NUR2392 MDC 2 EXAM 3 FOCUSED REVIEW MODULES 8, 9 and 10

*Please note this is just to be used as a guide. You are responsible for all material covered in class* *Review all concepts related to the topics* Disease/syndromes/problems (For each one, know the following: definiti ...

*Please note this is just to be used as a guide. You are responsible for all material covered in class* *Review all concepts related to the topics* Disease/syndromes/problems (For each one, know the following: definition/causes/risks/signs and symptoms/labs/treatment/possible complications/multidimensional care) Chapter 56 Non-inflammatory intestinal disorders Labs, Obstructions-mechanical; non-mechanical, IBS, Colon cancer, colostomy, colostomy care, abdominal hernias, hemorrhoids, Malabsorption syndrome Laboratory Studies:  Complete blood count – to determine the presence of infection or bleeding  C-reactive protein (CRP) – to determine the presence of inflammation  Erythrocyte sedimentation rate (ESR) – to determine the presence of inflammation  Liver function test – to determine the elevation of enzymes as result of hepatic inflammation  Stool culture – to determine the presence of blood and parasites  Serum Chemistry tests – to determine electrolyte imbalances  Serum Bilirubin – to determine the ability to metabolize bilirubin  Coagulation studies – to determine clotting ability  Serological test – to determine the specific virus causing the hepatitis  Carcinoembryonic antigen (CEA) – to determine the presence of colorectal cancer Diagnostic Studies:  Computed tomography – to determine distention, abscess or perforation  Magnetic resonance enterorrhaphy – to determine changes in the bowel lumen, wall, and mesentery; also assesses bowel motility  Ultrasound – to determine abnormalities in organs and blood flow  Colonoscopy – to determine abnormalities in the colon  Sigmoidoscopy – to determine abnormalities of the sigmoid colon  Biopsy – removal of tissues in order to determine the presence of malignancy  Barium enema – may reveal irregularities or narrowing of the colon or wall thickening  Abdominal x-ray – may reveal enlarged organs, free air or fluid in the abdominal cavity -Red blood cell life: 90-120 days -WBC life: 13-17 days NUR2392 MDC 2 Exam 3 Focused Review Modules 8, 9, & 10 Obstructions -Intestinal contents continue to accumulate above the obstruction which results in the distention of the abdomen. Results in decreased absorption of fluid and electrolytes. Mechanical Obstruction: The bowel is physically blocked by problems outside of the intestine (adhesions), in the bowel wall (Crohn’s disease), or in the intestinal lumen (tumors).  Complications of appendicitis  Hernias  Fecal impactions  Intussusception: telescoping of a segment of the intestine within itself  Volvulus (twisting of intestine) Nonmechanical: (paralytic ileus or a dynamic ileus) peristalsis is decreased or absent as a result of neuromuscular disturbance, resulting in a slowing of the movement or a backup of intestinal contents.  Complication of surgery: day 3/4, no bowel sounds  Hypokalemia Signs and Symptoms  Obstipation: severe constipation  Abdominal distention  Peristaltic waves  Borborygmic: gurgling or rumbling noise  High-pitched bowel sounds/none at all  Tachycardia  Hypokalemia Complications  Metabolic alkalosis/acidosis  Hypovolemia  Peritonitis (more so from strangulated obstruction)  Septic Shock  Increased intrabdominal pressure or ACS Interventions Non-surgical management o NG tube: at least every 4 hours, assess the patient with an NGT for proper placement, tube patency, and output (quality and quantity). Also assess for peristalsis.