Med Surge certification- Gastrointestinal
Appendicitis - mucosal ulceration that triggers inflammation, causing temporary
obstruction
Appendicitis causes - fecalith, foreign body obstruction, barium ingestion, neoplasm,
stricture, infection
Appendicitis s/s - per umbilical pain that starts generalized and then localizes to
Burney’s point with rebound tenderness and guarding
Rousing’s sign
Oturator sign
Anorexia, N/V, low grade fever, tachycardia
Appendicitis diagnosis - elevated WBC count with increase in immature cells
ultrasound for unperforated appendix
CT
Appendicitis Nursing Interventions - -Explain preop procedures
-fowler's position to minimize pain
-NPO
-pain control, but not enough to mask perforation
-positioning
-Frequent VS, IV access, IV fluids
Complications:
Perforation which may lead to peritonitis; wound infection, obstruction, abscess
colorectal cancer - adenocarcinoma of the colon or rectum, or both
sigmoid and descending colon have circumferential growth and constrict lumen
ascending colon are large and palpable
colorectal cancer risk factors - Obesity
Tobacco use
Physical inactivity
Insulin resistance
Low fiber in the diet
High amount of animal fat in the diet
Diets low in vitamin A, C, and E
Ulcerative colitis
familial history
history of colitis, polyps, IBD
, colorectal cancer complications - partial or complete bowel obstruction, extension of
tumor into surrounding blood vessels
-results in hemorrhage, perforation, abscess formation, peritonitis, sepsis, death
colorectal cancer signs and symptoms - Fatigue, Unintended weight loss, bloody stool,
melena (black tarry stool), changes in bowel habits, persistent abdominal discomfort
symptoms usually occur in late stages
colorectal cancer diagnosis - fecal occult blood test along with either a double-contrast
barium enema or a colonoscopy
rectal examination
biopsies
CT for staging
Trans rectal ultrasonography
colorectal cancer treatment - surgical resection of colon
hemicoloectomy in advanced disease
Radiation, chemo. if metastasized to lymph node
colorectal cancer nursing interventions - physical and emotional support and allow
verbalization of feelings through coping stages
Assess bowel and urinary elimination
Monitor fluid and electrolyte balance
Assess tissue perfusion
Provide adequate nutrition- avoid irritating foods, caffeine, alcohol
Assess and treat pain
Promote gas exchange
Prevent infection
Maintain peristomal skin integrity
esophageal cancer - Squamous cell carcinoma (worldwide); adenocarcinoma (U.S.)
can spread through mucosa, lymph nodes, with mediastina perforation and erosion of
great vessels
Esophageal cancer risk factors - ABCDEFGH
Achalasia/alcohol
Barrett's esophagus
Corrosive esophagitis/cigarettes
Diverticula
Esophageal webs (Plummer Vinson)
Familial
Gird
Hot dogs (nitrosamines)
Esophageal cancer signs/symptoms - Most common is dysphagia. 2nd most common is
weight loss. Other: bleeding, epigastria pain, hoarse, cough
Appendicitis - mucosal ulceration that triggers inflammation, causing temporary
obstruction
Appendicitis causes - fecalith, foreign body obstruction, barium ingestion, neoplasm,
stricture, infection
Appendicitis s/s - per umbilical pain that starts generalized and then localizes to
Burney’s point with rebound tenderness and guarding
Rousing’s sign
Oturator sign
Anorexia, N/V, low grade fever, tachycardia
Appendicitis diagnosis - elevated WBC count with increase in immature cells
ultrasound for unperforated appendix
CT
Appendicitis Nursing Interventions - -Explain preop procedures
-fowler's position to minimize pain
-NPO
-pain control, but not enough to mask perforation
-positioning
-Frequent VS, IV access, IV fluids
Complications:
Perforation which may lead to peritonitis; wound infection, obstruction, abscess
colorectal cancer - adenocarcinoma of the colon or rectum, or both
sigmoid and descending colon have circumferential growth and constrict lumen
ascending colon are large and palpable
colorectal cancer risk factors - Obesity
Tobacco use
Physical inactivity
Insulin resistance
Low fiber in the diet
High amount of animal fat in the diet
Diets low in vitamin A, C, and E
Ulcerative colitis
familial history
history of colitis, polyps, IBD
, colorectal cancer complications - partial or complete bowel obstruction, extension of
tumor into surrounding blood vessels
-results in hemorrhage, perforation, abscess formation, peritonitis, sepsis, death
colorectal cancer signs and symptoms - Fatigue, Unintended weight loss, bloody stool,
melena (black tarry stool), changes in bowel habits, persistent abdominal discomfort
symptoms usually occur in late stages
colorectal cancer diagnosis - fecal occult blood test along with either a double-contrast
barium enema or a colonoscopy
rectal examination
biopsies
CT for staging
Trans rectal ultrasonography
colorectal cancer treatment - surgical resection of colon
hemicoloectomy in advanced disease
Radiation, chemo. if metastasized to lymph node
colorectal cancer nursing interventions - physical and emotional support and allow
verbalization of feelings through coping stages
Assess bowel and urinary elimination
Monitor fluid and electrolyte balance
Assess tissue perfusion
Provide adequate nutrition- avoid irritating foods, caffeine, alcohol
Assess and treat pain
Promote gas exchange
Prevent infection
Maintain peristomal skin integrity
esophageal cancer - Squamous cell carcinoma (worldwide); adenocarcinoma (U.S.)
can spread through mucosa, lymph nodes, with mediastina perforation and erosion of
great vessels
Esophageal cancer risk factors - ABCDEFGH
Achalasia/alcohol
Barrett's esophagus
Corrosive esophagitis/cigarettes
Diverticula
Esophageal webs (Plummer Vinson)
Familial
Gird
Hot dogs (nitrosamines)
Esophageal cancer signs/symptoms - Most common is dysphagia. 2nd most common is
weight loss. Other: bleeding, epigastria pain, hoarse, cough
