appendicitis peak incident is between _____-______ years old
44540
appendicitis begins as a ________, _______ pain in
___________________ area
pain progresses over _______-_______ hrs and localizes over
_________ ________ quadrant
dull, steady..periumbilical
4-6..right lower
s/s of appendicits
-_____________
-________ ____________ ____________
-_______________
nausea
low grade fever
anorexia
sudden pain relief of appendicitis may indicate _____________ of the ______________
rupture of the appendix
rupture of the appendix may lead to ________________
peritonitis
pt with appendicitis will have ___________ pain at ______________ point
rebound..mcburney's
when you mash down on the RLQ and then you let up and the pt feels a
lot of pain
rebound pain
appendix is in the __________ ____________ quadrant
right lower
clinical diagnosis (s/s) of appendicitis
-elevated __________
-_______________ _______________-_______________ ___________
WBC abdominal sonogram
exploratory lap
___________ tend to have not as severe symptoms of
appendicitis
-tends to _____________ before they can get them back to surgery
(if it _____________ all the contents from the appendix goes in to
the _______________ cavity NOT GOOD)
Elderly
rupture
ruptures...abdominal
Treatment for Appendicitis
_______ ____________ ________________
________-____________ position (hurts them to lie ______)
No _____________ or _______________ Surgery �
___________________ __________________ If ___________
present, may have a _________ in place at the incision site
No ____________ ___________
IV fluids Antibiotics High Fowler's
(flat) enemas or laxatives laparoscopic
appendectomy abscess...drain heavy lifting
hot belly
peritonitis
s/s of peritonitis
_________ over abdominal area ____________
tenderness abd. ___________ and ____________
_____________ _______ abd ___________ >________
degrees ______________ ______________ and
____________ shallow ______ increase __________ and
_______ decreased _____________ _____________
_______________
pain
rebound
distention...rigidity
board like
fever..100
anorexia
nausea and vomiting
RR
pulse...BP
bowel sounds
dehydration
nursing care of peritonitis
maintain __________ and _________________ (IVF _______ or _______)
_______ distention (_______ suction)
______ supp
assess for return of _________
monitor ________
S/S of _____________-_______________
decrease _________________ process (________________, ________, _________-___________)
fluid and electrolytes (NS..LR)
GI ...NG
K+
BS
I&O
dehydration..hypovolemia
infectious...antibiotics...VS..semi-fowlers
treatment of peritonitis
_____ cause
_______________
______ fluids (______ or ______)
decrease ________ ___________ (_____ suctioning)
___________ to close ________________
ID
antibiotics
IV..NS...LR
abd distention
surgery..perforation
diagnostics of peritonitis
________
_______ ___-________
peritoneal ______________
CBC
abd. x-ray
peritoneal lavage
risk factors for peritonitis
________ surgery
_________ pregnancy
______________
____________
____________
_______________
abd
ectopic
diverticulum
trauma
ulcers
appendicitis
major cause of death of peritonitis
sepsis
with peritonitis you will have pain over in the ________________ as
_________ gets in the belly it will swell
abdomen..fluid
refers to two chronic inflammatory GI disorders
-crohn's dz and ulcerative colitis
inflammatory bowel dz
No __________ for these
Crohn�s disease Ulcerative colitis
cure
__________ and _______ ________________ make Crohn�s disease
Ulcerative colitis worse
NSAIDs...oral..contraceptives
Crohn's disease can occur anywhere in the ______ tract from the
_________ to the ___________,
but most commonly involves the ___________ ___________ and
_______________ __________.
Segments of normal __________ can occur between diseased
portions, so-called �_________� lesions.
GI..mouth...anus
distal ileum...proximal colon
bowel...skip
usually starts in the rectum and moves in a continual fashion toward
the cecum.
Although mild inflammation may occur in the terminal ileum,
____________ ______________ is a disease of the colon and rectum.
Ulcerative colitis
ulcerative colitis
Crohn�s Disease Symptoms:
________________ tenderness and _________ in
__________, ____________ unrelieved by
_______________, ___________________,
________________ ________________ deficits
(__________________), pt will complain of
______________, _____________
Abdominal..spasm..RLQ
Diarrhea..defecation
Steatorrhea
Anorexia
Nutritional...malnutrition
fatigue
anemia
Crohn�s Disease Diagnostic findings:
__________ blood and ______________, �String Sign� on
____-______
Decreased ____/_____ low ______________
and low _____________ levels, Elevated __________,
elevated ________ (______is going to be elevated bc it tells how
your body is responding to inflammation�______________
___________________ rate)
Occult..Steatorrhea..X-ray
H/H,
albumin...protein
WBC
ESR...ESR...erythrocyte sedimentation rate
Crohn�s Disease Complications:
Intestinal __________________, ____________
disease, _________ and ______________ imbalance,
_________________, _____________ and ____________
formation
obstruction
Perianal
Fluid...electrolyte
Malnutrition
Fistula..abscess
Crohn�s Disease s/s
Usual age is _________ to mid-______ after ________
__________
_______________ abd. pain
____________ (intermittent)
_______________ ____________ is common (may be severe)
Sometimes have _____________ _______________
________________ and __________________ deficiency
teens...30s..60
Diarrhea
Cramping
Fever
Weight loss
rectal bleeding
Malabsorption...nutritional
Crohn�s Disease
Complications:
_____________
____-_________ is increased incidence and severity
_______________ is common
strictures
c-diff
Perforation
Crohn�s can be in your __________, __________, _________..not just
the GI tract
joints..liver...eyes
Ulcerative Colitis
Symptoms:
_____________ _____________,
-Passage of ______________ and ________
-________ abd pain
-Intermittent _____________ (urge to go to the bathroom)
Bloody Diarrhea
mucous and pus
LLQ
tenesmus
Ulcerative Colitis Diagnostic findings:
_____________ in the stool, _________ and
_______________ imbalances, Decreased _____/____ and
______________ levels, Elevated ________
Blood
Fluid...electrolyte
H/H...albumin
WBC
Ulcerative Colitis Complications:
Toxic _____________ (large intestine begins to widen
(dilate) _________________, Increased risk for
________________ fractures (bc the body cant absorb nutrients)
megacolon
Perforation
osteoporic
#NAME?
Tenesmus
Ulcerative Colitis
Rectal _______________ is common
________ pain is common and severe constant
bleeding
Abd
Management of Chronic IBD
Nutritional Therapy
________ and/or _________ (______________ _______________
as needed) _______-residue, ________-____________,
________-_________ diet Avoid foods that exacerbate
___________ (ie.._______in those with lactose intolerance)
Avoid _________ foods (they increase intestinal motility) (avoid
extreme in temp.) May need to __________________
Oral..IVF...Parenteral Nutrition
Low
high-protein..high-calorie
diarrhea...milk
cold
supplement
Management of Chronic IBD
Medications
________________ ________________
_______________ (____________)
_______________ (________________ (PO) or
__________-_________ (IV)) _________________ (__________:
monitor liver enzymes, and ____________)
Sedatives
Antidiarrheals
Antibiotics (flagyl)
Corticosteroids (Prednisone...Solu-Cortef)
Immunomodulators (Imuran...Methotrexate)
Surgery _______% of patients with Crohn�s
undergo _____________ ________% of patients with ulcerative
colitis eventually have total ______________
70...surgery
25...colectomies
Management�Inflammatory Bowel Disease
Assess
_______, __________ habits, __________ habits
Pain..bowel..dietary
Inflammatory Bowel Disease Interventions
Establish ____________ ______________ _____________
________ relief, optimal _____________,
bowel elimination patterns,
pain
nutrition
_____________ cause a moon face and more resistant to infections,
increase in Blood sugar
Corticosteroids
Inflammatory Bowel Disease - Patient Teaching Nutrition management
_________, high-___________,
________-___________, high _________,
____________ rich diet
Bland..protein..low residue..calorie..vitamin
Ileostomy and Kock Pouch
A surgical creation of an opening into the _________-or
___________ ___________ (usually via an ileal stoma on the abdominal
wall) Allows for drainage of _________ matter from the
__________ to the outside of the body
ileum..small intestine
fecal...ileum
_______________: drains continuously and have to wear all the time
With the__________ ___________: it has a valve and you can empty
through the catheter
Ileostomy
kock pouch
Postoperative care
Ileostomy
Monitoring of
___________ viability _______________
juncture Peristomal __________ ____________
Stoma
Mucocutaneous
skin integrity
Look at the stoma, should be ________ to ________ , shows that there
is blood flow going to it
-if its __________ contact HCP bc its not getting blood flow
pink..red
purple
Postoperative care
Ileostomy
Output may be as high as _________�__________mL per
24 hours
Observe for
__________ and _____________ imbalance
_______________ _______________ abscess
__________ ____________ obstruction ______________
1500�1800
Fluid and electrolyte
Hemorrhage
Abdominal
Small bowel
Dehydration
Postoperative care
Ileostomy
Initial drainage will be __________
_______________ incontinence of mucus from manipulation of anal
canal __________ exercises **______________ skin
care**
Usually within the first _______ days that they are at high risk
for bowel obstruction
Important to protect __________ from breakdown
If you allow the _________ to be wet for a long period of time it
will break down easier
liquid
Transient
Kegel
Perianal
30
skin
skin
Small Bowel Obstruction
________________, ___________ _____________ pain
May pass ___________ & ___________ Does not pass
_________ or _________ matter (look for this)
_____________ of gastric contents leads to _______, then fecal
____________ (will look like poop) if _______________ is
complete _________________ occurs
________________ distention The lower the
________________, the more marked the distention
___________________ Shock
Cramping, colicky abdominal blood & mucus
flatus or fecal Vomiting
...bile...vomitus...obstruction Dehydration
Abdominal obstruction Shock
Hypovolemic Shock: bc their ____________ and their _______ not
working, and they are ____________ everything up, they will be at a
deficit of fluid volume
obstructed...guts..vomiting
Management of A Small Bowel Obstruction
__________ _____ _________
-To correct ________ and ______________ imbalances
Assess ____________ ____________
Return of normal___________ __________, passing of ________, ___________
Measure ________________ ____________ Monitor
________, ____/_____, ________ studies ________
___________
-For decompression
Prepare for ________________ if symptoms worsen or do not
improve
Complete _______________, __________________ and ____________ occurs
NPO IV fluids
fluid...electrolyte
bowel sounds
bowel sounds...flatus..stool
abdominal girth VS, I/O, lab studies NG
suction surgery
obstruction...strangulation...necrosis
Large Bowel Obstruction s/s
_______________
is the only symptom for months with obstructions in the sigmoid
colon or rectum.
Altered __________ of stool __________ ___________
_____________ ________________ _____________ (lack
of wanting to eat)
Constipation shape Iron Deficiency
Anemia Weakness Anorexia
Late symptoms
_____________ ______________�may see loops of bowel
outlined through the abdominal wall
___________, _____________ abdominal pain
__________ _____________ (very, very late sign)
Abdominal distention
Crampy..lower
Fecal vomiting
Management of a large bowel obstruction
-Monitor for ________________ symptoms, prepare pt for ____________
_____________ ____________�temporary or permanent colostomy to
remove the obstructing lesion
If you don�t listen to the __________ ____________ long enough
you can miss early signs of things
worsening...surgery
Surgical resection
bowel sounds
mechanical blockage or paralytic ileus
bowel obstruction
the _______________ the obstruction the quicker the symptoms
higher
bowel obstruction s/s:
________________ _______________
________________ __________________ with failure to pass
____________________ ____________ _______________ increased
to _______________
they are __________ _________________ at first...then go ______________
abdominal distention
vomiting
constipation...flatus
bowel sounds...silent
high pitched...silent
sac-like herniations of the lining of the bowel that extend through a
defect in the muscle layer.
may occur anywhere in the intestine, but are most common in the
sigmoid colon.
Diverticulum
Diverticular disease increases with _______
is associated with a______-_______ diet.
Diagnosis is usually by _____________
age
low-fiber
colonoscopy
Multiple diverticula without inflammation
Diverticulosis
Diverticulosis
Usually ___________________
Associated with decreased __________ in diet
Often preceded by chronic _________________
asymptomatic
fiber
constipation
Infection and inflammation of diverticulum
Diverticulitis
Diverticulitis
____________ or _____________
-if becomes __________ it is serious
Acute..chronic
acute
Diverticulitis complications include:
_______________ ____________ formation
________________ _______________ Development of
a ___________
Peritonitis Abscess Bleeding
Septicemia fistula
Diverticulitis Symptoms include:
Mild to mod _______ abd pain ____/_____
_____________ and ___________ __________________
(increased ________)
LLQ
N/V
Fever and chills
Leukocytosis (WBC)
Interventions Diverticulitis
Maintain normal _______________ pattern Adequate
____________ intake, __________, high ____________ foods
watch for: _______________, _________________,
___________________ is a surgical emergency
elimination
fluid...soft..fiber
Bleeding..peritonitis..Perforation
Internal and external, most common cause of bright
red bleeding with defecation
Hemorrhoids
Tear or ulcer in the lining of the anal canal. Extremely painful,
bleeding of bright red blood
Anal fissure
Painful, contains foul-smelling pus
Anorectal abscess
May develop from trauma, fissures or Crohn�s disease
Anal fistula
Located in intergluteal cleft, may be caused by trauma or congenital
Pilonidal sinus or cyst
most common cause of bright red bleeding with defecation
hemorrhoids
anal fissures can be caused by over use of _____________ and
__________ to _____________
laxatives..straining to defecate
an occupation that has to do with _____________ for prolonged period
of time or ___________ ___________ are bad for hemorrhoids
sitting..heavy lifting