Adult Nursing GI Disorders: IBD, Acute Abdomen, Colorectal Cancer & Ostomy Care

What is the primary focus of a GI history?

To assess symptoms like pain, bowel patterns, and family history related to gastrointestinal disorders.

What does pain moving from the umbilicus to the RLQ indicate?

Appendicitis until proven otherwise.

What are the signs of lower GI bleeding?

Bright red blood in stool.

What are the signs of upper GI bleeding?

Black, tarry stool.

What is the order of abdominal examination?

Inspect, auscultate, percuss, palpate.

What does a rigid abdomen or new rebound indicate?

A need to call the provider immediately.

What laboratory tests are important for assessing GI disorders?

CBC, BMP, albumin, ESR, CRP, stool culture.

What imaging tests are commonly used for GI assessment?

Abdominal x-ray, CT with contrast, ultrasound.

What is the primary characteristic of Crohn's disease?

Chronic, immune-mediated inflammation of the bowel that can occur anywhere from mouth to anus.

What differentiates ulcerative colitis from Crohn's disease?

Ulcerative colitis affects only the rectum and colon, is continuous, and involves only the inner lining.

What are common complications of inflammatory bowel disease (IBD)?

Hemorrhage, perforation, toxic megacolon, fistula, malnutrition.

What dietary recommendations are made during an IBD flare?

High-protein, high-calorie, low-residue diet with small frequent meals.

What is irritable bowel syndrome (IBS)?

Recurrent abdominal pain tied to bowel movements with normal bowel structure.

What are the red flags that indicate a condition other than IBS?

Blood, night symptoms, weight loss, fever, anemia, onset after age 50.

What is celiac disease?

An immune reaction to gluten that damages the small intestine lining.

What are common symptoms of celiac disease?

Fatty stools, bloating, weight loss, fatigue, itchy rash.

What is the confirmatory test for celiac disease?

Small bowel biopsy.

What dietary restrictions are necessary for someone with celiac disease?

Avoid wheat, barley, and rye; safe options include rice, corn, and potatoes.

What is the nursing priority during a flare of inflammatory bowel disease?

Monitor fluid and nutrition, and assess for complications.

What lifestyle changes can help manage inflammatory bowel disease?

Smoking cessation, stress management, and regular exercise.

What is the significance of a patient's family history in GI disorders?

It can indicate genetic predisposition to conditions like IBD and colorectal cancer.

What is the role of a dietitian in managing celiac disease?

To provide guidance on a lifelong gluten-free diet and monitor nutritional status.

What is the importance of teaching patients about ostomy care?

To ensure proper self-care and management of the stoma and peristomal skin.

What are the common triggers for irritable bowel syndrome?

Stress, anxiety, certain foods, and prior GI infections.

What is the expected lab finding during an IBD flare?

Low hemoglobin and hematocrit, high ESR and CRP.

What is the nursing intervention for a patient with suspected bowel obstruction?

Report absent bowel sounds and signs of distention immediately.

What is the significance of teaching patients about medication adherence in IBD?

To prevent flares and maintain remission.

What is the classic symptom of appendicitis?

Umbilical pain that settles in the right lower quadrant (RLQ).

What signs indicate appendicitis?

McBurney's point tenderness, rebound tenderness, and Rovsing's sign.

What laboratory findings are associated with appendicitis?

Elevated white blood cell count (WBC) and confirmation via CT or ultrasound.

What is the risk associated with untreated appendicitis?

Rupture risk within 24 to 48 hours.

What are the post-operative care instructions after an appendectomy?

Ambulate, use an incentive spirometer, manage pain, and advance diet as bowel function returns.

What is peritonitis?

An inflammation of the peritoneum, often caused by a ruptured appendix or diverticulum.

What are the signs and symptoms of peritonitis?

Severe diffuse pain, rigid abdomen, rebound tenderness, distention, and absent bowel sounds.

What is the management for peritonitis?

NPO, NG tube, IV fluids, antibiotics, and prepare for surgery.

What is the difference between diverticulosis and diverticulitis?

Diverticulosis is the presence of pouches in the colon wall, while diverticulitis is inflammation or infection of those pouches.

What are the symptoms of diverticulitis?

Left lower quadrant (LLQ) pain, fever, high WBC count, and nausea.

What dietary management is recommended during a diverticulitis attack?

Clear liquids, then low fiber; avoid laxatives, enemas, and heat.

What are potential complications of diverticulitis?

Abscess, perforation, fistula, obstruction, and bleeding.

What is bowel obstruction?

A condition where the bowel is blocked, preventing the passage of contents.

What nursing care is required for bowel obstruction?

NPO, NG tube, IV fluids, strict intake and output monitoring, and pain management.

What is colorectal cancer and its common risk factors?

Most colorectal cancers begin as polyps; risk factors include age over 50, family history, and lifestyle factors like smoking and obesity.

What symptoms depend on the location of colorectal tumors?

Right-sided tumors may cause anemia and fatigue; left-sided tumors may cause changes in bowel habits and bright red blood.

What is the recommended age to begin colorectal cancer screening?

Average risk screening begins at age 45.

What are the types of stool-based tests for colorectal cancer screening?

FIT, high-sensitivity FOBT, and stool DNA-FIT.

What is the gold standard for colorectal cancer diagnosis?

Colonoscopy with biopsy.

What are the treatment options for colorectal cancer?

Polyp removal, bowel resection, chemotherapy, and radiation for rectal cancer.

What does a healthy stoma look like?

Pink to red, moist, shiny, slightly raised with mild swelling and a little bleeding early on.

What are key nursing responsibilities in ostomy care?

Monitor stoma appearance, educate on pouching techniques, and ensure skin protection.

What is the significance of monitoring fluid and electrolytes in GI disorders?

Diarrhea, vomiting, and NG suction can lead to significant fluid and potassium loss.

What should be reported in a patient with abdominal pain and signs of peritonitis?

Fever, rigid abdomen, rebound tenderness, and absent bowel sounds.

What is the nursing assessment for a patient with suspected diverticulitis?

Assess for LLQ pain, fever, and signs of infection; monitor vital signs and lab results.

What dietary changes are recommended after recovery from diverticulitis?

High-fiber diet and adequate hydration.

What initial tests are ordered for Grant upon admission to the medical-surgical unit?

CBC, BMP, ESR, CRP, stool culture.

What does a CBC test look for and why is it important for Grant?

It checks for anemia and infection, which are critical in assessing Grant's overall health.

What does a BMP test measure and why does it matter?

It measures electrolytes and kidney function, important for managing fluid balance in Grant.

Define tenesmus.

Tenesmus is the feeling of incomplete bowel evacuation, often associated with inflammatory bowel disease.

Name one stool test that would help in diagnosing Grant's condition.

Fecal occult blood test (FOBT) or stool culture.

What are the key features to differentiate between Crohn's disease and Ulcerative Colitis?

Crohn's can affect any part of the GI tract and has skip lesions, while Ulcerative Colitis is limited to the colon and has continuous lesions.

Which diagnosis fits Grant better, Crohn's or Ulcerative Colitis, and what three findings support this?

Ulcerative Colitis; findings include rectal bleeding, urgency, and continuous lesions on colonoscopy.

What single test can definitively settle the diagnosis between Crohn's and Ulcerative Colitis?

Colonoscopy with biopsy.

What are the nursing priorities for Grant?

Risk for infection, deficient fluid volume, imbalanced nutrition, and ineffective coping.

What should be included in the plan of care to maintain skin integrity for Grant?

Wipe the perianal area with warm water or a gentle wet wipe and apply barrier cream.

What is the purpose of polyethylene glycol (PEG) bowel prep before a colonoscopy?

To empty the bowels for a clear view of the colon during the procedure.

What dietary modifications should be taught to Grant during a flare?

Avoid high-fiber foods and dairy; focus on low-residue foods.

What medications are typically prescribed for Ulcerative Colitis?

Mesalamine, corticosteroids, and possibly biologics.

What are the expected outcomes after treatment for Grant?

Reduced stool frequency, no visible blood, and improved nutritional status.

What should Denise's nursing assessment focus on after her colonoscopy?

Monitoring for signs of bleeding, infection, and managing her diabetes medications.

What are the risk factors for colorectal cancer identified in Denise's case?

Age, smoking history, and a diet high in red meat.

What is the significance of a positive FIT test compared to a guaiac FOBT?

FIT is more sensitive for detecting colorectal cancer and does not require dietary restrictions.

What should be included in Denise's discharge teaching?

Medication management, dietary changes, and signs to call the provider.

What is the expected consistency of stool from a sigmoid colostomy?

Formed stool, which is important for pouch selection and teaching.

What is a common complication of a stoma?

Peristomal irritation or fungal infection.

What are the nursing priorities for Denise before her surgery?

Ensure informed consent, manage blood glucose levels, and prepare for post-operative care.

What dietary changes occur once Grant is in remission?

He can gradually reintroduce high-fiber foods and a more varied diet.

Why is individualized dietary advice important for patients with GI conditions?

Each patient's tolerance to foods can vary significantly based on their specific condition and treatment.

What role does the Wound, Ostomy, and Continence (WOC) nurse play in Denise's care?

They assist in marking the stoma site and providing education on stoma care.

What should Denise's sister know about colon cancer screening recommendations?

Starting at age 45, a stool test yearly and a colonoscopy every 10 years.

What is the importance of follow-up care after treatment for colorectal cancer?

To monitor for recurrence and manage any long-term effects of treatment.