MDC2 Final Exam Study Guide
ATI has additional practice questions for review in Learning Systems RN 3.0.
Ch. 56 – Care of Patients with Noninflammatory Intestinal Disorders
● Nonmechanical (paralytic ileus)- doesn’t involve a physical obstruction in or outside
the intestine. Peristalsis is decreased or absent due to neuromuscular disturbance
making it slow in movement or a backup of intestinal contents. Infections, anesthesia
slows it down. No movement. Absent bowel tones listen for 5 minutes
● Mechanical obstruction: bowel is physically blocked by problems outside the intestine
(adhesions), in the bowel wall (Crohn’s), or in the intestinal lumen (tumor).
■ Volvulus means twisting in bowels
■ Intussusception: telescoping bowel within itself
■ Obstipation: no passage of stool
■ Peristaltic Waves: moves nutrients and waste through the small intestines
■ Bobborygmi: high pitched bowel sounds
■ Fibrosis from endometriosis, vascular disorders, tumors, adhesions,
appendicitis, hernias, fecal impactions, crohn’s strictures.
○ s/s/: distended abdomen, N/V, constipation, pressure on organs, respiratory,
obstipation (no passage of stool
● SMALL-BOWEL OBSTRUCTIONS ● LARGE-BOWEL OBSTRUCTIONS
● Abdominal discomfort or pain possibly ● Intermittent lower abdominal cramping
accompanied by visible peristaltic waves in
upper and middle abdomen
● Upper or epigastric abdominal distention ● Lower abdominal distention
● Nausea and early, profuse vomiting (may ● Minimal or no vomiting
contain fecal material)
● Obstipation ● Obstipation or ribbonlike stools
● Severe fluid and electrolyte imbalances ● No major fluid and electrolyte imbalances
,● Metabolic alkalosis ● Metabolic acidosis (not always present)
● Colorectal cancer labs (CEA), diagnostics
○ Colon and rectum that make up large intestines (large bowel)
○ Adenocarcinomas: tumors on the glandular epithelial tissue of the colon
○ Most arise from adenomatous polyps
○ Metastasize by direct extension or spreading through the blood or lymph
○ Risk Factors: older than 50 years, genetics, family history of cancer, predisposing
diseases like adenomatous polyposis or Crohn’s, or ulcerative colitis.
○ Labs: positive fecal occult blood test indicated GI bleed;
■ Carcinoembryonic Antigen (CEA): normal value is less than 5ng/mL.
Used to monitor effectiveness of treatment and to identify disease
recurrence
■ Double-contrast barium enema (colonoscopy): USED TO DIAGNOSE
CRC; air and barium instilled into colon; provides visualization of polyps
and small lesions that does a barium enema alone.
● Colonoscopy provides views of the entire large bowel from the
rectum to the ileocecal valve.
■ Sigmoidoscopy: visualization of the lower colon using a fiberoptic scope;
polyps are seen and removed, tissue samples can be taken for biopsy
● Irritable bowel syndrome health teaching and testing (hydrogen breath test)
○ Functional GI disorder that causes chronic or recurrent diarrhea, constipation,
and/or abdominal pain and bloating
○ Hydrogen Breath Test: small-bowel bacterial overgrowth breath test.
■ When small-intestinal bacterial overgrowth or malabsorption of nutrients
is present, an excess of hydrogen is produced. Some of the hydrogen is
absorbed into the bloodstream and travels to the lungs where it is
exhaled. Usually a person with IBS will have an increased amount of
hydrogen when they exhale.
■ Teach the patient that they will need to be NPO for at least 12 hrs before
the test. They could only have water. In the beginning the patient blows
into the hydrogen analyzer. Small amounts of test sugar are ingested and
additional breath samples are taken every 15 minutes for 1 to 5 hours
Ch. 57 – Care of Patients with Inflammatory Intestinal Disorders
● Peritonitis: life-threatening, acute inflammation and infection of the visceral/parietal
peritoneum and endothelial lining of the abdominal cavity
○ Cause: E. Coli, Streptococcus, Staphylococcus, Pneumococcus, and
Gonococcus
, ○ S/S: Rigid, boardlike abdomen; Abdominal pain, distended abdomen, N/V,
anorexia, diminished bowel sounds, inability to pass flatus or feces, rebound
tenderness in abdomen, high fever, tachycardia, dehydration, poor skin turgor,
hiccups, possible respiratory compromise
■ Acutely ill, lying still, knees flexed, signs of pain with coughing or
movement
● Appendicitis: acute inflammation of the appendix; RLQ Pain,
○ Cause: when inflammation occurs when lumen (opening) of appendix is
obstructed (blocked)
○ Lab Findings: moderate elevation of WBC 10,000-18,000, ultrasound for
enlarged appendix;
■ CT Scan: If symptoms are recurrent or prolonged (reveals a presence of
fecaloma- small “stone” of feces)
● Ulcerative colitis vs Crohn’s disease
○ Ulcerative Colitis: creates widespread inflammation of the rectum and
rectosigmoid colon but can extend to the entire colon when the disease is
extensive
■ Location: begins in the rectum and proceeds in a continuous manner
toward the cecum
■ Cause of exacerbation: intestinal infection, etc.
■ Peak: 15-25 years and 55-65 years
■ Number of Stools: 10-20 liquid, bloody stool per day
■ Complications: Hemorrhage, nutritional deficiencies
■ Need for Surgery: infrequent
■ Intestinal Mucosa: hyperemic (increased blood flow), edematous,
reddened. Bleeding and small erosions, or ulcers in severe inflammation
●
● SEVERITY ● STOOL ● SIGNS/SYMPTOMS
FREQUENCY
● Mild ● <4 stools/day with/wo ● asymptomatic
blood
● Moderate ● >4 stools/day w/wo ● Mild symptoms, abd.
blood Pain, nausea
● Severe ● >6 bloody stools/day ● Fever, tachycardia,
anemia, abd. Pain,
elevated C-reactive
protein/ ESR
● Fulminant ● >10 bloody stools/day ● Increased symptoms,
require transfusion,
colonic distention on
x-ray
ATI has additional practice questions for review in Learning Systems RN 3.0.
Ch. 56 – Care of Patients with Noninflammatory Intestinal Disorders
● Nonmechanical (paralytic ileus)- doesn’t involve a physical obstruction in or outside
the intestine. Peristalsis is decreased or absent due to neuromuscular disturbance
making it slow in movement or a backup of intestinal contents. Infections, anesthesia
slows it down. No movement. Absent bowel tones listen for 5 minutes
● Mechanical obstruction: bowel is physically blocked by problems outside the intestine
(adhesions), in the bowel wall (Crohn’s), or in the intestinal lumen (tumor).
■ Volvulus means twisting in bowels
■ Intussusception: telescoping bowel within itself
■ Obstipation: no passage of stool
■ Peristaltic Waves: moves nutrients and waste through the small intestines
■ Bobborygmi: high pitched bowel sounds
■ Fibrosis from endometriosis, vascular disorders, tumors, adhesions,
appendicitis, hernias, fecal impactions, crohn’s strictures.
○ s/s/: distended abdomen, N/V, constipation, pressure on organs, respiratory,
obstipation (no passage of stool
● SMALL-BOWEL OBSTRUCTIONS ● LARGE-BOWEL OBSTRUCTIONS
● Abdominal discomfort or pain possibly ● Intermittent lower abdominal cramping
accompanied by visible peristaltic waves in
upper and middle abdomen
● Upper or epigastric abdominal distention ● Lower abdominal distention
● Nausea and early, profuse vomiting (may ● Minimal or no vomiting
contain fecal material)
● Obstipation ● Obstipation or ribbonlike stools
● Severe fluid and electrolyte imbalances ● No major fluid and electrolyte imbalances
,● Metabolic alkalosis ● Metabolic acidosis (not always present)
● Colorectal cancer labs (CEA), diagnostics
○ Colon and rectum that make up large intestines (large bowel)
○ Adenocarcinomas: tumors on the glandular epithelial tissue of the colon
○ Most arise from adenomatous polyps
○ Metastasize by direct extension or spreading through the blood or lymph
○ Risk Factors: older than 50 years, genetics, family history of cancer, predisposing
diseases like adenomatous polyposis or Crohn’s, or ulcerative colitis.
○ Labs: positive fecal occult blood test indicated GI bleed;
■ Carcinoembryonic Antigen (CEA): normal value is less than 5ng/mL.
Used to monitor effectiveness of treatment and to identify disease
recurrence
■ Double-contrast barium enema (colonoscopy): USED TO DIAGNOSE
CRC; air and barium instilled into colon; provides visualization of polyps
and small lesions that does a barium enema alone.
● Colonoscopy provides views of the entire large bowel from the
rectum to the ileocecal valve.
■ Sigmoidoscopy: visualization of the lower colon using a fiberoptic scope;
polyps are seen and removed, tissue samples can be taken for biopsy
● Irritable bowel syndrome health teaching and testing (hydrogen breath test)
○ Functional GI disorder that causes chronic or recurrent diarrhea, constipation,
and/or abdominal pain and bloating
○ Hydrogen Breath Test: small-bowel bacterial overgrowth breath test.
■ When small-intestinal bacterial overgrowth or malabsorption of nutrients
is present, an excess of hydrogen is produced. Some of the hydrogen is
absorbed into the bloodstream and travels to the lungs where it is
exhaled. Usually a person with IBS will have an increased amount of
hydrogen when they exhale.
■ Teach the patient that they will need to be NPO for at least 12 hrs before
the test. They could only have water. In the beginning the patient blows
into the hydrogen analyzer. Small amounts of test sugar are ingested and
additional breath samples are taken every 15 minutes for 1 to 5 hours
Ch. 57 – Care of Patients with Inflammatory Intestinal Disorders
● Peritonitis: life-threatening, acute inflammation and infection of the visceral/parietal
peritoneum and endothelial lining of the abdominal cavity
○ Cause: E. Coli, Streptococcus, Staphylococcus, Pneumococcus, and
Gonococcus
, ○ S/S: Rigid, boardlike abdomen; Abdominal pain, distended abdomen, N/V,
anorexia, diminished bowel sounds, inability to pass flatus or feces, rebound
tenderness in abdomen, high fever, tachycardia, dehydration, poor skin turgor,
hiccups, possible respiratory compromise
■ Acutely ill, lying still, knees flexed, signs of pain with coughing or
movement
● Appendicitis: acute inflammation of the appendix; RLQ Pain,
○ Cause: when inflammation occurs when lumen (opening) of appendix is
obstructed (blocked)
○ Lab Findings: moderate elevation of WBC 10,000-18,000, ultrasound for
enlarged appendix;
■ CT Scan: If symptoms are recurrent or prolonged (reveals a presence of
fecaloma- small “stone” of feces)
● Ulcerative colitis vs Crohn’s disease
○ Ulcerative Colitis: creates widespread inflammation of the rectum and
rectosigmoid colon but can extend to the entire colon when the disease is
extensive
■ Location: begins in the rectum and proceeds in a continuous manner
toward the cecum
■ Cause of exacerbation: intestinal infection, etc.
■ Peak: 15-25 years and 55-65 years
■ Number of Stools: 10-20 liquid, bloody stool per day
■ Complications: Hemorrhage, nutritional deficiencies
■ Need for Surgery: infrequent
■ Intestinal Mucosa: hyperemic (increased blood flow), edematous,
reddened. Bleeding and small erosions, or ulcers in severe inflammation
●
● SEVERITY ● STOOL ● SIGNS/SYMPTOMS
FREQUENCY
● Mild ● <4 stools/day with/wo ● asymptomatic
blood
● Moderate ● >4 stools/day w/wo ● Mild symptoms, abd.
blood Pain, nausea
● Severe ● >6 bloody stools/day ● Fever, tachycardia,
anemia, abd. Pain,
elevated C-reactive
protein/ ESR
● Fulminant ● >10 bloody stools/day ● Increased symptoms,
require transfusion,
colonic distention on
x-ray
