Critical Care Exam III Gastrointestinal Questions and Answers
4 views 0 purchase
Course
Gastroenterology
Institution
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
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller lectknancy. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $18.49. You're not tied to anything after your purchase.
