Fichas
Gastrointestinal
Fichas del conjunto (40)
- 1AppendicitisCaused by an obstruction of the lumen or opening of the appendix.
●Fecaliths, or hard pieces of stool, can be the initial cause of the obstruction.
●Adolescents and young adults are at increased risk. - 2PeritonitisInflammation of the peritoneum
●Results from infection of the peritoneum due to puncture (surgery or trauma), septicemia, or rupture of part of the gastrointestinal tract.
●This can lead to septicemia and is a life‑threatening event. - 3GastroenteritisInflammation of the stomach and small intestine
●Triggered by infection (either bacterial or viral).
●Vomiting and frequent, watery stools place the client at increased risk for fluid and electrolyte imbalance and impaired nutrition - 4Ulcerative ColitisEdema and inflammation primarily in the rectum and rectosigmoid colon.
●In severe cases, it can involve the entire length of the colon. Mucosa and submucosa become hyperemic (increase in blood flow), and the colon will become edematous and reddened. It can lead to abscess formation.
●Edema and thickened bowel mucosa can cause partial bowel obstruction. Intestinal mucosal cell changes can lead to colon cancer or insufficient production of intrinsic factor, resulting in insufficient absorption of vitamin B12 (pernicious anemia).
●Classified as either mild, moderate, severe, and fulminant - 5Expected Findings Ulcerative colitis●Abdominal pain/cramping: often left‑lower quadrantpain
Anorexia and weight loss
PHYSICAL ASSESSMENT FINDINGS
●Fever
●Diarrhea: up to 15 to 20 liquid stools/day
●Stools can contain mucus, blood, or pus.
●Abdominal distention, tenderness, and/or firmness uponpalpation
●High‑pitched bowel sounds
●Rectal bleeding - 6Lab Tests Ulcerative colitisHematocrit and hemoglobin: Decreased
Erythrocyte sedimentation rate (ESR): Increased
WBC: Increased
C‑reactive protein: Increased
Serum albumin: Decreased
Stool for occult blood: Can be positive
K+, Mg, and Ca: Decreased - 7Diagnostic Tests Ulcerative colitisSigmoidoscopy or colonoscopy: Can diagnose ulcerativecolitis.
Barium enema: Helpful to distinguish ulcerative colitis from other disease processes.
CT scan or MRI: Can identify the presence of abscesses.
Stool examination: For the presence of parasites ormicrobes - 8Diagnostic Findings Ulcerative colitisUlcerations and inflammation of the sigmoid colon and rectum
- 9Crohn's DiseaseInflammation and ulceration of the gastrointestinal tract, often at the distal ileum.
●All bowel layers can become involved; lesions are sporadic. Fistulas are common.
●Can involve the entire GI tract from the mouth to the anus.
●Malabsorption and malnutrition can develop when the jejunum and ileum become involved. Requires supplemental vitamins and minerals, possibly including vitamin B12 injections - 10Expected Findings Crohn's DiseaseAbdominal pain/cramping: often right‑lower quadrantpain
●Anorexia and weight loss
PHYSICAL ASSESSMENT FINDINGS
●Fever
●Diarrhea: five loose stools/day with mucus or pus
●Abdominal distention, tenderness and/or firmness uponpalpation
●High‑pitched bowel sounds
●Steatorrhea - 11Lab Tests Crohn's DiseaseHematocrit and hemoglobin: Decreased
ESR: Increased
WBC: Increased
C‑reactive protein: Increased
Serum albumin: Decreased
Folic acid and B12: Decreased
Anti‑glycan antibodies: Increased
Stool for occult blood: Can be positive
Urinalysis: WBCK+, Mg, and Ca: Decreased - 12Diagnostic Tests Crohn's DiseaseEndoscopy
●Newer diagnostic tools such as video capsule endoscopy are being used.
●Proctosigmoidoscopy: Performed to identify inflamedtissue.
●Colonoscopy and sigmoidoscopy: A lighted, flexible scope is inserted into the rectum to visualize the rectum and large intestine.
Abdominal ultrasound, x‑ray, and CT scan: CT scans can show bowel thickening.
Barium enema: Barium is inserted into the rectum as a contrast medium for x‑rays. This allows for the rectum and large intestine to be visualized, and is used to diagnose ulcerative colitis. A barium enema can show the presence of diverticulosis and is contraindicated in the presence of diverticulitis due to the risk of perforation - 13Diagnostic Findings Crohn's DiseaseSmall intestine ulcerations and narrowing
- 14Nursing Care Ulcerative colitis & Crohn's DiseaseInstruct the client to seek emergency care for indications of bowel obstruction or perforation (fever, severe abdominal pain, vomiting).
●The client should receive instructions regarding the usual course of the disease process.
●The client should receive instructions regarding medication therapy and vitamin supplements.
●The client will need monitoring by colonoscopy due to the increased risk of colon cancer.
●Instruct clients who have extreme or long exacerbations that NPO status and administration of total parenteral nutrition promotes bowel rest while providing adequate nutrition - 15Nursing Care Ulcerative colitis & Crohn's Disease ContinuedEducate the client to eat high‑protein, high‑calories, low‑fiber foods.
●Assist the client in identifying foods that trigger manifestations.
●Instruct the client to avoid caffeine and alcohol, and to take a multivitamin that contains iron.
●Advise the client that small frequent meals can reduce the occurrence of manifestations.
●Inform the client that dietary supplements that are high in protein and low in fiber (elemental and semi‑elemental products, canned nutrition beverages) can be used.
●Monitor for electrolyte imbalance, especially potassium. Diarrhea can cause a loss of fluids and electrolytes.
●Monitor I&O, and assess for dehydration.
●Educate the client regarding the use of vitamin supplements and B12 injections, if needed - 16Medications 5‑aminosalicylic acid: Anti‑inflammatory Ulcerative colitis & Crohn's DiseaseSulfonamides: Sulfasalazine
Nonsulfonamides
●Mesalamine
●Balsalazide
●Olsalazine (for clients intolerant to sulfasalazine, rarely used) - 17Nursing Considerations SulfonamidesMonitor CBC, and kidney and hepatic function.
◯Sulfasalazine is given orally.
◯Adverse effects include nausea, fever, and rash.
◯Monitor for the development of agranulocytosis, hemolytic anemia, and macrocytic anemia.
◯Can take up to 2 to 4 weeks for therapeutic effects - 18Patient Education SulfonamidesAdvise the client to take the medication with a full glass of water after meals.
◯Tell the client to avoid sun exposure.
◯Teach the client to increase fluid intake to 2 L/day.
◯Tell the client this medication can cause urine, skin, and contact lenses to have a yellow‑orange color.
◯Tell the client to notify the provider if nausea, vomiting, anorexia, sore throat, rash, bruising, or fever occur.
◯The client should take medication as directed. The usual maintenance dose of sulfasalazine is 2 to 4g/day. - 19Patient Education NonsulfonamidesThe adverse effects are not as serious as sulfasalazine.
◯These medications can be contraindicated if the client has a salicylate or sulfa allergy.
◯Monitor for kidney toxicity.
◯Inform the client to report headache or gastrointestinal problems (abdominal discomfort, diarrhea) - 20Medications Corticosteroids Ulcerative colitis & Crohn's Disease●Prednisone
●Prednisolone
●Hydrocortisone
●Budesonide - 21Nursing Considerations CorticosteroidsFor rectal inflammation, topical steroids can be administered by a retention enema.
●Used to induce remission.●Not for long‑term use due to adverse effects.
●Prolonged use can lead to adrenal suppression, osteoporosis, risk of infection, and cushingoid syndrome. Use corticosteroids in low doses to minimize adverse effects.
●Monitor blood pressure.
●Reduce systemic dose slowly.
●Monitor electrolytes and glucose.
●Can slow healing - 22Patient Education CorticosteroidsAdvise the client to take the oral dose with food.
●Warn the client to avoid discontinuing dose suddenly.
●Tell the client to report unexpected increase in weight or other indications of fluid retention.
●Teach the client to avoid crowds and other exposures to infectious diseases.
●Instruct the client to report evidence of infection (clients who have Crohn’s disease; can mask infection) - 23Medications Immunosuppressants Ulcerative colitis & Crohn's Disease●Cyclosporine
●Methotrexate
●Azathioprine
●Mercaptopurine - 24Nursing Considerations ImmunosuppressantsMonitor for pancreatitis and neutropenia.
●Can take up to 6 months to see therapeutic effects.
●Not used as monotherapy.
●Reserved for refractory disease due to toxicity. - 25Patient Education ImmunosuppressantsTeach clients to avoid crowds and other chances of exposures to infectious diseases and to report evidence of infection.
●Advise the client to monitor for indications of bleeding, bruising, or infection - 26Medications Immunomodulators Ulcerative colitis & Crohn's Disease●Suppresses the immune response
●Inhibits tumor necrosis factor, an antibody found in Crohn’s diseas
●Infliximab
●Adalimumab (self‑administered by subcutaneous injection)
●Natalizumab (can cause progressive multi‑focal leukoencephalopathy a deadly brain infection)
●Certolizumab - 27Nursing Considerations ImmunomodulatorsFollow directions for IV use with care and in accordance with facility policy; can require pretreatment to reduce infusion reactions.
●Many adverse effects are possible, including chills, fever, hypotension/hypertension, dysrhythmias, and blood dyscrasias.
●Monitor liver enzymes, coagulation studies, and CBC. - 28Patient Education ImmunomodulatorsTeach clients to avoid crowds and other chances of exposures to infectious diseases and to report evidence of infection. The client is at risk for development or reactivation of tuberculosis.
●Advise the client to monitor and report evidence of bleeding, bruising, or infection, and transfusion or allergic reaction - 29Medications Antidiarrheals Ulcerative colitis & Crohn's Disease●Diphenoxylate and atropine
●Loperamide - 30Nursing Considerations AntidiarrhealsUsed to decrease risk of fluid volume deficit and electrolyte imbalance. They also reduce discomfort.
●Use of antidiarrheals can lead to toxic megacolon (massive dilation of the colon with a risk of the development of gangrene and peritonitis). Usecautiously.
◯Observe for manifestations of toxic megacolon that can result in gangrene and peritonitis (hypotension, fever, abdominal distention, decrease or absence of bowelsounds).
●Observe for indications of respiratory depression, especially in older adult clients. - 31Patient Education AntidiarrhealsDue to the central nervous system effects, teach the client to avoid hazardous activities until the response to the medication is established
- 32DiverticulitisDiverticulitis is inflammation and infection of the bowel mucosa caused by bacteria, food, or fecal matter trapped in one or more diverticula (pouch‑like herniations in the intestinal wall). Diverticulitis is not to be confused with diverticulosis, which is the presence of many small diverticula in the colon without inflammation.
●Not all clients who have diverticulosis develop diverticulitis.
●Diverticula can perforate and cause peritonitis, and or severe bleeding - 33Expected Findings DiverticulitisAcute onset of abdominal pain often in left‑lower quadrant
●Nausea and vomiting
PHYSICAL ASSESSMENT FINDINGS
●Fever
●Chills
●Tachycardia - 34Lab Tests DiverticulitisHematocrit and hemoglobin: Decreased
ESR: Increased
WBC: Increased
Stool for occult blood: Can be positive - 35Nursing Care DiverticulitisFor severe manifestations (severe pain, high fever), the client is hospitalized, NPO, and receives nasogastric suctioning, IV fluids, IV antibiotics, and opioid analgesics for pain.
●Instruct the client who has mild diverticulitis about self‑care at home. The client should take medications as prescribed (antibiotics, analgesics, antispasmodics) and get adequate rest.
●Educate the client to consume a clear liquid diet until manifestations subside. The client can progress to a low‑fiber diet as tolerated - 36Nursing Care Diverticulitis ContinuedInstruct the client to add fiber to the diet once solid foods are tolerated without other manifestations. The client should slowly advance to a high‑fiber diet as tolerated when inflammation resolves.
●Teach the client to avoid seeds or indigestible material, which can block diverticulum (nuts, popcorn, seeds).
●Instruct client to avoid foods or drinks that can irritate the bowel. (Avoid alcohol. Limit fat to 30% of daily calorie intake.)
●Provide the client with instructions to promote normal bowel function and consistency. (Can take bulk‑forming laxatives. Drink adequate fluids. Avoid use of enemas.) - 37Medications Antimicrobials DiverticulitisTreat infection (decrease inflammation in Crohn’s disease, ineffective for ulcerative colitis)
●Ciprofloxacin
●Metronidazole
●Sulfamethoxazole‑trimethoprim - 38Nursing Considerations Antimicrobials DiverticulitisCan cause a superinfection. Instruct client to observe for manifestations of thrush or vaginal yeast infection.
●Discontinue ciprofloxacin for tendon pain. Can cause tendon rupture. ●Decreased dose should be used for clients who have impaired kidney function.
●Monitor kidney and hepatic studies. - 39Patient Education Antimicrobials DiverticulitisInstruct client that urine can darken (expected, harmless effect).
●Teach client to monitor for manifestations of CNS effects (numbness of extremities, ataxia, and seizures) and to notify the provider immediately. - 40Risk factors for Inflammatory bowel diseasesGenetics: Ulcerative colitis and Crohn’s disease
Culture: Caucasians (ulcerative colitis), Jewish heritage (ulcerative colitis and Crohn’s disease), and African Americans (diverticular disease)
Gender and age: The incidence of ulcerative colitis peaks at adolescence to young adulthood (more often in females) and older adulthood (more often in males). Crohn’s disease usually develops in adolescents and young adults, but can occur at any age. Diverticulitis occurs more often in older adults and affects men more frequently than women.
Tobacco use: Crohn’s disease
Información
- Descripción
- Gastrointestinal Flashcards Fichas sobre Gastrointestinal, creado por Joel Rodriguez el 19/02/2019.
- Creado por
- Joel Rodriguez
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