MDC2 Final Exam Study Guide.
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 ● Intermittent lower abdominal cramping
possibly accompanied by visible
peristaltic waves in upper and middle
abdomen
● Upper or epigastric abdominal ● Lower abdominal distention
distention
● Nausea and early, profuse vomiting ● Minimal or no vomiting
(may contain fecal material)
● Obstipation ● Obstipation or ribbonlike stools
● Severe fluid and electrolyte imbalances ● No major fluid and electrolyte
imbalances
,MDC2 Final Exam Study Guide.
● 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
, MDC2 Final Exam Study Guide.
○ 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
FREQUEN
CY
● Mild ● <4 stools/day ● asymptomatic
with/wo blood
● Moderate ● >4 stools/day ● Mild symptoms,
w/wo blood abd. Pain, nausea
● Severe ● >6 bloody ● Fever,
stools/day tachycardia,
anemia, abd.
Pain, elevated C-
reactive protein/
ESR
● Fulminant ● >10 bloody ● Increased
stools/day symptoms, require
transfusion,
colonic distention
on x-ray
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 ● Intermittent lower abdominal cramping
possibly accompanied by visible
peristaltic waves in upper and middle
abdomen
● Upper or epigastric abdominal ● Lower abdominal distention
distention
● Nausea and early, profuse vomiting ● Minimal or no vomiting
(may contain fecal material)
● Obstipation ● Obstipation or ribbonlike stools
● Severe fluid and electrolyte imbalances ● No major fluid and electrolyte
imbalances
,MDC2 Final Exam Study Guide.
● 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
, MDC2 Final Exam Study Guide.
○ 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
FREQUEN
CY
● Mild ● <4 stools/day ● asymptomatic
with/wo blood
● Moderate ● >4 stools/day ● Mild symptoms,
w/wo blood abd. Pain, nausea
● Severe ● >6 bloody ● Fever,
stools/day tachycardia,
anemia, abd.
Pain, elevated C-
reactive protein/
ESR
● Fulminant ● >10 bloody ● Increased
stools/day symptoms, require
transfusion,
colonic distention
on x-ray
