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60 Cards in this Set
- Front
- Back
Three classifications of Diarrhea
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Decreased Fluid Absorption
Increased Fluid Secretion Motility Disturbances |
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A patient is having an issue with decreased fluid absorption and is experience diarreah, why?
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The pt. large intestine is not reabsorbing fluids. The lg. intestine's job is to reabsorb fluids.
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A patient has experience food poision from eating at a local restrurant and is experience diarrhea, why?
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The patient is having a motility disturbance-increase in peristalsis to push out the bad.
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A patient comes into the doctors office with compliants of increased stress and anxiety and recent diarrhea why is this pt. experience diarrhea?
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The pt. is having an increase in peristalsis. Motility disturbance.
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An acute bout of diarreah is either
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bacterial and viral and is self-limiting
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A pt. is having a bout of chronic diarrhea (lasts 2 or more weeks and reoccurs) what type of complications can this pt. have
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dehydration and electrolyte imbalances.
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A pt. reports to the doctors office and reports recent diarreah what may the nurse want to know about this patient? (Assessment)
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History of travel, diet, medication use, previous surgery (dumping syndrome), family history and personal contacts.
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What diagnostic tests are done for diarrhea?
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CBC, LFT's, iron/folate levels, O&P, Endoscopy, GI series with barium swallows.
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Why would the doctor want to do LFT's on a pt. with complaints of diarrhea?
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The liver produces bile that emuisifies fat and if there is a metabolism issue then fats will be in stool and will give the pt. diarrhea.
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True or False Laxative abuse can cause diarrhea?
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True
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Causes of Decreased fluid absorption diarreah?
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Laxative abuse, mucosal damage: Crohn's disease, radiation, Ulcerative colitis (UC), ischemic bowel disease (IBD)
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Causes of Increased fluid secretion diarreha?
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infectious bacterial endotoxins, antibiotics, foods containing sorbitol, hormonal (adenoma of pancreas)
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Antibiotics can cause?
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C-diff-pt. will be put into isolation. C-diff is an intestinal bacteria that is kept in check by normal intestinal flora and when normal flora is destroyed the C-diff is now free to cause problems.
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Motility Disturbances of diarrhea
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IBS (Irritable bowel syndrome); gastroectomy (dumping syndrome).
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A 38 year old patient with a spinal cord injury can have fecal incontinence due to a
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neruo-muscular issue (sensory problem)
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If the muscles of the anus become flacid and cannot contract the patient may become
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fecal incontinent
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What sensory problems are common with fecal incontinence?
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MS, Parkensons, ALS, stroke, spinal cord injury, dementia
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When there is a fecal impaction what is commonly seen
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seepage (liquid stools) that are able to get around the impaction due to an increase in fluid secreations.
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Diagnostics of Fecal Incontinence are
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rectal exam, abdominal X-Ray's, sigmoidoscopy
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Managment of fecal incontinence
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antidiarrheal meds if non infections cause (Immodium), bowel and bladder training programs, suppositories to reestablish regularity, high fiber diet and increased fluid intake, and exercise (if non-neruo/muscular).
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When assessing a pt. for constipation what is important for the nurse to know?
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What is the normal bowel movement pattern for this patient? If the patient only goes on a regular basis every 3 days then they will most likley not be constiptated.
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Signs and symptoms of constipation are?
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adbominal pain, distention, bloating, headache, nausea, flatulence, palpable mass, decrease in frequency of bowel movements.
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True or False an anticholinergic will not cause a pt. to become constipated?
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False. Anticholinergics cause the bowel and bladder to slow. They can cause constipation.
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True or False Hypothyroidism is a cause of constipation
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True
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True or False Diabetes is not a cause of constipation
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False, it is a causative factor
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True or False a Megacolon is not a cause of constipation
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False, it is a cause
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T/F: Scleroderma (a Collagen Vascular issue) is a cause of constipation?
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True
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T/F IBS can cause constipation?
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True
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Why is the Valsalva maneuver and syncope an issue with constipation?
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This is due to straining. When you push you stimulate the vagus nerve (CN 10-goes all way down to anus) when stimulated it decreased heartrate, blood profusion to brain and one can then pass out (syncope-faint).
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Complications of Constipation are
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Valsalva maneuver and syncope, diverticulosis, obstipation (fecal impaction) secondary to constipation may cause bowel perforation.
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Aviod what type of enema for constipation?
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Soap sud enema should be avoided
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What type of enema can be used to alleviate constipation?
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oil retenion to soften feces
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True or False Laxatives can be used without caution for constipation?
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FALSE
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T/F the fluid intake of the pt. should be increased to 3000mL/day when constipated?
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TRUE
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Types of fiber
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Insoluble fiber-whole wheat, bran
Soluble fiber-oat bran, fruits, vegetables |
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Etiology of Appendicitis
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obstruction in the lumen caused by feces, foreign bodies (ex. poppy seeds), tumors.
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Where is the pain felt for appendicitis?
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RLQ pain to the umbilicius area
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Pt. reports to the ER nurse that his RLQ pain has suddenly subsided and the nurse notes that his abdomen is distended, hard and rigid-what does this tell the nurse?
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That the appendix has perforated (this is bad b/c the fecal matter is no longer in the bowel and this causes massive infection-peritonitis).
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What is McBirney's point?
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half way between the umbilicus/right illiac crest-this is where the appendicitis pain localizes.
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What is rebound tenderness
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press down on the part of the body where it hurts and pain stops, release and the pain is felt again.
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A pt. comes to the ER with RLQ pain, muscle guarding of the abdomen, rebound tenderness of RLQ and a positive Rovsing's sing what might this patient have?
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Appendicitis
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Why does the nurse perform a urine analysis for a pt. that is suspected of having appendicitis?
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The doctor wants to make sure there is no issue with the urters as there is one in the RLQ as well)
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Diagnostic for appendicitis
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history and physical, CBC (to check for elevated WBC) and urine analysis.
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Surgery for appendicitis is MOSTLY performed when (though sometimes if this does not happen surgery is performed)
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perforation occurred
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The pt. is NPO, ice bag to the RLQ, IV fluids are given and pt. is on antibiotics what might this pt. have?
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Appendicitis
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All GI problems (except one) are given pain meds only when?
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A diagnosis is made b/c pain meds can mask symptoms.
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An inflammatory process in the peritonium that results in extracellular fluid shifts are
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Peritonitis
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What can cause peritonitis?
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blood born infections, cirrhosis of the liver, pancreatitis, peritoneal dialysis, abdominal surgery, perforations/ruptures of the bowel, appendix.
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Does Renae Hate GI/GU True or False
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TRUE
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S/S of peritonitis are
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high fever (101.0 and above), tachycardia, tachypena, nausea, vomiting, abdominal pain, tenderness, distention, rigidity, alteration in bowel sounds.
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Diagnostic studies for peritonitis
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CBC, serum electrolytes, abdominal x-ray, CAT scan, ultrasound, abdominal paracentesis
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SHOCK is inadequate
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profusion of organs, lactic acid builds up in the blood, cells of body die. Several causes-cardiac, hypovolumic shock etc...)
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iron deficiency anemia is closely corr. with
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ascending colon cancer
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Bowel Disorder Diagnostics
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CBC, Serum electrolytes, occult blood in stool, pus, and mucous, stool culture to r/o infection, sigmoidoscope/colonscopy/biopsy, barium enema
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Ulcerative Colitis involves the
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mucosa and submucos of rectum, sigmoid colon and upper colon-ulcers in the bowel.
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T/F pseudopopls and shortening of the colon are a result of UC
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TRUE
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A pt comes in with the following s/s: fluid and electrolyte imbalances, protein loss and multiple abscess/ulcerations, fever, tachycardia, weight loss, and lower abdominal pain, bleeding and diarrhea-what could be the cause
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UC (Ulcerative Colitis)
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True/False: Sulfa drugs are not used to treat UC?
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False, they are used to treat UC (sulfasalazine-Azulfidine)
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What microbal is used often to tx. UC?
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Rowasa (mesalamine)
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Can a pt. with UC get Kayopectate?
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NO!! it is not absorbed well.
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