Critical Care Exam III Gastrointestinal Questions and Answers
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Gastroenterology
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Gastroenterology
Assessment with GI - Answer-look, listen, feel
Diverticula - Answer-out pouches seen within the colon
Diverticulosis - Answer-many out pouches seen throughout the colon
Diverticulitis - Answer-inflammation of the out pouches in the colon
Pathophysiology of Diverticulosis - Answer--Most ...
Critical Care Exam III Gastrointestinal
Questions and Answers
Assessment with GI - Answer-look, listen, feel
Diverticula - Answer-out pouches seen within the colon
Diverticulosis - Answer-many out pouches seen throughout the colon
Diverticulitis - Answer-inflammation of the out pouches in the colon
Pathophysiology of Diverticulosis - Answer--Most common in sigmoid colon
-Occur at points of weakness
-Part of the aging process
-Food and bacteria become trapped
-Diverticulum may perforate and local abscess forms
-Potential for peritonitis, bleeding, and narrowing of the bowel lumen (leading to
obstruction)
-Inflammation may also lead to fistulas to bladder and vagina
Health Promotion/Disease Prevention with Diverticulosis - Answer--Encourage high
fiber diet (whole-grain breads and cereals) 25-35g/day.
-Fruits & vegetables
-Drink plenty of fluids
-Avoid alcohol
-Foods containing seeds (small seeds)
-Dietary fats-30%
-Avoid all fiber when symptoms of diverticulitis (only in ACUTE diverticulosis)
Risk Factors for Developing Diverticulosis - Answer--> 60 years of age
-Male
-Diets low in fiber
Clinical Manifestations of Diverticulosis - Answer--On exam, observe for abdominal
distention
-Patient may report tenderness to involved area
-Elevated temp(low grade-101*F)
-Chills may be present
-Localized muscle spasm
-Rebound tenderness (can be from peritonitis)
Manifestations with Generalized peritonitis - Answer--profound guarding occurs
-rebound tenderness is widespread
-sepsis
,-hypotension
-hypovolemic shock
Lab/Diagnostic Tests with Diverticulosis - Answer--Diverticula usually is detected with
ENDOSCOPY
-Diverticulitis
-Elevated WBC's
-Decreased h/h, if bleeding
-Stool for OB may be positive
-X-ray with barium (risky, can clog up diverticula)
-may show diverticula
-CT or ultrasound-
-detects abscess
-thickening of GI tract due to diverticulitis (due to swelling)
Collaborative Interventions with Diverticulosis - Answer--Goal: decrease inflammation
and improve tissue perfusion
-Broad-spectrum
-antibiotics (flagyl, bactrim, cipro)
-Analgesic for pain
-(Demerol or Morphine)
-IV fluids
-Antichlolinergic
-reduce hypermotility
-Avoid increase intra-abdominal pressure
-(bending, lifting, straining, coughing)
-Begin clear liquids, then progress diet slowly
-Patients with severe symptoms keep NPO
-With nausea & vomiting- insert NGT
-After recovery:
-teach about high-fiber diet to prevent recurrence
-avoid fiber when symptoms are present
Surgical Management with Diverticulosis - Answer--Emergency Surgery:
-peritonitis, bowel obstruction, and pelvic abscess.
-Colon resection w-w/o colostomy
-Open or Minimal Invasive Surgery (MIS)
-MIS has fewer complications
-Colostomy teaching
-ostomy nurse
If a pelvic abscess is present - Answer-won't do colonoscopy
Surgical Management Stoma - Answer--Stoma is pinkish to cherry red without
retraction.
-Open abdominal surgery may have NGT and drain in place.
, -laparoscopy usually does not have NGT.
-Drainage usually after about 2-4 days.
-Encourage patient to look at stoma.
-Collaborate with ostomy nurse to teach patient how to self manage.
-Skin barriers, such as a wafers are cut to fit around fistula, a drainage pouch, and
clamp.
-Effluent drainage should not touch the skin.
Nursing Diagnosis with Diverticulosis - Answer--Altered Nutrition r/t NPO status
-Alterations in bowel patterns r/t constipation
-Fluid volume deficit related to actual blood loss or fluid loss
-Potential or actual infection
Evaluation/Outcomes with Diverticulosis - Answer--The patient will have adequate
nutrition within 3 days AEB: minimal weight loss, maintaining albumin levels
-The patient will have normal bowel function within 3 days AEB: soft formed BM
-The patient will have normal fluid and electrolyte balance with 3 days AEB: normal h/h,
electrolytes, fluid balance
Acute GI Hemorrhage Statistics - Answer--Potential life threatening emergency
-Results in 400,000 hospital admission/yearly
-Costing $2 billion/annually
-Mortality rate-13% in hospital
-Rebleeding is common (15%)
GI Hemorrhage - Answer--Characterize by:
-acute massive bleeding
-Regardless of cause results in:
-Hypovolemic shock
-Multiple Organ Dysfunction Syndrome (MODS)
-Most common cause of death
-Exacerbation of underlying cause, hypovolemic shock
Assessment findings with GI hemorrhage - Answer--Clinical presentation (depends on
amount of blood lost)
-Hallmarks of GI hemorrhage
-Hematemesis
-Hematochezia and melena
-Lab Studies
-Hemoglobin
-Hematocrit
-Poor indicators of severity of blood loss
-If patients hematocrit is 45% before an bleeding episode, it will be 45% hours later. It
may take as long as 72 hours for the redistribution of plasma from the extravascular
space to the intravascular space.
-Diagnostics
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