EXAM 4 MEDSURG FINAL
Ø Chapter 58 care for patients with intestinal disorders
o Irritable bowel syndrome:
Patho: unknown
What part of the intestine does it affect? Colon, lower gi tract, Small and large
intestine
1. Ibs-c: constipation dominant
2. Ibs-d: diarrhea dominant
3. Ibs-m: mixed, or alternating from diarrhea to constipation
Clinical manifestations:
Pain in the left lower quadrant
Test: CT-scan, lactose test, stool test
Tx: low fermentable diet, low fructose
Teaching:
how they should be eating and how often. Avoid anything that has
peppermint. Manage stress!!! Paxil, soloft, Prozac
What complications? Dehydration
Administer iv fluids: half-saline 0.45 with some potassium supplement due to
lose of electrolytes.
Nursing dx: chronic pain, ineffective coping, ineffective health maintenance
o Crohn’s disease vs ulcerative colitis: Where does it start? Does it affect the transverse
colon or ascending colon?
Crohn’s disease: patchy
Infl Terminal ilium
am has skipped lesions and can occur from mouth to anus
ma Ulcerative colitis: continuous
tor Colon, rectum to the anus
y Tx: antibiotics: check pg. 1344
bo Antimicrobials- ciprofloxacin and metronidazole… these are given to help
wel
dis control manifestations of crohn’s disease, but it is ineffective in ulcerative
eas
e colitis. This is used to treat secondary infections and helps reduce small
intestinal bacterial growth and reduces flares.
Amino salicylates (sulfasalazine, mesalamine, olsalazine) – this blocks the
production of prostaglandins and leukotrienes to decrease inflammation…
, contraindicated in patients allergic to aspirin… medication works 2-4 weeks
after start date.
Glucocorticoids- dexamethasone and budesonide- this decreases inflammation
but should be given for short periods of time during exacerbation
Immunomodulators- azathioprine
Antidiarrheals- loperamide and diphenoxylate hcl
Clinical manifestations-
Persistent diarrhea, abd pain or cramps, fever, weight loss, mouth ulcers,
malnutrition, fluid imbalance, anemia, blood from rectum
Medical treatment- fluid and electrolyte management, rest, and medications
Surgical management
Colectomy:
o For crohn’s is reserved for patients for whom medical management has
failed and or who experienced complications from the disease. These
complications may include structures, abscesses, intestinal obstruction,
perforation, hemorrhage, or cancer.
o Patients with ulcerative colitis for whom medical management has failed or
who have experienced complications may undergo a colectomy and be
cured of the disease but not of the extra intestinal manifestations.
Includes excessive long-term side effects such as high-dose cortical
steroids.
Complications
, Perineal abscess, fistula (more common in crohns), strictures (narrowing the
intestine and makes it difficult of food to pass
Nursing management
Assess intake and output and daily weight will help determine nutritional
status of patients with suspected IBD. Frequent diarrhea can cause
dehydration (loss of fluids) and potassium or hypokalemia.
Nursing interventions:
Vital signs, nutritional intake, frequency and characteristics of stool, intake
and output, daily weight, fluid and electrolyte status, psychosocial assessment
Actions
Encourage small frequent meals, encourage periods of rest, pain management
Teaching
Importance of nutrition, annual colonoscopy start having colonoscopy at 50
years old
o Celiac disease:
- A genetic autoimmune disease disorder that damages the small intestine. It is related to
eating foods containing gluten found in wheat, barley, and rye.
- Assess for vital signs and pt. may have diarrhea
Clinical manifestations-
diarrhea, steatorrhea, flatulence, weight loss, and signs of malabsorption
Medical diagnosis-
Most sensitive test: antitissue transglutaminase antibody test… if finding is
greater than 10 units/mL
Teaching-
Avoid gluten
use dishwasher if available because dishwasher can get rid of gluten on
dishes, eat gluten free, consult dietician
o Diverticulitis:
, - inflammation of a diverticulum, especially in the colon, causing pain and disturbance of
bowel function.
Medical diagnosis-
abdominal x-ray, CT scan
The CT scan also helps differentiate from other sources of abdominal pain and
complicated cases of diverticulitis.
The white blood cells are monitored for elevations initially associated with
inflammation and possible infection but should decrease with treatment.
Complications-
perforation, abscess, fistula, bleeding, bowel obstruction
Actions-
patients are often NPO to allow bowel rest and fluid balance must be
maintained.
give ordered antibiotics suction to decrease gastric motility
give lip balm for cracked lips
Surgical management:
Indications for surgery may include perforation, obstruction, abscess
formation which is not responding to antibiotic treatment, or fistula
information between the colon and another pelvic organ
Nursing management:
Fever often accompanies diverticulitis, ranging from a low-grade fever to
101°F (38.3°C) go to inflammation. Tachycardia often accompanies
increased temperature. Pain accompanies diverticulitis, usually in the left
lower quadrant or mid abdomen depending on what area of the colon is
involved.
Nursing interventions:
Administer IV fluids: patients are often NPO during the acute phase to
allow the bowel to rest, fluid balance must be maintained
o Administer oral antibiotics
Nasogastric tube
Ø Chapter 58 care for patients with intestinal disorders
o Irritable bowel syndrome:
Patho: unknown
What part of the intestine does it affect? Colon, lower gi tract, Small and large
intestine
1. Ibs-c: constipation dominant
2. Ibs-d: diarrhea dominant
3. Ibs-m: mixed, or alternating from diarrhea to constipation
Clinical manifestations:
Pain in the left lower quadrant
Test: CT-scan, lactose test, stool test
Tx: low fermentable diet, low fructose
Teaching:
how they should be eating and how often. Avoid anything that has
peppermint. Manage stress!!! Paxil, soloft, Prozac
What complications? Dehydration
Administer iv fluids: half-saline 0.45 with some potassium supplement due to
lose of electrolytes.
Nursing dx: chronic pain, ineffective coping, ineffective health maintenance
o Crohn’s disease vs ulcerative colitis: Where does it start? Does it affect the transverse
colon or ascending colon?
Crohn’s disease: patchy
Infl Terminal ilium
am has skipped lesions and can occur from mouth to anus
ma Ulcerative colitis: continuous
tor Colon, rectum to the anus
y Tx: antibiotics: check pg. 1344
bo Antimicrobials- ciprofloxacin and metronidazole… these are given to help
wel
dis control manifestations of crohn’s disease, but it is ineffective in ulcerative
eas
e colitis. This is used to treat secondary infections and helps reduce small
intestinal bacterial growth and reduces flares.
Amino salicylates (sulfasalazine, mesalamine, olsalazine) – this blocks the
production of prostaglandins and leukotrienes to decrease inflammation…
, contraindicated in patients allergic to aspirin… medication works 2-4 weeks
after start date.
Glucocorticoids- dexamethasone and budesonide- this decreases inflammation
but should be given for short periods of time during exacerbation
Immunomodulators- azathioprine
Antidiarrheals- loperamide and diphenoxylate hcl
Clinical manifestations-
Persistent diarrhea, abd pain or cramps, fever, weight loss, mouth ulcers,
malnutrition, fluid imbalance, anemia, blood from rectum
Medical treatment- fluid and electrolyte management, rest, and medications
Surgical management
Colectomy:
o For crohn’s is reserved for patients for whom medical management has
failed and or who experienced complications from the disease. These
complications may include structures, abscesses, intestinal obstruction,
perforation, hemorrhage, or cancer.
o Patients with ulcerative colitis for whom medical management has failed or
who have experienced complications may undergo a colectomy and be
cured of the disease but not of the extra intestinal manifestations.
Includes excessive long-term side effects such as high-dose cortical
steroids.
Complications
, Perineal abscess, fistula (more common in crohns), strictures (narrowing the
intestine and makes it difficult of food to pass
Nursing management
Assess intake and output and daily weight will help determine nutritional
status of patients with suspected IBD. Frequent diarrhea can cause
dehydration (loss of fluids) and potassium or hypokalemia.
Nursing interventions:
Vital signs, nutritional intake, frequency and characteristics of stool, intake
and output, daily weight, fluid and electrolyte status, psychosocial assessment
Actions
Encourage small frequent meals, encourage periods of rest, pain management
Teaching
Importance of nutrition, annual colonoscopy start having colonoscopy at 50
years old
o Celiac disease:
- A genetic autoimmune disease disorder that damages the small intestine. It is related to
eating foods containing gluten found in wheat, barley, and rye.
- Assess for vital signs and pt. may have diarrhea
Clinical manifestations-
diarrhea, steatorrhea, flatulence, weight loss, and signs of malabsorption
Medical diagnosis-
Most sensitive test: antitissue transglutaminase antibody test… if finding is
greater than 10 units/mL
Teaching-
Avoid gluten
use dishwasher if available because dishwasher can get rid of gluten on
dishes, eat gluten free, consult dietician
o Diverticulitis:
, - inflammation of a diverticulum, especially in the colon, causing pain and disturbance of
bowel function.
Medical diagnosis-
abdominal x-ray, CT scan
The CT scan also helps differentiate from other sources of abdominal pain and
complicated cases of diverticulitis.
The white blood cells are monitored for elevations initially associated with
inflammation and possible infection but should decrease with treatment.
Complications-
perforation, abscess, fistula, bleeding, bowel obstruction
Actions-
patients are often NPO to allow bowel rest and fluid balance must be
maintained.
give ordered antibiotics suction to decrease gastric motility
give lip balm for cracked lips
Surgical management:
Indications for surgery may include perforation, obstruction, abscess
formation which is not responding to antibiotic treatment, or fistula
information between the colon and another pelvic organ
Nursing management:
Fever often accompanies diverticulitis, ranging from a low-grade fever to
101°F (38.3°C) go to inflammation. Tachycardia often accompanies
increased temperature. Pain accompanies diverticulitis, usually in the left
lower quadrant or mid abdomen depending on what area of the colon is
involved.
Nursing interventions:
Administer IV fluids: patients are often NPO during the acute phase to
allow the bowel to rest, fluid balance must be maintained
o Administer oral antibiotics
Nasogastric tube
