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 accompanied by visible peristaltic waves in upper and middle abdomen ● Intermittent lower abdominal cramping ● Upper or epigastric abdominal distention ● Lower abdominal distention ● Nausea and early, profuse vomiting (may contain fecal material) ● Minimal or no vomiting ● 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