signup and view all the answers

A patient with constipation-predominant IBS (IBS-C) is prescribed linaclotide (Linzess). How does this medication help to alleviate constipation?

<p>It increases intestinal fluid secretion and accelerates fecal transit. (A)</p> Signup and view all the answers

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?

<p>Fermentation of unabsorbed FODMAPs by gut bacteria. (C)</p> Signup and view all the answers

Following a hemorrhoidectomy, a patient reports severe pain. While NSAIDs and acetaminophen are prescribed, what should be avoided due to potential complications?

<p>Opioids. (A)</p> Signup and view all the answers

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?

<p>Anal fissure. (B)</p> Signup and view all the answers

A patient with IBS is considering using probiotics to manage symptoms. Which statement provides the MOST accurate guidance regarding probiotic use in IBS?

<p>Specific multistrain probiotics have shown promise, but the most effective strains are still under investigation. (D)</p> Signup and view all the answers

Which of the following non-pharmacological interventions is MOST appropriate for promoting healing of anal fissures and reducing discomfort?

<p>Sitz baths to promote circulation and cleanliness. (B)</p> Signup and view all the answers

During the nursing assessment of a patient with suspected IBS, what aspect of their symptom presentation is MOST crucial to document?

<p>Temporal relationship between symptoms, food intake, and elimination patterns. (B)</p> Signup and view all the answers

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?

<p>Maintain their regular IBS medications and dietary pattern as much as possible. (D)</p> Signup and view all the answers

A patient with suspected celiac disease is undergoing diagnostic testing. Which test result would MOST strongly suggest the patient has celiac disease?

<p>Presence of tissue transglutaminase (tTG) antibody (IgA). (D)</p> Signup and view all the answers

A patient is diagnosed with an anorectal abscess. What signs and symptoms would the nurse expect to see?

<p>Fever, pain, redness and swelling in the rectal area. (D)</p> Signup and view all the answers

A patient with IBS reports significant anxiety related to unpredictable bowel movements. What intervention is MOST appropriate to address this aspect of their condition?

<p>Teaching relaxation techniques and stress management strategies. (B)</p> Signup and view all the answers

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?

<p>Consulting a registered dietitian for comprehensive dietary education and planning. (C)</p> Signup and view all the answers

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?

<p>Providing instructions on keeping the area clean and dry, especially after bowel movements. (A)</p> Signup and view all the answers

Besides dietary modifications and medication, what additional information can the nurse provide to a patient with IBS to enhance their self-management skills?

<p>Keeping a food diary linked to symptom occurrence to identify triggers. (D)</p> Signup and view all the answers

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?

<p>Cheddar cheese. (C)</p> Signup and view all the answers

A patient presents with melena. Where is the MOST probable site of bleeding?

<p>Small bowel. (C)</p> Signup and view all the answers

The nurse is caring for a patient experiencing severe diarrhea due to malabsorption. Which nursing intervention is MOST critical to implement?

<p>Monitoring fluid and electrolyte balance and replacing losses as needed. (B)</p> Signup and view all the answers

A patient is experiencing hematochezia. Which area of the gastrointestinal tract is the MOST likely source of the bleeding?

<p>Colon. (C)</p> Signup and view all the answers

A post-operative patient reports abdominal distention, cramping pain, and inability to pass flatus. Which condition should the nurse suspect?

<p>Small-bowel obstruction. (C)</p> Signup and view all the answers

A patient with lower GI bleeding develops tachycardia and worsening hypotension. What should the nurse do FIRST?

<p>Report the findings to the healthcare provider immediately. (C)</p> Signup and view all the answers

A patient being evaluated for lower GI bleeding has decreased hemoglobin and hematocrit levels. What does this finding suggest?

<p>Blood loss. (B)</p> Signup and view all the answers

In a patient experiencing a small bowel obstruction, what is the MOST immediate physiological consequence that the nurse should anticipate?

<p>Collection of intestinal contents, gas, and fluid proximal to the obstruction. (A)</p> Signup and view all the answers

A patient diagnosed with a nonmechanical bowel obstruction (paralytic ileus) has hypokalemia. How does hypokalemia contribute to this condition?

<p>By impairing neuromuscular function, leading to decreased intestinal motility. (D)</p> Signup and view all the answers

A patient with suspected lower GI bleeding has stools that appear normal. What diagnostic test would be appropriate to assess for occult blood?

<p>Stool occult blood test. (C)</p> Signup and view all the answers

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?

<p>Maintaining a high-fiber diet to promote regular, soft bowel movements. (C)</p> Signup and view all the answers

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?

<p>Adhesions. (A)</p> Signup and view all the answers

A patient with a small bowel obstruction is experiencing significant abdominal distention. What physiological process directly leads to this distention?

<p>Collection of intestinal contents, gas, and fluid proximal to the obstruction. (D)</p> Signup and view all the answers

A patient is diagnosed with intussusception. What is the underlying mechanism of this condition?

<p>Telescoping of one part of the intestine into another. (A)</p> Signup and view all the answers

The nurse is assessing a patient with a suspected small bowel obstruction. Which assessment finding would indicate a potential complication requiring immediate intervention?

<p>Rebound tenderness and a rigid abdomen. (A)</p> Signup and view all the answers

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?

<p>Cross-contamination of gluten in seemingly gluten-free foods. (D)</p> Signup and view all the answers

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?

<p>Using lactase enzyme supplements when consuming dairy. (D)</p> Signup and view all the answers

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?

<p>Edema, necrosis, and possible perforation of the intestinal wall. (D)</p> Signup and view all the answers

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?

<p>Rye. (A)</p> Signup and view all the answers

A patient presents with hematochezia. What is the priority initial nursing action?

<p>Monitoring vital signs and reporting changes. (C)</p> Signup and view all the answers

Which dietary factor is MOST strongly associated with an increased risk of developing colorectal cancer?

<p>Lack of fiber in the diet. (C)</p> Signup and view all the answers

A patient with colorectal cancer is experiencing persistent nausea and vomiting. Where is the tumor most likely located?

<p>Ascending colon (A)</p> Signup and view all the answers

Which screening method offers the BEST combination of direct visualization and tissue sampling for colorectal cancer detection?

<p>Colonoscopy with biopsy (B)</p> Signup and view all the answers

A patient is scheduled for a colectomy with anastomosis. What does this surgical procedure involve?

<p>Removing a portion of the colon and reconnecting the remaining sections. (B)</p> Signup and view all the answers

What is the primary mechanism of action of monoclonal antibody therapy, such as bevacizumab, in treating colorectal cancer?

<p>Blocking the formation of new blood vessels that nourish cancer cells. (D)</p> Signup and view all the answers

Following surgical resection of a colorectal tumor, a patient develops peritonitis. What is the MOST likely cause of this complication?

<p>Anastomosis leak. (D)</p> Signup and view all the answers

A patient recovering from colorectal cancer surgery asks about the purpose of CEA blood tests. Which explanation is MOST accurate?

<p>To assess the patient's response to treatment and detect cancer recurrence. (C)</p> Signup and view all the answers

Which of the following is a potential complication of colorectal cancer that may require emergent surgical intervention?

<p>Complete obstruction of the colon. (A)</p> Signup and view all the answers

A patient undergoing treatment for colorectal cancer develops a tumor extension to the peritoneum. Which complication is MOST associated with this?

<p>Ascites and abdominal pain. (A)</p> Signup and view all the answers

What is the PRIORITY nursing diagnosis for a patient experiencing significant changes in bowel habits and blood in the stool, suggestive of colorectal cancer?

<p>Fear related to uncertain prognosis (A)</p> Signup and view all the answers

A patient is prescribed cetuximab (Erbitux) for colorectal cancer. How does this medication work to inhibit cancer growth?

<p>Blocking the growth signal of cancer cells. (A)</p> Signup and view all the answers

What is the rationale for using immunological tests in home screening kits for colon cancer?

<p>To look for small amounts of blood in the stool. (B)</p> Signup and view all the answers

Besides surgery, what other treatment modalities may be used in managing colorectal cancer and potentially improving survival rates?

<p>Radiation therapy, chemotherapy, and monoclonal antibody therapy (A)</p> Signup and view all the answers

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?

<p>Flexible sigmoidoscopy or colonoscopy. (D)</p> Signup and view all the answers

What finding in a post-operative colorectal cancer patient with a perineal wound drain should be immediately reported?

<p>Large amounts of drainage or bleeding (A)</p> Signup and view all the answers

Which of the following intestinal surgeries involves removing the entire colon, rectum, and anus, typically resulting in a permanent ileostomy?

<p>Total proctocolectomy (D)</p> Signup and view all the answers

Following a colectomy with anastomosis, a patient experiences abdominal distention, fever, and increasing pain. What complication should the nurse suspect?

<p>Anastomotic leak (C)</p> Signup and view all the answers

A patient with a Kock pouch continent ileostomy reports difficulty inserting the catheter. What is the MOST likely cause?

<p>Valve slippage (A)</p> Signup and view all the answers

A patient who underwent a hemicolectomy asks about the expected changes in their bowel movements. What is the MOST accurate response?

<p>Stool will be passed via rectum and anus. (D)</p> Signup and view all the answers

What dietary modification is MOST appropriate for a patient recovering from a colectomy to minimize cramping and excessive peristalsis?

<p>High-protein, high-calorie, low-residue diet (A)</p> Signup and view all the answers

A patient with a new ileostomy is concerned about managing the effluent. Which characteristic is expected with a conventional ileostomy?

<p>Continuous flow of liquid effluent (A)</p> Signup and view all the answers

Which question is MOST important to ask a patient during data collection when assessing risk factors for colorectal cancer?

<p>Is there a history of IBD? (D)</p> Signup and view all the answers

Following an abdominoperineal resection, a patient expresses concern about body image and sexuality. What nursing intervention is MOST appropriate?

<p>Providing information about support groups and counseling services (B)</p> Signup and view all the answers

A patient is scheduled for a lower anterior resection. Which explanation BEST describes this procedure?

<p>Removal of the upper two-thirds of the rectum (B)</p> Signup and view all the answers

What is the MOST important instruction to provide a patient managing a continent ileostomy (Kock pouch)?

<p>Empty the pouch routinely to prevent pouch rupture. (C)</p> Signup and view all the answers

A patient with a new colostomy reports feeling overwhelmed and anxious. Which nursing intervention would be MOST appropriate initially?

<p>Allowing the patient time to express concerns and fears. (B)</p> Signup and view all the answers

A patient is receiving parenteral nutrition (PN) due to imbalanced nutrition related to anorexia after colorectal surgery. What is the MOST important nursing action?

<p>Monitor PN as ordered to provide nutrients. (B)</p> Signup and view all the answers

A patient is scheduled for an ileocolectomy. What anatomical structures will be removed during this procedure?

<p>Right side of the colon and diseased portion of the ileum (C)</p> Signup and view all the answers

During the evaluation phase of a patient's care plan for fear related to colorectal cancer diagnosis, which outcome indicates effective nursing interventions?

<p>The patient verbalizes less fear and demonstrates increased understanding of their condition. (C)</p> Signup and view all the answers

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?

<p>Practice thorough hand hygiene to prevent the spread of infection. (A)</p> Signup and view all the answers

A patient is admitted with frequent diarrhea. What is the priority nursing intervention to prevent skin breakdown?

<p>Applying a moisture barrier to the perianal area after each bowel movement. (B)</p> Signup and view all the answers

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?

<p>Weighing the patient daily and recording intake and output. (B)</p> Signup and view all the answers

Which of the following assessment findings is MOST indicative of peritonitis following a ruptured appendix?

<p>Board-like abdominal rigidity with rebound tenderness. (A)</p> Signup and view all the answers

A patient is suspected of having appendicitis. What intervention should be avoided?

<p>Applying a heating pad to the abdomen. (B)</p> Signup and view all the answers

A patient with peritonitis is being treated with fluid and electrolyte replacement. What assessment finding indicates that the treatment is effective?

<p>Stable vital signs and balanced intake and output. (C)</p> Signup and view all the answers

What is the PRIMARY reason for maintaining a patient with peritonitis NPO?

<p>To decrease intestinal peristalsis and allow the bowel to rest. (C)</p> Signup and view all the answers

A patient undergoing evaluation for possible appendicitis reports right lower quadrant pain. Which assessment finding would suggest the pain is likely due to appendicitis?

<p>Pain is intensified when the left lower quadrant is palpated (Rovsing's sign). (B)</p> Signup and view all the answers

Following an appendectomy, a patient develops a fever and abdominal distension. What complication is MOST likely?

<p>Paralytic ileus. (B)</p> Signup and view all the answers

A patient is diagnosed with peritonitis secondary to a ruptured diverticulum. Which laboratory result would the nurse anticipate?

<p>Increased white blood cell count. (D)</p> Signup and view all the answers

What is the PRIMARY goal of antibiotic therapy in a patient with peritonitis?

<p>To prevent or treat sepsis. (D)</p> Signup and view all the answers

A patient with a history of cirrhosis develops peritonitis. What is a potential cause of peritonitis in this patient population?

<p>Spontaneous bacterial peritonitis due to ascites. (D)</p> Signup and view all the answers

Which of the following is a postoperative instruction for a patient following a laparoscopic appendectomy to promote healing and prevent complications?

<p>Avoid strenuous activity and heavy lifting for several weeks. (A)</p> Signup and view all the answers

A patient is being evaluated for appendicitis. Which sequence of assessment techniques is MOST appropriate?

<p>Inspection, auscultation, percussion, palpation. (D)</p> Signup and view all the answers

What is the significance of a patient with appendicitis keeping their right leg flexed?

<p>It is a position assumed to relieve abdominal pain associated with appendicitis. (B)</p> Signup and view all the answers

Flashcards

Appendicitis

Inflammation of the appendix.

Colectomy

Surgical removal of all or part of the colon.

Colitis

Inflammation of the colon.

Colostomy

Surgical procedure that brings one end of the large intestine out through the abdominal wall.

Signup and view all the flashcards

Constipation

Infrequent or difficult bowel movements.

Signup and view all the flashcards

Diarrhea

Frequent passage of loose, watery stools.

Signup and view all the flashcards

Diverticulitis

Inflammation of diverticula in the colon.

Signup and view all the flashcards

Diverticulosis

Presence of diverticula in the colon without inflammation.

Signup and view all the flashcards

Expected Outcome for Constipation

Passing soft, formed stool every 1 to 3 days without straining.

Signup and view all the flashcards

Best Time for Defecation

After a meal, when bowels are most active.

Signup and view all the flashcards

DPMD or Footstool

Device Promoting More Defecation: elevate feet to flex hips.

Signup and view all the flashcards

Recommended Daily Fluid Intake For Constipation

2 to 3 L per day.

Signup and view all the flashcards

Definition of Diarrhea

Three or more loose or watery stools in 24 hours.

Signup and view all the flashcards

Chronic Diarrhea Duration

More than 14 days.

Signup and view all the flashcards

Main Causes of Acute Infectious Diarrhea

Viruses, bacteria, and protozoa from contaminated food or water.

Signup and view all the flashcards

Chronic Diarrhea Causes

Inflammatory diseases (Crohn's, ulcerative colitis).

Signup and view all the flashcards

Diarrhea Prevention

Proper food handling, storage, and refrigeration.

Signup and view all the flashcards

Characteristics of Diarrhea Stools

Foul-smelling, undigested food particles, mucus, blood or pus.

Signup and view all the flashcards

Recommended Daily Fiber Intake

19 to 38 grams per day, depending on gender and age.

Signup and view all the flashcards

Enteral Feeding Formula

Full-strength is safer than diluted.

Signup and view all the flashcards

Natural ways to treat constipation

Eat high-fiber foods and drink sufficient water.

Signup and view all the flashcards

Medications Causing Constipation

Narcotics, tranquilizers, and antacids with aluminum can decrease intestinal motility.

Signup and view all the flashcards

Anal Conditions & Constipation

Hemorrhoids or fissures can cause a delay in defecation due to pain.

Signup and view all the flashcards

Medical Conditions Causing Constipation

Diabetes, hyperparathyroidism, hypothyroidism, multiple sclerosis, lupus, or stroke can interfere with normal bowel function.

Signup and view all the flashcards

Diet & Constipation

Low intake of dietary fiber and fluids reduces stool bulk.

Signup and view all the flashcards

Symptoms of Constipation

Abdominal pain/distention, indigestion, rectal pressure, incomplete emptying, intestinal rumbling, straining, and hard, dry stool.

Signup and view all the flashcards

Fecal Impaction

When the fecal mass becomes too dry to pass, leading to a blockage.

Signup and view all the flashcards

Valsalva Maneuver

Straining during bowel movements that can lead to cardiac, neurological, and respiratory complications.

Signup and view all the flashcards

Megacolon

Grossly dilated loops of the colon proximal to the dry fecal mass causing obstruction.

Signup and view all the flashcards

Diagnostic Tests for Constipation

Radiographic defecography, sigmoidoscopy, colonoscopy, or anorectal manometry.

Signup and view all the flashcards

Lifestyle Changes for Constipation

Increased physical activity, 2-3 L of water daily, warm water/caffeine in the morning, responding to urges, and abdominal exercises.

Signup and view all the flashcards

Bulk-Forming Agents

Psyllium (Metamucil) to increase stool bulk

Signup and view all the flashcards

Stool Softeners

Docusate sodium (Colace) to soften the stool.

Signup and view all the flashcards

Defecation Posture Modification Device (DPMD)

A device used to modify posture during defecation to promote bowel emptying

Signup and view all the flashcards

Expected outcome of diarrhea treatment

Maintaining formed, soft stool every 1 to 3 days.

Signup and view all the flashcards

Why obtain patient history about diarrhea?

To help identify the underlying cause of diarrhea.

Signup and view all the flashcards

Why use transmission precautions for diarrhea?

To prevent the spread of infection.

Signup and view all the flashcards

Why give antidiarrheal medications?

To control diarrhea.

Signup and view all the flashcards

Why keep skin clean and dry with diarrhea?

To protect the skin from liquid stools and their enzymes.

Signup and view all the flashcards

Risk for Deficient Fluid Volume is related to?

Frequent passage of stools and insufficient fluid intake

Signup and view all the flashcards

Expected Outcome: Maintaining a stable weight, vital signs

Maintaining a stable weight, vital signs, and normal urine output.

Signup and view all the flashcards

Appendix

Small, fingerlike appendage attached to the cecum of the large intestine.

Signup and view all the flashcards

What happens due to the small size of the appendix?

Obstruction leading to inflammation and susceptibility to infection.

Signup and view all the flashcards

Appendicitis: Signs and Symptoms

Abdominal pain, anorexia, nausea, vomiting, diarrhea, fever, and increased WBCs.

Signup and view all the flashcards

McBurney point location

Midway between the umbilicus and the right iliac crest.

Signup and view all the flashcards

CBC result in appendicitis?

Elevated leukocyte (WBC) and neutrophil counts.

Signup and view all the flashcards

Peritonitis

Inflammation of the peritoneum.

Signup and view all the flashcards

Common causes of peritonitis

Ruptured appendix, peptic ulcer, gangrenous gallbladder, perforated colon, pancreatitis.

Signup and view all the flashcards

Abdominal Distention Relief

Distention relief via orogastric or NG tube.

Signup and view all the flashcards

Peritonitis Treatment

Excision, drainage, or repair may address it.

Signup and view all the flashcards

Ostomy Purpose

Can divert stool, aiding infection resolution.

Signup and view all the flashcards

Post-Peritonitis Surgery

Wound drain, NG tube, urinary catheter.

Signup and view all the flashcards

Peritonitis Complications

Intestinal obstruction, hypovolemia, septicemia.

Signup and view all the flashcards

Diverticulum

Outpouching of the colon wall.

Signup and view all the flashcards

Diverticulosis Definition

Multiple diverticula without inflammation.

Signup and view all the flashcards

Diverticulitis Cause

Tear + inflammation/infection of diverticulum.

Signup and view all the flashcards

Diverticular Disease Risk

Chronic constipation, obesity, hiatal hernia.

Signup and view all the flashcards

Diverticula Development

Weak colon spots give way to pressure.

Signup and view all the flashcards

Diverticulosis Factors

Low-fiber diets, chronic constipation.

Signup and view all the flashcards

Diverticulosis Location

Sigmoid colon.

Signup and view all the flashcards

Diverticulitis Risk Factors

Older age, diet, lifestyle, medications.

Signup and view all the flashcards

Diverticulitis Symptoms

Steady/crampy LLQ pain, nausea, constipation.

Signup and view all the flashcards

Diverticulitis Diagnosis

CT scan confirms; avoid colonoscopy.

Signup and view all the flashcards

Food Poisoning Diarrhea

Sudden onset diarrhea, often with nausea and vomiting, resulting from contaminated food.

Signup and view all the flashcards

Hypokalemia Symptoms

Muscle weakness, low blood pressure, anorexia, paresthesia, drowsiness, and potentially fatal heart arrhythmias.

Signup and view all the flashcards

Diarrhea: Signs & Symptoms

Frequent, watery stools; abdominal cramping; distention; anorexia; intestinal rumbling.

Signup and view all the flashcards

Diarrhea: Causes

Inflammatory bowel diseases, infections, antibiotics, surgery, laxatives, enteral feedings, and radiation therapy.

Signup and view all the flashcards

Diarrhea: Diagnostic Tests

History, stool lab tests (bacteria, pus, blood). Stool tests for bacterial pathogens should be completed for diarrhea lasting more than 1 week.

Signup and view all the flashcards

Diarrhea: Therapeutic Measures

Fluids/electrolytes, antidiarrheals, antimicrobials, probiotics, fecal transplant

Signup and view all the flashcards

Diarrhea: Fluid Replacement

Replacing lost fluids and electrolytes due to excessive stool output.

Signup and view all the flashcards

Antidiarrheal Medications

Loperamide (Imodium) or diphenoxylate (Lomotil).

Signup and view all the flashcards

Probiotics for Diarrhea

To restore normal intestinal flora.

Signup and view all the flashcards

Fecal Transplant

Restores normal intestinal flora in those who are ill or who have chronic conditions.

Signup and view all the flashcards

When to Seek Medical Care (Diarrhea)

Diarrhea lasting >2 days, severe abdominal pain, fever ≥102°F, bloody/tarry stools, dehydration signs, or occurs in high-risk person.

Signup and view all the flashcards

Diarrhea: Dehydration Signs

Tachycardia, hypotension, decreased skin turgor, weakness, thready pulse, dry mucous membranes, and oliguria.

Signup and view all the flashcards

Diarrhea: Dehydration Lab Values

Increased serum osmolality, increased urine specific gravity, increased hematocrit.

Signup and view all the flashcards

Diarrhea: Data Collection

Ask about the cause, symptoms, diet, recent travel, and medications. Document stool characteristics and dehydration signs.

Signup and view all the flashcards

Enteritis

Inflammation of the intestine.

Signup and view all the flashcards

Deficient Fluid Volume (Risk)

Impaired fluid volume due to factors like diarrhea or fluid shift. Monitor I&O.

Signup and view all the flashcards

Crohn Disease

An autoimmune disease causing inflammation in the GI tract.

Signup and view all the flashcards

Crohn's Location

Any part of the GI tract, often the terminal ileum.

Signup and view all the flashcards

Skip Lesions

Inflamed areas alternating with healthy tissue in Crohn's.

Signup and view all the flashcards

Intestinal Obstruction (Crohn's)

Narrowing of the intestinal lumen due to inflammation and scar tissue.

Signup and view all the flashcards

Fistulas (Crohn's)

Abnormal connections between structures caused by inflammation in Crohn's.

Signup and view all the flashcards

Enterovaginal Fistula

Small bowel to vagina.

Signup and view all the flashcards

Enterovesicular Fistula

Small bowel to bladder.

Signup and view all the flashcards

Crohn's Main Symptoms

The main symptoms are crampy abdominal pain and chronic intermittent diarrhea.

Signup and view all the flashcards

Crohn's Lab Findings

Anemia, infection, and low albumin.

Signup and view all the flashcards

Imaging Tests for Crohn's

CT enterography and magnetic resonance enterography (MRE).

Signup and view all the flashcards

Crohn's Confirmation

Endoscopy with biopsies for granulomas.

Signup and view all the flashcards

Crohn's Management Goal

The aim is to achieve and maintain remission.

Signup and view all the flashcards

Crohn's Medication Classes

5-aminosalicylates, biologic response modifiers, corticosteroids, anti-inflammatory corticosteroid, and immunomodulators.

Signup and view all the flashcards

Mild Crohn's Treatment

Oral enteric-coated budesonide.

Signup and view all the flashcards

Strictureplasty

Surgical widening of narrowed areas in the intestine.

Signup and view all the flashcards

Small Intestine Resection with Anastomosis

Removal of a diseased section of the small intestine, followed by reconnection.

Signup and view all the flashcards

Colectomy with Ileorectal Anastomosis

Surgical removal of the colon, reconnecting the small intestine to the rectum.

Signup and view all the flashcards

Proctectomy

Surgical removal of the rectum.

Signup and view all the flashcards

Proctocolectomy with Ileostomy

Removal of both the rectum and colon, requiring an ileostomy.

Signup and view all the flashcards

Ileostomy

A surgically created opening in the ileum to bring bowel contents to the abdominal surface

Signup and view all the flashcards

5-Aminosalicylates

Medications that decrease inflammation and suppress the immune system in IBD.

Signup and view all the flashcards

Biologic Response Modifiers

Medications that selectively target inflammatory agents to interfere with the inflammatory response

Signup and view all the flashcards

Corticosteroids for IBD

Medications that decrease overall intestinal inflammation.

Signup and view all the flashcards

Immunomodulators for IBD

Medications used in immunosuppression to reduce inflammation in IBD.

Signup and view all the flashcards

Ulcerative Colitis

Inflammation and ulceration in the large intestine and rectum.

Signup and view all the flashcards

Symptoms of Ulcerative Colitis

Symptoms include diarrhea with blood or pus, abdominal pain, and rectal bleeding.

Signup and view all the flashcards

Possible Causes of Ulcerative Colitis

Possible factors include infection, allergy, and autoimmune responses.

Signup and view all the flashcards

Systemic symptoms of ulcerative colitis

Weight loss, fever, fatigue, severe dehydration

Signup and view all the flashcards

Stool Examination

Laboratory analysis of stool that can help identify infections or inflammation.

Signup and view all the flashcards

Ulcerative Colitis Complications

Bleeding, toxic megacolon, perforation, osteoporosis, colorectal cancer risk.

Signup and view all the flashcards

Diagnosing Ulcerative Colitis

History/exam, stool analysis, colonoscopy, biopsy, barium enema, CT, MRI.

Signup and view all the flashcards

Anemia in Ulcerative Colitis

Anemia due to blood loss in the stool.

Signup and view all the flashcards

Liver Dysfunction in UC

Elevated serum alkaline phosphatase, protein loss.

Signup and view all the flashcards

Ulcerative Colitis Treatment

Diet changes, meds, surgery to remove colon/rectum.

Signup and view all the flashcards

Diet for Ulcerative Colitis

Avoid gas/diarrhea causing foods, high-fiber, caffeine, spicy foods, milk.

Signup and view all the flashcards

Ileoanal Pouch

Anal sphincter preserved; ileum forms pouch attached to anus.

Signup and view all the flashcards

Pouchitis

Inflammation of the pouch, complication of ileoanal pouch, treatable with antibiotics.

Signup and view all the flashcards

UC Symptom History

Onset, duration, frequency, severity; diet, stress correlation.

Signup and view all the flashcards

Nutritional Status in UC

Weight loss, dehydration are signs.

Signup and view all the flashcards

Caffeine, Nicotine, Alcohol

Stimulate bowel, cause cramping, diarrhea; note allergies, intolerances.

Signup and view all the flashcards

Assessing Pain in UC

Rate pain, note character, association with meals to plan care.

Signup and view all the flashcards

Desired Stool Outcome

Formed, soft stool every 1-3 days.

Signup and view all the flashcards

Perianal Skin Care

Keeping the perianal area clean and dry protects skin from liquid stool and enzymes.

Signup and view all the flashcards

Sitz Baths

Sitz baths help keep the perianal area clean and prevent skin breakdown.

Signup and view all the flashcards

Malabsorption Impact

Malabsorption can lead to inadequate nutrition.

Signup and view all the flashcards

Elemental Formula

To allow the colon to rest and provide nutrients absorbed in the upper bowel.

Signup and view all the flashcards

Irritable Bowel Syndrome (IBS)

A functional problem without damage to the colon mucosa, characterized by abdominal pain and altered bowel habits.

Signup and view all the flashcards

IBS Management

Diet, lifestyle, stress management, and medication.

Signup and view all the flashcards

IBS Diagnosis

History, physical exam, stool tests, and possibly imaging to rule out other conditions.

Signup and view all the flashcards

IBS Symptoms

Chronic abdominal pain and altered bowel habits (constipation or diarrhea).

Signup and view all the flashcards

IBS General Measures

Adequate hydration, exercise, rest, avoiding trigger foods (gluten, FODMAPs).

Signup and view all the flashcards

IBS Constipation Relief

High-fiber diet, psyllium, or polyethylene glycol.

Signup and view all the flashcards

Smaller, Frequent Meals in IBS

Eating smaller, frequent meals is helpful in reducing bowel contractions.

Signup and view all the flashcards

IBS Stress Reduction

Stress management and behavioral therapy.

Signup and view all the flashcards

Effective Coping Strategies

Talking about concerns and identifying acceptable solutions.

Signup and view all the flashcards

Parenteral Nutrition (PN)

Provide nourishment when the patient cannot tolerate oral intake.

Signup and view all the flashcards

Assessing Disease Knowledge

Determines patient's understanding of the disease.

Signup and view all the flashcards

Glossitis

Inflammation of the tongue

Signup and view all the flashcards

Stomatitis

Inflammation of the mouth

Signup and view all the flashcards

Dermatitis Herpetiformis

Skin rash with severe itching and blistering, seen in celiac disease.

Signup and view all the flashcards

Celiac Disease

Multifactorial disease where gluten triggers an autoimmune response in the small intestine.

Signup and view all the flashcards

Foods to Avoid in Celiac Disease

Wheat, rye, and barley.

Signup and view all the flashcards

Common Nutritional Deficiencies in Celiac Disease

Vitamins A, D, E, B12, fiber, iron, calcium, magnesium, zinc, and folate

Signup and view all the flashcards

Positive Tissue Transglutaminase (tTG) antibody (IgA)

Presence indicates celiac disease

Signup and view all the flashcards

Biopsy Result in Celiac Disease

Shows flattened mucosa and loss of villi

Signup and view all the flashcards

Goals of Gluten-Free Diet

Relieve symptoms, promote intestinal healing and improve nutritional status

Signup and view all the flashcards

Treatment for Lactose Intolerance

Limit or avoid foods containing lactose

Signup and view all the flashcards

Nursing Care for Malabsorption Disorders

Monitoring fluid and electrolyte balance, nutritional status, and skin integrity

Signup and view all the flashcards

Intestinal Obstruction Definition

When the flow of intestinal contents is blocked.

Signup and view all the flashcards

Mechanical Intestinal Obstruction

Blockage occurs within the intestine from conditions causing pressure on the intestinal walls.

Signup and view all the flashcards

Nonmechanical Intestinal Obstruction

Peristalsis is impaired and intestinal contents cannot be propelled through the bowel.

Signup and view all the flashcards

Adhesions (Small-Bowel Obstruction)

Loops of intestine adhere to areas in the abdomen that are not healed.

Signup and view all the flashcards

Inguinal Hernia

Hernia located in the groin where the spermatic cord (males) or round ligament (females) exits the abdominal wall.

Signup and view all the flashcards

Femoral Hernia

Hernia that occurs in the groin, specifically below the inguinal ligament.

Signup and view all the flashcards

Ventral (Incisional) Hernia

Hernia resulting from a weakness in the abdominal wall, typically post-surgery.

Signup and view all the flashcards

Reducible Hernia

Hernia that easily returns to the abdominal cavity, either spontaneously or manually.

Signup and view all the flashcards

Irreducible (Incarcerated) Hernia

Hernia where the contents are trapped due to adhesions or edema.

Signup and view all the flashcards

Strangulated Hernia

Incarcerated hernia where blood and intestinal flow are completely cut off.

Signup and view all the flashcards

Herniorrhaphy

Surgical repair involving an incision, replacing hernia contents, and sewing weakened tissue.

Signup and view all the flashcards

Hernioplasty

Surgical repair replacing the hernia and reinforcing the abdominal wall with mesh.

Signup and view all the flashcards

Post-Hernia Repair Activity Restrictions

Avoid activities increasing abdominal pressure, such as heavy lifting or coughing.

Signup and view all the flashcards

Malabsorption

Condition where the GI system cannot absorb one or more major nutrients.

Signup and view all the flashcards

Lactose Intolerance

Enzyme deficiency causing inability to digest lactose (milk sugar).

Signup and view all the flashcards

Steatorrhea

Frequent loose, bulky, foul gray stools with increased fat content.

Signup and view all the flashcards

Vitamin K Deficiency

Vitamin deficiency increases risk of bleeding.

Signup and view all the flashcards

Hernia Prevention Lifestyle

Maintaining normal weight, not smoking, and eating high-fiber foods.

Signup and view all the flashcards

FODMAPs Definition

Carbohydrates that cause IBS symptoms due to poor absorption and fermentation.

Signup and view all the flashcards

Fructans (FODMAP)

Wheat, rye, onions, garlic, and artichokes. Restrict these on a low FODMAP diet.

Signup and view all the flashcards

Galacto-oligosaccharides (FODMAP)

Legumes (soybeans, chickpeas, lentils), cabbage and brussels sprouts. Restrict these on a low FODMAP diet.

Signup and view all the flashcards

Lactose (FODMAP)

Milk, dairy products, beer, and sauces. Restrict these on a low FODMAP diet.

Signup and view all the flashcards

Fructose (FODMAP)

Honey, apples, dates, mangoes, papaya, pears, watermelon, high-fructose corn syrup. Restrict these on a low FODMAP diet.

Signup and view all the flashcards

Sorbitol (FODMAP)

Apples, pears, stone fruits, sugar-free mints/gum. Restrict these on a low FODMAP diet.

Signup and view all the flashcards

Mannitol (FODMAP)

Mushrooms, cauliflower, sugar-free mints/gums. Restrict these on a low FODMAP diet.

Signup and view all the flashcards

Why fructans and GOSs cause gas.

Humans lack the enzymes to break them down, causing malabsorption and gas.

Signup and view all the flashcards

Data collection for IBS

Monitor pain, bowel habits, food intake, and psychosocial factors.

Signup and view all the flashcards

Promote self-management of IBS

Encourage food diary use and consult a dietitian.

Signup and view all the flashcards

Hernia definition

Abnormal protrusion through the wall of a cavity.

Signup and view all the flashcards

What causes Hernias?

Increased intra-abdominal pressure from things like coughing or lifting.

Signup and view all the flashcards

Medication for IBS-related constipation

Psyllium or polyethylene glycol.

Signup and view all the flashcards

Medication for IBS-related Diarrhea

Loperamide (Imodium)

Signup and view all the flashcards

Key Data to Collect for IBS

Height, weight, symptoms, bowel patterns, and psychosocial effects.

Signup and view all the flashcards

Hematochezia

Blood in the stool.

Signup and view all the flashcards

Colorectal Cancer

Cancer originating in the epithelial lining of the colon or rectum.

Signup and view all the flashcards

Colorectal Cancer Symptom

Most common symptom is a change in bowel habits.

Signup and view all the flashcards

Stool Changes in CRC

Blood or mucus may be present in stools.

Signup and view all the flashcards

CRC Diagnosis

Identifies colorectal cancer by biopsy during endoscopy.

Signup and view all the flashcards

Computer-aided polyp detection system

Cancer detection system with better cancer detection rates.

Signup and view all the flashcards

Colonography

A CT scan that performs a virtual colonoscopy.

Signup and view all the flashcards

Carcinoembryonic Antigen (CEA)

Blood test to assess response to GI cancer treatment.

Signup and view all the flashcards

Surgical CRC Treatment

Stent placement, resection, or ostomy creation.

Signup and view all the flashcards

Medical CRC Treatment

Radiation therapy, chemotherapy, and monoclonal antibody therapy.

Signup and view all the flashcards

Monoclonal Antibody Therapy

Antibodies that work to kill cancer cells.

Signup and view all the flashcards

Bevacizumab (Avastin)

Blocks new blood vessel formation to starve cancer cells.

Signup and view all the flashcards

Cetuximab & Panitumumab

Block cell's growth signal to stop it from growing.

Signup and view all the flashcards

CRC Complications

Bleeding, obstruction, perforation, peritonitis, metastasis.

Signup and view all the flashcards

CRC Risk Factors

Personal/family history, lack of fiber, lifestyle factors.

Signup and view all the flashcards

Open Colectomy

Open colon resection with anastomosis.

Signup and view all the flashcards

Ileocolectomy

Removal of the right colon and ileum, with anastomosis.

Signup and view all the flashcards

Hemicolectomy

Removal of the right or left side of the colon.

Signup and view all the flashcards

Total Colectomy

Removal of the entire colon with ileorectal anastomosis.

Signup and view all the flashcards

Total Proctocolectomy

Removal of the colon, rectum, and sometimes the anus, creating an ileostomy.

Signup and view all the flashcards

Transanal Resection

Removal of rectal cancer through the anus.

Signup and view all the flashcards

Transanal Endoscopic Microsurgery

Resection higher in rectum, through the anus.

Signup and view all the flashcards

Lower Anterior Resection

Removal of cancer in upper rectum, with anastomosis.

Signup and view all the flashcards

Abdominoperineal Resection

Removal of sigmoid colon, rectum, and anus, leading to a colostomy.

Signup and view all the flashcards

Ostomy

Surgically created opening diverting stool to the outside of the body.

Signup and view all the flashcards

Stoma

Portion of bowel sutured onto the abdomen.

Signup and view all the flashcards

Continent Ostomy

Internal reservoir to collect stool, with intermittent catheterization.

Signup and view all the flashcards

Peristaltic Waves (Obstruction)

Waves of muscle contractions that try to move intestinal contents past an obstruction.

Signup and view all the flashcards

Fecal Vomiting

Vomiting of fecal matter due to severe intestinal obstruction.

Signup and view all the flashcards

Abdominal Distention

A swollen abdomen, often a sign of bowel obstruction.

Signup and view all the flashcards

Sharp, Sustained Abdominal Pain

A possible sign of bowel perforation (a hole in the bowel wall).

Signup and view all the flashcards

High-Pitched, Tinkling Bowel Sounds

High-pitched sounds heard near a mechanical bowel obstruction.

Signup and view all the flashcards

Absent Bowel Sounds

Absence of bowel sounds, indicating non-mechanical obstruction.

Signup and view all the flashcards

Dehydration (from Obstruction)

Extreme thirst, drowsiness, aching, and malaise due to fluid and electrolyte loss.

Signup and view all the flashcards

Obstruction Location & Distention

The lower the obstruction, the greater the abdominal swelling.

Signup and view all the flashcards

Bowel Obstruction: Diagnostic Imaging

X-rays and CT scans showing dilated loops of bowel.

Signup and view all the flashcards

Bowel Obstruction: Initial Treatment

NPO (nothing by mouth) status, NG tube, IV fluids.

Signup and view all the flashcards

Mechanical Obstruction: Surgery

Surgical removal of the obstruction (tumors, adhesions).

Signup and view all the flashcards

Large-Bowel Obstruction: Causes

Caused by carcinoma, IBD, diverticulitis, tumors, or impaction.

Signup and view all the flashcards

Large-Bowel Obstruction: Symptoms

Crampy lower abdominal pain and distention.

Signup and view all the flashcards

Large-Bowel Obstruction: Treatment

Enemas, manual disimpaction, surgical resection, colostomy.

Signup and view all the flashcards

Hemorrhoids

Enlarged veins in the anal tissue due to increased pressure, often from straining.

Signup and view all the flashcards

Internal Hemorrhoids

Hemorrhoids above the internal sphincter, usually not painful unless prolapsed.

Signup and view all the flashcards

External Hemorrhoids

Hemorrhoids below the external sphincter, causing itching and pain, especially when thrombosed.

Signup and view all the flashcards

Anal Fissures

Cracks or ulcers in the anal canal lining, often due to constipation or hard stools.

Signup and view all the flashcards

Anorectal Abscess

A collection of pus in the rectal area, causing pain, redness, and swelling.

Signup and view all the flashcards

Melena

Blood in stool that has been in the GI tract for at least 8 hours, resulting in black, tarry stools.

Signup and view all the flashcards

Significant blood loss symptoms

Dizziness, nausea and lightheadedness with hypotension.

Signup and view all the flashcards

Signs of blood loss

Cool skin and paleness.

Signup and view all the flashcards

Vitals for hypovolemic shock

Rapid heart rate and decreased blood pressure.

Signup and view all the flashcards

Hemorrhoid Prevention: Posture

Avoiding prolonged periods of sitting or standing reduces pressure on rectal veins.

Signup and view all the flashcards

Hemorrhoid Prevention: Diet

Increasing fluid intake and using stool softeners reduces straining during bowel movements.

Signup and view all the flashcards

Sitz Bath Benefit

Sitz baths increase circulation to the anal area, promoting comfort and healing of hemorrhoids and fissures.

Signup and view all the flashcards

Preventing Anorectal Issues

High-fiber diet and ample fluids (2-3 L/day) promote regular, soft bowel movements, preventing anorectal problems.

Signup and view all the flashcards

Anal Fissure Symptom

Bright red bleeding, severe pain, leading to constipation and worsening symptoms.

Signup and view all the flashcards

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

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Quiz Team

More Like This

Gastrointestinal Disorders Quiz
8 questions
Gastrointestinal Disorders Quiz
48 questions

Gastrointestinal Disorders Quiz

ReliableInspiration7759 avatar
ReliableInspiration7759
Use Quizgecko on...
Browser
Browser