Chapter 34 Nursing Care of Patients with Lower Gastrointestinal Disorders
Lower Gastrointestinal System Small Intestines Large Intestines Rectum Anus
Constipation Fecal Mass Held In Rectum Feces Become Dry, Hard Many Causes Prevention: High-fiber Diet, Fluids, Exercise Obstipation
Signs and Symptoms Abdominal Pain Distention Indigestion Rectal Pressure Incomplete emptying Headache Fatigue Decreased Appetite Constipation
Constipation Complications Impaction Ulcers Straining Megacolon Chronic Laxative Abuse Fibrosis
Constipation Therapeutic Interventions High-fiber Diet, 2 to 3 L Fluid Daily Strengthen Abdominal Muscles Exercise Bulk-forming Agents Stool Softeners Education
Constipation (cont d) Data Collection Establish Rapport History Auscultate Bowel Sounds Inspect/Palpate Abdomen
Diarrhea Fecal Matter Passes Rapidly Decreased Absorption Causes Bacterial/Viral Infection Food Allergies Prevention
Diarrhea Signs And Symptoms Fever Foul Odor Abdominal Cramping Distention Anorexia Intestinal Rumbling
Diarrhea Therapeutic Interventions Identify Cause Replace Fluids/Electrolytes Increase Fiber/Bulk Diphenoxylate (Lomotil), Loperamide (Imodium) Lactinex Restores Normal Flora Antimicrobial Agents
Appendicitis Inflammation of the Appendix Fever, Nausea/Vomiting, Anorexia, Pain Right Lower Quadrant Increased White Blood Cells NPO, Surgery Postoperative Care
McBurney s Point
Peritonitis Inflammation/Infection of Peritoneal Cavity Signs and Symptoms Abdominal Pain Abdominal Rigidity Nausea/Vomiting Fever
Peritonitis Therapeutic Interventions NPO Fluid/Electrolyte Replacement Naso/Orogastric Tube Antibiotics Surgery Pain Control
Complications Peritonitis
Diverticulosis/Diverticulitis Diverticulum Outpouching of Bowel Mucous Membrane Diverticulosis Multiple Diverticula Diverticulitis Inflammation/Infection of Diverticulum
Diverticulum
Diverticulosis/Diverticulitis Causes Chronic Constipation Decreased Intake of Dietary Fiber Therapeutic Interventions Prevent Constipation Intravenous Antibiotics Pain Control Surgery
Crohn s Disease Inflammatory Bowel Disease Any Part of the Intestine Remissions and Exacerbations Cause Unknown Hereditary
Crohn s Disease Signs and Symptoms Abdominal Pain or Cramping Weight Loss Diarrhea Fluid and Electrolyte Imbalance
Crohn s Disease Complications Malnutrition Fissures Abscesses Fistulas
Fistulas
Crohn s Disease Diagnosis Laboratory Testing Endoscopy with Biopsy Ultrasound Multiphase CT Enterography Magnetic Resonance Enterography
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
Ulcerative Colitis Inflammatory Bowel Disease Colon and Rectum Remissions and Exacerbations
Ulcerative Colitis Signs and Symptoms Abdominal Pain 5 to 20 Stools Daily Rectal Bleeding Fecal Urgency Anorexia Weight Loss Cramping Vomiting Fever Dehydration
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
Restorative proctocolectomy
Irritable Bowel Syndrome (IBS) Altered Intestinal Motility/Increased Sensitivity to Visceral Sensations Bowel Mucosa Not Changed Psychological Stress/Food Intolerances More Common in Women
Irritable Bowel Syndrome Signs and Symptoms Gas Bloating Constipation Diarrhea Abdominal Pain Depression, Anxiety
Irritable Bowel Syndrome Diagnosis History Physical Examination
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
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
Abdominal Hernias Types Inguinal Umbilical Ventral (Incisional)
Types of Hernias
Abdominal Hernias Signs and Symptoms None Bulging Complications Strangulated Incarcerated Hernia
Abdominal Hernias Therapeutic Interventions None Observation Support Devices Surgery Herniorrhaphy Hernioplasty
Abdominal Hernias Nursing Care Education Postoperative No Coughing Activity Education
Absorption Disorders Inability to Absorb One or More Major Nutrients Types Celiac Disease Lactose Intolerance
Absorption Disorders General Signs and Symptoms Weight Loss Weakness General Malaise
Absorption Disorders Therapeutic Interventions Celiac Disease High-calorie, High-protein, Gluten-free Diet Lactose Intolerance Avoid Lactose Foods; Lactaid
Absorption Disorders Nursing Care Monitor Fluids, Electrolytes, Nutritional Status Daily Weight Intake and Output Education
Mechanical Bowel Obstructions
Bowel Obstruction Flow of Intestinal Contents is Blocked Mechanical Blockage Occurs Within the Intestine Non-mechanical Peristalsis is Impaired Partial or Complete
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
Bowel Obstruction Signs and Symptoms Abdominal Distention Fluid/Electrolyte Imbalance Diagnosis Abdominal X-Ray CT Scan CBC and Electrolytes
Bowel Obstruction Therapeutic Interventions NPO Frequent Mouth Care Nasogastric Tube Fluid and Electrolyte Replacement Medications Antibiotics Anti-emetics Analgesics Surgery
Anorectal Problems Hemorrhoids Anal Fissures Anorectal Abscess
Anorectal Problems Nursing Care Postoperative Pain Control Sitz Baths Dressing Changes Stool Softeners
Lower Gastrointestinal Bleeding Causes Diverticulitis Polyps Anal Fissures Hemorrhoids Inflammatory Bowel Disease Cancer
Lower Gastrointestinal Bleeding Occult Blood, Melena, Bright Red Stools Treat Cause Nursing Care Monitor Stools, Bleeding Vital Signs Diagnostic Prep
Colorectal Cancer
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
Colorectal Cancer Diagnosis Colonoscopy with Biopsy Sigmoidoscopy with Biopsy Proctosigmoidoscopy CT Scan Abdominal and Rectal Examination Immunological Tests Fecal Occult Blood CEA
Colorectal Cancer Therapeutic Interventions Surgery Resection Abdominoperineal Resection Colostomy Radiation Chemotherapy Monoclonal Antibody Therapy Analgesics PN as Necessary
Colorectal Cancer Nursing Care Support and Education Postoperative Care