Noninflammatory Bowel Disorders Overview

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Questions and Answers

What is the primary cause of hemorrhoids?

  • Genetic factors
  • Viral infections
  • Increased dietary fiber
  • Sedentary lifestyle and straining (correct)

Which condition is NOT classified as a noninflammatory bowel disorder?

  • Colon cancer
  • Hernia
  • Crohn’s disease (correct)
  • Irritable bowel syndrome

What does it mean if a hernia is described as irreducible?

  • It resolves on its own
  • It is caused by excessive physical activity
  • It can be pushed back into place
  • It cannot be moved back into its original position (correct)

What is a potential consequence of a strangulated hernia?

<p>Loss of blood supply to the bowel (D)</p> Signup and view all the answers

Which factor increases the risk of developing bowel cancer?

<p>Age over 50 years (D)</p> Signup and view all the answers

Which factor is associated with an increased risk of developing a femoral hernia?

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

What is an expected finding when assessing a hernia?

<p>Protrusion or lump at the involved site (A)</p> Signup and view all the answers

What nursing action is recommended for a client whose hernia does not require surgery?

<p>Advise wearing a truss pad with a hernia belt during waking hours (D)</p> Signup and view all the answers

What should a postoperative client do to prevent complications during recovery?

<p>Avoid increased intra-abdominal pressure for 2 to 3 weeks (B)</p> Signup and view all the answers

Which of the following is NOT a risk factor for developing a hernia?

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

Which of the following symptoms is commonly related to irritable bowel syndrome (IBS)?

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

What influence is NOT considered a potential contributor to the development of IBS?

<p>Direct food poisoning (D)</p> Signup and view all the answers

Which of the following criteria does NOT help in diagnosing IBS?

<p>Chronic nausea lasting over 2 months (D)</p> Signup and view all the answers

Which of the following factors is least likely to influence IBS symptoms?

<p>Daily exercise routine (B)</p> Signup and view all the answers

Which cytokine is mentioned as part of the immunological factors related to IBS?

<p>Pro-inflammatory interleukins (C)</p> Signup and view all the answers

Which dietary change is recommended for managing symptoms of irritable bowel syndrome?

<p>Consume 2 to 3 L of fluid daily (C)</p> Signup and view all the answers

Which of the following is NOT considered a risk factor for developing irritable bowel syndrome?

<p>Having a sedentary lifestyle (C)</p> Signup and view all the answers

Which symptom is associated with diarrhea-predominant irritable bowel syndrome?

<p>Mucous in stools (D)</p> Signup and view all the answers

What is an expected finding during the assessment of a patient with irritable bowel syndrome?

<p>Cramping pain in abdomen (B)</p> Signup and view all the answers

Which of the following beverages should be avoided by individuals managing irritable bowel syndrome?

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

What is the purpose of the hydrogen breath test in diagnosing conditions related to irritable bowel syndrome?

<p>To identify malabsorption, impaired digestion, or bacterial overgrowth (B)</p> Signup and view all the answers

Which of the following laboratory tests is typically expected to show normal results in patients with irritable bowel syndrome?

<p>Erythrocyte sedimentation rate (ESR) (A)</p> Signup and view all the answers

How long should a client remain NPO prior to undergoing a hydrogen breath test?

<p>12 hours (A)</p> Signup and view all the answers

What could a positive result in the hydrogen breath test indicate?

<p>Excess hydrogen in the bloodstream due to bacterial overgrowth or malabsorption (A)</p> Signup and view all the answers

Which of the following statements about the hydrogen breath test is false?

<p>The test can indicate successful digestion without the need for additional testing. (C)</p> Signup and view all the answers

What is the purpose of instructing a client with IBS to keep a food diary?

<p>To adjust diet in order to prevent exacerbations. (C)</p> Signup and view all the answers

Which of the following medications is specifically indicated for diarrhea-predominant IBS in females?

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

What is a potential side effect of Loperamide when used for IBS-D?

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

What dietary recommendation is essential for managing symptoms of IBS?

<p>High-fiber and fluids diet (B)</p> Signup and view all the answers

Under which condition should Psyllium be discontinued when used for IBS treatment?

<p>Severe abdominal cramping or rectal bleeding (B)</p> Signup and view all the answers

What is the primary mechanism by which alosetron alleviates symptoms in IBS-D patients?

<p>Blocks 5-HT3 receptors that innervate the viscera (C)</p> Signup and view all the answers

Which observation should prompt immediate discontinuation of alosetron?

<p>Fever with signs of dark urine and bloody diarrhea (C)</p> Signup and view all the answers

What is a key consideration when prescribing lubiprostone for IBS-C?

<p>It is contraindicated in patients with known bowel obstruction. (B)</p> Signup and view all the answers

How long may it take for manifestations of IBS to resolve with treatment using alosetron?

<p>3 to 4 weeks (D)</p> Signup and view all the answers

What should clients avoid while taking alosetron to minimize risks?

<p>Antihistamines and psychoactive drugs (D)</p> Signup and view all the answers

What is the primary function of Linaclotide in the treatment of irritable bowel syndrome?

<p>Increase fluid and motility in the intestine (B)</p> Signup and view all the answers

Which condition is characterized by diminished peristalsis within the bowel, often occurring postoperatively?

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

What is a common cause of large intestine obstructions in older adults?

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

What surgical intervention is typically required for complete mechanical bowel obstructions?

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

Which of the following factors is associated with mechanical bowel obstructions?

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

What is the primary cause of nonmechanical obstructions like paralytic ileus?

<p>Decreased peristalsis due to various disorders (B)</p> Signup and view all the answers

Which of the following is NOT a manifestation of nonmechanical obstructions?

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

Which electrolyte imbalance is commonly associated with nonmechanical obstructions?

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

What role do vascular disorders play in nonmechanical obstructions?

<p>They reduce blood flow, leading to decreased peristalsis. (D)</p> Signup and view all the answers

Which inflammatory condition can contribute to nonmechanical obstructions?

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

What is a key sign of small bowel obstruction in a patient?

<p>Visible peristaltic waves and projectile vomiting (D)</p> Signup and view all the answers

Which of the following symptoms is most associated with obstipation?

<p>Inability to pass stool or flatus for more than 8 hours (D)</p> Signup and view all the answers

In the case of a large intestine obstruction, which finding is typically expected?

<p>Hypoactive bowel sounds below the obstruction (A)</p> Signup and view all the answers

What metabolic condition might result from a small bowel obstruction?

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

Which observation might initially accompany abdominal distention in a small bowel obstruction?

<p>High-pitched bowel sounds above the obstruction (D)</p> Signup and view all the answers

Which laboratory test result is most indicative of dehydration in a patient with an obstruction?

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

What is a common characteristic of stools in patients experiencing an obstruction?

<p>Diarrhea or ribbon-like stools around an impaction (D)</p> Signup and view all the answers

Which diagnostic procedure is particularly useful for determining the exact location of an obstruction?

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

Which electrolyte imbalance is commonly associated with large intestine obstructions?

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

What symptom is expected in a patient experiencing significant lower abdominal distention due to an obstruction?

<p>Intermittent abdominal cramping (A)</p> Signup and view all the answers

What is an appropriate nursing intervention for a patient with a nonmechanical cause of obstruction?

<p>Administer IV fluid and electrolyte replacement (C)</p> Signup and view all the answers

Which position is recommended for a patient experiencing a nonmechanical bowel obstruction?

<p>Semi-Fowler’s position (C)</p> Signup and view all the answers

What is the primary nursing action for a patient with a mechanical bowel obstruction?

<p>Prepare for surgery (A)</p> Signup and view all the answers

Which assessment finding is critical to monitor in a patient with a nonmechanical bowel obstruction?

<p>Presence of bowel sounds (D)</p> Signup and view all the answers

What dietary management should be avoided for a patient recovering from a nonmechanical bowel obstruction?

<p>High-fiber foods (D)</p> Signup and view all the answers

What is the primary purpose of administering alvimopan in a clinical setting?

<p>To reverse the action of opioids on bowel motility postoperatively (D)</p> Signup and view all the answers

Which nursing action is essential when managing a patient with a nasogastric (NG) tube?

<p>Irrigate the NG tube with 30 mL sodium chloride every 4 hours as prescribed (A)</p> Signup and view all the answers

Which assessment finding should be monitored closely in a patient receiving opioids postoperatively?

<p>Signs of myocardial infarction (C)</p> Signup and view all the answers

What is a common nursing intervention for a patient on an NG tube to ensure skin integrity?

<p>Frequently assess the nasal area for skin breakdown (D)</p> Signup and view all the answers

Which of the following represents a key component of nursing care when monitoring patients with NG tubes?

<p>Maintain intermittent suction as prescribed (A)</p> Signup and view all the answers

What is a possible surgical intervention performed to address a bowel obstruction?

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

Which nursing action is crucial after NG tube removal to assess patient's tolerance of intake?

<p>Clamp the tube for 1 to 2 hours after eating (C)</p> Signup and view all the answers

What is a key nursing responsibility in monitoring a patient post-surgery for bowel obstruction?

<p>Monitoring bowel sounds regularly (B)</p> Signup and view all the answers

After a bowel obstruction surgery, what should be prioritized in patient care?

<p>Assessing for hemodynamic instability (D)</p> Signup and view all the answers

What is the purpose of an exploratory laparotomy in bowel obstruction?

<p>To determine and correct the cause of obstruction (D)</p> Signup and view all the answers

What is a crucial nursing action to monitor hydration levels in a patient at risk for dehydration due to a small bowel obstruction?

<p>Evaluate skin turgor and mucous membranes. (D)</p> Signup and view all the answers

Which laboratory value should be closely monitored to detect electrolyte imbalance in a patient with persistent vomiting?

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

What action should a nurse take if there is evidence of fluid imbalance in a patient?

<p>Notify the provider and document findings. (D)</p> Signup and view all the answers

What complication could result from persistent vomiting associated with a small bowel obstruction?

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

What should a nurse assess to evaluate dehydration in patients with a small bowel obstruction?

<p>Hematocrit, BUN, and specific gravity. (D)</p> Signup and view all the answers

What is a nursing action recommended for monitoring electrolyte levels in patients with small bowel obstruction?

<p>Monitor electrolytes, especially potassium levels (D)</p> Signup and view all the answers

Which of the following is a potential consequence of persistent vomiting in the context of metabolic alkalosis?

<p>Loss of gastric hydrochloride (B)</p> Signup and view all the answers

What nursing action should be taken following the assessment of unexpected laboratory findings in a patient suspected of having metabolic alkalosis?

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

Which symptom might indicate hypoventilation in a patient with metabolic alkalosis due to small intestinal obstruction?

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

What nursing intervention is crucial for older adults experiencing increased thirst response due to electrolyte imbalances?

<p>Provide oral hygiene routinely (A)</p> Signup and view all the answers

What is a potential complication of a large bowel obstruction?

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

Which nursing action is essential for monitoring a patient with suspected metabolic acidosis?

<p>Obtaining arterial blood gas (D)</p> Signup and view all the answers

What is a common respiratory pattern observed in patients compensating for metabolic acidosis?

<p>Deep, rapid respirations (C)</p> Signup and view all the answers

Which symptom may indicate a worsening condition in a patient with metabolic acidosis?

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

What should the nurse do upon obtaining unexpected laboratory findings for a patient suspected of metabolic acidosis?

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

Flashcards

Hernia

Bowel displacement through a weak abdominal muscle.

Irreducible Hernia

A hernia that cannot be pushed back into place.

Strangulated Hernia

Hernia cutting off blood supply to the bowel.

Strangulated Hernia Symptoms

Abdominal pain, fever, vomiting, fast heart rate, and swollen abdomen.

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Incisional Hernia

Hernia occurring post-surgery due to poor incision healing.

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Hernia Assessment

Examining the patient for a bulge or lump at the site of the hernia, usually in the groin, umbilicus, or a healed incision.

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Hernia Risk Factors

Factors that increase the chances of developing a hernia, including male sex, advanced age, increased intra-abdominal pressure, and genetics.

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Hernia Truss

A supportive device worn to prevent abdominal contents from bulging into a hernia sac when surgery isn't necessary.

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Post-Hernia Surgery Care

Instructions for patients after hernia surgery, including avoiding heavy lifting, coughing, and straining, and managing constipation.

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Prevent Constipation After Hernia Surgery

Important to prevent constipation by increasing fiber and fluids to reduce straining and pressure on the surgical site.

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Irritable Bowel Syndrome (IBS)

A common disorder that affects the large intestine, causing symptoms like diarrhea, constipation, bloating, and abdominal pain.

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IBS Etiology

The cause of IBS is not fully understood, but it's believed to be influenced by a combination of environmental, immunological, genetic, hormonal, and stress factors.

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IBS Triggers

Certain factors can worsen IBS symptoms, including dairy products, caffeinated beverages, infectious agents, food intolerances, stress, and anxiety.

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IBS Diagnosis

IBS is diagnosed primarily based on the presence of typical symptoms, such as recurrent abdominal pain, changes in bowel frequency and stool appearance.

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IBS Criteria

Common criteria for diagnosing IBS include recurrent abdominal pain occurring at least 3 days a month for the past 3 months, accompanied by two or more of the following: improvement with bowel movements, onset with changes in stool frequency, and onset with changes in stool appearance.

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IBS Symptoms

Common IBS symptoms include cramping abdominal pain, changes in bowel frequency, bloating, gas, and the feeling of incomplete defecation.

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IBS Diet

A diet rich in fiber and fluids is recommended for IBS. Avoid trigger foods like dairy, wheat, corn, fried foods, alcohol, spicy foods, and aspartame.

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IBS Risk Factors

Factors that increase your risk of developing IBS include being female, experiencing stress, eating large fatty meals, consuming caffeine and alcohol.

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Hydrogen Breath Test

A test used to detect malabsorption, impaired digestion, or bacterial overgrowth in the gut. It measures the amount of hydrogen gas in the breath after ingesting a test sugar.

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IBS and the Hydrogen Breath Test

The hydrogen breath test can help rule out IBS, as IBS doesn't typically cause bacterial overgrowth or malabsorption.

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NPO Before Test

The patient must not eat or drink anything except sips of water for at least 12 hours before a hydrogen breath test.

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Excess Hydrogen: Bacterial overgrowth or Malabsorption

A positive hydrogen breath test indicates too much hydrogen in the blood, likely due to bacterial overgrowth in the gut or malabsorption.

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IBS Diagnostic Tests

IBS is diagnosed primarily based on symptoms, not lab tests. Tests like the hydrogen breath test are used to rule out other conditions but not confirm IBS.

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IBS-D

Diarrhea-predominant Irritable Bowel Syndrome, characterized by frequent, watery stools.

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Loperamide for IBS-D

A medication that slows down bowel movements by decreasing peristalsis and increasing stool bulk, helping manage diarrhea.

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Psyllium for IBS-D

A bulk-forming laxative that adds fiber to stools, aiding in regularity and managing diarrhea.

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Alosetron for IBS-D

A medication specifically for IBS-D that blocks serotonin receptors in the gut, reducing urges and making stools firmer.

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Alosetron

A medication specifically for IBS-D that blocks serotonin receptors in the gut, reducing urges and making stools firmer.

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Alosetron: Contraindications

Alosetron is contraindicated for clients who have a history of bowel obstruction, Crohn’s disease, ulcerative colitis, impaired intestinal circulation, or thrombophlebitis.

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Lubiprostone

An IBS-specific medication that increases fluid secretion in the intestine to promote intestinal motility, indicated for IBS-C.

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Linaclotide: What does it do?

Linaclotide is a medication used to treat irritable bowel syndrome with constipation (IBS-C). It works by increasing fluid and motility in the intestines, which can help relieve pain, cramping, and constipation.

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Mechanical Bowel Obstruction

A mechanical bowel obstruction occurs when something physically blocks the intestines, preventing food and waste from moving through. This can be caused by things like adhesions, tumors, or a hernia.

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Nonmechanical Bowel Obstruction

A nonmechanical bowel obstruction happens when the intestines are paralyzed, meaning there's no muscle movement to help things move through. This can be caused by things like surgery or certain medications.

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Treatment for Bowel Obstruction

Depending on the type, treatment for a bowel obstruction can include fluid and electrolyte replacement, decompression of the bowel (removing the blockage), and surgical intervention if needed.

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Risk Factors for Mechanical Obstruction

Conditions that increase your risk of developing a mechanical bowel obstruction include adhesions, tumors, endometriosis, Crohn's disease, radiation therapy, and hernias. Older adults are more susceptible due to conditions like diverticulitis, fecal impaction, and cancer.

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Nonmechanical Obstruction

A bowel obstruction caused by a lack of muscle movement (paralysis) in the intestines, preventing food and waste from moving through.

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Causes of Paralytic Ileus

Paralytic ileus, a type of nonmechanical obstruction, can be caused by factors affecting the intestines' ability to contract, such as neurogenic disorders, vascular disorders, electrolyte imbalances, and inflammatory responses.

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Neurogenic Causes of Paralytic Ileus

Neurogenic causes of paralytic ileus include conditions that affect the nerves controlling intestinal movement, such as manipulation of the bowel during surgery or spinal fractures.

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Vascular Causes of Paralytic Ileus

Vascular causes of paralytic ileus include problems with blood flow to the intestines, such as vascular insufficiency or mesenteric emboli.

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Electrolyte Imbalances and Paralytic Ileus

Electrolyte imbalances, particularly low potassium (hypokalemia), can contribute to paralytic ileus by disrupting the proper functioning of intestinal muscle cells.

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Obstipation

Inability to pass stool or gas for more than 8 hours despite feeling the urge to defecate.

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Small bowel obstruction: Symptoms

Severe fluid and electrolyte imbalance, metabolic alkalosis, visible peristaltic waves (possible), epigastric or upper abdominal distention, abdominal pain, projectile vomiting with fecal odor.

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Large bowel obstruction: Sounds

High-pitched bowel sounds above obstruction, hypoactive or absent bowel sounds below.

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Bowel obstruction: Distention

Abdominal distention, visible peristaltic waves (possible).

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Large bowel obstruction: Symptom

Obstipation: inability to pass stool or gas for more than 8 hours despite feeling the urge to defecate.

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Dehydration Indicator

Increased hemoglobin, BUN, creatinine, and hematocrit levels in blood tests can indicate dehydration.

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Strangulation Clue

Elevated blood amylase and WBC count may suggest strangulating obstructions, indicating compromised tissue.

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Metabolic Imbalance

Arterial blood gases (ABGs) reveal metabolic imbalance, depending on the type of obstruction.

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Obstruction Location

CT scan precisely identifies the cause and location of the bowel obstruction.

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Obstruction Evaluation

Flat plate and upright abdominal x-rays assess the presence of air and gas patterns to evaluate bowel obstruction.

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Bowel Rest

A medical instruction to avoid eating or drinking anything, allowing the digestive system to rest and heal.

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Semi-Fowler's Position

A position where the patient's head and upper body are raised to 30-45 degrees, promoting comfort and breathing.

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What is a Nonmechanical Bowel Obstruction?

A condition where the intestines are paralyzed, preventing food and waste from moving through, often caused by surgery or medication.

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What is 'Nothing by Mouth' (NPO)?

Medical instructions to withhold food and fluids by mouth.

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Managing Pain for Obstruction

Once the cause of the obstruction is identified, focus on managing pain effectively to improve patient comfort and recovery.

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Opioid Antagonist (Alvimopan)

A medication used for short-term treatment to reverse the effects of opioids on bowel motility after surgery, helping to restore normal bowel function.

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Postoperative Paralytic Ileus

A condition where the intestines are paralyzed after surgery, preventing normal movement of food and waste.

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Nasogastric (NG) Tube with a Vent

A tube inserted through the nose into the stomach to decompress the bowel and remove excess fluid/gas. The vent prevents damage to the stomach lining during continuous suction.

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Maintain Intermittent Suction

Regularly removing fluid/gas from the stomach through the NG tube, as prescribed by the doctor.

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What is an Exploratory Laparotomy?

A surgical procedure where the abdomen is opened to investigate and correct the cause of a bowel obstruction, if possible.

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What is a Colostomy?

A surgical procedure that creates an opening in the colon, allowing stool to be diverted through a stoma on the abdomen, often used for bowel obstruction relief.

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Hemodynamic Instability

A condition where the body's circulatory system is compromised, leading to fluctuations in blood pressure, heart rate, and other vital signs.

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NG Tube Patency

Ensuring that the nasogastric tube is open and functioning correctly to drain fluids and gas from the stomach.

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Clamp NG Tube

Temporarily stopping the flow of drainage through the nasogastric tube to allow the patient to tolerate food and drink before removal.

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Dehydration in Bowel Obstruction

Dehydration occurs due to persistent vomiting caused by a small bowel obstruction, leading to fluid and electrolyte imbalances.

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Electrolyte Imbalance in Bowel Obstruction

Electrolyte imbalances, particularly low potassium levels, arise from persistent vomiting associated with small bowel obstruction.

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Nursing Actions for Dehydration

Assess for signs of dehydration, such as changes in hematocrit, BUN, vital signs, skin turgor, and urine output. Notify the provider and administer IV fluids as ordered.

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Nursing Actions for Electrolyte Imbalance

Monitor electrolyte levels, especially potassium. Notify the provider of any imbalances and administer IV fluids as ordered to replenish electrolytes.

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What is an Electrolyte Imbalance?

An electrolyte imbalance occurs when the levels of essential minerals in your body's fluids, like sodium, potassium, and calcium, become too high or too low.

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Electrolyte Imbalance (Small Bowel Obstruction)

A condition caused by persistent vomiting in a small bowel obstruction, resulting in loss of minerals like potassium.

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Metabolic Alkalosis (Small Bowel Obstruction)

An imbalance where the body becomes too alkaline due to loss of gastric acid from persistent vomiting.

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Metabolic Acidosis (Large Bowel Obstruction)

An imbalance where the body becomes too acidic due to obstruction preventing waste removal.

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Hypoventilation (Metabolic Alkalosis)

A compensatory action by the lungs to correct metabolic alkalosis by reducing breathing rate and increasing CO2 levels.

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Deep, Rapid Respirations

A compensatory action by the lungs to try and correct metabolic acidosis by breathing faster and deeper, attempting to expel excess CO2 and bring the body's pH back to normal.

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Nursing Actions for Metabolic Acidosis

Monitor for deep, rapid respirations, confusion, hypotension, and flushed skin. Obtain arterial blood gas and notify the provider of any unexpected laboratory findings.

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Study Notes

Noninflammatory Bowel Disorders

  • Noninflammatory bowel disorders cause pain, altered bowel habits, bleeding, and malabsorption.
  • Examples include hemorrhoids, cancer, hernia, irritable bowel syndrome (IBS), and intestinal obstruction.

Hemorrhoids

  • Hemorrhoids are swollen or inflamed veins in the rectum.
  • Causes include increased intra-abdominal pressure (e.g., straining, obesity, prolonged sitting/standing, constipation, weightlifting).
  • Pregnancy increases the risk.

Bowel Cancer

  • Bowel cancer can be linked to age (50+ increased risk), genetics, or chronic bowel diseases (e.g., Crohn's disease, ulcerative colitis).

Hernias

  • A hernia is when a part of the intestine pushes through a weak spot in the abdominal muscles.
  • Types of hernias:
    • Incisional hernias are a surgical complication from poor healing of the surgery site. Possible causes are poor nutrition, infection, or obesity.
  • Important features of hernias
    • Irreducible hernias: cannot be pushed back into place with manual pressure and require immediate surgery.
    • Strangulated hernias: the blood supply to a part of the intestine is cut off. Symptoms include abdominal distension, rapid heartbeat (tachycardia), vomiting, abdominal pain, and fever. Requires immediate surgical intervention to prevent bowel necrosis and perforation.

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