1 keith rischer rn, ma, cen nursing care & interventions for clients with inflammatory...
TRANSCRIPT
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Keith Rischer RN, MA, CEN
Nursing Care & Interventions for Clients with Inflammatory
Intestinal Disorders
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Today’s Objectives…
Describe commonalities in diseases of the gastro-intestinal tract.
Compare indicators for malignancy throughout the gastro-intestinal system.
Discuss relevance of diagnostic test results to the nursing plan of care.
Discuss the pathophysiology and assessment findings of ulcerative colitis and Crohn’s disease.
Consider nursing interventions for a client with a new ostomy.
Develop a teaching plan for a client integrating the use of medication and diet.
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Ulcerative colitis is one of a group of bowel diseases of unknown etiology characterized by remissions and exacerbations (flare-ups).
Mucosal lining of the colon or rectum is affected.
Loose stools containing blood and mucus, poor absorption of vital nutrients, and thickening of the colon wall can result.
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Physical assessmentClinical manifestationsPsychosocial assessmentLaboratory assessmentRadiographic assessment
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Interventions:• Record the color,
volume, frequency, and consistency of stools.
• Identify factors that cause or contribute to diarrhea.
• Eliminate gas-producing and spicy foods.
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• Eliminate by trial foods containing lactose.• Eat a low-fiber, high-protein, high-calorie diet.• Use antidiarrheal medications.• Monitor skin.• Record weight regularly.• Rest the bowel.
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Salicylate compoundsCorticosteroidsImmunosuppressive drugsAntidiarrheal drugsOther drugs
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Internal ileal reservoirIntra-abdominal pouch created from the
terminal ileum by the surgeonStool stored in the pouch drained by
catheterCare of pouchEffluent, or drainage, monitored
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Removal of the colon and the rectum with the ileum sutured into the anal canal
Spares the rectal sphincter and need for an ostomy
Preoperative careOperative procedurePostoperative care
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Interventions include:• Pain management in
ulcerative colitisComprehensive pain
assessmentEvaluation of effectiveness
of pain control measures used
Reduction or elimination of precipitating factors for pain.
Teach use of non-pharmacologic pain reducing measures.
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Interventions include:• Monitoring for signs and symptoms of
gastrointestinal bleeding• Monitoring all stools for blood, using both
gross and occult examination• Monitoring hematocrit, hemoglobin, and
electrolyte values• Monitoring vital signs• Preparing for possible blood administration
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Idiopathic inflammatory disease of the small intestine and the colon, or both
All layers of the bowel involved, mostly terminal ileum
Bowel fistulasRare cancer of the small bowel and colon
develop.Malabsorption of vitamins and nutrients
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Physical assessmentClinical manifestationsPsychosocial assessmentDiagnostic assessment
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Drug therapyNutritional managementComplication managementFluid and electrolyte therapySkin carePrevention of infectionComplementary and alternative therapy
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LaparoscopySmall bowel resection and ileocecal
resectionsStricturoplastyPreoperative careOperative procedurePostoperative care
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Diverticulosis is the presence of many abnormal pouchlike herniations in the wall of the intestine.
Diverticulitis is the term used to describe an inflammation of one or more of the diverticula.
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HistoryPhysical
assessmentClinical
manifestationsDiagnostic
assessment
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Drug therapyDiet therapyRestIntravenous fluids to correct dehydrationIntravenous antibioticsAnticholinergicsAnalgesics
(
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Avoid laxativesRestNothing by mouth in the hospital
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Preoperative careOperative procedurePostoperative care
• Drain care• Care of the ostomy• Nothing by mouth followed by clear liquids
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Localized induration and fluctuance due to the inflammation of the soft tissue near the rectum or anus
Rectal pain first symptomSurgical incision and drainageNursing interventions focused on helping
the client maintain comfort and optimal perineal hygiene
High-fiber diet