Flashcards
Spring 2019 GI disorders
Flashcards do conjunto (89)
- 1UPPER GI DISORDERS What is head and neck squamous cell carcinoma (HNSCC)?1). An oral cancer
2). Most oral cancer lesions occur on the lower lip, lateral border and undersurface of the tongue.
3). Oral lesions:
a. precancerous leukoplakia
b. precancerous hyperkeratosis
c. precancerous erythroplakia
If we do not check these lesions regularly they can lead to cancer
4). Oropharyngeal cancer starts in the throat behind the mouth. - 2UPPER GI DISORDERS What are the signs and symptoms of head and neck squamous cell carcinoma (HNSCC)?The Early Signs:
1). Lips have a painless ulcer
2). Tongue will have an ulcer, thickening, soreness, and sensitivity to spicy food.
3). Late signs: voice changes, chronic sore throat, neck mass, dysphagia (trouble swallowing), and ear pain. - 3UPPER GI DISORDERS What are risk factors of head and neck squamous cell carcinoma (HNSCC)?1). Tobacco
2). Excessive alchohol consumption
3). HPV
4). Sunlight - 4UPPER GI DISORDERS How do we diagnosis head and neck squamous cell carcinoma (HNSCC)?1). get an oral scraping of the lesion and send to cytology
2). Toluidine blue test; place the blue dye and see if cancer cells suck it up
3). Biopsy with cytology
4). CT, MRI, PET - 5UPPER GI DISORDERS How do we treat head and neck squamous cell carcinoma (HNSCC)?SURGICAL:
Excision of the tumor:
1). partial mandibulectomy (removal of the mandible)
2). Hemiglossectomy (removal of half of the tongue)
3). Glossectomy (removal of the whole tongue)
Radical neck dissection:
Removes several muscle groups, veins, glands, and even parts of the thyroid and parathyroid
Non-surgical treatment:
Radiation
Chemotherapy - 6UPPER GI DISORDERS What are nursing considerations for head and neck squamous cell carcinoma (HNSCC)?1). Protect the airway and protect it
2). Aspiration precautions with HOB elevated
3). Nutrition: PEG, NG, Daily wt.
4). Promote wound healing
5). Palliative care when prognosis is poor, or patient decides against surgery - 7UPPER GI DISORDERS What is esophageal cancer?1). The cause is unknown
2). Complications:
a. esophageal obstruction
b. esophageal perforation
c. hemorrhage
d. metastasis - 8UPPER GI DISORDERS What are the signs and symptoms of esophageal cancer?Progressive dysphagia-trouble swallowing
pain
weight loss
sore throat
horseness
persistent cough - 9UPPER GI DISORDERS What are the risk factors for esophageal cancer?Smoking
Excessive ETOH
Barrett's esophagus
Obesity
Age
Men more than women - 10UPPER GI DISORDERS How do we diagnose esophageal cancer?1). Endoscopy with biopsy
2). EUS (Endoscopy ultrasonography)
3). Barium swallow - 11UPPER GI DISORDERS How do we treat esophageal cancer?1). Endoscopy
2). Photodynamic and/or laser therapy
3). radiation and chemotherapy
4). palliative use is to relieve obstruction
5). Stents
6). Esophagectomy-remove part or all of the esophagus w/dacron graft to replace resected part.
7). Esophagogastrostomy-remove part of esophagus and attach it to the stomach
8). Esophagoenterostomy-remove part of the esophagus and attach it to the colon. - 12UPPER GI DISORDERS What are some nursing considerations that treat esophageal cancer?1). Palliative relieve
obstruction, restoring swallowing function, maintain, nutrition, and hydration
2). Pre-op teaching and preparation; information about chest tubes, IV lines, NG tubes, pain management, turning, coughing, and deep breathing
3). Post-op care; NG tube care, respiratory precautions - 13UPPER GI DISORDER Give me a little info about stomach cancer?1). affects men more than women
2). unfortunately metastasis occurs early because of the large blood and lymph supply to the stomach - 14UPPER GI DISORDER What are the signs and symptoms of stomach cancer?1). Early signs: weight loss, anemia, pernicious anemia, PUD (peptic ulcer disease), early satiety
2). Advance disease: obstruction, ascites, the presence of ascites is a poor prognosis--seeding of tumor cells into the peritoneal occurs late in the course of the disease. - 15UPPER GI DISORDER What are theirs factors of stomach cancer?1). repeated exposure to irritants
2). smoking
3). Obesity
4). Helicabacter Pylori
**no single causative agent** - 16UPPER GI DISORDER How do you diagnose stomach cancer?1). EGD and biopsy (best option)
2). Endoscopy ultrasound/CT
3). Labs ordered:
a. CBC (anemia)
b. Guaiac (Stool)
c. Liver enzymes
d. Serum amylase (pancreas) - 17UPPER GI DISORDER What is the treatment for stomach cancer?1). Surgery (treatment of choice)
- 18UPPER GI DISORDERS When using surgery as a form of treatment for stomach cancer describe billroth I and II?1). Billroth I, more formally Billroth's operation I, is an operation in which the pylorus is removed and the distal stomach is anastomosed directly to the duodenum.
2). Billroth II, more formally Billroth's operation II, is an operation in which the greater curvature of the stomach is connected to the first part of the jejunum in end-to-side anastomosis. - 19UPPER GI DISORDERS Why do we perform the Billroth I and II surgical procedure for stomach cancer?1) When the lesion is located in the antrum or pyloric region.
- 20UPPER GI DISORDERS When is a total gastrectomy with a esophagojejunostomy needed for stomach cancer?1). When the lesion is located in the fundus.
- 21UPPER GI DISORDERS When do complications occur when we are treating stomach cancer?1). nutritional deficiencies
2). anemia from a chronic disease
3). pernicious anemia from removing the stomach which rid us of our important intrinsic factor
4). dumping syndrome-Dumping syndrome is a condition that can develop after surgery to remove all or part of your stomach or after surgery to bypass your stomach to help you lose weight. ... Also called rapid gastric emptying, dumping syndrome occurs when food, especially sugar, moves from your stomach into your small bowel too quickly. - 22UPPER GI DISORDERS What are some nursing considerations for stomach cancer?1) with the Billroth 1&II partial gastrectomies the pre op and post op goal should be nutrition. Correct anemia, pre-op a bowel prep, and post op a gastric decompression with an NGT.
- 23UPPER GI DISORDERS What are some nursing considerations for stomach cancer continued?2). NGT tube drainage color, IV fluids, pain management, when to advance feedings.
- 24UPPER GI DISORDERS What are some nursing considerations for stomach cancer continued again?1). for that total gastrectomy; just know there will be less drainage due to no stomach secretions, look for signs of leakage of fluids, Give IV fluids, give TNP, slowly advance the diet.
- 25UPPER GI DISORDERS what is dumping syndrome short version and long version:1). It is a rapid emptying of the stomach contents into the small bowel.
2). dumping syndrome-Dumping syndrome is a condition that can develop after surgery to remove all or part of your stomach or after surgery to bypass your stomach to help you lose weight. ... Also called rapid gastric emptying, dumping syndrome occurs when food, especially sugar, moves from your stomach into your small bowel too quickly. - 26UPPER GI DISORDERS What causes the dumping syndrome and what are some signs and symptoms:1). cause: you ate food and it has been 15-30 minutes later after you ate.
2). symptoms: epigastric fullness, weakness, vertigo, diaphoresis, tachycardia, and abdominal cramping. - 27UPPER GI DISORDERS How do we diagnose dumping syndrome?1). well there pyloric sphincter needs to be missing from them.
2). Then when they eat or drink at the same time it all will be dumped into there duodenum - 28GI DISORDERS How do we treat dumping syndrome?1). we provide the interventions by encouraging them or even feeding them small dry feedings daily, low carbohydrates, moderate protein, fat, and avoid simple sugars.
- 29UPPER GI DISORDERS Nursing considerations for dumping syndrome?1). Teach your patient not to have fluids with food
2). Teach them no high carbs like bread and potatoes. - 30LOWER GI DISORDERS What is IBD-inflammatory bowel disease? Does it have various classifications? When can it start?1). It is a poorly understood autoimmune disease where you have periods of inflammation and then remission.
2). Yes
3). mid teens too early 30s and then after 60 years old it is super common. - 31LOWER GI DISORDERS IBD-inflammatory bowel disease is classified into two categories, they are?1). Ulcerative colitis
2). Chron' disease - 32LOWER GI DISORDERS Describe the autoimmune IBD-inflammatory bowel disease known as ulcerative colitis:1). Ulcerative Colitis is "itis", inflammation from the rectum to the "C", cecum
- 33Describe the autoimmune IBD-inflammatory bowel disease known as Crohn' disease:1). mouth to the anus..."itis", anywhere along the GI digestive tract. However, there will be characteristic lesions called SKIP LESIONS and it is a whit patchy area and they will be in different areas. Also the inflammation will involve the entire thickness of the bowel wall and have a cobblestone appearance.
- 34LOWER GI DISORDERS What are some complications of the autoimmune IBD-inflammatory bowel disease known as ulcerative colitis:1). Fistula-abnormal connection between two openings,
2). strictures which is an abnormal narrowing of the intestine
3). eventually cancer - 35LOWER GI DISORDERS Describe the autoimmune IBD-What are some complications of the autoimmune inflammatory bowel disease known as Crohn' disease:1). There can be extra intestinal involvement like arthritis or cholangitis.
2). Colorectal cancer
3). Toxic Mega"C"loon-that is an acute paralysis or dilation of the colon requiring immediate medical sx. - 36LOWER GI DISORDERS What are some signs and symptoms of the autoimmune IBD-inflammatory bowel disease known as Crohn' disease:1). Diarrheal stools they do not need to contain blood
2). Abdominal pain
3). Weight loss
4). Fatigue
5). Malabsorption - 37LOWER GI DISORDERS What are some signs and symptoms of the autoimmune IBD-inflammatory bowel disease known as ulcerative colitis:1). Frequent bloody stool (you will see the blood as red)
1 continued). Severe cases will have 10 to 20 cases of diarrhea
2). Abdominal pain
3). Anemia-blood loss duh - 38LOWER GI DISORDERS What are some tests to diagnose the autoimmune IBD-inflammatory bowel diseases known as Ulcerative colitis and Crohn' disease:Tests:
1). a. Stool sample
b. colonoscopies
c. capsule endoscopy
Labs:
2). Hgb/Hct will be low (duh bleeding)
3). WBC count will be high infection plausible-UTI, Fistulas, perforation
4). Albumin will be low from malnutrition
5). ESR-erythrocyte sedimentation rate it is the test to monitor inflammation duh-will be high because of inflammation
Electrolytes:
6). sodium, chlorine, and potassium will be imbalanced - 39LOWER GI DISORDERS What are some treatments for the autoimmune IBD-inflammatory bowel disease known as Ulcerative colitis:1). Surgery when conservative treatments fail.
2). Drainage of the abdominal abscess or abscesses
3). Start to suspect cancer if treatments are not working.
**Surgery that performs a total proctolectomy with permanent ileostomy or a total proctolectomy with ileoanal pounch and a anal anastomosis. - 40LOWER GI DISORDERS What are some treatments for the autoimmune IBD-inflammatory bowel disease known as Crohn' disease:1). Surgery will be performed only because of complications from things like strictures, obstructions, and bleeding with a fistula
**know that surgery causes short bowel syndrome and there is no cure.**
Surgery that performs a total proctolectomy with permanent ileostomy or a total proctolectomy with ileoanal pounch and a anal anastomosis. - 41LOWER GI DISORDERS What are some nursing considerations for the autoimmune IBD-inflammatory bowel diseases known as Ulcerative colitis and Crohn' disease:1). Nutritional goal is with tube feedings, TNP, or just a flare up-lets restart a regular diet gradually.
2). When you have a flare-up of IBD keep NPO then rest your bowels, control inflammation, infection, and give IBD drugs. - 42LOWER GI DISORDERS What are five drugs used on the autoimmune IBD-inflammatory bowel diseases known as Ulcerative colitis and Crohn' disease:1). Aminosalicylates: sulfasalazine, mesalamine-used to decrease inflammation and also can turn urine orange. DO NOT get in the sun or UV
2). Antimicrobial: flagyl, cipro, biaxin-prevent or treat infection
3). Corticosteroids: prednisone, budesonide, hydrocortisone-will decrease the inflammation but will raise BG so DO NOT abruptly stop med.
4). Immunosuppressant: Imuran, methotrexate-will suppress immune system, and maintains remission of Chron' WATCH OUT for infection
5). Biologicals: Remicade, Humira-both inhibit cytokine tumor necrosis factor, TNF - 43LOWER GI DISORDERS There are two types of polyps, name them "HA"?1). adenomatous polyps which are very cancerous
2). Hyperplastic polyps which is benign-a tumor in situ that does not spread. - 44LOWER GI DISORDERS What are the signs and symptoms of adenomatous polyps and Hyperplastic polyps?1). rectal bleeding
2). blood in the stool
3). can be asymptomatic - 45LOWER GI DISORDERS How do we diagnose adenomatous polyps and Hyperplastic polyps?1). A colonoscopy with a barium enema (white liquid placed in the rectum enhances the picture).
2). virtual colonoscopy - 46LOWER GI DISORDERS How do we treat adenomatous polyps and Hyperplastic polyps?1). again a colonoscopy but this time a polypectomy removal.
- 47LOWER GI DISORDERS What are some nursing considerations for adenomatous polyps and Hyperplastic polyps?1). There is a risk for bleeding after the colonoscopy
2). fever
3). severe abdominal pain
4). abdominal distention: could be a sign of a perforation or a hemorrhage. - 48LOWER GI DISORDERS What is colorectal cancer (CRC):1). (CRC), also known as bowel cancer and colon cancer, is the development of cancer from the colon or rectum (parts of the large intestine). A cancer is the abnormal growth of cells that have the ability to invade or spread to other parts of the body.
- 49LOWER GI DISORDERS What causes colorectal cancer (CRC):1). Cause is unknown
- 50LOWER GI DISORDERS What are the risk factors for colorectal cancer (CRC):1). men more than women
2). >50 years old
3). have a genetic family history of CRC
4). History of chronic IBD-particulary the ulcerative colitis.
5). A diet high in red meat and or fat - 51LOWER GI DISORDERS What are some complications for colorectal cancer (CRC):1). A bowel obstruction
2). GI bleeding
3). Fistula-abnormal connection between to internal body parts
4). perforation
5). peritonitis-inflammation of the tissue that lines the inner wall of the abdomen and covers and supports most of your abdominal organs. Peritonitis is usually caused by infection from bacteria or fungi.
6). metastasis to the liver
7). metastasis to the lungs
8). metastasis to the bone
9). metastasis to the brain - 52LOWER GI DISORDERS What are signs and symptoms for colorectal cancer (CRC):Early CRC signs and symptoms:
1). fatigue
2). weight loss
Late advanced CRC signs and symptoms:
1). abdominal tenderness
2). palpable mass
3). sometimes remember no SS at all
4). blood in the stool is not normal so always if you see blood this is a red flag
5). Lesions on the left or right sides
RIGHT SIDED LESION VERSES A LEFT SIDED LESION:
6). Right sided lesions are more likely to cause diarrhea
7). Left sided lesions are usually detected later and could present with bowel obstruction - 53LOWER GI DISORDERS How do we diagnose colorectal cancer (CRC): there are 6 screening and or diagnostic tools including which gold standard?Screening and diagnostics:
a. Colonoscopy with biopsy (gold standard to diagnose colorectal cancer (CRC))
b. fecal occult blood test or fecal immunochemical test (FIT)-both of these test for hidden blood in stool
c. CBC-to check for anemia
d. liver function test to check for metastasis
e. CEA: carcinoembryonic antigen is a tumor marker
f. CT for metastasis - 54LOWER GI DISORDERS what is the treatment for colorectal cancer (CRC):1). Hemicolectomy-half the colon
2). (APR) abdominal-perineal resection-removes the rectum and patient will have a permanent colostomy
3). (LAR) Low anterior resection-if the tumor is above the anus, we can remove the rectum and anastomose the colon to the anal canal. A temporary ileostomy or colostomy may be done to divert the stool so this allows time for the anastomosis to heal. - 55LOWER GI DISORDERS which treatment the APR or the LAR of colorectal cancer (CRC) will result in a permanent colostomy bag:1). (APR) abdominal-perineal resection-removes the rectum and patient will have a permanent colostomy
- 56LOWER GI DISORDERS what are the nursing considerations for colorectal cancer (CRC):1). If the patient does have a surgery then post-operatively they need:
a. NGT
b. pain control
c. peristalsis-the involuntary movement of the bowel by auscultation for bowel sounds or possible palpation is present before we feed our patient
d. care of the ostomy bags from the APR and LAR surgeries.
e. wound care of stomas
f. jp drains
g. open wounds and drains are still possible and need meticulous care. - 57LOWER GI DISORDERS what is an ostomy:1). An ostomy pouching system is a prosthetic medical device that provides a means for the collection of waste from a surgically diverted biological system and the creation of a stoma. Pouching systems are most commonly associated with colostomies, ileostomies, and urostomies.
- 58LOWER GI DISORDERS why do we need an ostomy, list four reasons-easy:1). If we get IBD-inflammatory bowel disease particularly ulcerative colitis which could then lead to
2). colorectal cancer
3). perhaps trauma to the GI
4). a ruptured diverticulum - 59LOWER GI DISORDERS Can an ostomy be temporary or permanent:1). Yes
- 60LOWER GI DISORDERS There are three types of ostomy name them:1). colostomies,
2). ileostomies, and
3). urostomies. - 61LOWER GI DISORDERS the ostomy-colostomies can be described as:1). The end of the colon (large intestine) is brought through this opening to form a stoma.
a. the lg investing or sigmoid, located near the rectum: produces solid feces
b. the descending colon on our left side: produces semi-solid to solid feces
c. the transverse colon is directly below the stomach: produces semi-liquid to semi-solid feces.
d. the ascending colon located on our right side: produces semi-liquid feces - 62LOWER GI DISORDERS the ostomy-ileostomies can be described as:1). stoma constructed by bringing the end or loop of small intestine out onto the surface of the skin. we might remove all or part of the colon; produces: semi-liquid feces
*electrolyte loss - 63LOWER GI DISORDERS the ostomy- urostomies can be described as:A urostomy is a surgical procedure that creates a stoma for the urinary system. A urostomy is made to avail for urinary diversion in cases where drainage of urine through the bladder and urethra is not possible: no feces just urine
- 64LOWER GI DISORDERS When picking a site for any three ostomies, colostomies, ileostomies, and or the urostomies what is a consideration before surgical initiation:1). the site for the ostomy should be within the rectus muscle on a flat surface
2). The site location should be a place where the patient can see and care for it. - 65LOWER GI DISORDERS What will we expect during treatment and care for the colostomies, ileostomies, and or the urostomies, there are four major points of care or concern?1). The stoma needs to be dark pink or slightly red (dusky is used as a descriptive that means dark red)
2). there will be some initial edema,
3). There indeed will be slight bleeding at first
4). NO black, brown, or blue color this could indicate both necrosis or ischemia - 66LOWER GI DISORDERS What will we expect during treatment and care for the colostomies, ileostomies, and or the urostomies and the pouch attachment after a surgery:1). check skin around the ostomy frequently
2). protect the skin
3). keep it clean, dry, and intact
4). change the pouch as needed
5). do not tape a leaking pouch
6). bag should measure 1/8 larger than the stoma
7). empty the bag every 3-5 days or when the bag is 1/3 full - 67LOWER GI DISORDERS What are the nursing considerations for colostomies, ileostomies, and or the urostomies:1). If the patient is going to surgery for one of the pouches then pre-operative consideration of NPO status needs addressed
2). perhaps a pre-operative bowel prep like golytely, and careful dietary meal intake before surgery
3). After the colostomy and instillation of ostomy pouch they can return to a regular diet with exception
4). Avoid high fiber food-FRUITS. Fiber-rich fruits include: bananas, oranges, apples, mangoes, strawberries, raspberries.
VEGETABLES. Generally, the darker the color, the higher the fiber content. ...
BEANS & LEGUMES. Beans and legumes are flavorful, fiber-filled additions to salads, soups, and chilis. ...
BREADS & GRAINS. ...
NUTS.
5). Encourage lots of fluid for hydration and filtration
6). avoid consumption of extended release or enteric coated medications they are not digestible
7). alert pharmacy about ostomy pouch to aide in avoiding the extended release or enteric coated medication. - 68LOWER GI DISORDERS What is malabsorption syndrome?1). Malabsorption syndrome refers to a number of disorders in which the small intestine can't absorb enough of certain nutrients and fluids. Nutrients that the small intestine often has trouble absorbing can be macronutrients (proteins, carbohydrates, and fats), micronutrients (vitamins and minerals), or both.
- 69LOWER GI DISORDERS What three organs are affected in malabsorption syndrome (besides the small intestine) and therefore result in hindering the ability to regulate normal digestion and absorption?The small intestine is associated with malabsorption syndrome, however, so can the:
1). stomach
3). liver
4). pancreas - 70LOWER GI DISORDERS What occurrence will happen if malabsorption syndrome interrupts the regulation of normal digestion and absorption?1). short bowel syndrome
2). corrective surgery
3). resection of intestines
4). Lactase intolerance is the most common
5). Celiac disease-gluten sensitivity.
6). Short bowel syndrome - 71LOWER GI DISORDERS What is the most common occurrence that happens with malabsorption syndrome:4). Lactase intolerance is the most common
- 72LOWER GI DISORDERS There are three disorders associated with malabsorption syndrome, name them:1). Lactase deficiency
2). Gluten-sensitive enteropathy Celiac Disease; or AKA Celiac Disease
3). Short bowel syndrome - 73LOWER GI DISORDERS What is the malabsorption syndrome lactase deficiency?1). Lack of the enzyme lactase in the small intestine. Lactase is needed to digest lactose, a sugar found in milk and most other dairy products and also used as an ingredient in other foods.
**lactase is usually not always genetic and again lactase cannot break down lactose into two simple sugars, glucose and galactose. - 74LOWER GI DISORDERS What is the malabsorption syndrome Gluten-sensitive enteropathy Celiac disease?1). is an immune inflammatory disease in which people can't eat gluten because it will damage their small intestine. If you have celiac disease and eat foods with gluten, your immune system responds by damaging the small intestine. Gluten is a protein found in oats, wheat, rye, and barley.
- 75LOWER GI DISORDERS What are the signs and symptoms for the malabsorption syndrome lactase deficiency?1). Abdominal cramps
2). Bloating
3). Gas
4). Pain
5). Diarrhea - 76LOWER GI DISORDERS What are the signs and symptoms for the malabsorption syndrome Gluten-sensitive enteropathy Celiac disease?1). Diarrhea
2). Flatulence
3). Steatorrhea-is the presence of excess fat in feces. Stools may be bulky and difficult to flush, have a pale and oily appearance and can be especially foul-smelling. An oily anal leakage or some level of fecal incontinence may occur
4). abdominal distention
5). malnutrition - 77LOWER GI DISORDERS How do we diagnose for the malabsorption syndrome lactase deficiency or the Gluten-sensitive enteropathy Celiac disease?1). a 72 hour quantitative stool collection (yuk)
2). CT and endoscopy
3). Capsule endoscopy
LABS:
4). CBC for the Prothrombin time (PT) is a blood test that measures how long it takes blood to clot, however, we are going to use it in this instance to see if vitamin k absorption is adequate. - 78LOWER GI DISORDERS How do we treat the malabsorption syndrome lactase deficiency or the Gluten-sensitive enteropathy Celiac disease?1). Avoid lactose for the lactase deficiency : Some cheeses - generally aged cheese contains less lactose, soft and processed cheeses contain higher levels of lactose, Buttermilk, Cheese spreads and cheese foods, Cottage and ricotta cheese.
Cream, Evaporated & condensed milk.
Hot chocolate mixes, homemade ice cream.
2). Avoid Gluten for theGluten-sensitive enteropathy Celiac disease-food that contain: oats, wheat, rye, and barley, brown rice, four, etc. - 79LOWER GI DISORDERS What are the nursing considerations for the malabsorption syndrome lactase deficiency or the Gluten-sensitive enteropathy Celiac disease?1). Just teach the patient the food to avoid and how to read food labels.
2). adhere to the restrictive diet
3). supplements may be needed
4). refer the patient for a dietary consultation
5). read the medication labels because some contain gluten as a preservative. - 80LOWER GI DISORDERS What is short bowel syndrome?1). short version when we remove a great portion of the small intestine we get short bowel syndrome.
2). (SBS, or simply short gut) is a malabsorption disorder caused by a lack of functional small intestine. The primary symptom is diarrhea, which can result in dehydration, malnutrition, and weight loss. ... Most cases are due to the surgical removal of a large portion of the small intestine. - 81LOWER GI DISORDERS What causes short bowel syndrome and what are the signs and symptoms?1). Severity depends on the amount of bowel removed as well as the location of the resection typically the sm intestine is the cause.
Signs and Symptoms:
2). diarrhea
3). steatorrhea-Steatorrhea-is the presence of excess fat in feces. Stools may be bulky and difficult to flush, have a pale and oily appearance and can be especially foul-smelling. An oily anal leakage or some level of fecal incontinence may occur - 82LOWER GI DISORDERS How do we diagnose short bowel syndrome?1). we look for signs of malnutrition
2). we look for vitamin and mineral deficiencies
3). is there weight loss
4). hypocalcemia <8.6 lab - 83LOWER GI DISORDERS How do we treat short bowel syndrome?1). Fluid and electolyte balance
2). nutrition
3). control the diarrhea
4). parenteral nutrition may be necessary-Parenteral nutrition is the feeding of specialist nutritional products to a person intravenously, bypassing the usual process of eating and digestion.
5). enteral nutrition via PEG tube feeding
6). oral supplements including calcium - 84LOWER GI DISORDERS What are the nursing considerations for short bowel syndrome?1). Patient should eat 6 small meals a day-this is to increase contact of food with intestines
2). refer the patient to a dietician - 85LOWER GI What is parenteral nutrition TNP?1). A special formula given through a vein provides most of the nutrients the body needs. The method is used when someone can't or shouldn't receive feedings or fluids by mouth. Can be given in the hospital or at home. A central line needs to be accessed and used.
- 86LOWER GI how do we deliver the parenteral nutrition TNP?TPN is administered into a vein, generally through a PICC (peripherally inserted central catheter) line, but can also be administered through a central line or port-a-cath.
- 87LOWER GI What benefits are recelieved by the patient from the parenteral nutrition TNP?1). Nutrients direct via the blood stream
2). hypertonic solution: sodium chloride-
5% NaCl (hypertonic)
3% NaCl (hypertonic)
A hypertonic solution is a particular type of solution that has a greater concentration of solutes on the outside of a cell when compared with the inside of a cell.
**hypertonic solution contain vitamins and trace elements** - 88LOWER GI how do we treat or maintain the delivery of the parenteral nutrition TNP?1). monitor daily orders
2). monitor the central line
3). Administer the TNP same time each day
4). check blood sugars every 4-6 hours
5). monitor fluid balance
6). monitor Intake and output
7). Daily weights - 89LOWER GI What are the nursing consideration for the delivery of the parenteral nutrition TNP?1). DO BLOOD CHECKS Q 4-6
2). DO NOT give the TNP through a peripheral access moron who does that
Why, it can cause phlebitis!!