Podcast
Questions and Answers
A patient presenting with ileus exhibits abdominal distention, abdominal fullness, and inability to pass gas. Which of the following is a late finding associated with ileus that indicates a more serious complication?
A patient presenting with ileus exhibits abdominal distention, abdominal fullness, and inability to pass gas. Which of the following is a late finding associated with ileus that indicates a more serious complication?
A patient with ileus is experiencing metabolic alkalosis. What can you infer about the location of the obstruction based on this information?
A patient with ileus is experiencing metabolic alkalosis. What can you infer about the location of the obstruction based on this information?
A patient with a history of multiple surgeries is suspected of having ileus. What imaging study would be most appropriate to diagnose this condition?
A patient with a history of multiple surgeries is suspected of having ileus. What imaging study would be most appropriate to diagnose this condition?
In the context of ileus management, what is the primary purpose of placing a nasogastric (NG) tube to suction?
In the context of ileus management, what is the primary purpose of placing a nasogastric (NG) tube to suction?
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Which of the following is NOT a potential complication of ileus?
Which of the following is NOT a potential complication of ileus?
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A patient with ileus is experiencing a potassium level of 2.1. What can you infer about the location and severity of the obstruction?
A patient with ileus is experiencing a potassium level of 2.1. What can you infer about the location and severity of the obstruction?
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What is the main goal of fluid resuscitation with potassium in a patient with ileus?
What is the main goal of fluid resuscitation with potassium in a patient with ileus?
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A patient with ileus is having a bowel obstruction. What is the most likely cause of this obstruction?
A patient with ileus is having a bowel obstruction. What is the most likely cause of this obstruction?
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What is the purpose of placing an ostomy in a patient with ileus?
What is the purpose of placing an ostomy in a patient with ileus?
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Which of the following nursing assessments would be MOST helpful in identifying a potential complication of ileus?
Which of the following nursing assessments would be MOST helpful in identifying a potential complication of ileus?
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Study Notes
Inflammatory Bowel Disease (IBD)
- IBD (Crohn's disease and ulcerative colitis) causes constant inflammation in the body.
- Results in damage to the small intestines and can leave scar tissue.
- Ileus, a non-mechanical obstruction, can occur due to intestinal paralysis after surgery.
Clinical Manifestations
- GI Symptoms: Distention (swelling), abdominal fullness (due to inability to pass gas), pain, cramping, breath odor, nausea, vomiting, diarrhea (early), constipation (late).
- Other Symptoms: Fever, tachycardia (late - associated with strangulation).
- Severe Cases: Septic shock.
Complications
- Prevent Complications: Electrolyte imbalances, dehydration, intestinal perforation, infection, jaundice, obstructed blood supply to the intestine (leading to infection, tissue death, and sepsis), peritonitis.
- Severe complications can lead to bowel death.
Patient Management and History
- Patient History: Multiple surgeries are a significant factor.
- Diagnostic Imaging: CT scan to evaluate potential complications.
- Sign of Perforation: Absence of contrast on the CT scan.
Treatment
- Initial Management: NPO (nothing by mouth), nasogastric tube (NGT) for suction, fluid resuscitation (with potassium replacement), surgery, ostomies, and parental nutrition.
- IV Fluids: D5W, Normal Saline, Potassium (20%).
Post-Surgical Care and Healing
- Ostomy placement: Required after some surgeries.
Assessing Tissue Perfusion
Metabolic Imbalances
- Metabolic Acidosis: Associated with large volume diarrhea.
- Metabolic Alkalosis: Often caused by prolonged vomiting.
Nursing Assessment and Management
- Comprehensive Assessments: Pain, surgery history, vomit characteristics, medications, diet, bowel patterns.
- Vital Signs monitoring: Tachycardia, fever.
- Lab Values: Assessment of WBC count to evaluate for infection (elevated WBC suggests infection, potentially peritonitis).
- Physical Exam: Tenderness, fever, peritonitis-related signs (infection symptoms).
- Absent Bowel Sounds: A sign of possible obstruction.
- Other Assessments: Changes in VS, elevated WBC, possible need for antibiotics.
- Monitoring pt in hospital: Urine output, Creatinine (to assess kidney function). NG tube output monitoring.
Nursing Interventions
- Post-Op: Maintain proper nasogastric tube placement and functions.
Obstruction-related Imbalances
- Small Bowel Obstruction: Leads to vomiting, metabolic alkalosis.
- Small Bowel Obstruction (more subtle): Metabolic acidosis can occur.
- Hypokalemia: Low potassium levels (2.1 mEq/L) can be a sign of a small bowel obstruction.
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Description
This quiz delves into Inflammatory Bowel Disease (IBD), focusing on its clinical manifestations, complications, and patient management. Understand the symptoms associated with Crohn's disease and ulcerative colitis, as well as the necessary interventions to prevent severe complications.
