NUR 315 Exam 3 Study Guide LATEST UPDATE

NUR 315: Exam 3 Study Guide Gastrointestinal System • Stomach pain, cramps and spasms are some of the most frequent complaints of patients in the emergency room departments • The prevalence of GI problems increases with age Acute Diarrhea • Frequent passage of loose or watery stools persisting 3-5 days that are not bloody, purulent (puss= infection), or greasy (patient not absorbing fat= problem with absorption) • Acute is 2 weeks duration • Most cases are self-limited and brief, and require only symptomatic management • Large volume o Viral or bacterial infection of large or distal small intestine o Can alter volume and electrolyte balance o Always worry about fluid and electrolyte imbalances o Usually a viral or bacterial infection o Fever is not associated with GI symptoms; self-limiting, goes away on its own • Small volume o Frequent loss of small amounts of stools o Characteristic of ulcerative colitis and Crohn’s disease o Characteristics with problems with absorption of fluids in colon and/or small bowel o Indicative of an inflammatory disorder • Other symptoms o Fever o Headache o Vomiting o Abdominal pain/discomfort o Malaise Constipation • Changes in the frequency, size, and consistency, and ease of stool passage • One or more common and persistent presenting complaints • Among the most frequent reasons for self medication, especially in the elderly • There is no test for or standard definition of constipation o Very subjective • Passing the stool or GI discomfort w/ stool passage? • Pt’s might overuse laxatives (become habit forming in peristalsis of bowels) in order to self medicate • Stools less than once every 3 days o Frequency is individual • Causes o Dehydration o Delayed gastric motility o Sedentary lifestyle o Low fiber diet o Psychogenic o Drugs side effect, etc. • Treatment o Check for fecal impaction especially in the elderly  Very difficult stool to pass o Start treatment with lifestyle changes:  Increase fluid intake to at least six 8-oz. water/day • Optimal intake at least 8 glasses to 2 liters of water  Increase fiber  Regular exercise program  Bowel training/regular bowel habits o If lifestyle changes don’t work:  Laxatives  Stool softeners  Enemas  Suppository Anorexia • Loss of appetite or desire for food • Occurs as a symptom of other GI problems • Also present with conditions not associated with the GI tract Nausea • Subjective, unpleasant sensation that may precede vomiting • Caused by: o Distention or irritation anywhere in the GI tract o Stimulated by higher brain center Vomiting • Complex reflex mediated by vomiting center in the medulla oblongata of the brain • Occur in response to: o Excessive distention or irritation of the stomach or duodenum o Chemical stimulation o Pain  Vomiting can be a response to pain (ex. Intracranial pressure like a tumor, cause projectile vomiting, b/c affecting vomiting center in the brain) o Projectile vomiting occurs with direct stimulation of vomiting center- due to increase ICP o Chemoreceptors receiving feedback from GI tract from the metobolic disturbance o Symptoms that precede vomiting  Nausea  Tachycardia  Sweating Types of Abdominal Pain (know parietal vs. visceral) • Parietal pain o Caused by stimulation of pain receptors in the parietal peritoneum or abdominal wall. The pain is localized, sharp, intense, and one-sided (lateralized) • Visceral Pain o Caused by stimulation of abdominal organs; pain is vague, diffuse (non localized), and dull • Referred Pain o Is felt at a distance from the affected tissue or organ; is localized at some point along the afferent nerve pathway of the organ or tissue o Gallbladder pain usually presents as right shoulder pain Intestinal Obstruction • Impaired movement of intestinal contents • Mechanical obstruction o Caused by any condition that affects the patency of the bowel lumen o Tumor o Adhesion  Scar tissue formation that blocks flow of gas or stool through the gut o Severe constipation