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Chapter 47
Unit 7: Nursing care of clients with gastrointestinal disorders
| Question | Answer |
|---|---|
| NG decompression | suction applied to relieve abdominal distention -from an intestinal obstruction (either mechanical or functional) |
| when do you do decompression? | when pt is vomiting, BS are absent, abdominal pain, hiccups |
| Ostomies; permanent or temporary ileostomy qualities -post op amount? | -Can be both -surgical opening in ileum; performed when entire colon must be removed d/t disease (crohn's) liquidy, 500-1000ml/day, continuous output, paste like -post op? 1,000 ml/day, bile colored/liquid |
| transverse colostomy | POST OP; small semi-liquid w/ some mucus 2-3 days after surgery, blood after surgery as well can be present -semi formed or formed, output will return to pts normal bowel routine |
| sigmoid colostomy | POST OP; small to moderate amount of mucus w semi-formed stool 4-5 days after surgery -semi formed stool after several days-weeks, output will return to pts normal bowel routine |
| stoma assessment | beefy red and moist |
| Peristomal care -stoma should appear? -skin barriers & creams ok? | -pink & moist (red, beefy) -yes; allow to dry before applying new appliance clean around it with water, make sure the appliance fits properly so there is no skin breakdown |
| LIS and LCS | low intermittent suctioning, low continuous suctioning |
| NG tube placement *MUST DO ATLEAST 2* | inject air into stomach and watch for rise (not really recommended), xray, aspirate and check pH of contents, MUST have xray before you can feed them thru the tube |
| Pg. 529 Bariatric surgeries -what are they | Treatment for morbid obesity when other wt control methods have failed |
| What do bariatric surgeries do? | Reduce the functional size of the stomach(vertical banded gastroplasty) |
| Different types of laparoscopic procedures 1. Vertical banded gastroplasty -involves | Stapling stomach to reduce its functional size |
| 2. adjustable banded gastroplasty -invovles | Constricting the functional size of the stomach |
| 3. Intestinal bypass | includes bypassing the stomach & part of the small intestine to decrease the absorption of nutrients & calories -removes a portion of the stomach & creates a pouch or sleeve w remaining portion (sleeve gastrectomy) |
| Indications fro bariatric surgery: | history of morbid obesity BMI >40, BMI >35 w/ comorbidities |
| Post procedure bariatric surgery: -anastomosis -position -meals | Monitor for a leak (emergency) -semi fowlers for lung expansion -6 small meals a day when oral nutrients can be resumed -monitor for dumping syndrome |
| Client education post bariatric surgery: -limitations regarding liquids or pureed foods for the first 6 weeks -walk daily ___ mins -overeating can | -30 mins -can dilate surgical pouch causing wt to be regained |
| Complications of bariatric surgery; -Dehydration, malabsorption/malnutrition | -smaller stomach or bypassed portions of the intestinal tract = fewer nutrients ingested & absorbed |
| When should an ostomy bag be emptied? | 1/4 to 1/2 drainage |
| Dietary changes w ostomies.. -Foods that cause odors? F,E,A,G,B,DGLF -What can help decrease gas? | Fish, eggs, asparagus, garlic, beans, dark green leafy vegetables -Yogurt! |
| What should clients with an ileostomy or small intestine colostomy avoid? | High fiber foods for the first 2 months -increase fluids, chew food well |
| Complications to an ostomy: Stomal ischemia/necrosis: S/S? | pale pink or bluish/purple in color & dry -black/purple = serious! |
| Necrotic stoma nursing actions? | VS, notify provider/surgeon |
Created by:
mary.scott260!
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