Nurs 125 GI PART II Study Guide
Second portion of the GI series.
Terms in this set (47)
An acute inflammation of the vermiform appendix that occurs most often among young adults.
Most common cause of appendicitis
Obstruction by fecaliths.
A very hard piece of feces.
A location in the RLQ of the abdomen between the umbilicus and the anterior iliac crest. Classic area for pain related to appendicitis.
Symptoms of appendicitis
The beginning stages will start as cramp-like pain in the epigastric or periumbilical area. As the inflammation progresses, nausea and vomiting can occur. Later on the pain becomes localized to McBurney's point.
Nursing responsibilities for appendicitis
- Keep patient NPO.
-Initiate IV access.
- Administer IV fluids to prevent fluid and electrolyte imbalances.
- Keep patient in semi-fowlers position.
- Once confirmed, administer opioid analgesics and antibiotics as prescribed.
What are some things you should NEVER do if someone is suspected of having appendicitis?
1) Administer a laxative or enema. Doing either of these two things can cause perforation of the appendix.
2) Apply heat. This increases circulation to the area and can cause the appendix to perforate due to all the extra fluid coming to it.
Removal of the appendix.
A minimally invasive surgical procedure with one or more small incisions near the umbilicus through which a small endoscope is placed.
Natural orifice transluminal endoscopic surgery (NOTES)
A newer procedure that does not require an external skin incision. Instead, the surgeon can go through a natural orifice and enter the peritoneal cavity.
Tests done to confirm appendicitis
-WBC between 10,000-18,000.
An open surgical approach with a larger abdominal incision for complicated or atypical appendicitis or peritonitis.
A life-threatening, acute inflammation of the visceral/parietal peritoneum and endothelial lining of the abdominal cavity.
Bacterial invasion of the blood.
Key features of Peritonitis
-Rigid, boardlike abdomen
-Nausea, anorexia, vomiting
-Diminishing bowel sounds
-Inability to pass flatus or feces
-Rebound tenderness of abdomen
-WBC count of >= 20,000
Emergent problems associated with Peritonitis
-Respiratory compromise (related to extra pressure being placed on the diaphragm.... the lungs cannot expand as well.)
- Hypovolemia (due to all the fluid flowing into the "third space.")
-Septicemia (As a result of bacteria getting into the blood stream.)
-Kidney failure (Due to the loss of blood flow through the kidneys.)
-Fluid and electrolyte imbalances (related to hypovolemia and kidney failure.)
Nursing interventions for the patient with peritonitis
-Initiate IV access
-Insert NG tube
-Administer fluids and broad-spectrum antibiotics as ordered.
-Patient is NPO
-Administer oxygen as prescribed
-Monitor respiratory status diligently
-Pt in semi-fowlers (as tolerated)
-Monitor pain and administer analgesics as ordered
Surgical intervention for peritonitis
Focuses on controlling the contamination, removing foreign material from the peritoneal cavity, and draining collected fluid.
An exploratory laparotomy or laparoscopy is used. Before the incision is closed, the surgeon will irrigate the peritoneum with antibiotic solutions.
Post-op care for the patient with peritonitis
-Monitor LOC, vitals, respiratory status, and I&O hourly at the least.
-Maintain semi-fowlers position to promote drainage into the lower abdominal cavity and increase lung expansion.
*Remember to monitor for any S&S of pneumonia since breathing is compromised.
An increase in the frequency and water content of stools and/or vomiting as a result of inflammation of the mucous membranes of the stomach and intestinal tract.
*Mainly in the small bowel; can be caused by either a bacterial or viral infection.
Bacterial Gastroenteritis caused by Campylobacter enteritis
-Transmitted fecal-oral route.
-Incubation period is 1-10 days.
-Communicable for 2-7 weeks.
-Highest incidence during warm months.
-More severe infection, foul smelling stools with blood common.
-20-30 bowel movements/day for up to 7 days.
-Many WBCs and RBCs on fecal gram stain.
Bacterial Gastroenteritis caused by Escherichia coli
-Transmitted fecal-oral route,
-Humans are the reservoir for this bacterium, often asymptomatic.
-Highest incidence in areas of poor sanitation during warm months.
-Diarrhea can last for up to ten days, with blood or mucous in stool possible.
Bacterial Gastroenteritis caused by Shigellosis
-Transmitted fecal-oral route.
-Incubation period 1-7 days.
-Communicable during, and four weeks after illness.
-Humans can be carriers for months.
-Blood and mucous in stools for up to 5 days.
-Many WBCs on fecal gram stain.
-This infection must be reported to the health department.
Viral Gastroenteritis caused by "epidemic viral"
-Caused by many parvovirus-type organisms.
-Transmitted fecal-oral route.
-Incubation period 10-51 hours.
-Communicable during acute illness.
-Diarrhea commonly limited to 24-48 hours.
Viral Gastroenteritis caused by Rotavirus and Norwalk virus
-Transmitted fecal-oral and possible respiratory route.
-Incubation is 48 hours.
-Rotavirus most common in infants and young children
-Norwalk virus mainly affects young children and adults.
-Rapid onset of nausea, abdominal cramps, vomiting, and diarrhea. Usually a mild form of gastroenteritis.
How to prevent transmission of Gastroenteritis
Advise patients and their families to:
-Wash hands thoroughly for at least 30 seconds with an antibacterial soap; maintain good personal hygiene.
-Restrict use of glasses, dishes, eating utensils, and toothpaste for personal use. Disposable utensils can come in handy.
-Maintain clean bathroom facilities.
-Inform healthcare provider if symptoms persist for more than 3 days.
-Do not prepare food for others. If the patient works in food service, the healthcare department should be consulted about return to work.
A type of chronic inflammatory bowel disease that creates widespread inflammation of mainly the rectum and rectosigmoid colon but can extend to the entire colon. *Associated with periodic remissions and exacerbations.
*the peak incidence at age is 15-25 years old and 55-65 years old.
An unpleasant and urgent sensation to defecate.
Classifications of severity of Ulcerative Colitis
Mild- <4 stools/day with or without blood. Patients are asymptomatic and lab values are normal.
Moderate- >4 stools/day with or without blood. Patients have minimal symptoms, mild abdominal pain, mild intermittent nausea, and possible increased C-reactive protein.
Severe- >6 bloody stools/day. Patients have fever, tachycardia, anemia, abdominal pain, and elevated C-reactive protein.
Fulminant- >10 bloody stools/day. Patients have increasing symptoms, anemia, and colonic distention.
Cultural considerations for Ulcerative Colitis
More common in those of Jewish or European descent.
What is the most definitive diagnostic test for Ulcerative Colitis?
Three priority problems associated with Ulcerative Colitis
1) Diarrhea and incontinence related to inflammation of the bowel mucosa.
2) Pain related to inflammation and ulceration of the bowel mucosa and skin irritation.
3) Potential for lower GI bleeding and resulting anemia.
Massive dilation of the colon that can lead to gangrene and peritonitis.
An inflammatory disease of the small intestine (most often), the colon, or both. Causes a thickened bowel wall.
Peak incidence occurs between 15-40 years of age.
The presence of many abnormal pouch like herniations (Diverticula) in the wall of the intestine.
The inflammation of one or more diverticula.
A localized area of induration and pus caused by inflammation of the soft tissue near the rectum or anus.
A tear in the anal lining.
An inflammation of the gallbladder.
Inflammation from gallstones.
Inflammation related to cholelithiasis.
Inflammation of the gallbladder without gallstones.
Yellow discoloration of the sclerae.
Risk factors for Cholecystitis
-American Indian, Mexican American, or Caucasian
-Rapid weight loss or prolonged fasting
-Increased serum cholesterol
-Women on hormone replacement therapy or older birth control pills
-Family history of gallstones
-Gastric bypass surgery
-Sickle cell disease
-Glucose intolerance/diabetes mellitus
Key features of Cholecystitis
-Episodic or vague upper abdominal pain that can radiate to right shoulder.
-Pain triggered by high fat or high volume meal.
-Nausea and/or Vomiting.
-Feelings of abdominal fullness
-Jaundice, clay-colored stool, dark urine, steatorrhea
Postcholecystectomy syndrome (PCS)
Abdominal pain with vomiting that occurs several weeks to months after a cholecystectomy. An ERCP is usually performed to find the cause of this condition.