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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