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Lewis Chapter 43
Terms in this set (52)
Chronic functional disorder characterized by intermittent and recurrent abdominal pain and stool pattern irregularities (diarrhea, constipation, or both).
IBS: Encourage patient to increase dietary fiber to at least________g/day.
IBS: Factors that play a role in the pathophysiology: (hint, there are 3)
Depression, PTSD, anxiety.
IBS: the key to an accurate diagnosis is:
a thorough history and physical examination.
IBS: in addition to abdominal pain and diarrhea, or constipation which other GI symptoms can they experience? (hint, there are 5)
Abdominal distention, excessive flatulence, bloating, urgency, and sensation of incomplete evacuation.
IBS: True or false: when asking the patient about health history emphasis should be on the following:
- psychosocial factors i.e. physical or sexual abuse.
- Family Hx
- Drug and Diet.
IBS: factors that precipitate symptoms: (hint, there are 4)
Stress, psychologic factors, prior gastroenteritis, and specific food intolerances.
IBS: Symptom-based criteria for IBS have been standardized and are referred to as:
A) Braden scale criteria
C) IBS Criteria
D) The Rome Criteria
E) Glasgow Coma scale
braden scale is for pressure ulcer risk, CIWA is for alcohol withdrawal assessment. IBS criteria is made up. Glasgow coma scale is for the neurological measurement of how alert and conscious someone is.
IBS: in addition to abdominal pain and diarrhea, or constipation which other NON-GI symptoms can they experience? (hint, there are 2)
Fatigue and sleep disturbances.
IBS: You overhear the physician telling your patient to eliminate broccoli and cabbage from his diet and to replace them with yogurt or milk products. You know the patient is experiencing a lot of farting and abdominal distention, what do you think the rational is for the doctor's recommendation?
This can help determine if there is a lactose intolerance issue.
IBS: _________ is a synthetic opioid that decreases intestinal transit and enhances intestinal water absorption and sphincter tone, can be used for IBS patient with diarrhea.
It's 90 degrees outside and you're working in the ER. You call your patient "Mr. Splats" back to the exam room. You notice his mucosal membranes are dry and he appears sunburned. When you ask him what brought him in, he responds with "Well, I was at my baseball game and I was sliding into home, and my pants were full of foam. So I got into my chevy and I felt something heavy." What do you think his diagnosis is?
Diarrhea (secondary to dehydration)
IBS: Abdominal discomfort or pain for at least 3 months, with onset at least 6 months before that has at least two of the following characteristics:
-Relieved with pooping
-Onset associated with a change in stool frequency
-Onset associated with a change in stool appearance.
Remember kids! don't be a fool, check your stool :)
The Rome III criteria.
Poorly understood chronic inflammation of the GI tract, characterized by periods of remission interspersed with periods of exacerbation. Name disease and two classifications.
Inflammatory Bowel Disease (IBD), Crohn's disease or Ulcerative colitis.
IBD: Which of the following are common complications of Crohn's:
A) Toxic Megacolon.
D) Anal Abscesses
B, C, and D
A is a complication of Ulcerative colitis.
IBD: Usually starts in rectum and spreads in a continuous pattern up the colon:
A) "The back door boogie"-haha get it?
B) Pathologic location for Ulcerative Colitis
C) Pathologic location for Crohn's Disease
B, Ulcerative Colitis
IBD: 20 year old Theresa comes in for concerns about bloody stools. She says its been going on for a few weeks but she just thought it was her period (she's kind of an idiot). With more questions you find out she frequently has a fever and with more assessing you find that she is severely underweight, almost malnourished looking. While palpating her abdomen you feel a mass in the right iliac fossa. This confirms your theory that she has:
A) Ulcerative colitis
B) Food poisoning
C) Celiac disease
D) Crohn's Disease
D, Crohn's disease
IBD: Perforation, Toxic megacolon, and occasional strictures are complications of_________.
IBD: The following symptoms are characteristic of which IBD?
- Bloody diarrhea
- Abdominal pain
- Rectal bleeding
- Tenesmus (continue, recurrent bm)
IBD: Labs have come back for your patient with Ulcerative colitis. You notice the WBC is 17,000, would is this indicative of? (Select all that apply)
A) Aplastic Anemia
B) Toxic Megacolon
D) Folate Deficiency
B and C
A and D would be low and do not apply to this scenario.
IBD: Occurs anywhere along GI tract in characteristic skip lesions; most frequent site is terminal ileum. Pathophys location for:
B) Crohn's Disease
B, Crohn's disease
Ostomy: It is POD #1 for the patient with a new colostomy. The nurse has her hands full with 5 other patients but knows the colostomy bag needs to be changed. Who would be an appropriate person to delegate this task to?
C) The patient
D) The nurse can not delegate this task to any of the above. The nurse must do this.
Although LPNs and NAPs provide much of the osmotic care for patients with established osmotic, patients with new osmotic have complex needs and require frequent assessment, planning, intervention, and evaluation by a RN.
IBD: Why did the doctor order serum Sodium, potassium, chloride, bicarbonate, and magnesium, and why are they all low?
From Fluid and Electrolyte loss from diarrhea and vomiting.
IBD: Patients with_________ are more likely to experience a bowel obstruction, fistulas, fissures, and abscesses.
Diverticular Disease: Diverticula may occur at any point within the GI tract but are most commonly found in the ______ colon.
IBD: _______ foods tend to trigger diarrhea.
Diverticular Disease: Majority of patients with __________ have no symptoms. Those with symptoms typically have abdominal pain, bloating, farting, and/or changes in poopin' habits.
IBD: Parenteral nutrition allows for a positive nitrogen balance while resting the bowel, but Enteral feedings are preferred because of their effects on the colonic microflora. Where would you expect to find Enteral feeding being administered?
A) An NG tube or peg tube.
B) A handful of vitamins
A. NG or peg tube
Diverticular Disease: In patients with ____________ abdominal pain is localized over the involved area of the colon. The most common symptoms of ___________ in the sigmoid colon include left lower quadrant abdominal pain and sometimes fever, leukocytosis, and a palpable abdominal mass.
IBD: which of the following would you expect to give to your patient? (SELECT ALL THAT APPLY)
A) Grapefruit juice
B) Ferrous sulfate
C) Potassium (If taking a corticosteroid)
B, C, D.
Rational: Iron for chronic blood loss. Potassium if on corticosteroid because of sodium retention and loss of potassium (can get hypokalemic and Toxic megacolon), and Zinc from chronic diarrhea.
Ostomy: Output from a(n) ____________ has not entered the colon ad thus it will be liquid.
Diverticular Disease: Diagnostic studies are based on history and physical and the preferred method_____________.
CT scan with oral contrast.
IBD: TRUE OR FALSE: many patients are lactose intolerant and improve when dairy products are avoided. Since dairy is important for their calcium intake, yogurt and cheese can be substituted.
Celiac Disease: True or False:
if patients do not adhere to the GF diet, this can lead to complications like, anemia and osteoporosis.
Celiac Disease: Pure oats don't contain gluten so why should they be avoided for CD?
They can become contaminated with wheat, rye, and barley during the milling process.
IBD: Your patient's albumin results came back and the result is 2.3. What is likely going on?
Protein loss from the bowel and poor nutrition. This is a severe state of IBD.
Lactose Intolerance: Symptoms and when you'd expect to see the onset.
Bloating, farting, cramping abdomina pain, diarrhea. Occur 30min-several hours after milk products.
Ostomy: Who is an appropriate delegatee for placing the osmotic pouching system for an established ostomy, and empty osmotic bag and measure liquid contents?
Ostomy: TRUE or FALSE:
The NAP can assist stable patients with colostomy irrigation.
Lactose Intolerance: how is it diagnosed?
DNA testing, lactose intolerance test, a lactose hydrogen breath test.
IBD: Parenteral nutrition allows for a positive nitrogen balance while resting the bowel, but Enteral feedings are preferred because of their effects on the colonic microflora. Where would you expect to find Parenteral nutrition being administered?
A) from a mother or father
B) Through an AC site.
C) PICC line.
C. Picc line
Steatorrhea is a manifestation of which of the following? (SELECT ALL THAT APPLY)
A) Lactose intolerance
B) Short Bowel Syndrome
C) Celiac Disease
D) Diverticular Disease
B and C.
Ostomy: Who should the nurse have monitor skin around osmotic for breakdown, provide skin care around the osmotic, irrigate colostomy in stable patient, and monitor the Volume, color, and odor of the osmotic drainage?
Diverticular Disease: prevention. (SELECT ALL THAT APPLY)
A) high-fiber diet.
B) decreased intake of fat and red meat.
C) High levels of physical activity.
A , B, and C
Foul smelling diarrhea, Steatorrhea, farting, abdominal distention, and symptoms of malnutrition are symptoms of?
Decreased bone density, osteoporosis, dental enamel hypoplasia, iron and folate deficiencies, peripheral neuropathy, and reproductive problems are associated with:
Celiac Disease. (the non GI symptoms that may or may not be felt)
Celiac Disease: Gold standard for diagnosing the disease.
Histologic evidence from biopsy of small intestine.
Ostomy: Which statement about ostomies by the knew nurse is correct?
A) Output from a sigmoid colostomy resembles normal formed stool and SOME patients are able to regulate emptying time so they do not need to wear a collection bag.
B) Ileostomys are only for men.
C) Eating sprouts can cause obstructions in ileostomy.
Rational (note that it says SOME patients are able to regulate emptying.) B obviously isn't true. C is not true because sprouts are not listed as obstructing agents. They can however cause gas.
Celiac Disease: one of the most common manifestations:
Iron deficiency anemia.
Celiac Disease: You are teaching your patient about foods to eat. Which of the following choices show that your teaching was effective? (SELECT ALL THAT APPLY)
A) Fried Chicken
B) Potato Bread
C) Corn Tortillas
C and D.
Rational: Corn tortillas and yogurt don't have gluten in them.
Fried chicken is breaded ya dumb-dumb
Potato Bread must have barley, rye, gluten, wheat. Potatoes are ok but the bread kind isn't (can't imagine it's that big of a loss though).
Your patient presents with steatorrhea, diarrhea, malnutrition, and oxalate kidney stones what do you presume the diagnosis is?
Short Bowel Syndrome
SBS: Why should the patient on Parenteral Nutrition not be on it for too long?
Long term use can cause cirrhosis of the liver and cholelithiasis.
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