Main drug therapy for ulcerative colitis is

sulfa for one year

Key concept this client will be sulfa for at least a year after the diagnosis is made corticosteroids they made be on or off depending on exacerbation, If they
have anorexia may have to give the IV fluids
Chrons Di ease
Effects any part of the GI tract not just the move from the rectum through the sigmoid like ulcerative colitis
Cause is unknown, periods of exacerbation and remissions just like ulcerative, however incidence is more rare than ulcerative
Inflammation that effects different segments of the GI tract, most commonly in the small intestine, fistulas and abscesses will occur, the esophagus,
stomach, duodenum involvement rare.
Inflammation result in thicken and narrowing of lumen (stricture may develop) which then diminish the blood flow in the colon which causes fistulas,
inflammation is not continuous so normal bowel between the inflammation are normal. What will happen with this client?
Clinical symptoms diarrhea that is not bloody biggest difference in chrons and ulcerative, abdominal pain and severe cramping and they also pain around
the umbilicus, fistulas because of the narrowing, and the obstructions, they can be perianal or vaginal, impaired absorption of fat so they have malnutrition
systemic complications include arthritis, liver disease, kidney stones, renal disease
Key concept fistula formation between the bowel and bladder is very common in chrons disease, and is evident when a patient develops a fever and
symptoms of a UTI and foul smelling urine. Often time when we test test the urine we find feces in the urine that tells you they have a fistula.
INTESTINAL OBSTRUCTION
Intestinal obstructions may be partial or complete. There are mechanical and non mechanical obstructions
Chrons disease is actually an obstruction too because of the strictures.
Mechanical:
Caused by an occlusion of the lumen any kind of occlusion is mechanical
Occurs mostly in the ileum and the small intestine
90% of all obstructions
pain comes and goes in waves (cramping)
Non mechanical
nuerovascular or vascular disorder
most common is paralytic ileus
Key concept: Paralytic ileus is a lack of intestinal peristalsis and the presence of no bowel sounds, this is your assessment findings.
Typically occurs after abdominal surgery, high risk after surgery for paralytic
also caused by peritonitis, chrons, ulcerative colitis, and electrolyte abnormal especially hypokalemia, also after lumbar or thoracic injury or
fractures its a nerve issue.
Patho
fluids, gas and contents accumulate proximal to the obstruction (distension), this causes decreased fluid absorption, and further dilates the intestines,
diminishes blood flow, causing edema, congestion and necrosis which can rupture the bowel, hypo tension can also happen
s/s
abdominal distension, n & v, abdominal pain, inability to pass flatus, constipation, proximal to the obstruction you will hear
borborgymi(hyperactive, high pitched bowel sounds you dont need a stethoscope that loud)
SMALL BOWEL OBSTRUCTION
Rapid onset, projectile vomiting which can relieve the abdominal pain, but fecal movement only for short time, abd distension (non or minimal) and
crampy pain
LARGE BOWEL OBSTRUCTION
Vomiting is rare, because impact lower, but if they do vomit it will be fecal matter, patient has suction in stomach and you will see feces in the container,
very dangerous lack of bowel sounds, and pain, constipation and distension(check girth)
Therapeutic management for both
decompress small intestines (NG)
decompress large intestinal (enemas, rectal tubes, sigmiodscopy, colonscopy, NG tube)
IV tpn because they are NPO

Surgery: Colectomy, colostomy ilostomy (most common txt is surgery)

MALIGNANCIES OF LARGE INTESTINE
Second most common cancer of cancer deaths
Highest in cecum, ascending colon and sigmoid colon
commonly spreads to the liver via the portal vein
Key concept: the early sign of cancer is change in bowel habits.
Clinical manifestation:
Left side (sigmoid)
Rectal bleeding
alternating constipation.diarrhea
narrow ribbon like stools
Key concept: Patient with a lesion on the sigmoid side (left) will have alternating diarrhea, constipation and rectal bleeding and narrow ribbon
like stools. Usually with right sided lesions usually asymptomatic, stools can be liquid, they have vague abdominal pain, can be anemic because of occult
blood and start to have bleeding in stool, this stool will look darker than left sided. If the tumor is large enough you can palpate it
Therapy:
Endoscopic polyectomy
laser therapy (can be palliative if the cancer has spread)
Irrigate the peritoneum with anti neoplastic agents
Surgery(most common)
Right hemicolectomy
if the cancer is in the cecum, ascending colon, hepatic fixture or transverse colon
Left sided
Left transverse colon, splenic fixture, descending colon, sigmoid, upper rectum are resected
If cancer is within 5 cm of anus, abdominal perineal resection is done
abdominal perineal resection
1.
removal of distal rectum an anus thru perineal incision; then the proximal sigmoid becomes permanent colostomy
2.
The areas of colostomy: ascending, descending, ileostomy, and sigmoid.
3.
Care for the colostomy
1.
perineal wounds: drains or left open to drain
2.
drain left in place until drainage less than 50cc/24hrs
3.
side to side positioning, sitz bath
Ostomy care and patient teaching
1.
Explain what it is
2.
home care instruction (wash with soap and water change bag when 1/3 or full)
3.
financial aspects (equipment) (case management)
4.
diet (no spicy foods, decrease gassy foods, hold fiber then add as tolerated
5.
sexual activity and social life
6.
Because liquid stools we need to prevent dehydration by drinking 3000ml day at least because large intestine is not there to absorb the fluid.
ABDOMINAL TRAUMA
Blunt trauma
penetration (gun shot, stabbings) these have higher mortality rate due to gross contamination
Key concept: if the patient has been stabbed in the abdomen priority nursing care includes assessing the airway and assessing s/s of hypovalemic shock
(hypo-tension, tachycardia, anxiety, agitation, cool and clammy skin, confusion, decreased urine output) also the nurse does remove the object or palpate,
listen carefully with stethoscope to hear bowel sounds can be important, then notify doctor of hypovalemic shock if present.
CIRRHOSIS OF THE LIVER
Chronic progressive degeneration of the liver cells as they regenerate they become fibrotic, this interferes with normal activity and impeded vascular flow
ALCOHOLIC CIRRHOSIS
Most common
Excess alcohol formation
scar formation throughout the liver
7.
Key concept: usually associated with alcohol abuse, first change of liver is an accumulation of uncomplicated fat cells in the liver are
potentially reversible if the person stops drinking alcohol early. All these fat deposits in the liver cells can be reversible. If alcohol continues
large scar formations happen throughout the liver and it is irreversible.
POST NECROTIC CIRRHOSIS
Complication of viral, toxic, or autoimmune hep
scar tissue is throughout the liver.

BILIARY CIRRHOSIS
Associated with chronic biliary obstruction and infection
liver is fibrotic with presenting jaundice
CARDIAC CIRRHOSIS
Caused by rt sided heart failure
Cor pulmonale (enlargement of rt vent)
constrictive pericarditis (fiber thicken of pericardium caused by gradual scarring or fibrosis of the membrane) heart becomes very rigid
tricuspid insufficiency
Clinical manifestations
GI disturbances (anorexia, dyspepsia, flatulence, n&v, change in bowel habits)
abdominal pain RUQ or epigastrium
Enlargement of spleen and liver
Others:
Fever
lassitude (weakness; low energy)
weight loss
Key concept: as a result of the livers altered metabolism of carbs and proteins or fats, dull ache in the stomach and very
heavy feeling in RUQ due to stretching o swelling
Late s/s
Jaundice
peripheral edema
ascites
skin lesion
hematologic disorders
endocrine disturbances
peripheral neuropathies
Key concepts: s/s of sever liver dysfunction with accompanying jaundice include clay stools, peritis and dark urine. Later stages may result in portal
hypertension. Skin lesions include spider angiomas which are small dilate blood vessels, due to an increase circulation of estrogen as a result of the
damaged liver inability to metabolize steroid hormones.
HEPATIC ENCELAPATHY
Risk for a coma
s/s of impending coma
esticsis (flapping tremors)
ask the patient to extend there arms out in front of them if the client is unable to hold this position they are at risk
Increase ammonia causes Slow deep respirations and hyperactive reflexes mental changes.
Treatment includes lactolos which detracts the ammonia in the gut and causes diarrhea, explosive diarrhea which expels the ammonia thereby decreases the
levels. This help improve the nervous system.
PORTAL HYPERTENSION
Increased central venous pressure
splenomegaly
large collateral veins
ascites
systemic hypertension
esophageal varices
Key concept: structural damage in the liver cause this due to cirrhosis which compresses and destroys hepatic veins
Changes result in obstruction of the normal flow of blood to the portal system which is what supplies the liver with blood results in portal hypertension.
The goal is to reduce the risk for bleeding associated with portal hypertension, therefore the patients are often given stool softeners
Key concept: Esophageal varices are complexed veins at the end f the esophagus and they are enlarged and swollen as a result of portal hypertension.
Common in cirrhosis. Die within 6 weeks. The nurse must assess the client for hemorrhage. The patient will be txt with balloon tapanode to reduce
bleeding in the esophagus, 250ml of air inflate, x-ray confirm placement. NURSING: Deflate the balloon every 8-12 hrs to avoid necrosis. The most
common complication of balloon tampanode is aspiration pneumonia, therefore suction and frequent oral hygiene must be performed.
ASCITES
Due to decreased albumin and increase portal hypertension
peripheral edema
abdominal distension due to water and proteins in the abdominal area
accumulation of serous fluid in the abd, the lymp are unable to carry away excess proteins and water causing them to leak through the liver and into the
peritoneal cavity. Retention of sodium as well as increased antiduertic hormone causes additional water in the abd. Because of increase edema there is
decreased invascular volume and decreased renal blood flow, and decreased glumaular activity
Key concept: clients with severe ascites must be evaluated for respiratory changes, such as decreased lung expansion bc of diaphragm pressure place the
client in the fowler's position to relieve pressure on the diaphragm. Patients with ascites should never be in a flat position, the patient might also be more

comfortable in the tripod position. There number on issue is breathing.

S/s in ascites that accompanying: peritoneal distension, umbilical (cullens) stria, dry cough, sunken eyeballs, decreased urine and hypokalemia which may
b due to the diuretics they are placed on,
TREATMENT FOR ASCITES
paracentitis can not take to much because will have hypo tension.
PANCREATITIS
Inflammation of the pancreas
Key concepts: Some patients recover completely, some clients still have reoccurring attacks, and other chronic complications. IN the us the most common
cause is alcoholism followed by gallbladder issues.
Client may assume may positions to relieve the pain. Pain is due to the distension of the pancreas, peritoneal irritation and obstruction of the biliary tract.
S/s
n/v
low grade fever
leukocytos
hypotension
tachycardia
jaundice
abd tenderness
guarding
Grey turners (bruising of the flanks)
Cullens
electrolyte imbalance
hypocalemia which is associated with pacreatitis and includes muscle twitching, digit numbness, seizure and mental confusion.
The nurse should plan to administer calcium gluconate.
SURGICAL INTERVENTIONS
Necessary for acute pancreatisis r/t gallstones. And also an abscess,
Percutaneous drainage of a pseudocyst usually necessitates a drainage tube left in placement
Nursing management
NPO
Small feeds beginning to introduce carbs slowly
bland diet no stimulants-coffee or alcohol
need fat soluble vitamins
TPN may be needed