Chapter 34. Nursing Care of Patients with Lower Gastrointestinal Disorders

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1 Chapter 34 Nursing Care of Patients with Lower Gastrointestinal Disorders

2 Lower Gastrointestinal System Small Intestines Large Intestines Rectum Anus

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5 Constipation Fecal Mass Held In Rectum Feces Become Dry, Hard Many Causes Prevention: High-fiber Diet, Fluids, Exercise Obstipation

6 Signs and Symptoms Abdominal Pain Distention Indigestion Rectal Pressure Incomplete emptying Headache Fatigue Decreased Appetite Constipation

7 Constipation Complications Impaction Ulcers Straining Megacolon Chronic Laxative Abuse Fibrosis

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11 Constipation Therapeutic Interventions High-fiber Diet, 2 to 3 L Fluid Daily Strengthen Abdominal Muscles Exercise Bulk-forming Agents Stool Softeners Education

12 Constipation (cont d) Data Collection Establish Rapport History Auscultate Bowel Sounds Inspect/Palpate Abdomen

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14 Diarrhea Fecal Matter Passes Rapidly Decreased Absorption Causes Bacterial/Viral Infection Food Allergies Prevention

15 Diarrhea Signs And Symptoms Fever Foul Odor Abdominal Cramping Distention Anorexia Intestinal Rumbling

16 Diarrhea Therapeutic Interventions Identify Cause Replace Fluids/Electrolytes Increase Fiber/Bulk Diphenoxylate (Lomotil), Loperamide (Imodium) Lactinex Restores Normal Flora Antimicrobial Agents

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18 Appendicitis Inflammation of the Appendix Fever, Nausea/Vomiting, Anorexia, Pain Right Lower Quadrant Increased White Blood Cells NPO, Surgery Postoperative Care

19 McBurney s Point

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24 Peritonitis Inflammation/Infection of Peritoneal Cavity Signs and Symptoms Abdominal Pain Abdominal Rigidity Nausea/Vomiting Fever

25 Peritonitis Therapeutic Interventions NPO Fluid/Electrolyte Replacement Naso/Orogastric Tube Antibiotics Surgery Pain Control

26 Complications Peritonitis

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28 Diverticulosis/Diverticulitis Diverticulum Outpouching of Bowel Mucous Membrane Diverticulosis Multiple Diverticula Diverticulitis Inflammation/Infection of Diverticulum

29 Diverticulum

30 Diverticulosis/Diverticulitis Causes Chronic Constipation Decreased Intake of Dietary Fiber Therapeutic Interventions Prevent Constipation Intravenous Antibiotics Pain Control Surgery

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32 Crohn s Disease Inflammatory Bowel Disease Any Part of the Intestine Remissions and Exacerbations Cause Unknown Hereditary

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34 Crohn s Disease Signs and Symptoms Abdominal Pain or Cramping Weight Loss Diarrhea Fluid and Electrolyte Imbalance

35 Crohn s Disease Complications Malnutrition Fissures Abscesses Fistulas

36 Fistulas

37 Crohn s Disease Diagnosis Laboratory Testing Endoscopy with Biopsy Ultrasound Multiphase CT Enterography Magnetic Resonance Enterography

38 Crohn s Disease Therapeutic Interventions Medications Aminosalicylates: Azulfidine (sulfasalazine) Antidiarrheal Biologic: Humira (adalimumab) Corticosteriods Immunomodulators: Imuran (azathioprine) Avoid Offending Foods Surgery if Necessary Elemental Formula or PN if Required Support and Education

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40 Ulcerative Colitis Inflammatory Bowel Disease Colon and Rectum Remissions and Exacerbations

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43 Ulcerative Colitis Signs and Symptoms Abdominal Pain 5 to 20 Stools Daily Rectal Bleeding Fecal Urgency Anorexia Weight Loss Cramping Vomiting Fever Dehydration

44 Ulcerative Colitis Therapeutic Interventions Avoid Offending Foods Medications Aminosalicylates: Azulfidine (sulfasalazine) Antidiarrheal Biologic: Humira (adalimumab) Corticosteriods Immunomodulators: Imuran (azathioprine) Surgery if Necessary Elemental Formula or PN if Required

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47 Restorative proctocolectomy

48 Irritable Bowel Syndrome (IBS) Altered Intestinal Motility/Increased Sensitivity to Visceral Sensations Bowel Mucosa Not Changed Psychological Stress/Food Intolerances More Common in Women

49 Irritable Bowel Syndrome Signs and Symptoms Gas Bloating Constipation Diarrhea Abdominal Pain Depression, Anxiety

50 Irritable Bowel Syndrome Diagnosis History Physical Examination

51 Irritable Bowel Syndrome Therapeutic Interventions Low FODMAP Diet High Fiber and Bran Diet Avoid Trigger Foods Smaller, Frequent Meals Stress Management Behavioral Therapy Exercise Medications Depend on Type of IBS

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54 Abdominal Hernias Pathophysiology Protrusion of Organ or Structure Through Weakness or Tear in Wall of Abdomen Etiology Weakness in Abdominal Wall with Increased Intraabdominal Pressure

55 Abdominal Hernias Types Inguinal Umbilical Ventral (Incisional)

56 Types of Hernias

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59 Abdominal Hernias Signs and Symptoms None Bulging Complications Strangulated Incarcerated Hernia

60 Abdominal Hernias Therapeutic Interventions None Observation Support Devices Surgery Herniorrhaphy Hernioplasty

61 Abdominal Hernias Nursing Care Education Postoperative No Coughing Activity Education

62 Absorption Disorders Inability to Absorb One or More Major Nutrients Types Celiac Disease Lactose Intolerance

63 Absorption Disorders General Signs and Symptoms Weight Loss Weakness General Malaise

64 Absorption Disorders Therapeutic Interventions Celiac Disease High-calorie, High-protein, Gluten-free Diet Lactose Intolerance Avoid Lactose Foods; Lactaid

65 Absorption Disorders Nursing Care Monitor Fluids, Electrolytes, Nutritional Status Daily Weight Intake and Output Education

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67 Mechanical Bowel Obstructions

68 Bowel Obstruction Flow of Intestinal Contents is Blocked Mechanical Blockage Occurs Within the Intestine Non-mechanical Peristalsis is Impaired Partial or Complete

69 Bowel Obstruction Signs and Symptoms Abdominal Pain Blood and Mucus per Rectum Feces and Flatus Cease Fecal Vomiting May Occur Bowel Sounds High-pitched/Tinkling or Absent

70 Bowel Obstruction Signs and Symptoms Abdominal Distention Fluid/Electrolyte Imbalance Diagnosis Abdominal X-Ray CT Scan CBC and Electrolytes

71 Bowel Obstruction Therapeutic Interventions NPO Frequent Mouth Care Nasogastric Tube Fluid and Electrolyte Replacement Medications Antibiotics Anti-emetics Analgesics Surgery

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73 Anorectal Problems Hemorrhoids Anal Fissures Anorectal Abscess

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75 Anorectal Problems Nursing Care Postoperative Pain Control Sitz Baths Dressing Changes Stool Softeners

76 Lower Gastrointestinal Bleeding Causes Diverticulitis Polyps Anal Fissures Hemorrhoids Inflammatory Bowel Disease Cancer

77 Lower Gastrointestinal Bleeding Occult Blood, Melena, Bright Red Stools Treat Cause Nursing Care Monitor Stools, Bleeding Vital Signs Diagnostic Prep

78 Colorectal Cancer

79 Colorectal Cancer Major Cause: Lack of Dietary Fiber Signs and Symptoms Change in Bowel Habits Blood or Mucus In Stools Abdominal or Rectal Pain Weight Loss Anemia Obstruction

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81 Colorectal Cancer Diagnosis Colonoscopy with Biopsy Sigmoidoscopy with Biopsy Proctosigmoidoscopy CT Scan Abdominal and Rectal Examination Immunological Tests Fecal Occult Blood CEA

82 Colorectal Cancer Therapeutic Interventions Surgery Resection Abdominoperineal Resection Colostomy Radiation Chemotherapy Monoclonal Antibody Therapy Analgesics PN as Necessary

83 Colorectal Cancer Nursing Care Support and Education Postoperative Care

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