U.S National Library of Medicine (2007). Retrieved Oct 1, 2007 from http://medlineplus.gov/.
WebMD (2007). Retrieved Oct 1, 2007 from http://www.medicinenet.com/.
WebMD (2007). Retrieved Oct 1, 2007 from http://www.emedicineheatlh.com/.
Wednesday, October 3, 2007
Introduction
-This is a 77 year old male who came to the ER with complaints of having crampy, abdominal pain for several days, which then became worse.
- An x-ray was taken of the abdomen and showed distention of the right colon
- a colonoscopy was done and showed that he had diverticulitis with colon obstruction
- He was then schedualed to have a Sigmoid colon resection and colostomy.
-He has a history of high cholesterol, type 2 diabetes, cholecystectomy, abdominal hernia repair, left leg fracture.
- An x-ray was taken of the abdomen and showed distention of the right colon
- a colonoscopy was done and showed that he had diverticulitis with colon obstruction
- He was then schedualed to have a Sigmoid colon resection and colostomy.
-He has a history of high cholesterol, type 2 diabetes, cholecystectomy, abdominal hernia repair, left leg fracture.
Monday, October 1, 2007
Questions
1. What is given to empty the bowel of stool before a colon resection?
a). Cipro b) Colace
c). Surfak d). GoLytely
2. When should the ostomy bag be emtied?
a)Completely full b) 1/3 full
b) 1/2 full d) 3/4 full
3. Which of the following is an example of a food to avoid if you have a ?colostomy ?
a) Chicken b) Beans
c) Soup d) Bread
4. Bulging pockets of tissue that push out from the colon wall are called?
a) diverticulosis b) diverticulitis
c) diverticulum d) tumors
5. Which is an antibiotic commonly used to treat diverticulitis?
a) Rocephin b) Golytely
c) Cipro d) Lovenox
a). Cipro b) Colace
c). Surfak d). GoLytely
2. When should the ostomy bag be emtied?
a)Completely full b) 1/3 full
b) 1/2 full d) 3/4 full
3. Which of the following is an example of a food to avoid if you have a ?colostomy ?
a) Chicken b) Beans
c) Soup d) Bread
4. Bulging pockets of tissue that push out from the colon wall are called?
a) diverticulosis b) diverticulitis
c) diverticulum d) tumors
5. Which is an antibiotic commonly used to treat diverticulitis?
a) Rocephin b) Golytely
c) Cipro d) Lovenox
Medications
Schedualed Meds
Cipro (Fluoroquinolone antiinfective)
- Interferes with DNA synthesis of bacteria
- Side effects include restlessness, confusion, nausea, flushing, hypersensitivity
- assess patient for previous sensitivity
Flagyl ( amebicide antiinfective)
- Binds to and degrades DNA in bacteria
- Side effects include headache, dizziness, abdominal cramps, metallic taste, nephrotoxicity
- Assess for allergic reactions, monitory I&O
Lantus ( Long acting insulin)
- Onset : 1 hr
- Peak : 2-20 hr
- Duration: 24 hr
- monitor BS, and hypoglycemic reactions at peak times
Novolog ( Rapid Acting insulin)
- Onset: 15- 30 min
- Peak: 1/2 hr - 1 1/2 hr
- Duration: 3-4 hr
- monitor BS, and hypoglycemic reactions at peak times
Novolin R (Regular Insulin)
- Onset: 1hr
- Peak: 2-5 hr
- Duration: 8 hr
- monitor BS, assess for hypoglycemic reactions at peak times
Pepcid ( H2 histamine receptor antagonist)
- Inhibits histamine at the H2 receptor site in gastric parietal cells, which inhibits gastric acid.
- Side effects include dizziness, depression, dysrhythmias, constipation
- assess for signs of bleeding ulcers ( abdominal pain, hematemesis, occult blood in stools)
PRN Meds
Tylenol ( Non opiod analgesic)
- May block pain impulses peripherally that occur in response to inhibition of prostaglandin synthesis. Does not possess antiinflammatory, antipyretic action results from inhibition of prostaglandins in CNS
- Side effects include hepatotoxicity, hepatic seizure, renal failure
- Do not exceed 4g a day
Surfak (Laxative, emollient)
- Increases the water, fat penetration in intestine, allows for easier passage of stools.
- Side effects include bitter taste, throat irritation, anorexia, diarrhea
Reglan ( Cholinergic, antiemetic)
- enhances response to acetlycholine of tissue in upper GI tract, which causes contraction of gastric muscle, increases peristalsis
- Side effects include sedation, fatigue, restlessness, suicide ideation
- assess GI complaints, mental status
Cipro (Fluoroquinolone antiinfective)
- Interferes with DNA synthesis of bacteria
- Side effects include restlessness, confusion, nausea, flushing, hypersensitivity
- assess patient for previous sensitivity
Flagyl ( amebicide antiinfective)
- Binds to and degrades DNA in bacteria
- Side effects include headache, dizziness, abdominal cramps, metallic taste, nephrotoxicity
- Assess for allergic reactions, monitory I&O
Lantus ( Long acting insulin)
- Onset : 1 hr
- Peak : 2-20 hr
- Duration: 24 hr
- monitor BS, and hypoglycemic reactions at peak times
Novolog ( Rapid Acting insulin)
- Onset: 15- 30 min
- Peak: 1/2 hr - 1 1/2 hr
- Duration: 3-4 hr
- monitor BS, and hypoglycemic reactions at peak times
Novolin R (Regular Insulin)
- Onset: 1hr
- Peak: 2-5 hr
- Duration: 8 hr
- monitor BS, assess for hypoglycemic reactions at peak times
Pepcid ( H2 histamine receptor antagonist)
- Inhibits histamine at the H2 receptor site in gastric parietal cells, which inhibits gastric acid.
- Side effects include dizziness, depression, dysrhythmias, constipation
- assess for signs of bleeding ulcers ( abdominal pain, hematemesis, occult blood in stools)
PRN Meds
Tylenol ( Non opiod analgesic)
- May block pain impulses peripherally that occur in response to inhibition of prostaglandin synthesis. Does not possess antiinflammatory, antipyretic action results from inhibition of prostaglandins in CNS
- Side effects include hepatotoxicity, hepatic seizure, renal failure
- Do not exceed 4g a day
Surfak (Laxative, emollient)
- Increases the water, fat penetration in intestine, allows for easier passage of stools.
- Side effects include bitter taste, throat irritation, anorexia, diarrhea
Reglan ( Cholinergic, antiemetic)
- enhances response to acetlycholine of tissue in upper GI tract, which causes contraction of gastric muscle, increases peristalsis
- Side effects include sedation, fatigue, restlessness, suicide ideation
- assess GI complaints, mental status
Laboratory Data
Sigmoid colon resection and colostomy
Sigmoid Colon Resection- surgical procedure in which a diseased part of the large intestine is removed. To prepare for the procedure, the patient is asked to completely clean out the bowel. This is an important step if the bowel is to be opened safely within the peritoneal cavity to empty and cleanse the bowel, the patient is usually placed on a liquid diet for at least the day before surgery, with nothing taken by mouth after midnight. A series of enemas and/or oral preparations (GoLytely or Colyte) may be ordered to empty the bowel of stool. The patient may also be given a prescription for oral antibiotics the day before surgery to decrease bacteria in the intestine and to help prevent post-operative infection. A nasogastric tube is inserted through the nose into the stomach during surgery and may be left in place for 24–48 hours after surgery. This removes the gastric secretions and prevents nausea and vomiting. A urinary catheter may be inserted to keep the bladder empty during surgery, giving more space in the surgical field and decreasing chances of accidental injury.
After the procedure the nasogastric tube will remain in place, attached to low intermittent suction until bowel activity resumes. Fluids and electrolytes are infused intravenously until the patient's diet can gradually be resumed, beginning with liquids and advancing to a regular diet as tolerated. Most patients will stay in the hospital for five to seven days.
Colostomy- surgical procedure that involves connecting a part of the colon onto the anterior abdominal wall, leaving the patient with an opening on the abdomen called a stoma. This opening is formed from the end of the large intestine drawn out through the incision and sutured to the skin. After a colostomy, feces leave the patient's body through the stoma, and collect in a pouch attached to the patient's abdomen which is changed when necessary.
- Good skin care around the stoma is critical. Before applying a fresh pouch, the skin around the stoma is washed gently with a mild soap. A gauze dressing may be used to cover the stoma while the skin is cleaned. The skin is patted completely dry with a gauze pad. Rubbing should be avoided. A skin barrier, which may be a wafer or paste, is then applied to protect the skin from bowel contents draining through the stoma. The backing of the adhesive surface of the pouch is removed. Then pressed down around the stoma for 30 seconds. The pouch should be removed and drained when it is one-third to one-fourth full.
- A dietitian can help a person with a colostomy choose a balanced diet. It may be helpful to avoid some foods, such as those that cause gas and odor. These foods include: beans ,eggs ,fish ,members of the cabbage family and nuts . Foods or fluids such as fruits, coffee, carbonated beverages, or high-fiber items may cause diarrhea. Foods with hard-to-digest kernels, such as popcorn, may need to be avoided as well.
Diverticulitis
What is it ? - As a person ages, pressure within the colon causes bulging pockets of tissue that push out from the colon walls. These are called diverticulum. The condition of having these is called diverticulosis. When a diverticulum becomes infected and ruptures the condition is called diverticulitis.
Signs and Symptoms- Diverticulitis symptoms can feel like appendicitis, except you'll generally have pain in the lower left side of your abdomen, instead of the lower right side. The pain is usually severe and comes on suddenly, but sometimes you may have mild pain that becomes worse over several days and fluctuates in intensity. You may also have abdominal tenderness, fever, nausea, and constipation or diarrhea
How is a diagnosis made ? - can be made by a variety of tests. Barium x-rays (barium enemas) can be performed to visualize the colon. Diverticula are seen as barium filled pouches protruding from the colon wall. Direct visualization of the intestine can be done with a colonoscopy to make a diagonosis or rule out other diseases that may mimic diverticular disease.
Treatment - When diverticulitis occurs, antibiotics are usually needed. Some examples of commonly prescribed antibiotics include Cipro, Flagyl, Keflex, and Vibramycin. Liquid or low fiber foods are advised during acute diverticulitis attacks. In severe diverticulitis with high fever and pain, patients are hospitalized and given intravenous antibiotics. Surgery is needed for those with persistent bowel obstruction or abscess not responding to antibiotics.
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