Exam 2: Adults II

risk factors for irritable bowel syndrome

being female

having a family history of IBS

prior severe GI infections

mental health conditions like anxiety and depression

history of childhood abuse

Smoking

excessive alcohol consumption

types of irritable bowel syndrome

IBS-D: diarrhea

IBS-C: constipation

IBS-M: both

IBS-unclassified: meets criteria but cannot categorized

patho of irritable bowel syndrome

poorly coordinated signals between the brain and intestines lead to exaggerated responses to normal digestive processes, areas of bowel spasm and dilation

Manifestations of irritable bowel syndrome

Nausea with BMs

Flatus

Diarrhea

Constipation

Mucous in stools

Urge to defecate

Anorexia: due to discomfort

diagnostic tests for irritable bowel syndrome

colonoscopy, occult stool tests

Hydrogen breath test: pt drinks substance with glucose and then breathe into bag during certain intervals during digestive process, if increased levels of hydrogen in breath, then there can be struggles with digestion

criteria for irritable bowel syndrome

more frequent stools with onset of pain

visible abdominal distention

relief with defecation

feeling of incomplete evacuation

loose stools

expelling mucus

management of irritable bowel syndrome

Focus is to:

- control spasms

- minimize diarrhea

- release neurotransmitters to promote peristalsis

- address any depression

meds for IBS-C

Metamucil: adds bulk to stool with water, bulk-forming laxative

Linaclotide

Lubiprostone: increase fluid in small intestine

meds for IBS-D

Loperamide: slow bowel transit through digestive track

Psyllium

Antispasmodic agents - dicyclomine

Relax smooth muscle spasms and inhibit gas secretion, as needed basis

meds for IBS in general

Antispasmodic agents

Antidepressants: fluoxetine, sertraline, amitriptyline

complications associated with irritable bowel syndrom

Social isolation

Spasm, constipation, diarrhea

Fluid volume deficit

hypokalemia

role of the nurse when caring for IBS

Identify stressors or food triggers for patient

Prevent dehydration

Increase fluid intake

Chew slowly

Increase fiber

****Assess: electrolyte levels, weight, pain (LLQ)

Patho of Ulcerative Colitis

inflammation of the rectum and large intestine, effects mucosa and submucosa, increases risk for colon cancer, mucosa because edematous, reddened, and bloody

manifestations of ulcerative colitis

Blood in stool (in more severe cases)

10-20 BM a day: watery, mucus, bloody

Cramps in LLQ

Gradual onset

Symptoms of anemia

Weight loss

Rectal spasms

patho of Crohn's

patchy inflammation and ulceration of small and large intestine, - affects entire GI tract from mouth to anus

- slow progression

inflammation leads to thickened bowel walls, causes deep ulcerations which develop into bowel fistulas, can cause intestinal obstruction

manifestations of Crohn's

Diarrhea: 5-6 stools a day

Steatorrhea (fatty stool) due to malabsorption of bile

Malabsorption due to thickened bowel walls

Anemia due to iron deficiency

Increased risk of cancer

Abdominal pain: crampy, caused by strictures

Cobblestone appearance

labs for ulcerative colitis

low H&H (from bleeding)

elevated ESR, WBC, CRP

low albumin (malabsorption)

low electrolytes

labs for Crohn's

High WBC

low iron, B12, H&H, due to anemias

med management for Ulcerative colitis

Aminosalicylates (sulfasalazine): decreases inflammation and prevents IBD flare-ups

med management for Crohn's

Antimicrobials: metronidazole, ciprofloxacin

- Controls symptoms and treats secondary infections

complications of ulcerative colitis

Toxic megacolon

- extreme inflammation and distention of colon, requires emergent colectomy

symptoms include pain, distention of the abdomen, fever, rapid HR

complications of Crohn's

Intestinal obstruction, perianal abscesses, fistulas that can cause sepsis, malnutrition

role of the nurse when caring for UC and Crohn's

Encourage smaller frequent meals

Encourage periods of rest (decreases gastric motility)

Administer iron replacement, antibiotics

Provide meticulous skin care (excessive diarrhea can cause excoriation)

Encourage fluid intake, get colonoscopies regularly

Reduce fiber and fat during exacerbations

Avoid milk

general meds for inflammatory bowel disease (UC and crohn's)

Glucocorticoids - reduce inflammation and pain, monitor glucose (prednisone)

Antidiarrheals - suppress number of stools (loperamide), can cause bowel dilation

Immunodilators - modifies immune system to decrease inflammation (infliximab), avoid crowds and report bleeding

Biologics - alters immune response, infliximab, can cause pancreatitis, infection, blood dyscrasias (abnormal components of blood)

short bowel syndrome

more than 100cm of bowel removed leads to poor absorption of nutrients, if over 75% small intestine removed may need long term TPN

nursing assessment of IBD

- Signs of shock, low BP high HR

- Urine output should be at least 30ml/hr

- Daily weight

- Check electrolytes: potassium and magnesium

- Assess for dysrhythmias

nursing role regarding assessments and interventions throughout the TPN administration process

- assess hydration status

- assess weight and I/O

- Change everything every 24 hours

- 1.2 filter for lipids, 0.22 for no lipids

- Bag must be refrigerated within 2 hours

- Osmolarity above 900 should be in central line

- Glucose check every 6 hours

Identify reportable conditions and associated assessment findings with TPN

Temperature elevated > 100°F

Abnormal lab values

Metabolic complications

Drainage from peripheral or central line IV site

risk factors for colon cancer

Family history

Polyps

BMI over 30

IBD over 10 years

High fat and red meat diets

Cigarette and alcohol use

Type 2 DM

male

patho of colon cancer

mostly adenocarcinomas

- originate in glandular cells of organs

- spread through blood/lymph or seeding during surgical resection

common areas of metastasis is the liver, lungs, brain, bones, adrenal glands

manifestations of colon cancer

Insidious at the start (hard to see)

Transverse colon: gas pain and cramping, change in bowel habits, anemia

Ascending colon: vague abdominal pain/cramping, anemia

Descending colon: bright red blood in stool, clinical manifestations of bowel obstruction

Rectum: blood in stool, rectal discomfort, feeling of incomplete evacuation

where is cancer if there is bright red blood in the stool?

descending colon and then rectum

right sided tumors (ascending side)

grow very large without disrupting bowel patterns/appearance

*****loose stool because water isn't absorbed

left sided tumors (descending side)

associated with hematochezia (passage of red blood)

***more formed stool

stage 1 of tumor in colon cancer

tumor invades up to muscle layer

stage 2 of tumor in colon cancer

tumor invades up to other organs or perforates peritoneum

stage 3 of tumor in colon cancer

any level of tumor invasion, up to 4 regional lymph nodes

stage 4 of tumor in colon cancer

any level of tumor invasion, many lymph nodes affected with distant metastasis

complications with colon cancer

Fatigue

Infection

Anemia

Bowel obstruction/perforation

Fistula

role of the nurse when caring for patient with a colon cancer

Promote routine screening of colon and monitor for changes in bowel habits

Decrease fat and refined carbs in diet, eat high fiber foods

Increase veggie consumption

Educate on smoking and alcohol

Increase physical activity

risk factors of viral hepatitis

viral, chemicals, drugs, herbs, alcohol abuse, autoimmune disease

patho of viral hepatitis

widespread inflammation of liver cells and impaired ability to function, caused by a virus transmitted through bodily fluids or fecal oral route

manifestations of viral hepatitis

jaundice (due to inability excrete bilirubin)

clay colored stools

Amber colored urine

Elevated liver enzymes

Pruritus (due to accumulation of bile salts

Abdominal pain

Malaise

fulminant viral hepatitis

Severe, rapidly progressive

- Neurological decline due to hepatic encephalopathy, caused by accumulation of waste products in blood, blood is not detoxified and travels to the brain

- Can result in neuro decline, GI bleeding, coagulation disorders

labs for viral hepatitis

Elevated ALT/AST: confirms A,B,C

Low albumin due to malnutrition

signs of organ rejection

RUQ pain, fever, tachycardia, jaundice

nursing care of viral hepatitis

Provide small, frequent meals

Administer antiemetics

Encourage rest periods

Limit fat intake, avoid caffeine and alcohol

Use safe public water

complications associated with viral hepatitis

Cirrhosis

Liver cancer

Liver failure

celiac disease

genetic autoimmune disorder, gluten intake causes immune reaction attacking small intestine, leads to damage to villi causing lesions and cysts and mucosal inflammation

symptoms of celiac disease

diarrhea, steatorrhea, flatulence, weight loss, signs of malabsorption

risk factors of chronic pancreatitis

Heavy, prolonged alcohol used

**Men more than women

pancreatic cancer risk factors

Increased risk with age and smoking

Diets high in fat

Diabetes

Chronic pancreatitis

patho of Chronic pancreatitis

digestive enzymes autodigest pancreas and surrounding tissues for prolonged period of time which leads to inflammation

- pancreas is unable to produce enzymes for digestion and hormones for glucose regulation

manifestations of chronic pancreatitis

left upper abdominal pain that spreads to back

pain worse after eating/drinking

n/v

fruity breath

weight loss

clay stools

steatorrhea

weight loss due to decreased absorption of nutrients

patho of Pancreatic cancer

rapid growth of tumor causes deterioration of exocrine and endocrine function, may metastasise to the stomach, duodenum, gallbladder, intestine, and liver, tumor originates in lung, breast, thyroid

manifestations of pancreatic cancer

fatigue

weight loss

jaundice

epigastric and back pain

**symptoms do not emerge until disease has progressed significantly

labs for chronic pancreatitis

LOW: calcium and magnesium (due to fat necrosis, removes electrolytes from circulation into necrotic tissue)

HIGH: amylase and lipase, WBC, bilirubin, liver enzymes, glucose (decreased insulin production), ESR

management of chronic pancreatitis

IV fluids to restore hydration

May need nutrition

Insulin

Pancreatic enzyme replacement therapy (PERT): treat malnutrition with chronic pancreatitis

PPI or histamine blocker due to increased gastric acid production

Avoid alcohol

Limit fat in diet

management of pancreatic cancer

chemo/radiation

Surgical resection

Never touch NG tube

NPO until return of GI function

Antiemetics

complications associated with chronic pancreatitis

Pancreatic pseudocysts

Pancreatic cancer

Obstruction

Malnutrition

patho of HIV

retrovirus affecting immune system

- targets and destroys CD4 white blood cells

- immune system now does not work

- leads to opportunistic infections (TB, fungal, bacterial, cancer)

Certain populations at higher risk of HIV

sharing drug needles, female sex workers, homosexual males, use of drugs and alcohol, incarcerated people

Modes of transmission of HIV

sharing needles with other drug users, blood, semen, rectal and vaginal fluids, breastmilk (spread through infected bodily fluid contact), must get into blood or mucous membrane

# of HIV copies in a mL of blood

viral load

when is AIDS diagnosed?

When the patient's T-Cell count falls below 200

symptoms with HIV

Headache

Rash

Sore throat

Fever

Swollen lymph nodes

Weight loss

Diarrhea

Cough

Neuro problems (in 80% of patients)

how often is the CD4 count checked?

every 3-6 months for 2 years of treatment

how often is the viral load checked?

every three months for first 2 years of treatment, primary indicator of treatment of success of failure

if you get poked with an unknown needle, what should you do?

bleeding should be induced and area needs washed with soap and water

Truvada (for HIV)

pre exposure prophylaxis, daily use to reduce risk of acquiring HIV

Antiretroviral therapy for HIV

takes a pill combined of three meds

**must check renal and hepatic function prior

- doesn’t allow HIV to replication

- can cause fatigue and immunosuppression

- needs to be taken regularly

- can lead to drug resistance if not taken regularly

- Lifetime commitment

Pneumovax

vaccine to get every 5 years when your CD4 count is below 200

complications of HIV/AIDS

Pneumocystic pneumonia

Respiratory infections

Dermatologic manifestations: herpes

Fever

Fatigue

Severe bacterial infections

AIDS: overwhelming inflammatory response

IRIS

Wasting syndrome (cachexia)

management of HIV/AIDS

Encourage small frequent meals/snacks

Increase caloric intake via supplements

Mouth care if they have thrush

Use condoms every time

Avoid raw eggs and undercooked meat to reduce risk of illness

Avoid drugs and alcohol

Clean blood spills with bleach

p wave

atrial depolarization

T wave

ventricular repolarization

PR interval

delay of AV node to allow filling of ventricles

QRS interval

ventricular depolarization

patho of polycystic kidney disease

cysts develop gradually and progressively expand

- destroying underlying renal tissue and reduces blood flow and nutrient supply

- causes hypertension

- happens to both kidneys

manifestations of polycystic kidney disease

- no symptoms early

hypertension

hematuria

back and flank pain

kidney stones

urinary frequency

UTIs

increased abdominal girth and flank tenderness

diagnostics for polycystic kidney disease

IV pyelogram: contrast dye to see in x-rays

Abdominal ultrasounds

management of polycystic kidney disease

- Treatment of hypertension

- If severe, may need dialysis

- Needle aspiration to drain cysts

- Monitor BP, HR, RR, temp due to pain and infection, O2 (ALL HIGH)

- Administer antibiotics

- Follow renal diet (low sodium and potassium)

complications of polycystic kidney disease

Severe HTN

Renal calculi

Recurrent UTIs

Hematuria

Heart valve abnormalities

Aortic or cerebral aneurysms

**Renal failure

education for pts about renal cancer

Biological immunotherapy is common, shrinks cancer cells

Stage 4: most severe stage

Complications: end stage renal failure, prognosis are poor

patho of renal cancer

compresses underlying tissues which leads to decreased circulation to renal structures

symptoms of renal cancer

flank pain/mass, blood in urine, weight loss, fatigue, HTN, anemia, fever

risk factors of chronic kidney disease

Diabetes

HTN

Cardiac problems

Obesity

Tobacco use

60+ years old

Drug use

patho of chronic kidney disease

slow increases in BUN and creatinine

- caused by long term diseases

- can result from poorly managed AKI

- can be asymptomatic until very little function remains

stage 5 of chronic kidney disease

ESRD, dialysis or transplant is needed to survive, minimal to no function of kidneys

manifestations of chronic kidney disease

HTN

hyperkalemia

HF

edema

arrhythmias

uremia

anemia

acidosis

hypocalcemia

labs for chronic kidney disease

LOW: calcium, Hgb and Hct

HIGH: potassium, phosphate, BUN, creatinine

how to diagnose chronic kidney disease

Diagnosed based on consistently elevated serum creatinine levels and decreased creatinine clearance

nutrition for chronic kidney disease

Avoid preserved foods with salt

Small portions of protein

Limit fats

Limit phosphorous like deli meat, nuts, oatmeal

Limit potassium like beans, nuts, dairy, tomatoes, bananas

EAT: poultry with no skin, fruits, low fat dairy products, fish, veggies

Increase carb intake

what not to give before dialysis

BP meds, after dialysis patient is already hypotensive so we don't want to make them even more hypotensive

contraindications of getting a kidney transplant

untreated cancer, heart disease, coronary artery disease, drug abuse, severe psychiatric disease

renal replacement therapy

Artificial processes for removing waste and water from the body when the kidneys are no longer functioning adequately

indications for renal replacement therapy

elevated creatinine, K+, acidosis, uremic manifestations (nausea/vomiting, pruritus), GFR less than 10ml/min

peritoneal dialysis

1. infuses a dialysis solution (dialysate) into the peritoneal cavity (natural filter) through a surgically implanted catheter

2. After a set "dwell time," the used fluid is drained, and fresh fluid is introduced in a process called an "exchange"

indications for peritoneal dialysis

ESRD

people with poor vascular access

hemodialysis isn't tolerated (BP, rapid fluid shift)

children

people who are compliant with dialysis therapy

diabetic and older patients