Flashcards
Lower GI
Cards in this deck (53)
- 1Name at least 7 lower GI tests that we complete for definitive dx?1. Lower GI--Barium enema X-ray of lower GI tract under fluoroscopy-so contrast dye.
2. Endoscopy-can be passed through the esophagus to duodenum or the rectum to the area desired.
3. Colonoscopy-long flexible tubular scope examines the lining of your colon inserted through rectum.
4. Sigmoidoscopy-flexible tube looks inside your sigmoid colon
5. Proctoscopy/rectoscope-sm. flexible tube used to examine the anal cavity, rectum, or sigmoid, colon
6. Laparoscopy-incisional in abd or pelvis
7. laparotomy-incisional in abd cavity for dx or prep - 2The 5 lower GI tests that we complete for definitive dx comes with specific RN instructions; they are?1. NPO
2. Endoscopes are all the same the only difference is point of entry and how far we pass them through the GI tract.
3. Sigmoidoscopy is the least evasive
4. Proctoscope goes all the way, so to speak from the rectum entry.
5. lap were going to incisionally
cut you open to look at the cavity and you will have sedation with anesthesia.. - 3Lower GI Barium Enema requires 2 preparations, 2 Teaching points, and 2 Post nursing care instructions, name them? Is the test frequently used, and please explain?Preparation:
1. Clear liquids day before the test; NPO 8 hours before test
2. Complete emptying of the colon using laxatives or enemas on evening prior to test
Teach
1. cramping and urge to defecate may occur during procedure
2. barium will clear in 1-3 days - chalky stools
Post Nursing Care:
1. Prevent constipation: ↑ fluids,
2. laxatives, suppositories to assist in clearing bowel
—Not as frequently used due to endoscopy-- - 4What do you do for a barium swallow with a small bowel follow through?1. Drink barium, followed by x-rays q 30 min until barium reaches terminal ileum
Preparation:
2. NPO 8-12 hrs before test
Post Nursing Care:
3. Same as for barium enema - 5What is a colonoscopy by defn. and what does it allow the surgeon to do? Their is 1 preparation instruction listed, 3 teaching, and 2 post-op care instructions, please explain them to me?1. Colonoscopy—allows for visualization of colon with fiberoptic scope
and Allows for biopsy & removal of polyps
2. Preparation:
Same as for barium enema; HCP
3. Teaching:
Sedation used; must have ride home
May have cramping caused by air injected into bowel
Referred shoulder pain possible
4. Post Nursing Care:
Observe for bleeding and s/s of perforation:
Abdominal distention, pain, feeling of need to defecate when bowels are empty (tenesmus) - 6Again, what is the difference between an upper GI end.oscopy and a lower GI endoscopy?Upper is inserted into esophagus and thread to the duodenum.
Lower Gi has point of entry at rectum and thread to the upper greater transverse colon. - 7Explain why Gi health screening is important?Today show showing live colonoscopy:
https://www.youtube.com/watch?v=xCmnWsAqMIw - 8Why is a video capsule endoscopy (pill-cam) a better procedure than a traditional colonoscopy? list the 3 preparation steps?Allows for visualization of entire digestive system (small intestine!)
No sedation needed
Camera transmits images for 8-12 hours to device worn around neck or waist
Preparation:
1. Same as for barium enema/colonoscopy
2. Pill cam swallowed then resume clear liquids after 2hrs, & food/meds p 4 hrs
3. Pill cam exits with bowel movement - 9Their are 5 lower GI labs that are important to Dx lower GI problems; name them and give a brief description of what the labs are used to test?1. Stool Specimen
--culture, ova & parasites (for prolonged diarrhea)
--C&S-eggs, parasites
--occult blood (guaiac or Hemoccult test): Guac test yields a False positive if patient eats steak
--keep diet free of red meat for 24-48 hr before
2. Serum electrolytes - ↓ with diarrhea & N/V
3. Hemoglobin/Hct - ↑ with dehydration from diarrhea & N/V; HH-SS of dehydration possibly related to GI bleed
4. WBC - ↑ with infection; a check for infection
5. ESR - ↑ with inflammation--ESR: erythrocyte sedimentation rate --
The sedimentation rate (sed rate) blood test measures how quickly red blood cells (erythrocytes) settle in a test tube in one hour. The more red cells that fall to the bottom of the test tube in one hour, the higher the sed rate... These proteins are produced by the liver and the immune system under many abnormal conditions, such as an infection, an autoimmune disease, or cancer. - 10Talking about lower GI again, what is the definition of diarrhea?Definition
1. The passage of at least 3 loose or liquid stools/day
2. A symptom, not a disease
3. Chronic if lasts > 1 month - 11Their are clinical manifestations of diarrhea; what is the primary cause? list two and which is the most common? Their are 5 S/S please list them?Primary cause is ingestion of infectious agent
1. viral (most common), bacterial, parasitic agent is: Giardia
2. Also caused by meds, food intolerances, malabsorption diseases (IBD, celiac)
S/Sx
1. Explosive watery diarrhea
2. Abdominal cramping / pain
3. Leukocytes, blood and mucus in stool
4. Perianal skin irritation
5. Nausea/vomiting - 12Name 3 organisms that cause bacterial diarrhea?Bacterial:
1. salmonella (undercooked eggs,chicken),
2. e coli (undercookedmeat or contaminated fruit/veg)
3. C diff poor handwashing in hosp - 13As the nurse how do we assess 12 questions for diarrhea dx? What 4 diagnostic studies are we confirming orders for with our HCP?Assessment
1. Stool description & pattern
2. Foreign travel?
3. Changes in diet?
4. Medications? laxatives, or other meds that can cause diarrhea, recent abx use?
5. Hospitalizations? exposed to CDIFF possibly
6. Stress?
7. Illness? Family or friends ill?
8. S/S of dyhydration
dry skin, concentrated urine, BP & P changes
9. Abdominal distention/pain; perianal irritation
10. Daycare (children)
11. self-prepared meal prep or did you go out to eat?
12.. Foods—increase in carbs—osmotic diuresis or maybe lactose intolerance?
Diagnostic Studies
1. Stool occult blood ; culture (diarrhea > 3 days)
2. CBC, electrolytes--- Increased H&H and BUN levels suggest dehydration.
3. CMP – electrolyte disturbances
4. Stool – presence of WBC (infectious) - 14What are 8 collaborative care tx's that we can help suggest or implement to help with the symptoms of diarrhea?1. Avoid causative agent (meds, etc)
2. Fluid replacement: oral solutions (Gatorade) or IVs
3. Prevent transmission: Strict infection control
4. Protect skin (especially perianal area)
5. Provide ready access to bedpan/commode
6. No solids for 24 hours to rest bowel/ rest the gut
7. Reintroduce foods slowly
8. Poo Pill - 15When it comes to drug therapy for diarrhea Should we give Antidiarrheal agents long term or short term? 3 explanations and one long answer of why is needed, try and explain your answer??1. Antibiotic treatment is rare for acute diarrhea (<3 days)
2. Antidiarrheal agents may be given short term
3. Contraindicated for most infectious agents
WHY?
Antidiarrheals contraindicated with infectious agents because it will prolong exposure to the infectious organism(s).
What is the caution with drug therapy-diarrhea is happening because the body is doing what it needs to do so if we start giving meds/anti diarrheals
Substances to tx diarrhea-opiods, immodium, pepto, it will make the problem worse. - 16What Diarrhea drug therapy is going to work and be helpful? name 6 antidiarrheal drugs if you can?1. Opioid/Opioid Derivatives
--↓ peristalsis so delays transit and ↑ absorption from stools
--Immodium (loperamide), Lomotil (diphenoxylate /atropine),
2. Bismuth Subsalicylates
--↓ secretions in the digestive tract → ↓ inflammation
--provides a protective coating
--mild antibacterial
--Pepto- Bismol, Kaopectate - 17What is a dangerous Healthcare-associated Infection (HAI) that causes acute diarrhea; inflammatory bowel disease (IBD); and is transmitted pt. to pt. by healthcare workers, also associated with ABX usage?Clostridium Difficile
—Acute cases of diarrhea not the Chronic
—To avoid pt to pt transfer you need to wash you hands with soap and water not the alcohol sanitizer especially after caring for a patient with CDIFF; alcohol does not kill CDIFF
—Discontinue using antibiotics if it is suspect that the organism is assoc. w/ abx usage and PPIs up to 65% of pts..
—more common outbreaks are from ICU
—reoccurrence is a problem because CDIFF is everywhere.
—Tx w/ flagyl/metronidazole or vanco instead
—implement contact isolations
—use chlorine bleach based cleansers for surfaces; because the spore of CDIFF lives up to 2-3 months on surfaces (some sources would argue >5 mos. on surfaces. - 18What is fecal microbiota transplantation (FMT) aka Poop Transplants? True or false most effective tx for recurrent CDIFF? Is A fecal Pill 100% effective?1. Most effective tx for recurrent Cdiff - over 90% effective
--Infuse fecal bacteria from healthy donor via enema, colonscopy, or naso enteral tube
--Reestablishes healthy intestinal flora
2. New Fecal Pill: 100% effective in 2013 study
--Process feces down to bacteria only, then encapsulate
--Less invasive & covers more of GI tract
What is the benefit good result and no colonoscopy. - 19CASE STUDY QUESTION: A 42-yr-old client is admitted to the hospital and tells the nurse he is having 12 diarrheal stools a day and dizziness when he stands for the past 6 days. Physical assessment: BP 90/62, P-102, R-14, oral mucosa dry. Besides the diarrhea, what does the physical assessment suggest? What further information may the nurse want to ask?Orthostatic hypotension secondary to dehydration
- 20Case Study #2 Lab results are: BUN 22 mg/dl (8-20mg/dl) Hgb 19 g/dl (male 14-17.4 g/dl) Hct 58% (male 42-52%) WBC present in stool What do these tests signify?Elevated BUN (kidney function), H&H (anemia) indicate dehydration confirming our position. WBC in stool – infectious process (bacterial or parasitic)
- 21Case Study #3 The client tells the nurse that he just completed a 7 day course of Penicillin for a tooth abscess. With this information what will the nurse suspect as the etiology of the diarrhea? Based on the above, what should the nurse do next?C diff
Contact isolation
No immodium the antidiarrheal will keep the infection in longer so no. - 22Case Study #4 The client says to the nurse “Why can’t I just have some antidiarrheal medicine to stop the diarrhea?” What should be the nurse’s response?They are contraindicated in infectious diarrhea because they potentially prolong exposure to the infectious organism.
- 23Case Study #5 Constipation--Defined … ↓ in frequency from what is “normal” for individual Also: hard, difficult to pass stools incomplete evacuation of stools WHAT IS NORMAL FREQUENCY FOR BOWEL MOVEMENTS??Normal bowel movements: ranges from 3/day to every 3 days
Infrequent passing of stool - 24How do you determine a dx of constipation? list 5 things that you could ask and elaborate your care?1. History—are they a good historian
2. Usual defecation pattern, diet, exercise,
3. laxative use
4. Rectal exam; do a Digital exam if your worried about impaction
5. IF you suspect chronic diarrhea F/U w/:
--Abdominal X-ray
--Colonscopy, barium enema - 25What are some common causes of constipation? What are some common symptoms of constipation? What is the most common complication of constipation?1. Causes:
Decreased fiber and fluid in diet
Decreased activity/sedintary
Avoiding/Ignoring urge to defecate
Medications
Diseases that affect GI transit & neuro function (DM, Parkinsons, MS)
Emotions (stress or depression)
Chronic laxative use (leading to cathartic colon syndrome)-using all the time-bowel does not want to work anymore
common symptoms of constipation:
Complications:
Hemmorhoids
constipation
Signs/Symptoms of most common complication:
Abdominal pain, abd distention, ↑ flatulence, hard/dry stools - 26How do you treat acute constipation, I’ll give you a hint; their are 3 answers and a #1 choice, let me know?Laxatives
Manual disimpaction
Enemas
No. 1 choice-enema
More movement, regular bowel schedule, lax prn not as a daily thing, optimal position to deficate (squatty potty) - 27list 7 ways to teach them about constipation, and what is the GOAL for an RN to teach a constipated pt., list them?1. ↑ Fiber
2. ↑ Fluids: 2 L/day
3. Exercise regularly
4. Establish a Te time to defecate
5. Do not delay defecation
6. Avoid laxatives and enemas on a regular basis
7. Optimal position to defecate:
--Squatting or
--Sitting on toilet with feet on step stool
GOAL: Tips to get em to go:
Flexed hips (squatting position) during defecation straightens the angle between anal canal and rectum so stool exits easier. Plus gravity helps. - 28In addition to diet, fluids, and exercise, EBP shows that probiotics help with 3 things, list them? Also name some additional medications and their length of time that they work?In addition to diet, fluids & exercise -
Probiotics can help with constipation by:
1. Increasing gut transit time
2. Increasing stool frequency
3. Softening stool consistency
Enemas and these 3 other things on this list…
Usually
Colace
Docusate
These 2 stool softeners take effect in 72 hours…to prevent constipation
Senna-stimulant 12 hoursteaching here this might not work for awhile so senna in morning to resolve by afternoon and if that does not resolve we can switch over to the enema
Biscodyl-stimulant 12 hours teaching here
Relistor to be given with opiods to block the gi effect but not block the pain receptors throughout the body - 29What is fecal incontinence and what does it mean, what is it caused by and then How can fecal impaction cause fecal incontinence?Fecal Incontinence - involuntary passage of stool
Caused by:
Damage to internal/external sphincter
Anorectal surgery or perianal trauma
Obstetric trauma (episitomy)
Neurologic conditions: DM, MS, spinal cord injury, stroke
Physical impairment affecting toileting ability
Diarrhea
Secondary to fecal impaction
How can fecal impaction cause fecal incontinence?
Constipation leads to straining during defecation; straining weakens pelvic floor muscles → incontinence
Also – liquid stool leaks around impaction : this is the evidence of incontinence. - 30Collaborative Treatment is going to depend on the cause of the pt. caused symptoms, try to list 10 fixes for possible causes of fecal impaction?Depends on the cause:
Disimpaction, enemas if impacted
Bulking agents, high fiber diet or fiber supplements
Antidiarrheal agent: loperamide (Immodium)
Kegels – strengthens pelvic floor
Biofeedback – improves awareness of rectal sensation & strength of external sphincter
Bowel Training Program
When above fails:
Solesta gel injection into submucosa of anal canal
Bulks up tissue (narrows) anal canal
Last option: surgery
Sphincter augmentation with magnetic bead ring implant
Linux Fecal Incontinence System - started use in 2016
Sphincter repair or colostomy - 31Explain in your own words what a bowel training program is?Diet: increase fiber and fluids
Establish a regular defecation time
Usually 30 min after breakfast
Digital stimulation or suppository to have a bowel movement.
Ducolax or glycerine suppository:
15-30 min before usual evacuation time
DC suppository after pattern is established - 32How can the nurse care or prevent fecal incontinence-associated dermatitis (AD)?Prevent Incontinence-Associated Dermatitis (IAD)
* frequent perianal skin assessments
* prompt cleansing
* skin barrier cream
* fecal management system for bedridden patients
(can be used for up to 1 month)
Some additional suggestions: Skin,
Skin barrier creams
Clean them right away when have bowel movement
Fecal management systems bag stays external, rectal tube clean procedure. - 33Bowel obstruction occurs when intestinal contents cannot pass through the GI tract. List the 3 types of obstructions, and think about how to handle partial or complete obstruction?1. Large or small bowel
2. small bowel most common
3. Partial or complete
Intestinal contents cannot pass the bowel track small or lg bowel partial (conservative) or complete obstruction (surgery) - 34explain the causes of intestinal obstruction of the lower GI?1. 6-8 L of fluids enters small bowel daily
2. With obstruction: fluid, gas, & bowel contents back up in intestines
3. Electrolyte rich fluids can’t be absorbed
4. Retention of fluid in intestines →
--Hypovolemia
--Bowel tissue ischemia/necrosis → rupture
Extra things he discussed:
Distention decreased fluid absorption-hypovolemia electroylyte problems
Eschemia leads to necrotic bowel-sx to tx - 35explain the clinical manifestations of intestinal bowel obstruction of the lower GI?Clinical Manifestations :
Nausea & vomiting (can be projectile)
frequent with small bowel obstruction
(bile colored if proximal, fecal odor if distal)
rare in colon obstruction
Abdominal pain & distention
Constipation
SS of obstructions: N, V, constipation
Small (colicky pain), vomiting
Upper obstruction large absolute constipation
Good hx
Ct
Xray
Colonoscopy
Normal lab workup - 36explain the types of intestinal bowel obstruction of the lower GI?1. Mechanical: a physical obstruction
Small bowel obstructions
Surgical adhesions – most common
Occurs days to years post abdominal surgery
Hernias
Large bowel obstructions
Carcinomas, Volvulus, and Diverticular diseases
2. Non-mechanical: ↓ or absent peristalsis
Paralytic ileus
Lack of intestinal peristalsis; NO bowel sounds
Occurs post any abdominal surger
Early ambulation → ↑peristalsis
Physical obstruction: scar tissue like:
Adhesions: fibrous bands that connect tissue surfaces that are normally separated. This is a natural consequence of surgery as the body begins to heal, but it can cause significant complications for the patient. For example, following an abdominal surgery, adhesions may form between an incision in the abdominal wall and the small bowel, causing an obstruction in the small bowel. This type of adhesion often leads to additional surgical procedures to remove the obstruction.
Hernias
Carcinomas
Volvulous (twisted bowel) medical emergency
Non mechanical-paralytic ileus can no longer push contents through-sx patient, get them mobile - 37Identify this list of blower GI bowel obstructions?Adhesions
Strangulated inguinal hernia
Ileocecal intussusception
Intussusception from polyps
Mesenteric occlusion
Neoplasm
Volvulus of the sigmoid colon-Volvulus: bowel is twisted on itself - 38What is involved with collaborative care and surgery of the lower GI obstructed patient?Obstructions often resolve with conservative treatment
Surgery if not improved in 24 hours
Emergency surgery for strangulated bowel
Resection with end to end anastomosis
Possible colectomy, colostomy, ileostomy
Surgical intervention not often used if partial obstruction but if needed they can do Colect or Colo (permanently or temporary while gut repairs self)
Colectomy: surgical resection of part or all of colon
Colostomy: surgical procedure that brings one end of the large intestine out through the abdominal wall. Stools moving through the intestine drain into a bag attached to the abdomen.
Ileostomy: surgical procedure to bring one end of ileum (last section of small intestine) out through abdominal wall. Used when rectum and large intestine are not functional. - 39Continued Collaborative Care of the lower GI bowel obstruction patient entails 10 things, list them?Surgical intervention not often used if partial obstruction but if needed they can do Colect or Colo (permanently or temporary while gut repairs self)
Colectomy: surgical resection of part or all of colon
Colostomy: surgical procedure that brings one end of the large intestine out through the abdominal wall. Stools moving through the intestine drain into a bag attached to the abdomen.
Ileostomy: surgical procedure to bring one end of ileum (last section of small intestine) out through abdominal wall. Used when rectum and large intestine are not functional.
ASSESS, NPO, NG tube to decompress stomach, nutrition with IV fluids, how long parental nutrition, good oral hygiene - 40Diverticular Disease presents in 2 forms, what are they and describe?Diverticulosis - having multiple noninflamed diverticula (outpouchings in the colon)
Diverticulitis - an inflammation of the diverticula resulting in perforation into peritoneum
Can occur anywhere in GI tract, but most common in sigmoid colon.
TIPS--Osis-presence of outpouching
itis –inflamation of the outpouching that can result in perforation into the peritoneum area - 41Diverticular Disease explained?Common disorder affecting elderly
Associated with high luminal pressure in colon from deficiency of dietary fiber intake
Western diet high carbs, low fiber
↓ fiber slows transit time → more water absorption and smaller stool. Decreased stool size raises intraluminial pressure.
Inflammed diverticuli can cause erosion of bowel wall → perforation
Abscess occurs when body walls off perforation
Peritonitis occurs when cannot be contained
Tips--Elderly most common group affected
Other groups-high carb with low fiber
Big complication to look out for is perforation
SS next time - 42Diverticulosis and Diverticulitisis Surgical clinical manifestations explained?Diverticulosis sx :
Most have NO sx
abdominal pain, bloating, gas, or change in bowel habits
but no sx of inflammation
Diverticulitis sx in sigmoid colon:
Acute LLQ abdominal pain
Sometimes a palpable abdominal mass
Nausea/vomiting
Symptoms of infection: fever, ↑ WBC
OLDER ADULTS may be afebrile & normal WBC
Bloating
Gas
Changes in bowel habit
No symptoms of SS of inflammation
Itis-
Fever
RBC elevation
Older adults might have normal wbc or not be febrile - 43Collaborative Surgical Care Post op explained for Diverticulosis and Divertiulisis?Diverticulosis
High fiber diet (mainly from fruits & vegetables)
Decreased intake of fat and red meat
Weight reduction for the obese clients
Avoid factors that ↑ intra-abdominal pressure
restrictive clothing, straining at stool, lifting and bending
Acute diverticulitis
Goal: to let colon rest & inflammation subside
Home Mgmt: antibiotics and clear liquid diet
If Hospitalized :
Antibiotics
NPO & NG to decompress
IV fluids progressing to clear liquids to semisolids
Assess for s/s abscess, bleeding, peritonitis
Surgery only if cannot be managed medically
Bowel resection with anastomosis or temporary colostomy
TIPS: High fiber diet, no nuts and seeds not really a problem any more, watch your fat-lose weight, decrease pressure to the area, avoid restrictive clothing, straining,
IT IS-rest your colon, npo, ng tube into gut, abx, replace fluids through IV, SS of absess bleeding and peritonitis, sx last step - 44Case Study #6 A 44 yr old client is admitted to the hospital with a diagnosis of acute diverticulitis. The nurse explains to the client that the primary goal of treatment is to allow the colon to rest and the inflammation to subside. Based on this goal, what orders will the nurse expect to achieve this goal?NPO, NG suction, antibiotics, IV fluids, bedrest,
Longer time place patient paraenteral nutrition
Surgery only if pt has complications that cannot be managed medically: abcess, obstruction
Surgery is bowel resection with asastomosis or temporary colostomy - 45What are some possible nursing diagnoses? When the client is ready to eat, what will the nurse teach the client about his diet? What is the difference in diet management for diverticulosis vs diverticulitis?Acute pain RT inflammation of colon
Risk for fluid volume deficit RT NPO status
Anxiety RT pain and unfamilar routine in hospital
Pain
Discharge teaching
Decrease fat, increase fiber (increase fluids)
Difference one they can eat the other they cannot eat and were going to clear out their tummy - 46Define Peritonitis and talk a bit about it?Inflammation/infection of the peritoneum
Inflammation/Infection of the peritoneum-
Caused when infectious organisms enter peritoneal cavity
Ascites from cirrhosis
Rupture of organ in abdomen
appendicitis, diverticulitis, perforated ulcer
Peritoneal dialysis
Gunshot & knife wounds - 47Clinical manifestations and S/S of shock?Major s/s:
Severe ABDOMINAL PAIN
Guarding of abdomen
Rebound tenderness (don’t touch me)
Rigidity of abdomen
Other s/s
N/V
Abdominal distention
Fever
S/S of shock: look at notes
TIPS--S/S of shock: ↑ HR and resp, ↓ BP, cool clammy skin, ↓LOC, ↓ Urine output - 48Tell me a little bit about the Diagnostics for peritoneal aspiration and the procedure?Diagnostics for peritoneal aspiration--
CBC-ss to look for infection
Peritoneal aspiration
Abdominal X-ray, CT, or ultrasound
Peritoneoscopy (laparoscopy)
Peritoneal aspiration to analyze for blood, bile, and pus.
X-ray may show free air if perforation has occurred-visualize gut
CT & Ultrasound may show ascites and abcesses-visualize gut
Peritoneoscopy is direct visualization for diagnosis
Lap-to tx problem - 49Tell me about the collaborative care of the patient who is going to get a peritoneal aspiration?Surgery usually indicated
To locate cause, drain purulent fluid, and repair damage
Non- surgical management:
Antibiotics
NPO & NG to suction
Analgesics & antiemetics
IV hydration
Oxygen PRN
Assess for shock
Abdominal assessment (bowel sounds, distention, guarding)
Position with knees flexed for comfort-bring knees up
These guys are going to get sx - 50Please explain to me what you know about Hemorrhoids?Dilated veins around anus/lower rectum
Appear periodically, depending on amount of anorectal pressure
Symptoms - Rectal
bleeding with stools (bright red)
Itching
Pain
Prolapse (palpable at anal orifice)
EXTRA—
Internal (above internal sphincter)
External (outside external sphincter) - 51Hemorrhoids explained further and a list of predisposing conditions, explain to me?Caused by increased anal pressure and weakened anal tissue that supports hemorrhoidal veins
Predisposing conditions:
pregnancy
prolonged constipation
straining to defecate
heavy lifting
prolonged standing or sitting
obesity
Extra--Removed hemorrhoids not responsible for this in lower GI no test questions on this - 52Explain hemorrhoids conservative management?Conservative Management:
↑ fiber & fluids (prevents constipation)
Reduce straining
Anti-inflammatories
Astringents/anesthetics, topical steroid cream
Stool softeners
Sitz baths
Avoid prolonged sitting/standing
Removal only for excessive size, pain, bleeding
Know what they are and def. SS of hem-bleeding, itching, palpated, causes of increased pressure and dialation of veins-pregnancy (temp or lasts for awhile) prolonged constipation, heavy lifting, obesity, mgmnt to prevent constipation. Local antiinflammatory, sits bath, topical meds - 53Look over hemorrhoids removal and explain a bit about this?Non surgical:
Rubber band ligation – most often used, but can cause discomfort (not severe)
Surgical:
Hemorrhoidectomy – excision of hemorrhoids
Pressure relief cushion (doughnut) to sit on
Pain relief as for all hemorrhoids
First BM is often feared. Pain meds before first BM!!
Criteria for discharge: had first BM
Extras--Not common is sx removal:
Rubber band ligation: an anoscope inserted so hemorrhoid can be seen and ligated with a rubber band. Rubber band is left on hemorrhoid – constricts circulation and tissue dies and sloughs off.
Hemorrhoidectomy: surgical excision of hemorrhoids. Indicated with prolapse, excessive pain/bleeding, or large hemorrhoids. Packing may be inserted to absorb drainage.
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- Flashcards on Lower GI, created by Wednesday Patches on 22/07/2018.
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