Adult Health 1 Exam 2 – Vocabulary Practice Flashcards

Ulcerative Colitis (UC)

• Definition and Pathophysiology

  • Ulcerative colitis is a chronic inflammatory bowel disease (IBD) characterized by the immune system mistakenly attacking the lining of the colon and rectum.

  • The inflammation starts in the rectum and spreads continuously through the colon.

  • Unlike other forms of IBD, UC affects only the inner lining of the bowel, resulting in extensive irritation and bleeding of the intestinal mucosa.

• Clinical Manifestations

  • The hallmark symptom of ulcerative colitis is bloody diarrhea.

  • Patients often experience frequent bowel movements containing both blood and mucus due to the inflammation of the intestinal lining.

  • Pain is typically localized to the left lower quadrant (LLQ) of the abdomen because the descending and sigmoid colon are the areas most frequently involved.

  • During severe exacerbations, a patient may experience $15$ to $20$ liquid stools per day.

• Laboratory Findings and Physiological Impact

  • Dehydration and Electrolytes: High frequency of liquid stools puts patients at risk for the loss of sodium ($Na^+$), potassium ($K^+$), and chloride ($Cl^-$).

  • Protein Levels: Inflamed bowel walls lead to protein loss, resulting in low serum albumin levels.

  • Hematology: Blood loss through diarrhea can result in anemia, indicated by low hemoglobin ($Hb$) and hematocrit ($Hct$) values.

  • Inflammatory Markers: Because inflammation is systemic throughout the colon, tests often show elevated White Blood Cell (WBC) counts, elevated Erythrocyte Sedimentation Rate (ESR), and elevated C-reactive protein (CRP).

• Medical Emergencies and Complications

  • GI Bleeding: Sudden development of large amounts of blood in the stool, dizziness, tachycardia, or signs of shock constitute a medical emergency.

  • Colorectal Cancer: Chronic inflammation damages colon cells over time, increasing the long-term risk of malignancy.

• Pharmacological Interventions

  • Aminosalicylates: Medications such as sulfasalazine are used to reduce inflammation in the intestinal lining and maintain remission.

  • Corticosteroids: Drugs like prednisone are used for acute exacerbations to rapidly suppress inflammation and decrease bleeding.

  • Steroid Side Effects: Long-term use can lead to osteoporosis, hyperglycemia, increased infection risk, peptic ulcers, and adrenal suppression.

• Nutritional Support

  • During flare-ups, a high-protein, low-fiber diet is required. Protein facilitates healing, while low fiber reduces bowel stimulation.

  • Avoidance of triggers: Spicy foods, alcohol, caffeine, and dairy products.

  • Severe cases may require the patient to be NPO (nothing by mouth) for bowel rest, utilizing Total Parenteral Nutrition (TPN).

• Key NCLEX Point

  • If a question describes bloody diarrhea, mucus in the stool, and left lower quadrant pain, the diagnosis is usually ulcerative colitis.

Crohn’s Disease

• Definition and Pathophysiology

  • Crohn’s disease is a form of IBD that can affect any part of the gastrointestinal tract from the mouth to the anus.

  • It most commonly affects the terminal ileum, located in the right lower quadrant (RLQ).

  • Unlike UC, the inflammation extends through the entire bowel wall (transmural).

  • Skip Lesions: Patches of diseased bowel are separated by healthy tissue, creating a "cobblestone" appearance upon diagnostic visualization.

• Clinical Manifestations

  • Chronic diarrhea (not typically bloody).

  • Right lower quadrant (RLQ) abdominal pain.

  • Significant weight loss and fatigue.

  • Steatorrhea: Fatty stools resulting from malabsorption of fats.

• Complications

  • Fistulas: Abnormal connections between two body structures.

  • Strictures: Narrowing of the intestinal lumen, which may lead to bowel obstruction.

• Nutritional and Laboratory Impact

  • Vitamin B12: Because the terminal ileum is the site for $B_{12}$ absorption, patients often develop $B_{12}$ deficiency and megaloblastic anemia.

  • Malnutrition: Diseased bowel prevents proper nutrient absorption, resulting in decreased albumin levels and severe weight loss.

  • Management: High-calorie, high-protein diets are essential. TPN may be necessary if oral intake is insufficient.

• Key NCLEX Point

  • If a question mentions cobblestone lesions, fistulas, skip lesions, RLQ pain, or steatorrhea, think Crohn’s disease.

Appendicitis

• Pathophysiology

  • Caused by an obstruction of the appendix, often by fecal material (fecalith), leading to bacterial invasion and inflammation.

  • It is a surgical emergency because delay can result in rupture.

• Clinical Presentation

  • Classic pain pattern: Begins as vague periumbilical pain and then migrates to the right lower quadrant (RLQ).

  • McBurney’s Point: Tenderness at this specific RLQ location is a classic finding.

  • Associated symptoms: Nausea, vomiting, anorexia, fever, and rebound tenderness.

• Diagnosis and Nursing Care

  • Labs: Leukocytosis ($↑ WBC$) is typical.

  • Imaging: CT scans and ultrasounds are used for confirmation.

  • Priorities: Keep the patient NPO, administer IV fluids, and monitor for rupture signs while preparing for surgery.

  • Contraindications: Never use heating pads or laxatives, as these increase the internal pressure and the risk of the appendix rupturing.

• Key NCLEX Point

  • Periumbilical pain that migrates to the RLQ is the hallmark sign of appendicitis.

Peritonitis

• Definition and Etiology

  • Life-threatening inflammation of the peritoneum (the membrane lining the abdominal cavity).

  • Common causes include a ruptured appendix, perforated peptic ulcer, or perforated diverticulum, allowing bacteria to enter the abdominal cavity.

• Clinical Manifestations

  • The patient usually appears acutely ill and remains very still, as movement exacerbates pain.

  • Rigid, board-like abdomen: Caused by intense muscle guarding.

  • Other signs: Fever, abdominal distention, rebound tenderness, and absent bowel sounds.

• Complications and Treatment

  • Complications include sepsis, hypovolemic shock, acute kidney injury (AKI), and electrolyte imbalances.

  • Management: NPO status, IV fluids, broad-spectrum antibiotics, and NG tube insertion for gastric decompression.

  • Surgery is frequently indicated to repair the source of the contamination.

• Key NCLEX Point

  • A rigid, board-like abdomen is strongly associated with peritonitis.

Diverticulosis and Diverticulitis

• Diverticulosis

  • Small pouches (diverticula) form in weakened areas of the intestinal wall, often due to chronic constipation and low-fiber diets.

  • Common in older adults and often discovered incidentally during colonoscopy.

  • Prevention: High-fiber diet, adequate fluid intake, and exercise to reduce colonic pressure.

• Diverticulitis

  • Occurs when diverticula become inflamed or infected.

  • Symptoms: Left lower quadrant (LLQ) pain, fever, nausea, vomiting, and elevated WBC counts.

  • Management: Bowel rest, IV fluids, and antibiotics. A low-fiber or clear liquid diet is used only during the acute flare-up.

  • Contraindications: Rectal procedures and enemas are avoided during the acute phase due to perforation risk.

• Key NCLEX Point

  • Left lower quadrant pain combined with fever usually suggests diverticulitis.

Pyelonephritis

• Definition

  • A bacterial kidney infection that typically ascends from the bladder. Escherichia coli (E. coli) is the most frequent causative agent.

• Clinical Presentation

  • Symptoms: Fever, chills, flank pain, and costovertebral angle (CVA) tenderness.

  • Urinary symptoms: Dysuria, frequency, and urgency.

  • Systemic signs: Nausea, vomiting, and confusion (especially in elderly patients).

• Nursing Management

  • Priorities: Administer prescribed IV antibiotics and encourage hydration to flush the urinary tract.

  • Analgesia: Acetaminophen is preferred. Non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided as they may worsen kidney injury.

• Key NCLEX Point

  • Flank pain accompanied by costovertebral angle tenderness is highly suggestive of pyelonephritis.

Glomerulonephritis

• Etiology and Pathophysiology

  • Commonly follows a streptococcal infection (e.g., strep throat).

  • Inflammation damages the glomerular membrane, leading to the leakage of blood and protein into the urine.

• Clinical Presentation

  • Hematuria (blood in urine) and proteinuria (protein in urine).

  • Oliguria (low urine output).

  • Hypertension and facial or periorbital edema.

• Diagnostic Findings and Care

  • Accumulation of waste results in elevated Blood Urea Nitrogen (BUN) and creatinine, and a reduced Glomerular Filtration Rate (GFR).

  • Nursing interventions: Strict intake and output (I&O) monitoring, daily weights, and blood pressure monitoring.

  • Restrictions: Fluid, sodium ($Na^+$), and protein restrictions as prescribed to reduce renal stress.

• Key NCLEX Point

  • A history of strep throat followed by hematuria and periorbital edema identifies glomerulonephritis.

Nephrotic Syndrome

• Pathophysiology

  • Damage to the glomeruli leads to massive proteinuria (leaking of large amounts of protein into the urine).

  • Low serum albumin results in a drop in plasma oncotic pressure, causing fluid to shift into the tissues (generalized edema/anasarca).

  • The liver increases lipid production to compensate for protein loss, causing hyperlipidemia.

• Clinical Manifestations

  • Massive proteinuria and hypoalbuminemia.

  • Generalized edema and significant weight gain.

  • Fatigue and frothy urine (due to high protein content).

• Management

  • Treatment: Diuretics for edema, ACE inhibitors or ARBs to reduce protein loss, and statins for lipid management.

  • Nursing focus: Daily weights, I&O, abdominal girth measurement, and monitoring skin integrity.

• Key NCLEX Point

  • The classic triad for Nephrotic Syndrome is proteinuria + hypoalbuminemia + generalized edema.